Ever Shrinking Visit times

Ten minutes for diagnosis? Really?
Yes, really!
If only we had 90 minutes to perform a diagnostic evaluation, as we did as third-year medical students on hospital rotations.
 Or, if we had even 30 minutes for diagnosis, as I recall from internship.

But those days are gone. Today—as clinicians practicing in the age of evidence-based, cost-effective health care—office visits are of much shorter duration than in years past. For example, in a recent study of 4,454 patients seeing 138 physicians in 84 practices, the mean visit duration was 10 minutes 

Karnataka Cancer Hospital SCAM

10.19 Karnataka Cancer Hospital SCAM  update
 It was brought tc the notice of the Trust Board that, The Karnataka Cancer Hospital Bangalore was involved in serious criminal offence like creating false documents, providing treatment to the scheme beneficiaries even after death for about 2 months and submitting false claim proposals to SAST for settlement, etc.

 The EDC in their meeting held on 14.10.2015 have decided to de-empanel the hospital: and to forfeit Rs. 30.95 lakhs payable to the hospital. Accordingly, the hospital has been de-empanelled and the amount payable is forfeited.
As per the decision of the Trust Board / Executive Committee, the criminal complaint was filed on 22.07.2015 before Nandini Police station and same is registered under crime no. 131/2015 which is still under investigation. Expert Enquiry Committee

"Babudom" Privatization of Our Health Care V 3.0 : Ayushman Bharath is a Bigger scam than Rafael scam

 So who are the people who are going to manage the Greatest health insurance scheme of India.

BABUS and  Businessmen

IAS officers a corrupt and clueless bunch of Bureaucrats, who have stopped being doctors, engineers,Teachers,Lawyers,Scientists and have turned  themselves in to willing  instruments in this Multi billion  rupee looting of  Public Money and  health"

Look at the people attending the  10 meeting  of  karnataka Arogya

1. The Principal Secretary to Government, Department OF Health & Family
Welfare, Vikasa Soudha, Bangalore. - Chairperson  IAS
2. Representative from Labour Department, Vikasa Souda, Bangalore. --Trustee IAS
3. The Director, Health & Family Welfare Services, Ananda 1330 Circle, Bangalore. -
Trustee
4. Representative from Medical Education Dept.- Trustee
5. Representative from KlDWAl Memorial Institute of Oncology, Bangalore.
6. Dr. H. Sudarshan, Karuna Trust 81 Trustee, Suvarna Arogya Suraksha Trust --
Trustee
7. Dr. Devishetty, Narayana Hrudayalaya Multispeciality Hospital/ Businessman
8. Representative from Sri. Jayadeva institute of Cardiology, Bangalore. /Businessman
9. The Executive Director, SAST - Secretary of the Trust IAS

AP/Telangana Arogya Shree trust members

Trustees

Sri K. Ramakrishna Rao, IAS
Principal Secretary to Government. (FP), Finance Dept.
Government of Telangana


Sri Vikas Raj, IAS.
Principal Secretary to Government.;Rural Development Dept
Government of Telangana


Dr. Yogita Rana, IAS
Commissioner of Health Medical & Family Welfare.
Government of Telangana

Dr.K.Ramesh Reddy
Director Medical Education(FAC)
Government of Telangana
Dr. B. Shiva Prasad
Commissioner TVVP.
Government of Telangana
Dr. G.Srinivas Rao
Director of Health(FAC)
Government of Telangana
Financial Advisor:
Smt.D.Vijaya Kumari.
Deputy Secretary to Government,Finance Department
Government of Telangana
CEO Sri. K.Manicka Raj,IAS.
Chief Executive Officer, Aarogyasri Health Care Trust.
Secretary of the Trust

Best Breathing Technique by Dr.SS Reddy-Apollo-Hyd

Best Breathing Technique by Dr.SS Reddy-Apollo-Hyd 

I am 62 years old pediatric surgeon from Hyderabad India.presently contemplating  retirement  in  West Texas where I work as an internist. Dr.S.S.Reddy was one of my General surgery professors  in Osmania  Medical college /Osmania General Hospital and a good teacher. He was also a pioneer in Laparoscopy and setting up Corporate medical centers. I think Medinova Diagnostics and  Polyclinic was his first venture in Hyderabad.

I was Pleasantly surprised to see this video and  glad to see he is doing great at 86 years.

Hats off to you sir! May you Hit a century soon

Due to it's larger size i am not able embed the video Please click on the heading to go to Youtube to see this very useful video

Transcript

According to the ancient Yogi's who believed that in order for a man to be in harmony with himself and is environment he had to integrate the body the mind and the spirit these three becomes integrated hen  motion action and intelligence are in balance they discovered a way to achieve and maintain his balance  at whizzed through exercise breathing and meditation and r. SS Reddy has taken that one step ahead he believes age isn't how old you are but how old you feel it is a psychological barrier which needs to be broken down and once you do that sky's the limit these are the very words of an 86 year old man who believes and practices it every single day of his life and has no plans of stopping anytime soon one of the senior most distinguished surgeon of our country graduated from Andhra medical college in  and got his s    general surgery in  dr. SS Reddy has been a claim to be an excellent teacher and aggravation you fitness is it that you should be able to do your normal activities in life each person's normal activities are different and with age also they will change and t is necessary for us to keep our body absolutely in a condition to  function that you have to do in life so that there is no standard pattern an athlete has to be fit in a different manner an officer has to be fit in a different manner your person working on a computer has to be fit in a different manner so that there is no such thing as a standardized fitness but to keep the body able to do these functions it is a necessary for us to have a very healthy body for this two things are necessary the body should have enough oxygen that means you must breathe very comfortably it should have enough  to be able to give the number of calories that is necessary to function breathing is inevitable t's that  e  essing you possess every moment it's so important that the movement breathing ceases life ends every you breathe around 15 times a minute that's , times a day but you never think about it since your body does  it naturally in current breathing technique has profound effect on your health and can affect your body sufficiency they after day see whenever we want to breathe we are not doing it deliberately we exercise  e physical body and at the end of it because we run short of breath we start breathing in a fast gasping  manner that doesn't oxygenate your body well besides it is an enormous amount of unnecessary muscular activity which makes the heart pump a lot of blood and a heart rate increases and the end of it you are tired and all this is achieving only breathing faster and making your heart pump more this is what we call circulation all over the body that comes from the left side of the heart it has to pump at 12- to 150 millimeters of mercury to each every corner of the body now the same amount of blood comes back to what we call he venous system which is a continuation of the arterial system that is why it is called circulation it goes in a circle and all this comes to the right side of the heart then the right side of the heart pumps it into two lungs which are very close and it requires only  millimeters of pressure to pump the same amount of length to the two lungs and both chambers of the heart are simultaneously contracting hence the  purpose f  l this is for the blood to go through the lung to take oxygen and remove carbon dioxide what I thought  s  y not you o breathing deliberately we get it stimulated by unnecessary exercise and going into an oxygen  back which we call oxygen debt which makes you gasp and take breath which is not very good on he  her  And if you deliberately breathe you put yourself into a state where plenty of oxygen goes into the body and he carbon dioxide gets automatically eliminated and it is effortless because you are only breathing which is a   normal function and this is how I have taught as breathing as fundamental phenomenon to keep you fit if you're tensed breathe it will calm you down if you're worried breathe it will release the tension if you're anxious breathe it will bring you back to the present if you're moving too fast breathe it will remind you   low down now the interesting thing about breathing is breathing is done by warranty muscle the skeletal  muscle mainly diaphragm and the intercostal muscles that are at the dips now if it’s made voluntary and we  have to think about it and breathe it will be very difficult so again the body has done a wonderful  mechanism y  which our continuous need of oxygen is done without any effort on our part in other words it has been made  voluntary so the normal amount of breathing we do which is 500 ml in and 500 ml out what we call inspiration and expiration these go on without even our thinking about it when we are awake when we are asleep when you are working we don't even think we are continuously doing this breathing of  ml in and out because  at is enough for our routine normal function and activity at the same time if we want to breathe more we have do it consciously now to train ourselves to use it if you want to breathe in first it is difficult because our are trying to expand your chest hence by thinking I have found and by practice that if you breathe out fi rst which is very easy it automatically expands again and we breathe in without any effort this forces  without any tiring and without any difficulty so to pray in ourselves this is done easily by doing you round because with OO sound it is not possible for you to make it faster ,to make it different so I have found and t is easy to a note sent to breathe out by doing the Wu song like see how effortless it is dr. eddy believes that in order to take maximum oxygen intake we have to first breathe out completely so that here is more space in our lungs to easily breathe in more oxygen you everybody must be wondering  what's   special about this breathing breathing  in the sense you know we most of the time are not consciously breathing completely so for this we need to exhale completely and then at that point when you exhale completely there's a lot more oxygen that we take into a system and once this oxygen has gone into a  stem very cell every part of a body is more energized that's what he means by this breathing so this breathing when you do it for five minutes in the morning and like say even  minutes or  minutes in the evening keeps you more exercised instead of running and jogging and finding difficult to breathe we are sitting down or finding a time just took you know breathe and make ourselves feel more rejuvenated  that his and trust me when you sit at a place and you start breathing exhaling importantly and then inhaling f  there's a lot of difference in the way you continue the rest of your journey and my friends to follow a lot people follow it they're doing it either that while they're reading the newspaper having their coffee or  commuting to their office at their office desk and most of the time when they before the enter a party we breathe with  is effortlessly one and a half liters each time and leave out one and a half liters that is three times the normal amount this cannot be done by repeating this  breathing because then we have breathe so many times that it is impossible dr. he has been inspiring people around him for many years he started practicing this exercise  years ago and has shared it with many of his family members friends and many of his clients all over the world so what's his secret in staying so young and agile the secret to his fitness can be followed in three steps step one exhale slowly and completely it is easily done with the MM sound instant and natural to breathe in much more than we naturally do in that way we can breathe in a lot     minutes of breathing exhaling and inhaling is a shoe mantra for fitness step  while exhaling you must tighten he muscles each at a time starting with your arms legs and you entire body and this in turn towards the muscles for example contract or hold your stomach muscles while you breathe out a simple way to keep our neck and shoulder free of stress is raise both the shoulders and this forms a cup for the neck gently moves the neck sideways and then upwards nd downwards what I really like about my father-in-law is ore than his systemic kind of life it is his attitude he's got such a positive attitude no matter what nothing really disturbs him and that's hat I follow because I want to keep my calm at all times satin or  ion I started practicing his breathing techniques and it changed my complete lifestyle sometimes I feel that he is younger to me because he is so active all the time I've seen people of  and much older who can’t  talk who can't walk and are bedridden but this person's energy is just overwhelming I keep seeing hima nd his  activity levels are so much high that you can't even compare with a 30  year old guy when you see him you realize that age is just a number and but the fact is as you age be still being healthy is more important  when   initially told me about this exercise I've never taken it seriously but later on I thought okay fine let me try this once again and when he started doing it I've seen a lot of changes in my body it relaxes your whole system and it's a very good stress buster to most of the society is so trained to believe that exercise is a great thing which it is but that doesn't mean you tire yourself out reaping the rewards of exercise doesn't require strenuous workouts or trips to the gym it's about adding more movement and activity to your life when in small ways to keep the muscle active for your body activity the muscle has to be trained and  trained raining can be done by Toning which means that you tighten your muscle all down the body to make t rhythmic and easy it is good to synchronize with breathing out so that it serves breathing and at the same time Tone in the muscle so what we do is at the end of this you take a deep breath breathe out and   you breathe out again turn one part of the body now it is tough then you turn the lower leg turn the other  g turn this arm then turn the front of the body turn the back of the body this like a circle you do it five ten  times when the whole muscular system is now made LT and not tired at the end of it as you can see I am  T ie I am NOT setting and I've made my body fit without any effort that is why I will call it is effortless it’s rhythmic it is synchronous easily repeatable and you can do it anywhere and  anytime anyhow and that  the basis of this Fitness linked to breathing he strongly believes that what we need s rather a simple  routine  which can be one at any time anywhere at any place and especially at any age because as you grow older positive lifestyle is more important than ever the S.S. Reddy is one of the most influential leaders of this era and it's  great honor and privilege to have a chance to work with him it's been five years of association with him  d he has been a great mentor and have learned a lot of great deal of things both on the personal and  professional  through my growing years  I've always seen that they are very disciplined about his exercise and is regime through the years I've never seen his energy levels drop beat the morning or the evening all times that he follows are really easy and any of us of any age group can do it anyway he body needs  energy fr om food and drink to work properly and stay healthy your body uses energy the more active you are the ore energy your body will use the amount of energy you get from food is energy input the amount of energy your body uses is energy output he more food you eat the larger the input the more active you  e he bigger the output the important thing is to keep input and output in balance but how do you balance the calorie requirement of our population is only two-thirds of the gallery requirement of the Western population because calorie requirement is based on height and they're on average or four to six inches taller than us so they're calorie requirement is one and a half times more than us our other since two-thirds of hat they require so you should not go by what is written in books because they copy about western  calorie requirement and we have to take two-thirds of that amount weight loss is more than a physical challenge and  it's a mental challenge we are surrounded with mouth-watering junk food all around us it's  very difficult to resist the temptation but what we need to realize is the damage it can cause to our Health we need to constantly remind ourselves that though it might give us a temporary satisfaction being fit satisfies us for a lifetime now how r ts consumed this Caloriey is of no matter you can take it in any form  u ant and it should be limited to that amount carbohydrate is the main constituent of diet and it is essential as the body cannot function without carbohydrate because brain and heart they use only carbohydrate as their energy requirement they can't use protein or fat and sixty to seventy percent of our  diet should be carbohydrate twenty percent protein and ten percent fat. fat is essential because that is the  substrate for all hormone production in the body and it is necessary to balance our requirement whatever your  s food we take especially carbohydrate is converted into fat and stored in the body fat is stored as fat if we take more this is the common cause of obesity weight of the body is described in books as body mass index and there is a complicated formula to calculate that it is unnecessary there is a very simple formula which I have created  centimeters is  kg for each centimeter addition is  kg so that for any height in centimeters what is  you strike off the  kg if it is  centimeters strike off the  kg if it is  centimeters strike of he  kg it is very easy to remember twenty percent addition is called overweight twenty percent more is called obesity and more than that is called with obesity which means it is very dangerous to health in obesity is very very risky for developing hypertension mm pulmonary fibrosis for developing cardiac problems like myocardial infarction and heart failure one thing we must remember you respect to  whatever our weight the size of your heart and the size of your lung is constant according to our act there is a little variation between height and we must be very careful and check our weight and the weight increases the only way to reduce weight is to reduce our diet all other methods do not work from  I am doing this reading exercise morning  minutes evening  minutes wherever I am even in during long-distance flights also I will go near pantry I will do his since because it doesn't need any carpet or any specific place to  form like that I am continuing this I am very happy earlier I was almost  kgs after starting this without walking without the yoga asanas only with this breathing exercise now today I am only  kg and all perfectly ll right earlier I used to have joint pains now no giant paints I can run I can walk I can jump there is a greatness of this breathing exercise people always ask me how we do you stay so fit the secret is every  me I have to go for a party or a wedding I just do these breathing exercises and they come out so well Oh my you look so vibrant and energetic and also look fit for the occasion that's the secret as they say life is  ronic, only in absence of something will make us realize the true value of it so start valuing your breath  from this very moment let your breath be anchor so the right way of breathing you will be able to enjoy each  moment of your life all about learning is to practice and do things there is no purpose in reading and closing  book I have shown you easy methods of being fit and you have to learn them you have to practice them  day-to-day life and you will see the results very quickly this will produce book fitness without any straina and makes you or make your body extremely healthy I have found it in my own experience and I am  absolutely happy about this fitness regime please follow it and do it to the extent you can and do it every day   to be one once in a month or once in a way it has to be done regularly and it must become a part of our day to day life it's simple you know you can do it anytime anywhere and at any place because nobody  even knows that you're actually exercising you can do it anytime anywhere anyhow and I really enjoy doing  s exercises he has always been my inspiration and I'm sure when he ill always continue to be my inspiration in the future I suggest you try at least once this excess and I'm sure you know the changes in  e body I feel very active and energetic and believe me this lifestyle I owe it to her thank you doctor dr. eddy's mantra is nothing is impossible you can do whatever you want with the new lies the enormous  power which is untapped all the answers lies deep within you all you need to do is stuff with it you                                                                                                                                                      

OGH (Osmania general Hospital)should be saved

People come here with confidence’

DECCAN CHRONICLE

Former superintendent Dr S.S. Reddy tells us why OGH (Osmania general  Hospital)should be saved

 Dr S.S. Reddy

Osmania General Hospital is the largest state government hospital. It was started by the Nizam and has a glorious history. First of all, the building is an architectural beauty. It has to be conserved. There’s no question of that building being interfered with.

Apart from that, as a hospital, it has a good reputation. The services rendered are remarkable and noteworthy� When I was working in the hospital, I operated on ministers from the central and state governments. Many important people from outside the city too used to come to OGH for treatment.

The organisation that decided about the structure and strength of the building has categorically stated that the building is quite strong, that the foundation is good. It only requires regular maintenance, which has been neglected, as it happens in many government institutions, especially in the recent past.

I worked in Osmania General hospital from 1974 to 1983, as a surgeon first and was appointed the superintendent in 1981. The PWD had located an assistant engineer in the hospital premises to continuously look after the maintenance and upkeep of the hospital, and that was a very good decision. At that time, I had gotten the whole drainage and water supply redone. The hospital is at the bottom of a slope, near the Musi River.

The superintendent running the hospital can easily coordinate things. He has a management budget, and has immediate access to the government. You don’t just demolish a building of that beauty. The domes and structure, the height of each floor... it’s remarkable. Right at the entrance, you can see the top of the dome. At that time, to plan that height without any intervening structure was great.

People come with great confidence to the hospital. I would tell the government and the hospital authorities to first clear off all the little repairs that need some maintenance. Identify the problems that need major repairs and get them done immediately. The glory of this building should not be disturbed.

— As told to Christopher Isaac

"We thus find ourselves at crossroads: healthcare can be considered a commodity to be sold or it can be considered a basic social right because it cannot comfortably be considered both of these at the same time"-> Dr paul Farmer

I came across the title of this book in moneylife(a magazine) through an article on the healthcare system of India and how the latest promise of Mr Modi in his Universal Health Insurance Scheme is not the silver bullet that India has been looking for. Before reading this book I knew that the Indian healthcare stories are full of corruption, commercialization and medical negligence but after reading this i now know the magnitude of the situation and it is alarming at the very least

78 doctors have mustered the courage to allow the publishers and authors of this book to tell us what really has been going on in India. Methodology followed in this book is uniform as the interview questions which have been asked have been same to all of them. Some of the respondents have requested the authors to conceal their identity which is understandable. These doctors are the reason that common citizens like me now are aware of the rights we have and the avenues from which we can seek help

Since I've been reading this book, there has been a concept in my head which has been persistently nagging me. It is a concept of economics called as "Purely Public Goods". All those good which enjoy non-rivalry( money extraction by creating artificial supply shock) and non-excludability( no privileged access to anyone) are called purely public goods. The best example of this safe drinking water. Since it is required by all and cannot be allowed to be the reason that people fight or bid for it, its availability is monopolized by the government. I was wondering whether public health can be looked through the same prism or not. Can it be treated as a purely public service and the ownership should be monopolized by the government? This is the age old debate of whether health services should be treated as a social right or a commodity. In India, theoretically it is defined as a social right and is used by politicians whenever there's need whereas in practice, it is as commoditized as vegetables that we buy from our local vendors

I understand that a lot of my doctor brothers and sisters can put hundred arguments in front of to defend the privatization of medical care in India but i want to point out that any problem always has two ends to it and they should not forget that they themselves can be on the receiving end of what they have created or abetted. I won't be pointing out the various flaws which the system has been suffering from as it has been done by the author itself instead, I would like to talk about the models which we can emulate especially the supposed silver bullet, Universal Health Care(UHC)

UHC is a model in which health care has effectively been created into a purely public service. No patient pays for their treatment and all personnel are paid by the government. Funds for these treatments are garnered through taxes. This is a very simple yet innovative model which has been successfully implemented by UK, Thailand, Canada, Brazil and even Sri Lanka. It is important to note here that this model has succeeded in these countries because of excellent public health care facilities, trust hospitals and even the private hospitals which have willingly participated in the cause

Friends I don't know how many of us have realized but the social conscience of our country seems to be at its nadir and I can only apprehend what's more in store for us. It has been my observation and I'm sharing it with you here and I hope that some people would appreciate it. All of the problems which have been age old in our society like corruption, terror, malpractices, inhumanity etc etc, I feel in the current scenario, this has spread because our increasing inclination towards consumerism. You can look up the definition of the word in Wikipedia and you will be surprised to see the benign definition there--> acquisition of goods in ever increasing amounts. I'm not prompting any of us to the positive or the negative aspect of it but would like to urge to people to try to entertain this thought as to whether all of our problems has its roots in this concept
Parth Agarwal

"We thus find ourselves at crossroads: healthcare can be considered a commodity to be sold or it can be considered a basic social right because it cannot comfortably be considered both of these at the same time"-> Dr paul Farmer

dissenting diagnosis incomplete

fees, patients' rights and a grievance redressal mechanism. Towards this, standard guidelines for quality of care, treatment protocols and rational cost estimates of common health care services need to be developed. Trust hospitals, which have availed of large-scale public subsidies in terms of land at minimal cost and other benefits, must be made to effectively provide 20 per cent of beds for economically-weaker sections. • Substantially increase public health financing: India is already committed to increasing health financing to 3 per cent of GDP from the current level of 1.2 per cent. This implies making a quantum jump in the health care budget, a significant part of which should be utilized for strengthening of the public health system and enhancing health sector human power, while developing frameworks for regulating the private medical sector in parallel.

 • Ensuring laws and governance for the health system: Enactment of a National Health Act, which ensures the right to health and health care for all, could be an important legal step.

 Community Based Monitoring should be extended to ensure participatory planning and monitoring of all health services, with active involvement of civil society organizations.

Generating widespread awareness and people's organization for health rights is an essential condition to make any UHC system in India work successfully in people's interest. The dozen questions and answers above should give the reader an overall idea about a system for UHC, and how this goal can be achieved in India. Though it may sound like a dream, given the experience of so many other countries, it is clear that UHC is a realizable dream.

In the early twenty-first century, for both people and doctors, health care should cease to be a commodity, and should become a publicly organized service. With such a framework, health care should be considered a human right. Starting from the present crisis situation, moving towards a system which would fulfil the health rights of all residents in India, and would provide a stable, decent income with healthy working environments for all doctors, is a stupendous challenge, and would require extensive social churning. It is high time that all of us rise to meet this challenge, and convert the dream of Universal Health Care into reality

sections, and would also induce more doctors to step out of the commission-based rat race, and practise ethically. Some public-minded individuals or social groups need to engage with a few rational and ethical doctors in their area to initiate such a process. One essential ingredient for success would be the availability of at least a few rational and ethical doctors to start with, who would devote some time and energy for this activity. A second important component would be the presence of a committed social group or NGO, which may work as the secretariat of such a forum, particularly keeping in mind that most doctors are quite busy and may not be able to devote much time for coordination of such an activity. The core activity of such a forum would naturally be informing patients about some appropriate, rational doctors, based on their specific conditions and requirements. As far as possible, the options of a few providers would be given, enabling the patient to make the actual choice based on their own specific requirements and preferences. Along with this, regular public discussions could be conducted to promote interaction between doctors and citizens on key issues like: What would be a desirable form of regulating private hospitals? What are patients' rights and responsibilities? What is a rational approach to common conditions like childbirth, or measures like child vaccination? The 'Citizen—Doctor forums' would need to be given wide publicity so that
large numbers of citizens and more doctors would progressively join the group. It must be underlined here, that at the time of initiating such a process.

It must be underlined here, that at the time of initiating such a process in any area, clear criteria and procedures for including names of specific physicians in the list of rational and ethical doctors would have to be worked out. The forum could come out with a list of basic conditions that the involved doctors would need to sign, for being included in the list. This might include a poster display in the clinic on patients' rights, and a personal declaration that the doctor respects these rights; a declaration that the doctor does not take gifts and favours from pharmaceutical companies; a commitment to answering patients' queries and following rational treatment practices etc. At the same time, feedback from individual patients regarding each doctor would need to be analysed and taken into account, and if any doctor is found not following the basic criteria or declarations made by them, then they might be removed from the list. At the same time, doctors who have been
positively rated by large numbers of patients would be appreciated and continued in the forum. Some of the exchanges in the forum related to health awareness topics, rational treatment practices etc. could be mediated through a web portal or online platform. However, care would need to be taken that at no stage, or in any form, is an individual doctor or hospital allowed to advertise through this kind of a platform. Provided that the forum gets strong support from a number of rational and ethical doctors, it can start something like a second opinion service, whereby patients could choose from among a panel of rational and ethical specialists, to seek a second opinion (some appropriate fee could be charged for providing such opinions). Based on the demands of the forum's work, a person could be assigned to respond to the queries coming from patients, and for coordinating activities. Such Citizen—Doctor Forums are an emerging idea in the Indian setting. In this context, a notable voluntary service is currently run by the Hospital Guide Foundation, where referral advice is provided to patients free of charge in certain major cities. Hospital Guide Foundation—Connecting Patients with Quality


Hospital Guide Foundation—Connecting Patients with Quality Health Care Providers Hospital Guide Foundation (HGF)I is an NGO with a vision to revolutionize health care in India, by bridging gaps to make quality health care accessible across all sections of society. It is a free service that does not charge its patients, and also does not have any . commercial transaction with suggested health care providers/doctors, hence ensuring unbiased suggestions. HGF's current core service, • focused in Bangalore and Delhi, provides health care solutions by referring patients to appropriate doctors. HGF affiliates itself with practitioners after doing a reference check, so that the best of advice • can be given to patients. HGF draws upon the goodwill and help of doctors both in private and government sectors. Every patient request • is strongly evaluated and given equal importance, and then the patient : is referred to the appropriate specialty/doctor. This methodology gives the patient a fair chance in getting the correct diagnosis, • prognosis and treatment.

6; Globe trotting! courtesy Pharma company.

 Psychiatrists in India arerepeatedly offered personal gifts, foreign trips, etc. to woo them and get them to prescribe depot injections of Atypical Antipsychotics.The pharmaceutical company will even arrange for a nurse to visit the patient at home. "The relatives of the patients are happier to have  this done  to keep the  patient  sedated but manageable than  running around causing trouble" is how some  psychiatrists say justifying this practice.The more number of scripts  the more exotic  are the vacations.I know of  some Psychiatrists being  sponsored to Singapore,Venezuela,Rio in Brazil and Shanghai in China.

Those salesmen would tell me openly that they are willing to spend on an individual, not on the institution,' comments a general surgeon from a metropolitan city.

 A paediatrician from a metropolitan city suggests, 'The practice of pharma companies sponsoring doctors for conferences and CME (Continuing Medical Education) workshops must be stopped immediately.'

A gynaecologist from a big city observes,
'The area manager of a pharmaceutical company once paid me a visit along with his army of representatives. He asked me why I regularly use a certain product manufactured by them. 'l answered, "It is cheap, it is effective. That's why." 'He was confused.
He asked me in bewilderment, "Madam, we never give you any gifts." 'l replied, "There is no need for that." 'He just could not believe it. He kept asking, "How can this be, madam? Please tell me the reason."
 'This is the ridiculous situation that prevails. This is the reality.'

A paediatrician from a big city mentions, 'Our branch [of a doctors' association] was functioning well. We would organize CME workshops with our own funds. Gradually, the pharmaceutical companies pushed their way in. From 1995 onwards they began to organize their own CME workshops. Earlier, we would focus on the issues of importance that we had decided upon. But then the pharmaceutical companies began to select only those topics that would help them promote their new drugs. The workshops were free, with liquor thrown in. Finally the doctors in our city decided that all workshops henceforth would be organized by the pharmaceutical companies. I would ask them why they couldn't spend Rs 1000 per year on their own education. Why do you want it free?

Finally, through a secret ballot, my opposition was set aside and the basic principles of our [doctors' association] branch were changed in favour of the pharma companies. Obviously, I withdrew from it. Now all workshops in our city are conducted by pharmaceutical companies. 

Table of Contents:Dissenting Diagnosis By Arun Gadre, Abhay Shukla

1. Complete Interview: Dr Vijay Ajgaonkar, senior diabetologist, Mumbai
2. Malpractices in Private Hospitals
3. The Toxic Influence Of Pharmaceutical Companies
4. Health Care Becomes an Industry': The Growing Influence of Corporate and
Multi-specialty Hospitals
5. Social Attitudes and the Policy Context
6. Some Solutions Suggested by Doctors
PART Two: INITIATING THE CURE
7. Physicians, Heal System!
8. What Rights Do I Have as a Patient in a Private Hospital?
9. How Can I Recognize a Rational, Ethical Doctor?
10. How Should the Private Medical Sector Be Regulated?
11. Moving towards a System for Universal Health Care (UHC)
12. Joining Hands for Healing the Health Sector

5.COMMISSIONS/CUT PRACTICE

5. COMMISSIONS/CUT PRACTICE A pathologist in a big city shared, 'I did a job in a private set-up for fourteen years. Since the past eight months, I am running my own private practice, having left my lab in the city. A lot of very problematic things are going on nowadays.

 If I practise ethically, no patients are sent to me. One is expected to do all kinds of things: giving cuts, throwing parties with liquor thrown in, giving doctors whatever reports they want—for example, presenting the Widal Test for typhoid in a way that the doctor can admit the patient, even when he does not have typhoid. Out of 150 doctors whom I am in contact with, there are at the most three or four doctors who find my reports excellent and therefore send me patients without expecting anything in return. Just three or four! Today I am able to manage only because I have other sources of livelihood. '

 'Nowadays doctors don't record the [patient's] history properly,' said Dr Punyabrata Goon, a GP in Kolkata. 'They don't even examine the patient. They just write out a list of investigations. Because they get a commission for doing that. Almost all the laboratories in our area give 50 per cent commission and almost all the doctors accept these commissions. For many doctors, the money earned through commissions is much more than that earned from fees.
In our area, the commission rates are: X-rays 25 per cent, and 33 per cent for MRIs and CT scans.

A paediatrician in Delhi, Sanjay Bhatnagar explained how the system is harmful: 'I don't take cuts. I tell patients to go wherever they please to get the investigations done. The patient then goes to his own GP and asks him where he should do the test. The general practitioner gives him a slip referring him to a pathologist, and gets a cut for this. But I have no faith in that report. Unfortunately I cannot even tell the patient where the problem lies. ' A big city physician explains how even those who refuse to take cuts are drawn into the system: 'The routine hospital charges actually include the cuts. And even though I do not take cuts, this extra amount is not reduced from my patients' bills. Given this situation, many people ask me what I achieve by not taking cuts. I don't know. I consider taking cuts to be unethical and I don't take them. When I inquired, I was told that the hospital transfers the cuts that I do not take to a separate fund, which is used for emergency expenditures! '

'Nowadays the charges in the medical sector have increased to the extent that even I wonder whether I will be able to afford them in future,' lamented Dr Pratibha Kulkarni, a gynaecologist from Pune.

Most private hospitals, whether small or Big, are part of this system, though the latter are more transparent. A GP practising in a metropolis explained, 'The running charges in a small hospital are the same as in a multi-speciality hospital. But in the multi-speciality hospitals to which I send my patients, there is a rate chart, there is transparency. In small hospitals, protocols and rules are not followed for diagnosis and treatment. They charge whatever they want, and they extract as much money as they can from patients. I will not support the practice of cuts. Neither do I take cuts. Some general practitioners say that there is an outrageous disparity between their bills and those charged by specialists and hospitals. People do not pay even a little extra money to a general practitioner. But they will pay whatever specialists and hospitals demand. Then what is wrong with taking a share of that money? But I don't agree with this practice. Why should I cut into my patients' pockets when I refer a case that I cannot manage, to a specialist or hospital? No. Cuts cannot be justified whatever the reason behind them. Yes, one thing should change: One should ensure that hospitals and specialists levy only reasonable charges—we need a system where the current anarchy does not continue. '

reasonable c not continue.' need a system where the current anarchy does The cuts come under all sorts of heads. Dr Suchitra, a GP from Chennai, revealed, 'I happily refused to become a person who accepts commissions. Once a laboratory PRO visited me. He offered me a certain percentage as "IC". I did not even know what IC stood for. Apparently, it means "Interpretation Charges". What blasted interpretation? There is nothing in the laboratory report on which I can use my knowledge. This was nothing but a cut under a cute name. I refused, and told them to give the cut to the patient.' 'The way the "cuts" system works is, it actually operates against those who refuse to take them,' 

4. "Who are you to take decisions on our behalf?"

 "Who are you to take decisions on our behalf?"
What do you want us to do doctor? was a question I used to get asked all the time when I was practising surgery In India in the 80s and 90s. Families wanted me to make  decisions  for them.They had  an unshakable faith in me to make the correct decision for their  patient based on their circumstances.
 but now the  tables are turned  and  doctors are asked "Who are you to take decisions on our behalf?"
 A rampant malpractice is in the area of prescribing vaccines—it is organized, and takes place on a large-scale in planned fashion. The practitioner gets a cut on the Maximum Retail Price (MRP) The more expensive the vaccine, the higher the  commision.
Once it  is marketed to them, the patients definitely take them. But it places a big burden on their budgets. And if I don't recommend vaccinations, they will certainly ask me, "Who are you to take decisions on our behalf?"

 All vaccines should be manufactured and supplied by the government. There should be no involvement of private companies.' 

As Dr Arjun Rajagopalan, the surgeon from Chennai, pointed out, 'Even in the case of some ordinary business or trade, there is a clear distinction between business conducted ethically and business conducted unethically. Even that sense no longer exists in the medical profession. The practice of cuts/commissions is now routine. As the patients do not have the necessary knowledge, it is the duty of the doctor to look out for the patients' best interests. Taking a cut/commission that is even more than the fee charged for the consultation is totally wrong. But I feel sad when I see that there is no transparency whatsoever left in the private medical sector. 'Every week I come across two to three elderly persons who only need proper spectacles,' said an ophthalmologist working in one of the country's metropolises. 'But they have been told to get operated for cataract (which they don't even have), and they are told the charge is Rs 30,000—40,000. Those who have insurance fall into the trap and go in for the surgery. Those who don't have insurance come to me for a second opinion, and they are saved! 'Every month I get at least two to three cases where the patient has all

opinion, and they are saved! 'Every month I get at least two to three cases where the patient has all the paperwork ready. They have been told by some other ophthalmologist to have a cataract surgery, and they have come to me with the required money because someone has recommended me. I examine them and tell them that they have no cataract! This confuses them. They don't know whom to trust. They even harbour the suspicion that I don't understand the issue properly, or that I am scared to perform surgeries. They pressurize me to perform a surgery. But I refuse.' Patients from the economically weaker sections are specially prone to exploitation, as public health expert, Dr Rajib Dasgupta of Jawaharlal Nehru University, observes, 'Under the Rashtriya Swasthya Bima Yojana (RSBY, a scheme under which the government purchases the services of private hospitals for poor patients), private doctors diagnose a complicated hernia even when it is a simple hernia, since this fetches them a higher claim. Caesareans help them to earn more money than normal deliveries. And they claim they are forced to do this, because the fees that the government pays are very low! In the case of some surgical procedures, what these doctors claim is true. But missionary hospitals and some other service-oriented hospitals happily implement this scheme. The scheme is a support for them; which also means that the fees are adequate and costs involved to hospitals are affordable. '

Poppycock Partnerships /Corruption and the undermining of public health all over the world

Poppycock Partnerships /Corruption and the undermining of public health all over the world

pop·py·cock

ˈpäpēˌkäk/

noun

INFORMAL

1. nonsense.

   synonyms:

   nonsense, rubbish, claptrap, balderdash, blather, moonshine, garbage; informalrot, tripe, jive, hogwash, baloney, drivel, bilge, bunk, eyewash, piffle, phooey, twaddle; informalbushwa, malarkey, gobbledygook, mumbo jumbo;  informal,bunkum, tommyrot; vulgar slangcrapola, verbal diarrhea "their claims are poppycock" Unfortunately, many governments today are withdrawing from their responsibility to provide quality health services to people and are resorting instead to 'public-private partnerships' (PPPs).(poppycock) Eager votaries of such PPPs and state-supported health insurance schemes would have us believe that the state should hand over large-scale public funds to the private medical sector, based on the uncritical assumption that private providers will provide good quality health care to the population. In this context, these scathing reflections on the private medical sector from within the medical profession provide us with a healthy counterview. These observations give us a glimpse of what we might expect if the state decides to hand over responsibility for providing health care on a large-scale to unregulated, profit-driven private agencies, without any regulation or accountability. Allyson Pollock and her co-researcher Mark Hellowell argue that capital investment through PFI creates a large public sector cash liability. For example, they say that the £5.2 billion of PFI investment in Scotland has created a public sector cash liability of £22.3bn.[7] This cash liability is 'off balance-sheet' and does not show up on government statistics such as the Public Sector Borrowing Requirement (PSBR).  Pollock et al. conclude that the true risks of many privately financed contracts are not calculated correctly

KEM Hospital, Nair Hospital, JJ Hospital are all teaching hospitals, and procedures like angioplasty are performed there too. If well supported, these teaching hospitals can easily do better than all these corporate and multi-speciality hospitals. In that case, we should increase the facilities in these government hospitals. But our elected representatives ... have now become self-representatives. The facilities in public hospitals are not improved. Government hospitals are being ruined through deliberate neglect. Just as MTNL is being killed off so that private mobile companies can profit ... the government hospitals are being neglected so that corporate hospitals may benefit. Now see ... the radiology unit and lab have been outsourced by two of the largest public hospitals in Mumbai. Why was this done? The same reason—to promote the private sector. How can the poor afford this? One does not understand. Why would private hospitals do anything for free? Of course they avoid giving free services; there is no doubt about it. The history of these corporate hospitals and the influence they wield is frightening. My father established an association for a particular medical condition. It set up a hospital for the poor in a small building in Mahim, Mumbai. Members of the association were charged concessional rates for all services. When I was working there, my OPD would be the most crowded; people would queue up from 5 a.m. But then the hospital was taken over by a corporate hospital. Since it was a hospital run by a trust, they could not buy it directly. So then they took over the management of the association. They paid the membership fees of our lower-level staff to enrol them as members, and got a majority of votes in favour of corporate takeover. For the general body meeting of the association, the lower-level staff was brought there in buses, and subsequently they were taken to an expensive hotel for lunch. The doctors were also no different from the administration. Many of them would sign without even examining the patient and prepare a bill. They would do this with inpatients and patients in the operation theatre. Such doctors, too, happily joined the corporate bandwagon and also
Such doctors, too, happily joined the corporate bandwagon and also voted for it. And thus the corporate lobby finally took over the hospital management, and built a separate twelve-storey, air-conditioned hospital building. Hospitalization there for just two days would cost around Rs C npyrohrer 50,000. I could not bear to see this, and resigned. Then they, too, were unable to manage the hospital—it has now been taken over by Fortis. It is not just corporate hospitals, what is going on all around is uns eakable• violations occur everywhere.

It is not just corporate hospitals, what is going on all around is unspeakable; violations occur everywhere. I will give you an example from Pune. A judge was about to be appointed to a higher post and as part of the process went to a well- known doctor appointed by the government for this purpose. The doctor declared the judge unfit, saying that his blood pressure was high. The judge was angry. He checked his blood pressure elsewhere: it was normal! So he went back and confronted the doctor. The doctor told him without embarrassment, 'Will you be able to pay me X amount of money?' The judge shot back, 'Tomorrow I will be presiding as a judge. Should I change my judgement because one of the parties in a case comes to me with money? I will go to Mumbai and get a genuine certificate from another doctor. I will try not just once but ten times, and I will of course never give any money. And once I get a genuine certificate, I will file a suit against you.' This is the state of affairs with a famous, senior doctor! Another example, from Mumbai this time, of an MD in pathology. Acting on the suggestion of the doctor who had referred a patient to him,
Another example, from Mumbai this time, of an MD in pathology. Acting on the suggestion of the doctor who had referred a patient to him, this pathologist gave a fake report declaring that the patient was diabetic when his blood sugar was normal! A fake pathology report, being given by a MD in pathology! Why did the concerned general practitioner do this? Because the patient would now become the lifelong patient of the general practitioner. This is what goes on nowadays. And tell me ... there are private medical colleges which charge lakhs of rupees as capitation fees for admission. Most of those who take admission in such colleges are rolling in money. After graduating from such a college, what does such a doctor think about? He will extract lakhs of rupees from the patients' pockets. This situation must change! It is no longer possible for a poor student to get a medical education. If a poor student is admitted, one can at least hope that he will have some sensitivity towards other human beings. Even this is merely hope, of course, not a certainty. Nowadays one cannot trust anybody. 

Dissenting Diagnosis

By Arun Gadre, Abhay Shukla

3. UNNECESSARY PROCEDURES/OPERATIONS/SURGERIES

3. UNNECESSARY PROCEDURES/OPERATIONS/SURGERIES
 A GP from a metropolitan city says, 'After admitting a case of diarrhoea, on the first day itself some doctors administer ten to twelve different kinds of tablets to the patient. I use at most three medicines, which are usually sufficient. But nowadays even when there is no need, lots of medicines are prescribed. When one takes gifts from pharmaceutical companies, the strain is on the patients' pockets, and they end up consuming unnecessary medicines. This is also dangerous!' 

Such views are echoed by Dr Shyam Kagal, a physician from Pune. He says, 'I know a gastroenterologist who performs numerous endoscopies on the same patient, when one is sufficient! He adds, 'The Random Sugar Test is not the ideal test on the basis of which the patients' medication dose can be adjusted. Nevertheless, many physicians perform it.' 

This is true of psychiatry as well. Dr Sumit Das, a psychiatrist from Kolkata, reveals, 'In over 80 per cent of cases of depression, when the patient experiences headaches, even though the physician knows that the patient suffers from depression, MRIs and CT scans are performed on all such patients. '
' A GP from a big city regrets that 'nowadays even malpractice has become creative. Ingenious schemes are devised for "cut"-based practice. One patient turned up at a hospital and it was decided to perform a hernia operation, as he had been diagnosed with hernia. But it wasn't a hernia at all! Sometimes even when there is no serious ailment, a pretence of surgery is performed. Nothing is really wrong with the patient. But he is given anaesthesia and some stitches are put on the skin, to show that an "operation" has been done. A huge, completely unnecessary bill is charged. ' 'Unfortunately, we doctors have pharmaceutical companies as teachers,' laments Dr Gautam Mistry, a cardiologist in Kolkata. 'There is a need to quickly set up an independent mechanism which will play this role, whereby every year doctors can prescribe those medicines only after studying through this system (the system could also be online), not after having been tutored by medical representatives.

Dissenting Diagnosis

By Arun Gadre, Abhay Shukla

2. UNNECESSARY INVESTIGATIONS TB Gold and TB Platinum !

2. UNNECESSARY INVESTIGATIONS
Dr Jana, from Shahid Hospital, Chhattisgarh, explained how unscrupulous doctors cheated patients by advising unnecessary tests. 'First they show that the patient has contracted malaria. They show that by a lab test, and give treatment, but the patient does not get better. Then they do another test and show that the patient has typhoid. Doctors are given whatever reports they want by some labs, on payment of a commission. 'The investigations that are made are also often unnecessary. They are not indicated in the textbooks, but they have been euphemistically termed "routine investigations" just to increase the number of investigations required. '

Endorsing this view, Dr Arjun Rajagopalan, a surgeon from Chennai, said, 'It is a rare patient who gets away with just one or two investigations. All the patients I see hold a list of unnecessary tests.'
A pathologist from a metropolitan city revealed how many unnecessary investigations are advised. 'Take typhoid, for example. If the blood test is performed before the fifth day, it does not reveal anything. But it is carried out every alternate day from the first day onwards. The more expensive a test, the more it is prescribed. A sputum examination is generally sufficient to diagnose tuberculosis in the lungs. But the simple reality is that no test can detect it when the tuberculosis is elsewhere in the body—in the stomach, bones, or lymph nodes. But expensive tests like TB Gold and TB Platinum are prescribed. The more expensive the test, the more the commission.' The pathologist explained the phenomena of 'sink tests': 'This means the sample is just thrown into the sink without testing. The doctor prescribes tests, which by mutual understanding are not actually carried out by the pathologist, who collects the money for the test, and without testing he merely gives a "normal" report. Just one more way of increasing the commission. Many doctors have inadequate knowledge of new tests that are developed—and no desire to learn about them. A new test for TB has been developed. It is clearly written in the test
new tests that are developed—and no desire to learn about them. A new test for TB has been developed. It is clearly written in the test information that it cannot be performed on blood, but only on abdominal and lung fluids. Nevertheless, certain doctors give instructions to perform this test on blood samples. As pathologists, we don't try to enlighten the doctors on such issues, because then their pride is hurt, and then they stop sending us samples.' A gynaecologist based in a metropolitan city added, 'For pregnant women who are in good health, they incessantly keep prescribing heamograms, kidney function tests and liver function tests.' Dr Pratibha Kulkarni, a gynaecologist from Pune, gave an instance of when a twenty-two-year-old woman came to her for infertility treatment. 'All investigations were already done. Actually all that was needed was to carry out some basic investigations to verify that there was no big problem. One has to explain to the woman that she should just wait for six to eight months. But all investigations are carried out anyway.
'One woman had an abortion in a big hospital in the month of December because she did not want a child just yet. And then she came to me in April complaining that she could not become pregnant and asking for treatment despite the fact that in the previous month, March, all investigations for infertility had been performed in a big hospital, and she had successfully become pregnant as recently as three months ago. What investigations and treatments could be more unscientific?'

Dissenting Diagnosis

By Arun Gadre, Abhay Shukla

1.MALPRACTICES DURING DIAGNOSIS

1. MALPRACTICES DURING DIAGNOSIS
A general practitioner (GP) from a small town observed,
 'People have become educated, but there is a loss in that too. Nowadays they have heard of the phrase "Platelet Count" because of the dengue epidemic. The platelet count drops with any viral fever. I identify such patients in the OPD, and call them daily for a platelet count. Very few need to be admitted, maybe one in a thousand. But many other general practitioners tell educated patients, "See, the count is just 1,50,()()0 rather than 2 lakh." They give the patient a saline drip, admit him. If the patient is well-off, then straight to the ICU, and a completely avoidable bill of Rs 25,000— 30,000 follows! 'There is another peculiar practice. Some level of jaundice among newborns is physiological and normal. Very few babies have to be given treatment with ultraviolet light. But the pathologists give a report: Total bilirubin, 10 mg. They present this report on a printed form that is meant for adult patients. The range shown on that chart indicates the patient has jaundice if the bilirubin level is more than 1 mg. This range is for adults bilirubin, 10 mg. They present this report on a printed form that is meant for adult patients. The range shown on that chart indicates the patient has jaundice if the bilirubin level is more than 1 mg. This range is for adults who get jaundice from drinking contaminated water. Almost every newborn has some mild jaundice, and it is dangerous only when the bilirubin level is over 14—16 mg—not 1 mg as in the case of adults. 'Even educated patients are not equipped with the information regarding two different sets of values for the range of bilirubin: one set for adults and one entirely different set for neonates. Instead of using the format meant for neonates, doctors show educated patients the result of a newborn with reference to the adult range and not to the neonatal range. On the adult chart, I mg indicates danger, but the actual count is 10 mg!

regarding two different sets of values for the range of bilirubin: one set for adults and one entirely different set for neonates. Instead of using the format meant for neonates, doctors show educated patients the result of a newborn with reference to the adult range and not to the neonatal range. On the adult chart, I mg indicates danger, but the actual count is 10 mg! In the neonatal range, 10 mg of bilirubin is normal, while with reference to adult range it looks ten times higher! 'Naturally the parents are frightened and agree to have their normal newborn admitted to the emergency ward, and willingly pay the high costs of the treatment. And over and above that, for the rest of his life the patient sings praises of the doctor, as to how he saved the baby!'

 Dr Sanjib Mukhopadhyay, gynaecologist, Kolkata, commented, 'Unethical practices begin right from the stage of writing prescriptions. Listing the qualifications of these doctors, these prescriptions mention degrees that are not recognized by the Medical Council of India or degrees that one [can] get just by paying money. This must stop. This amounts to cheating an ignorant patient!'

Dissenting Diagnosis

By Arun Gadre, Abhay Shukla

What happens when brilliant brains start working in the wrong direction

What happens when brilliant brains start working in the wrong direction

From Dr Ajgaonkar's narration, we have seen how the unimaginable becomes possible, when conscience stops working, and brilliant brains start working in the wrong direction. This is no surprise. A doctor had alerted us to this danger over a century ago.
 The creator of the world- famous Sherlock Holmes, and himself a physician, stated:
When a doctor does go wrong he is the first of criminals. He has the nerve and he has the knowledge. —Sir Arthur Conan Doyle, The Speckled Band

 This is unfortunately true. Actually, a doctor's knowledge may be able to save a person's life; it can alleviate a patient's pain. It can ensure that a newborn baby's first cry goes out into the world after a safe delivery. But one essential requirement of a doctor's profession is that the doctor should remain equanimous when treating patients. He has to be careful not to get emotionally involved with any patient; in other words, the doctor must display a calm professionalism. But unfortunately such 'clinical detachment' is sometimes channelized in the service of gross and unscrupulous profiteering.
'clinical detachment' is sometimes channelized in the service of gross and unscrupulous profiteering. Some courageous doctors have become whistle-blowers to expose malpractices that occur while patients are admitted in hospitals. What is the truth about all these malpractices?  They are appealing to all of us: 'See, these are the unacceptable malpractices that are taking place behind closed doors; we are witnessing them, but we alone are unable to change this situation. Now society urgently needs to do something about this.' Patients need expert medical care at every stage of treatment: making a diagnosis, suggesting various alternative courses of treatment, conducting the treatment through investigations and procedures that the
patient prefers and can afford, and informing and counselling the patient properly about the risks that may arise during the course of the treatment. There is always an element of asymmetry in the relationship between doctor and patient. It springs from two sources. There is an information asymmetry and there is a power asymmetry. The asymmetry can be minimized through more awareness in patients but can never be bridged completely. However powerful or rich a person may be, as a patient he or she is always vulnerable. That is the reason why the Hippocratic Oath is given to only the medical profession. The doctor is given a responsibility to also think on behalf of the patient. Unfortunately today we have a situation where this human right is in jeopardy, and we increasingly have to purchase health services like any other commodity. Even in this situation we should have rights as consumers. For instance, appropriate fees should be charged for medical services, and the patient should feel confident that the costs and quality of service are appropriate. But to what extent does this actually happen? To what extent does the private medical sector acknowledge our rights?

Dissenting Diagnosis

By Arun Gadre, Abhay Shukla