Saturday, May 18, 2013

Angelina Jolie and the mystery of her breast removal surgery

Since morning I was visited by two Ladies  in my OPD.Both of them had very vague complaints.After talking for a while both of them revealed that they were scared after reading the news that Angelina Jolie went for some kind of breast removal surgery for preventing breast cancer and they wished to know if they also needed the same. At times I wonder if information has eased our lives or complicated it many fold.
Anyways ,let me try to simplify what she did and who need it.In our body there are two genes BRCA1 and BRCA 2.The purpose of them is to suppress cancer.Any mutation in them makes a person prone to various types of cancers.In women the associated cancers are Breast cancer,ovarian cancer,Fallopian tube cancer and peritoneal cancer.
The ladies who should be tested for BRCA 1 and 2 mutations are as follows
  • Women with a personal history of both breast cancer and ovarian cancer
  • Women with ovarian cancer and a close relative—defined as mother, sister, daughter, grandmother, granddaughter, aunt—with ovarian cancer, premenopausal breast cancer, or both
  • Women of Ashkenazi Jewish decent with breast cancer who were diagnosed at age 40 or younger or who have ovarian cancer
  • Women with breast cancer at 50 or younger and who have a close relative with ovarian cancer or male breast cancer at any age
  • Women with a close relative with a known BRCA mutation

  • Now the question is what is the role of removing Breast,ovaries,fallopian tube and uterus.
    It has been found the in BRCA positive Ladies a prophylactic removal of breast can prevent up to 90 % of Breast cancers.Removal of Ovaries and fallopian tube also decreases the incidence of ovarian cancer.But removal of these organ doesn't mean an absolute peace of mind. There is still a 4 % chance of peritoneal cancer in these ladies despite removing the ovaries.

    To go for it or not?If you have a BRCA 1 or 2 mutation,have completed your family it can be a choice for you but yes it is not an easy decision to take.And remember 99 % of us don't have a BRCA gene mutation.

    Also Read

    Wednesday, May 8, 2013

    Being Doctor is a huge responsibilty

    For almost over a month I have been thinking to speak out on this topic.It is the sensitive nature of the topic which prevented me from writing down the post.I will have to choose my words carefully.Don't wish to come out as a traitor trying to spill the inside beans ........but my inner has pushed me a little too hard and I think,a small post on this topic won't to any harm.
    As doctors we are dealing with human life.Just like anyone else we are also prone to errors and complications in our profession.Just that our margin of error is very low.It can lead to a botched up life of somebody.Now should all the doctors be crucified for a complication?Are all of them incompetent or negligent who have a complication in a patient.The answer is No.Despite our best attempts we might at time have complications in surgery/delivery/Cesarean etc.
    Now suppose you have been visiting to a doctor with very good references and word of mouth or Internet reviews support the person.You end up with a complication( Which at times can be life threatening and landing you in ICU).Your doctor either himself or herself or with the help of other senior doctors manages your complication or at times partially manages the complication.Comes out of OT and tells you......It was a complicated Surgery.Let us see what happens.......few days later patient is out of danger.How do you know that it was a really complicated surgery or the doctor botched up?Unfortunately as a lay person you would never know.If I were not a doctor even I can't differentiate between a genuine complication despite doctors competence and one due to lack of competence.
    Many times doctors who are very good in their field after a single complication derive a bad name which they don't deserve and at times case after case with a good communication skill and helpful colleagues keep on performing the so called 'difficult complicated' surgery.They are unsafe doctors.In a system like can't thrive with such practice.General medical council is very stringent in these matters and such a doctor would be sent for retraining.What happens in India........Well you have a good practice,so you are a revenue generator.There are a whole bunch of people to hide your incompetence.And so what never try to improve.
    Are such doctors at fault?May be they are up to a certain extent but then it is our system which encourages mediocrities.
    Though I wish to speak more.........but won't be able to speak any further.It is the system and even I have to survive in it.But yes,it would be a request to all the health care professionals as well as to my self.....self audit.And if you think you can do more harm,take help and that too in time.  
    As a patient.......Please just don't go by internet reviews (including mine).Try to find the credentials of the person.Try to find the educational qualifications.Not every surgeon is the same.Not every Gynaecologist is the same.Not every urologist is the same.Not evry orthopaedician is the same.Not every cardiologist is the same.If you look carefully you can see a difference in their qualification.Try to find who was trained where.An Mch Surgeon is more qualified than a DNB/fellow.If the same person has Mch as well as DNB.Fellowship,that is different.Diploma in a subject is nor same as the degree. I am sure..........for your own health you can do a little bit of research.
    In various sites I find people asking if the doctor talks nicely,gives time in the OPD,picks the phone,has delivered a celebrity.........but I have never seen anyone of you concerned about the real stuff ------Qualification and competence !! so think next time you visit a doctor.