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 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.


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.


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 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?


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 !!