Wednesday, July 20, 2016

Oh so famous

People ask me how is the settling down back to Gurgaon.And my answer is slow and steady. Well yes, exactly that is what it has been.

When I was about to join Artemis Hospital,there was continous enquiry at our call centre as if every pregnant Lady in Gurgaon just wished to shift over to me.But no...this isn't how things work.That was just initial frenzy.And it has settled down quite a bit.

I do get patients,every day 2 to 3  new ones ,who already have heard something positive about me .But yes it isn't a busy clinic by any standards ,certainly not by the standards I left it in 2014.So the upside is that I get plenty of time to talk to these patients and their families and their kids.All are happy and I enjoy the chats just like I used to do so in 2007 when I started initially in Gurgaon.

But today I was surprised.The patient who visited in my clinic ( she was following my India return ever since she got shifted to Gurgaon) is actually my tower mate and we live just 1 floor apart.And she had no clue.This much for my socializing and advertising.

As if this was not enough for me to feel bad about my anti social nature and lack of PR.another gentleman whom I met in my building lift and on knowing my name asked-Kaushiki,the famous Kaushiki Dwivedee,you live on this floor.Heard so much about you seen for the first time.Now tell me,wasn't it enough to make me feel so bad about my PR skills.

I don't have as many patients as I would like to and their are people who are trying to trace Kaushiki Dwivedee out.Need to do something fast.

Marketing.New paper ads!!Any suggestions?

Friday, July 15, 2016

Miscarriage and Progesterone ( To prescribe or not to prescribe)

This Miscarriage and Progesterone will be as pertinent to me whether I am donning the role of an Obstetrician or of an Infertility specialist.I am sure you know of some one had miscarriage.It is a very common process in pregnancy( as common as 1/4th Pregnancies would end up in termination).Why it happens?99 % as the Pregnancy is unhealthy and nature is trying to save you as a parent and the foetus if it survives undetected from the miseries to follow on birth.So is miscarriage a cause of sorrow or relief?? ( I would come across as ruthless,insensitive person giving such a statement.But this is a fact and how much hard I try to sugarcoat it,facts and statistics still remain the same)

In India ,it is a common practise to get Progesterone levels done,declare that there is a chance of miscarriage and start Progesterone or many times HCG injections.So many times it is done just routinely,randomly to 'prevent a miscarriage'Can miscarriages be really prevented,unless they are recurrent miscarriages where there are some factors in mothers body which isn't allowing a healthy foetus to grow?Or it is a late miscarriage due to incompetent cervix where 'a stitch in time can save nine'.If your gynecologist thinks she can prevent miscarriage by a shot of progesterone,probably she/he can but there isn't a scientific evidence to it.Good part is that Progesterone doesn't harm you or the foetus ,so don't worry even if you are on it.You wish to stop it or continue it,it is up to you.If you are my patient,I will explain you all these details but won't prescribe from my side unless you ask for it.

So is progesterone helpful.Yes it is in IVF conceived Pregnancies where Ovary has been suppressed by medications and there isn't proper formation of corpus luteum due to artificial intervention in the process of conception and after cerclage of cervix.I will write about usefulness of progesterone in one of the posts.

For those who wish to read further please follow this link

IVF Specialist-When you got to sleep ,you got to sleep!

Many a times I have been asked this question-What made you leave your flourishing practice and leave for Australia.And every time I come out with an answer which I feel was the probable reason.But I think the most important reason was deprivation of sleep.Yes,that is true.Readers ,I am sure you all are aware that medicine is a demanding profession.Without going in the data collection of which study shows what about in which country how many hours do the doctors sleep,it is a known fact that a doctor practising Obstetrics is sleep deprived.

In 2007 when I started my private practice ,totally new to Gurgaon and for that matter even Delhi,I had a zero patient base and then it improved.The numbers of emergencies( mostly deliveries) were limited.And conducting a vaginal delivery be it Normal,Vaccum or forceps used to give me an ultimate kick(More techniqualy difficult,more was the kick).......much more that elective gynaecology surgeries including Laparoscopy surgeries as well as uro gynaecology surgery which I was quite comfortable with even then - with what Dr Plemming and Dr Klazinga had taught in United Kingdom.

Slowly by God's Grace the practise improved and so did the number of deliveries.By 2014 ,I was awake almost every night with routine OPDs and OTs as scheduled.There were times I would reach delayed for OPD,with not so happy patients who had their appointments delayed by an hour or more already as I was stuck in Labour ward trying a vaginal delivery.7 years of Obstetrics was taking it's toll.I was still maintain the WHO approved 80 % vaginal delivery rate but that Kick was gone.It was a job ,no more a passion.And when I don't enjoy something just like any other human being I loose interest.It was making me cranky,irritable and bored.Increasing Number of patients didn't excite me any more.It wasn't healthy for me.

And then was the Option to take a break.Move to Australia.Have more regulated hours of work.The famous Work life balance.It was enthralling and rejuvenating. 2 years break helped me a lot.

And then is when I thought,if I wish to have my sleep and at the same time not increase my Caesarean section rates and sleep with a clear conscience.When I know that I didn't use early decelerations as and excuse of foetal distress,when I know that a high head of baby is genuinely a high head of baby when I call it a caesarean, when a thin meconium at 8 cms is no indication for a caesarean
section,I need to reduce the Obstetrics component of my private practise.Very Honestly it wasn't just the love of IVF,treating infertility and the money involved but most importantly ,trying to switch over from a totally unplanned life of obstetrician to a more routine life of 9 am to 5 pm.

Now after reading this post,if you have a question,why did I return back,I am not surprised by your query :) :) Perhaps 2 years from hence I will tell the real reason of my return too ;-) ;-)