Tuesday, July 22, 2014

A short Break

Dear Friends,


Life is Change and change for good.Stagnation isn't acceptable to me.....I felt I was stagnating and to further my skills,training,academics and teaching I have taken a break from my private Practice at Gurgaon.
I am moving abroad for an year to further my skills and to complete my Fellowship from Australia.I am sorry for the inconvenience caused to all my patients who have given me their immense love and made me what I am today.
I promise I will be back.Back as a better doctor and better human being.
In the meantime I can suggest you few doctors whom I find ethical and Good in no particular order.

Dr Deepa Maheshwari - Max Hospital ,Gurgaon.
Dr Veena Bhat - Artemis
Dr Urvashi Rathee - Artemis

For the time being the Blog will be taken care of my other adminstrators and not me( That is the requiement of my current job)

See you all soon......Miss you.

Kaushiki

Tuesday, May 6, 2014

It is same everywhere......Cost cutting


On a busy saturday one of by patient came to meet me.She has been a regular since 5 to 6 years now.Probably the very few patients I had in my initial months of joining the Max Hospital,Gurgaon.
Quite a jovial couple.And in her 1st pregnancy her husband and I would joke on all the possible family myths.What his dad said and what her mom said and so on and so forth and thus 40 weeks were over and she delivery a bonny baby boy.

Then we met in between as well ........for various small issues.

Now Pregnant again we were talking about her pregnancy and the working condition etc.Her husband is a senior banker and I was surprised to know the kind of conditions in which the bankers are working due to cost cutting,internal politics and other corporate issues and heavy load of demanding clients.It sounded so similar to our organisation and myself.

I was shocked and then reassured myself that this cost cutting hasn't just affected the healthcare system.I can't deny that.

Overall the mantra is make the employee work as much as possible (numbers) and before he starts to settle down unsettle him.This cost cutting leads to inefficient or over exerted front desk staff,guard,nurses,doctors (Not talking just about my hospital but is a trend every where).Mediocrity is encouraged as some one with more intellect would demand more.

Ultimately came to know that many bankers have become resto owners as couldn't cope up with the pressure of the job they were trained for.

Hmmmm.........He showed me a vision...........if bored or tired open a Dhabba!!

Thinking the menu already

Wednesday, April 30, 2014

Why doctors leave you confused?

I think of late my favourite topic has been patient doctor relationship.The most probable reason is probably an accusation made by a Woman ,doing media rounds, which other unsatisfied patients have quoted off and on whenever they wish to make me come across as a negligent doctor. It hurts as there was no negligence of mine anywhere. I will give the answer i.e , the way it should be given legally.

I have still kept a silence on this issue ,due to two reasons

one : the matter is under investigation
Second : Patient's confidentiality. I don't wish to go on a social media commenting about an unmarried woman which mars her future life  if I speak the total truth. But yes false allegations or rather half told truths become difficult to handle at times,when you wish to speak out loud but you can't as of now.

Once sorted ,I promise to come clear on this story, how it affected me and my colleagues who where implicated ,the media, the hospitals, doctors, nurses and also the friends, patients and relatives who have been immense support.( I dream of becoming a Chetan Bhagat.....doctor turned author :-)

It is a fact that I am a changed person.Not the same young enthusiast doctor who started practice seven years back.A stronger and wiser person but I  now strongly believes in defensive practice.First save yourself and then see what you can do for others.The number of investigations prescribed have gone up a little.I know there is always a risk as doctor can never be correct.If you don't write too many investigations,the allegation would be:doctor under investigated.And God forbid if things go wrong-----Doctor is Lynched.The allegation would be,we never stopped from getting investigated.
If you try to be defensive and get investigated,then of course,you are getting the patient over investigated then it is to make 'money'  from cuts and kickbacks.

A difficult situation indeed as a doctor. This isn't just my frustration but majority of the doctors feel the same and it is a matter of frequent discussion between doctors at the lunch time. SAVE YOURSELF FIRST. 

If you think me,I am the only one thinking so, then you a mistaken. Let me tell you a very recent incident. A young couple came to me.The Lady had early pregnancy.Had been diagnosed with hypothyroidism which was now under control.They had visited the Gynaecology department of a famous hospitalThe senior doctor clearly declined to help hem out in taking any decision regarding whether to continue or not to continue with the pregnancy as the TSH was high. She told them clearly to take their own decision. The couple questioned that they were lay person after all and needed medical opinion.And the answer was ,take your own decision.That is a different issue that endocrinologist at Medanata,one more gynaecologist from Fortis and myself helped them take a decision but yes our answers were also guarded too.

Why???

So Why did that senior doctor of a great Super specality hospital declined to help that couple.She saved her skin.She would not have got any brownie points to take the decision for that couple but a rare possibility of the baby having mental retardation would been a cause of litigation.Who wants it?

I am sure the couple who shared this story with me must be reading my post.Do you agree,it was confusing or rather highly confusing and stressful to take the decision of your own. was any google search helping out??.

Me as a single person can't stop anyone's thought process by writing my blog. But surely I can try before you start loosing good doctors who are burnt out of stress turning into a writer, businessman ,politicians  and administrators etc. I can surely see a crashing healthcare system in India where you will have mediocre students opting for medicine. We are not even a rich country who can get overseas doctor to fulfill our  health sector needs.

Think........






Friday, April 25, 2014

Cold and cough in pregnancy

Have you ever felt irritated if your Gynaecologist asks you to refer a physician if you ask for medicines for cold and flu while pregnant.I am sure many of you would relate to this situation.You might feel after all,it is just a flu.Why can't the doctor just tell me antibiotic and cough syrup telephonically.There is a specific reason to that.

While you are not pregnant,naturally you would visit a physician or GP who would get you investigated properly and then prescribe medicine as appropriate.While pregnant if you get a Viral infection,it might be a simple viral infection with no implication on the foetus or actually the viral infection might be sinister enough to cause problem to the foetus.Unless properly investigated acute problems can be missed.

Majority of times say 98% times it would be simple beingn virus but what happens then on the rest of two occassions. It might actually be something more serious.So why take a chance ?

I have mentioned in one of the posts about hydrops foetalis in a foetus.After detailed investigation it was found that the mother had got infected with a condition called cytomegalovirus which is transferred to the foetus as well.This cytomegalovirus usually either doesn't have a symptom or leads to chronic cough.In her case she had chronic cough and I did ask her to meet a physician or ENT specialist.Poor thing met the physician/ENT specialist as well but as CMV is such an uncommon condition it wasn't picked up and even if it was picked there is no treatment.It could be diagnosed only after the autopsy of the foetus.Sad it is.They are heart broken.Unfortunate !!

Another patient visited with chronic cough.Again asked them to meet a physician.I don't treat these non obstetric conditions myself as I am not the correct person to do so.They were luckier.The physician got an ultrasound of lung done and found fluid collected around the lung.The fluid was drained and now she is on quite strong antibiotics.Fortunately her condition isn't what will affect the baby.

So next time if your Obstetrician asks you to meet a physician for just a small 'flu',do so.It actually might be more than just a mere flu.


Thursday, April 24, 2014

Increasing rate of caesarean section.Does that worries you?

As the delivery date starts approaching,one of the commonest question asked by the pregnant woman is,'Í have heard that in Max Hospital the incidence of caesarean is very high'.They are apprehensive and so are their partners.Very anxiously they wait for me to answer their question.

Previously I used to get defensive about the whole thing.Answers like I can't comment about others......my rate is not more than 20% for caesareans......I can assure you that if anywhere in the world you can achieve a safe vaginal delivery ,you can achieve that with my team......

Now I ask a different question.To tell me a hospital which they have heard god about and i will deliver them there.To my surprise they don't have an answer.They say that,that we don't know.Strange....isn't it.

What you read online or what you hear from your friends are half truths.Most of the time those who have good experience they get too busy with the life and don't have time for such feedbacks.Those who had an unexpected outcome or below expected outcome,they are the one's who leave strong feedbacks.They are a very small minority of people but as they are the most vocal,they scare you.

Now the question,why is the caesarean rate increasing?It is multifactorial.I will give you an example.
I work in a team with consultants and registrars etc as every person in the team has got a delegated duty and we all know that as a team we perform better.That is the whole idea of making the team that if I am busy  with one patient another patient under my care shouldn't suffer if any medical need arises.Now a patient who has come to show me for 9 months wants me to be present with them through every step,which isn't possible.How can I or any doctor be present through out if the trials are as long as 24 to 36 hours?I try my best to be present for all the vaginal deliveries.It is easy in nights or early morning as the roads are vacant,but it can be a problem during the daytime if the traffic is heavy.So at times ( once or twice in a month it so happens that by the time I reach baby has been delivered and attended by Dr Deepa Maheshwari as she lives across the hospital and has 13 years of experience in obstetrics and gynaecology.So ultimately you have a achieved a safe vaginal delivery due to our team work even if I am delayed by few minutes.

Now last week a Lady with high risk pregnancy with both Diabetes and blood pressure of pregnancy was induced at 39 weeks by me.In most likelihood they would have been offered a caesarean section had they visited anywhere else.So we started the process and followed it as per the protocol with team members including me visiting her at regular interval.All going well.At around 3 Pm she was 4 cms dilated i.e at least 6 hours to be fully dilated and then suddenly at 4 pm I was called that she had progressed very fast and is fully dilated and pushing the baby.So she travelled 6 hours journey in one hour.Totally unexpected.So I left my home and Deepa left hers.Naturally Deepa reached earlier than me and delivered the baby safely.I reached in another 5 minutes.Naturally south City 2 is farther than south city1. 

Now what I got for the patient's husband wasn't a thanks but a complaint that I didn't reach in time and no one came in between to keep the moral up of my wife by giving her false hopes that only few minutes are remaining etc.Then he went ahead to leave this feedback/complain somewhere that Dr Kaushiki Dwivedee didn't come to attend my WIVE'S delivery not mentioning that what a high risk delivery it was,how nicely my team under my supervision managed it to let his wife have a normal delivery and even a precipitate labour like hers was nicely managed because it was or team and Max Hospital.

Now if despite working so hard and ethically one gets such brickbats,is there a reason for a doctor to try 24 /36 hours of normal delivery where there is always a possibility that heavy traffic might be a problem.Isn't performing caesarean at some pretext like baby's heart beat is getting low,fluid is low,no progress of labour is a better option for the doctor?

THE BALL LIES IN YOUR COURT.DO YOU WISH THE DOCTOR TO BE HONEST AND ETHICAL WITH YOU TO TRY NORMAL DELIVERY SINCERELY WITH AN OCCASSIONAL CHANCE THAT IT WON'T BE HER BUT HER TRAINED TEAM MEMBER MIGHT ATTEND YOUR VAGINAL DELIVERY OR WOULD YOU PREFER A CAESAREAN TO BE PERFORMED BY THE MAIN GYNAECOLOGIST AT THE TIME OF HER CONVENIENCE.CHOICE IS YOURS!!

Wednesday, April 16, 2014

Hterotrophic Pregnancy can be tricky

Am back to my domain,where I can write to my hearts content.What I feel about and what I consider true.
I had taken a small break from blogging as well as vlogging.Needed to feel the need to communicate with the world.Need to expose my thought,which were as true as I could express but did hurt few..

Few days back a you female had come to me. Hassled .She said, she have the most complex story and my exact words were, let me know how complex can it get?
Due to some gynaecological problem she was operated in past which affected her fallopian tube.She reached the IVF specialist for conception. And happily conceived twins. Then unfortunately she miscarried twins in second trimester due to incompetent cervix.

After a while she again went to the same set of doctors.This time IVF with singelton pregnancy.It was heterotrophic pregnancy this time.A pregnancy in tube and pregnancy in uterus. So now what to do? Her Gynaecologist-IVF specialist team assured her that the tubal pregnancy looked a vascular, won't rupture and thus no surgery wasn't needed.

A person knows in her heart of heart the correct answer. She knew it needed surgery to remove the fallopian tube and perform the OS tigehtinig in the same go. She came to me for second opinion and my opinion was to get rid of ectopic pregnancy surgically and tighten the mouth of the womb. Probably she didn't like my solution. After all I had suggested surgery.

I am considered "daring surgeon"which I am not.I am just practical surgeon who can see things which can happen after an year or may be 10 years.I told her that her ectopic pregnancy will rupture if she carries on.She didn't come back to me.I wished her to be operated. I felt 'point proven and sorry both. Almost 14 days later she was in the hospital with ruptured ectopic 'and blood all over in the abdomen. A team of general surgeon and 3 to 4 gynaecologist fixed her problem combined together which could have been done in one go that very day.

Yes I do feel at times : see I said so and my clinical sense isn't bad !!


Sunday, March 9, 2014

Satisfaction???

God gives different personalities to different people.
He has made me ambitious,restless and perhaps a go getter.So it transpires into diabetes,Hypertension and heart attacks in long run.Before I have sorted one agenda ,I am ready with a new target.A challenge for myself.A lack of patience makes me a figidity person while I am waiting for the target to be achieved.
So today my brother declared ,you have stagnated.Either be happy with the tag of a good doctor with nice practice or if you wish to reach a higher level become an educationist.God,,,,,that is difficult....For a doctor who has no support in GGN /Delhi.Did all the schooling.college and PG outside Delhi/NCR and has no standing amongst the local educationists, how do you intend to make that person an educationist?Go...Present in conferences.And my answer was....they won't let me deliver a guest lecture unless I know someone from the organising committee.You know that my networking skills are zero.Other option was to do real research have few publications on some topic and then no one can stop you from a guest lecture.And it all started with the Afghan president's wife delivering at another Gurgaon hospital and not under me despite me being a better Obstetrician an knowing my subject better than that person( I know it is a rather bold statement to make).I lacked the name of being an ex professor.As of now I am feeling very low at my self esteem.
I was told,I will be a good practitioner of average masses but should not think being a stalwart.Nothing wrong in that too,But then no doubt I need to spend time on research and academics.Soon my patients will me find out of GGN  for a conference outside.Which is the next one BTW??
All said and done whether I manage to become a stalwart amongst doctors or not.......academics and research is what I am lacking in as I am too busy just doing my private practice,trying to just appease my patients by being present when they are delivering with no time for my personal growth and development.Dilemma!!

Endometriosis

Have written so many times about this condition.One of the bad ones to have and the number of women coming with endometriosis is just increasing in leaps and bounds.
Endometriosis is a condition where there is spillage of blood in the abdominal cavity during periods.And over the period of time it becomes a painful condition with painful period,painful sex,heavy periods sometime even painful passage of stool.It compromises even the fertility.
               The treatment of endometriosis is unsatisfactory or drastic.There is nothing in between.Removal of cysts or removal of adhesion means that 75% of the women will have the symptoms back in 5 years unless the ovaries as well as uterus is removed along with.
                 Medical management can be in the form of Oral contraceptive pills,Injections called Zoladex, Mirena etc All these agents either stop the periods temporarily or lighten it,But once stopped there is bound to be recurrence.
                 The surgery for endometriosis needs special skills and should be performed by expert laparoscopic surgeon as there is a possibility of a bowel or bladder injury if they are badly stuck.

Sunday, February 9, 2014

Scar Endometrioma

Endometriosis is not an uncommon condition,where the inner linning of the uterus endometrium is implanted inside the abdomen at various sites due to back flow of period blood through the fallopian tube.It causes painful and heavy periods as well as painful sex,painful passage of stool etc.
It can be treated by certain medicines but primarily surgery.The treatment is unsatisfactory at best unless the Lady gets menopause or uterus and ovaries both are removed.
But today I wish to write about something much rarer SCAR EDOMETRIOMA.It is a condition when during any surgery involving uterus endometrium is imbedded in various layers of abdomen leading to tumor or swelling which increases in size prior to the period and during period and the lump is painful as well.It decreases in size after periods.The incidence of scar endometrioma after a caesarean is 0.1 % to0.01 %.The treatment of such a condition is to excise the lump with at least 1 cm of free margin as well to prevent such recurrence of the lump.
Recently I came acoss such patient who had a caesarean delivery about 6 years back and was having a lump at her caesarean scar since then.
My surgeon husband felt strongly that a surgeon rather than Gynaecologist should treat it as in past Gynaecologists have referred such cases to him rather than correct it themselves.But there is nothing so complicated about treating it and any surgeon i.e, Gynaecologist or surgeon who can repair and stitch anterior abdominal wall can operate it,which I did.
The idea of shairing is this fact is both for the Gynaecologists who transfer it to a surgeon and also for the patinet's to know the correct specialist for their treatment.
The dianosis of this condition can be confusing at times being confused with cancers or desmoid tumours ,infected scar etc.It can be confirmed finally with histopathology but prior to that ultrasound and if still confusion persists MRI can be used to come to a preoperative diagnosis.
Also while performing caesarean tissue handling should be kept to minimum( which is correct for any surgery)by the Gynaecologists.Despite careful tissue handling this is still a possibilty but every little bit of surgical technique counts in prevent such non serious but nagging post operative problems.

scar endometrioma



Sunday, February 2, 2014

Decaying Patient - Doctor relationship

Of Late I find myself mostly writing about patient doctor relationship.Am I getting Obsessive or actually there is a decay in the patient doctor relationship?Is it only me or is the world actually changing fast?Last week I took off from my max OPD as I was unable to handle the stress.Stress of dealing with the patients.No ,the issues weren't clinical.The issues were everything but clinical.

A young man comes to my clinic with his 'wife'.Claims to be an Army officer who can't tell where he is posted as he is in ínterrogation'.Doesn't want to take his wife to Army hospital as they admit for the smallest possible reason.Wishes to get termination of Pregnancy done.I advise them to come back to me with an ultrasound scan.Then after few days ,that Ármy officer'calls me that his wife is having severe abdominal pain post termination of Pregnancy with pills,which was conducted under my guidance.That left me surprised.Under my guidance? When was that?No we came to you but took the medicine ourselves.Great!! so how do I help you? He told me,''my wife is having severe abdominal pain'.What should I do? The natural answer was to bring her to the hospital emergency as obviously I can't do any operation at the clinic.So he lands up there with another couple.Now we know that she isn't wife but 'Fiancee'.Now this 'Fiancee'word has been so badly used misused by Gurgaon singles.If you copy the western ways of social values then why don't you have the guts to say the truth like they have.Anyways so after an Ultrasound to confirm the abortion and after first aid when the guy was asked to pay the bill,both the Army officer and his wife cum Fiancee had a strong urge for fag and they both wished to leave the hospital campus together.When asked by the Guard to go one by one to smoke this Army man calls me to tell me the 'misbehaviour' of the security department.When I told him that I can't sort this issue,he told me that he came to the hospital because of me so it was my moral responsibility to get the things done free for him.Why on earth? I can take care of your health issue but of course not of your social and financial issues.So,he tells me that in that case he will hang the phone.That left me speechless.Anyways.....I can't sort your bill.

There are many such stories..........A presumption amongst the youngsters that they can get away with anything and everything.Will bad mouth,leave a bad review on social networking site for the doctor.Sue the doctor.Say that corporate hospitals are looting them.........Then why do you come to these corporate doctors?Will that scare the doctor and hospital.actually when anything is misused it looses it's effect.No longer does these tantrums make any effect to us.But yes.....the trust is decaying.A patient should have full trust on his/her doctor and treating doctor should feel comfortable treating the patient.Suddenly it looks as if we are not on the same side of the table but as if we are opponents...........one ready to find fault and cry for a discount and another ready to get attacked and sued........Where will it take the health care system.very recently I saw a patient, who needed an opinion from haematologist and gynaecologist.And no one and I mean no one including me was ready to take a decision for her treatment.....we all were scared.The case was slightly complicated,the patient too confused and the doctors too scared.....we all told him to take her own decision.so who is the sufferer in the end......YOU!!

Gurgaon Stab Victims

Recently there were two incidents of stabbing where four robbers entered inside the houses of a Lawyer and an Architect.The Architect's wife is also a Lawyer.Both the incidents were unfortunate and should be condemned.Fortunately no lives were lost.

So in the second incident the robbers entered the house,didn't find much at home  and that infuriated them further which lead to insensible stabbing of the Architect's family........his lawyer wife and his mom and dad.

Now the Architect wasn't stabbed and brought his family to a private hospital for treatment.They did get timely treatment.All the three underwent major surgeries and the Surgeon saved all the three after operating continuously for many hours. Just after two days of the incident the Lawyer( wife of the Architect) has been discharged today.

So now the question is that why am I mentioning it on a health blog.It should be on a crime blog.Actually it should be there.But unless I mention the rest of the story ,no one would no the complete story.

Today when the Lady was being discharged,a group of lawyers entered the hospital.Demanded some discount ...........When it was told to them that as it wasn't a government hospital but a private hospital which the victims knew from the beginning,the mob threatened to burn the hospital.A group of well educated Lawyers.So they did manage to get discount.But is there any difference between the behaviour of the robbers and a mob who threatens to burn a hospital if the bill wasn't discounted?

This crime is no heinous than what the robbers did.Trying to burn a hospital full of patients to get a petty discount that too by Lawyers :-)

Saturday, January 18, 2014

But doctor you said it was NORMAL

This post is for all my present,past and future expectant couples.
After 5 years of MBBS ,I spent 3 years getting trained to be a Specialist and then again went to UK and trained further and now am aiming to get further trained in Australia sometime  in coming times. Have you ever wondered why and what?Pregnancy is after all so simple.You have sex,conceive,visit the doctor on monthly basis or as called get the investigations done as advised and comes term.Labour starts and epidural comes Handy and unable to push....doctor will pull the baby out.So simple.
But no it is not as simple. In these years we learn the NORMAL as well as the abnormal of the Pregnancy as well as other Gynaecological problem.
Have you ever wondered after labelling your pregnancy as low risk pregnancy why do I call you on regular basis to meet me,ask you to get investigated for various conditions as recommended by interntional guidelines for pregnancy care?Because a NORMAL Pregnancy has the potential to turn into abnormal anytime of the 40 weeks of pregnancy.And a regular visit is advised either to catch such a complication ASAP and correct it if possible and if Uncorrectable to terminate the pregnancy ASAP.
Why am I writing this post?I don't wish all of you to live the 40 weeks under fear of something bad striking your pregnancy but at the same .time a complication should neither be taken as self fault or doctor's negligence .Not all pregnancies are perfect and we have to accept it.

Just Last month I had 3 such incidents

Hydrops Foetalis of previous post I have already mentioned and the husband of the lady is still trying to find out some negligence and malpractice at my end.

Another couple had gone for a routine 20 weeks scan and found an Intrauterine death with Hydrops foetalis.They were much more reasonable and took it the way it should be taken i.e in right spirit,faced it bravely and now we are trying to find the reason so that it can be prevented in next pregnancy if possible.

3rd is the saddest of all story but bravest as well. An uncomplicated pregnancy till 40 weeks,all the necessary scans,caesarean delivery as demanded by the patient and a baby with an undeveloped left heart almost incompatible with child's survival.So they decided to let the child go without any unnecessary torture of ventilator etc. No venting involved.....they simply said even if the ultrasonologist had detected it during pregnancy the outcome would have been no different. But it is not so easy to take such a tragedy so calmly.

BUT AT THE END ONE HAS TO AGREE THAT NOT ALL PREGNANCIES HAVE A HAPPY OUTCOME,THINGS DO TURN FOR WORSE FROM LOW RISK PREGNANCY TO NORMAL FINDINGS.AND IT IS IMPOSSIBLE TO GET ALL THE PREGNANT WOMEN INVESTIGATED FOR ALL THE POSSIBLE COMPLICATIONS OF THE PREGNANCY.

So,trust GOD.....whatever the outcome,he has thought something better for you.

BTW all was well with Sunanda Pushkar till yesterday except for her tweets and today she is gone :-(
So normal does turn to abnormal.Ek pal hai Zindgi,ek pal kuch bhi nahi,kahe ka gum kaise khushi?

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