When in a group one speaks in a language that others don’t understand.
When one speaks out of turn.
When one asks a question when he knows the answer.
When one speaks louder than required.
When one coughs or sneezes without a hanky covering his mouth/nose.
Gives information culled from that morning’s newspaper.
Gives opinion without a knowledge base.
Doesn’t know when to stop.
This happens frequently in day to day dealings.
Now you know why I have taken to meditation!
Sunday, January 20, 2008
Tuesday, January 15, 2008
Hole in one
In the game of golf, hole in one has a special place. This means that on a three par hole your shot from the tee box lands the ball in to the hole. You will not get the same recognition if you were to do a four par in two strokes when it is called a birdie or a five par in three when it is called an eagle. Getting birdies and eagles is not uncommon but to get a hole in one is extremely rare and a golfer holds this as an achievement despite the fact that there is an element of luck in addition to skilled shot making in achieving this feat.
Life time of playing and you may not get his distinction and one may get it in the very first year of playing. It happened to a friend of mine within three months of playing and he couldn’t understand all the fuss the others made of this because he still was not aware of the rarity of the feat. Another one who achieved this after three decades of golf did it in the most unusual way. He mishit he shot which rolled all the way to the green and dropped into the hole. When he went in search of the ball which had sped and having not found it anywhere around he looked casually and found it resting at the bottom of the hole. A bad shot getting rewarded was his comment. This did not prevent his friends and others in the clubhouse extracting their pound of flesh in the form of several rounds of drinks at his cost.
I achieved this feat two Sundays ago. This short three par 135 yards, has a visible green and when the good seven Iron shot soared high and dropped near the pin I had no idea that it had dropped inside the hole till the caddies who could actually see the ball disappearing into the hole jumped up and screamed ‘ hole in one’. It took a few seconds to sink in and then it was few minutes of pure ecstasy and then on to some elated mood. That I had to stand rounds of drinks was a pleasure. It took nearly 20 years of playing this game to get this distinction.
Our club rewards the getter of a hole in one with a branded travel bag, ten cases of beer, 5 bottles of whiskey, six bottles of vodka and one case of white wine. As I couldn’t carry this booty in my small car, I had to requisition the club’s van to transport this to my home. My drinking is confined to an occasional weekend beer and the only way to get rid of this quantity of liquor which was occupying the much needed space in my garage was to give it away. I spread the word around that I am holding a garage offer. It took just three days for my friends to clear the whole lot to my delight!
Many of these wished me to keep getting hole in ones.
Silence
To remain silent needs a lot of discipline. Natural outlet for ones thought is to give expression and the best way is to mouth it. Most people love to talk and very few to listen. Even when they listen their brain is thinking what to say to what they are listening. When one is alone and the mouth is therefore necessarily shut one can remain silent. Easy said than done. The mind is active and the run of thoughts is incessant and thus you are not silent though you are not making noises. Emptying the mind of all thoughts, I believe, gives one bliss and meditation helps you to achieve this. I have just started with one technique that was taught to me and hopefully when it happens I will let you all know. At present I am at the stage of learning to sit cross-legged on the floor for the 35 minutes and let me tell you that it is no bliss.
Life time of playing and you may not get his distinction and one may get it in the very first year of playing. It happened to a friend of mine within three months of playing and he couldn’t understand all the fuss the others made of this because he still was not aware of the rarity of the feat. Another one who achieved this after three decades of golf did it in the most unusual way. He mishit he shot which rolled all the way to the green and dropped into the hole. When he went in search of the ball which had sped and having not found it anywhere around he looked casually and found it resting at the bottom of the hole. A bad shot getting rewarded was his comment. This did not prevent his friends and others in the clubhouse extracting their pound of flesh in the form of several rounds of drinks at his cost.
I achieved this feat two Sundays ago. This short three par 135 yards, has a visible green and when the good seven Iron shot soared high and dropped near the pin I had no idea that it had dropped inside the hole till the caddies who could actually see the ball disappearing into the hole jumped up and screamed ‘ hole in one’. It took a few seconds to sink in and then it was few minutes of pure ecstasy and then on to some elated mood. That I had to stand rounds of drinks was a pleasure. It took nearly 20 years of playing this game to get this distinction.
Our club rewards the getter of a hole in one with a branded travel bag, ten cases of beer, 5 bottles of whiskey, six bottles of vodka and one case of white wine. As I couldn’t carry this booty in my small car, I had to requisition the club’s van to transport this to my home. My drinking is confined to an occasional weekend beer and the only way to get rid of this quantity of liquor which was occupying the much needed space in my garage was to give it away. I spread the word around that I am holding a garage offer. It took just three days for my friends to clear the whole lot to my delight!
Many of these wished me to keep getting hole in ones.
Silence
To remain silent needs a lot of discipline. Natural outlet for ones thought is to give expression and the best way is to mouth it. Most people love to talk and very few to listen. Even when they listen their brain is thinking what to say to what they are listening. When one is alone and the mouth is therefore necessarily shut one can remain silent. Easy said than done. The mind is active and the run of thoughts is incessant and thus you are not silent though you are not making noises. Emptying the mind of all thoughts, I believe, gives one bliss and meditation helps you to achieve this. I have just started with one technique that was taught to me and hopefully when it happens I will let you all know. At present I am at the stage of learning to sit cross-legged on the floor for the 35 minutes and let me tell you that it is no bliss.
Tuesday, January 8, 2008
Female Infanticide
One of the worst crimes that is being committed is selective killing of female fetuses and infants soon after birth. Occasionally it is the mother who is responsible adds more tragedy to this crime. India takes the pride of place in committing and helping to perpetrate this most heinous crime against female life. Calling ourselves a developing nation is meaningless unless we give equal social and economic status to our women and treat them with respect they deserve with out being condescending. Hopefully with women’s empowerment this crime will become less and will in the course of time disappear.
I like to quote Dr.M.K.Mani a renowned Nephrologist and a sensitive human being from Chennai.
Cradle baby scheme
One or other illegal, worse, criminal action that governments all over the country have been unable to prevent is large scale murder of female infants. In 2002, the government of Tamilnadu introduced a scheme to prevent murder by persuasion if not by enforcement. Cradles were placed outside government hospitals and the girl babies could be deposited there. No questions were asked and the children were sent to orphanages to be brought up there. In few instances the parents openly brought their chideern over. They were counseled and in some cases they changed their minds and took the children back. The Dahrmapuri government hospital reported recently that it had received 955 babies since the scheme started. 39 were boys; 50 of the children were taken back by their parents. Despite this way out, many parents still resort to infanticide and between 35 and 70 cases are reported every year. Our neighboring Salem district the female to male birth ratio was 850 females to every 1000 males in the year 2000. Later studies are not available for the district as a whole, but studies from different primary health centres [PHCs] and villages show depressing ratios of between 706 and 901.Perhaps the cradle baby scheme needs more publicity in rural areas.
Pretty dismal isn’t it?
Kill the patient?
This morning while examining a patient I got a phone call. I told the caller that I will call him back after I finish this patient! The patient had the grace not to believe me and stayed put on the examination table.
I like to quote Dr.M.K.Mani a renowned Nephrologist and a sensitive human being from Chennai.
Cradle baby scheme
One or other illegal, worse, criminal action that governments all over the country have been unable to prevent is large scale murder of female infants. In 2002, the government of Tamilnadu introduced a scheme to prevent murder by persuasion if not by enforcement. Cradles were placed outside government hospitals and the girl babies could be deposited there. No questions were asked and the children were sent to orphanages to be brought up there. In few instances the parents openly brought their chideern over. They were counseled and in some cases they changed their minds and took the children back. The Dahrmapuri government hospital reported recently that it had received 955 babies since the scheme started. 39 were boys; 50 of the children were taken back by their parents. Despite this way out, many parents still resort to infanticide and between 35 and 70 cases are reported every year. Our neighboring Salem district the female to male birth ratio was 850 females to every 1000 males in the year 2000. Later studies are not available for the district as a whole, but studies from different primary health centres [PHCs] and villages show depressing ratios of between 706 and 901.Perhaps the cradle baby scheme needs more publicity in rural areas.
Pretty dismal isn’t it?
Kill the patient?
This morning while examining a patient I got a phone call. I told the caller that I will call him back after I finish this patient! The patient had the grace not to believe me and stayed put on the examination table.
Monday, December 31, 2007
Ushering in the new year
When you know that to morrow is going to be like any other day, why celebrate and wish?. Then, there are lots of things that are special. We would have aged by one year and may be a bit wiser, you remember your friends and relations at least this one day and vice versa. What do we wish each other? Usually peace, prosperity and happiness. Experience tells me that peace is unrelated to prosperity and so is happpiness. Peace and happiness can be related and coexist.In addition, I feel one should wish the other good health both mental and physical.Goodhealth is a prerequisite for peace and happiness.Physical health needs regulated eating and daily physical excercise and mental health needs detachment, a giving attitude and freedom from greed, jealousy and anger.
I wish all of you this in the coming year.
They say beauty is in the eyes of the beholder. I see it when the morning sun penetrates through the branches of trees laden with green leaves and the mist melts, in the round pearls of water on the leaves of the water lilly, in a child playing unobserved, a starlit cloudless sky in the still of the midnight and in the guileless smiles on the faces of Dalai Lama and swami Nithyananda
I wish all of you this in the coming year.
They say beauty is in the eyes of the beholder. I see it when the morning sun penetrates through the branches of trees laden with green leaves and the mist melts, in the round pearls of water on the leaves of the water lilly, in a child playing unobserved, a starlit cloudless sky in the still of the midnight and in the guileless smiles on the faces of Dalai Lama and swami Nithyananda
Thursday, December 27, 2007
Doctor's dilemma
A large percentage of our population depend on private medical practitioners for their primary care needs. This is despite the fact of there being in place a well structured and widely spread network of PHCs [primary health centres] and sub health centres [SHCs]. It is beyond the scope of this article to describe the ills besetting this network of health centres and why people don’t chose to seek help in these centres.
GPs come in different hues and colours. They include practioners of different systems like Ayurveda, Siddha, Unani, Homeopathy, Naturopathy, Electrotherapy, Hydrotherapy, Reiky, several kinds of Yoga and the like. Some of these combine their craft with dispensation of allopathic drugs. If you include chemists who also dispense advice and medicines you would not be very wrong. All these provide some sort of primary care. My paper is confined to the working methods of doctors who practice allopathic system and who have a basic MBBS degree.
In this write up I have tried to analyse why this section of qualified allopathic doctors have failed to deliver comprehensive, affordable quality medical care. As this is linked to unethical practices, it has some relevance to what is being discussed in this conference
It is a basic principle that when a cheaper and effective drug is available, that should be used preferably by the oral route unless there are specific reasons for not doing so. This rule is generally not followed. The reasons are: patient’s belief that injected drug is more powerful than the oral one and also their willingness to pay more. Doctors put in no effort to dispel this belief and in fact exploit this by obliging the patient. Costs of injectables are much higher than oral drugs and the cost of care thus goes up. Many doctors run unnecessary IV drips and the reason is the same. Demand for X-rays, Ultrasounds, CT and MRI studies and many lab tests is far in excess of actual need and again is driven by commercial rather than clinical considerations.
With the advent of private players into the health care scene urban India is witnessing a bloom in institutions providing health care. These laboratories and hospitals are competing for custom of the paying Indian. Doctors are enticed with monetary and other inducements to refer patients. It is common knowledge that this cut practice is wide spread and it adds to the cost of health care. It is also a medically known fact yearly medical examinations [package deals] as screening methods, when indiscriminately applied to all and sundry, are a huge waste of money and another reason for pushing up the cost of care.
Pharma companies and medical men have always been cosy bedfellows. One encourages the other to the detriment of the patient. When one can carry out a decent family practice with about 200 drugs where is the need for 10,000 odd combinations and brands of drugs which are available in the market? Pharma companies and equipment manufacturers sponsor doctors CME [continued medical education]. These meetings can be local, in another town or even abroad. Depending on his use to the company, the doctor’s travel, stay and even entertainment is taken care off. The sponsor naturally expects and in fact gets the returns by the way prescriptions and use of the branded equipment. Those who don’t want to enter into such a relationship often find it hard to organise professional meets or participate in one. That there are still few doctors left who have survived is fact that surprises me.
Are these facts not known to the consumers? Of course they know or are coming to know. This one of the reasons why they no longer hold us with the same degree of respect that they did 30 years ago. Physical assaults and increasing litigation are the direct outcome of this perception that we are exploiters.
Why are we unethical? The answers are many. A combination of prevailing socio economic scenario and the compulsion to keep up with the Joneses at any cost is one reason. Add to this the basic human quality of greed and inability to accept a low profile life in a society which seems to respect only the wealthy is another. Add family and peer pressure, we have a tailor made situation for practicing unethical medicine.
The only silver lining is that society is becoming more informed. Hopefully, the informed citizen of the future will seek out honest doctors if they exist, and will be able to get the profession to mend its ways.
This write up is based on a presentation made at the recently concluded bio ethics conference.
GPs come in different hues and colours. They include practioners of different systems like Ayurveda, Siddha, Unani, Homeopathy, Naturopathy, Electrotherapy, Hydrotherapy, Reiky, several kinds of Yoga and the like. Some of these combine their craft with dispensation of allopathic drugs. If you include chemists who also dispense advice and medicines you would not be very wrong. All these provide some sort of primary care. My paper is confined to the working methods of doctors who practice allopathic system and who have a basic MBBS degree.
In this write up I have tried to analyse why this section of qualified allopathic doctors have failed to deliver comprehensive, affordable quality medical care. As this is linked to unethical practices, it has some relevance to what is being discussed in this conference
It is a basic principle that when a cheaper and effective drug is available, that should be used preferably by the oral route unless there are specific reasons for not doing so. This rule is generally not followed. The reasons are: patient’s belief that injected drug is more powerful than the oral one and also their willingness to pay more. Doctors put in no effort to dispel this belief and in fact exploit this by obliging the patient. Costs of injectables are much higher than oral drugs and the cost of care thus goes up. Many doctors run unnecessary IV drips and the reason is the same. Demand for X-rays, Ultrasounds, CT and MRI studies and many lab tests is far in excess of actual need and again is driven by commercial rather than clinical considerations.
With the advent of private players into the health care scene urban India is witnessing a bloom in institutions providing health care. These laboratories and hospitals are competing for custom of the paying Indian. Doctors are enticed with monetary and other inducements to refer patients. It is common knowledge that this cut practice is wide spread and it adds to the cost of health care. It is also a medically known fact yearly medical examinations [package deals] as screening methods, when indiscriminately applied to all and sundry, are a huge waste of money and another reason for pushing up the cost of care.
Pharma companies and medical men have always been cosy bedfellows. One encourages the other to the detriment of the patient. When one can carry out a decent family practice with about 200 drugs where is the need for 10,000 odd combinations and brands of drugs which are available in the market? Pharma companies and equipment manufacturers sponsor doctors CME [continued medical education]. These meetings can be local, in another town or even abroad. Depending on his use to the company, the doctor’s travel, stay and even entertainment is taken care off. The sponsor naturally expects and in fact gets the returns by the way prescriptions and use of the branded equipment. Those who don’t want to enter into such a relationship often find it hard to organise professional meets or participate in one. That there are still few doctors left who have survived is fact that surprises me.
Are these facts not known to the consumers? Of course they know or are coming to know. This one of the reasons why they no longer hold us with the same degree of respect that they did 30 years ago. Physical assaults and increasing litigation are the direct outcome of this perception that we are exploiters.
Why are we unethical? The answers are many. A combination of prevailing socio economic scenario and the compulsion to keep up with the Joneses at any cost is one reason. Add to this the basic human quality of greed and inability to accept a low profile life in a society which seems to respect only the wealthy is another. Add family and peer pressure, we have a tailor made situation for practicing unethical medicine.
The only silver lining is that society is becoming more informed. Hopefully, the informed citizen of the future will seek out honest doctors if they exist, and will be able to get the profession to mend its ways.
This write up is based on a presentation made at the recently concluded bio ethics conference.
Sunday, December 16, 2007
Dhruva's test
Dhruva is a six years old youngster and much more knowledgeable than I when it comes to the electronic gadgetry he plays with. This provides him with great deal of fun and merriment when ever he comes to see me. The latter part takes more time than the actual consult. On one occasion he may bring his battery operated car with a hidden starter button and will demonstrate a trial run on the floor and challenge me to do the same. I cannot to this simple act to his great delight. Like this, each time he comes he has new gadget or a toy and usually I end up getting defeated. He also asks me simple riddles and most often I answer wrong. Dhruva has come to the inevitable and fair conclusion that I am a rather stupid and backward person.
Recently he was unwell with fever and he was brought to see me. I wanted to take his temperature and requested him to keep the thermometer tip under the tongue. He reluctantly agreed and after I finished, he asked me why don’t I take it from the ear which is very fast as his mother does? This was news to the backward doctor. Seeing the disbelief on my face, he explained patiently how it is done and promised to get me one when he comes over next time.
His father came after a few days with some problem and gifted me with a new digital thermometer with an ear piece. You have to just place it like you do with an otoscope and press a button and you get the reading. Dhruva however was very specific in his instructions to his father. ‘That doctor, he doesn’t know, you just don’t give it to him and come away, you show him how to use it by putting it in his [mine] ear’ The father told me this, but had the grace not to actually do it.
I am pretty sure Dhruva, when he comes next will test me. I am a bit nervous that I may fail!
Recently he was unwell with fever and he was brought to see me. I wanted to take his temperature and requested him to keep the thermometer tip under the tongue. He reluctantly agreed and after I finished, he asked me why don’t I take it from the ear which is very fast as his mother does? This was news to the backward doctor. Seeing the disbelief on my face, he explained patiently how it is done and promised to get me one when he comes over next time.
His father came after a few days with some problem and gifted me with a new digital thermometer with an ear piece. You have to just place it like you do with an otoscope and press a button and you get the reading. Dhruva however was very specific in his instructions to his father. ‘That doctor, he doesn’t know, you just don’t give it to him and come away, you show him how to use it by putting it in his [mine] ear’ The father told me this, but had the grace not to actually do it.
I am pretty sure Dhruva, when he comes next will test me. I am a bit nervous that I may fail!
Thursday, December 13, 2007
Practice experience
Old age has its advantages it is often said. The disadvantages however overweigh the advantages. Of the many, is the inability to cope with adversity. There was a time when I was able to handle several serious patient related issues simultaneously with out getting unduly affected. This is not so now. Patients who have been with me and have grown old alongside are getting into serious personal, family, financial and health related problems. Often they have no one near enough but not involved, to go to for advise except I. Earlier on when they brought their problems to me I could evaluate them dispassionately and then forget about them soon after. This is no longer possible. The feeling of immense sorrow long after the party has left my premises lasts often days and weeks after the event. My thoughts go back to the days when I was witness to the joys of the newly married couple 25 years ago, now occupied with an intense and hateful war with each other. I find it hard to accept or understand this hatred and not able to sort out any of their problems adds to my owes. This kind of happening is deeply disturbing and leaves me with profound disquiet which does seem to go away as it did in my younger days.
My patients seem to die more frequently now. Don’t be under the impression it is because of my doing, it is because of old age and related issues. Unlike younger doctors older doctors like me have more number of geriatrics. These have been my patients since their younger days and I have been a party who has watched their life’s drama [melodrama] unfold over the years, like they have watched mine. Yesterday I saw a deeply jaundiced patient of mine of 70 years who underwent rescective surgery for carcinoma gall bladder. We including the dynamic young surgeon thought we had achieved a cure as the problem was detected very early. Not more than five months have passed and she is back and almost certainly with liver mets. I have been her friend in the days she suffered looking after her husband who died after a prolonged struggle against restrictive lung disease and IHD. No sooner he went she developed this problem and now she is on her way out. Both have been my patients of over twenty years.
These episodes are becoming common and as I said earlier leaves me emotionally drained. They say in youth the emotions are brittle, but I feel it is so when one grows old. What made me write these few lines and share these feelings is the hope that by doing so I may lighten this burden.
B.C.Rao
Miscellany
Any naturalist who is lucky enough to travel, at certain moments has experienced a feeling of overwhelming exultation at the beauty and complexity of life, and a feeling of depression that there is so much to see, to observe, to learn, that one life time is too short a time to be allotted for such a paradise of enigmas as the world is. You get it when, for the first time you see the beauty, variety and exuberance of the tropical rain forest, with its cathedral maze of thousand different trees, each bedecked with gardens of orchids, epiphytes, enmeshed in a web of creepers: an interlocking of so many species that you can not believe that the number of different forms have evolved. You get it when you see a vast concourse of mammals living together, or a vast, restless conglomeration of birds. You get it when you see a butterfly emerge from a chrysalis; a dragon fly from its pupa; when you observe the delicate and multifarious courtship displays, the rituals and taboos that go into making of the continuation of species. You get it when you see a stick of leaf turn into an insect, or a piece of dappled shade into a herd of zebras. You get it when you see a gigantic school of dolphins stretching as far as the eye can see, rocking and leaping exuberantly through their blue world; or a microscopic spider manufacturing from its frail body a transparent, apparently never ending line that will act as a transport as it sets on its aerial exploration of the vast world that surrounds it.
Gerald Durrel. Naturalist, zoo keeper and writer.
From his book, ‘golden bats and pink pigeons.’
Truth and Beauty
The light alone, like the mist over the mountain driven,
Or music by the night wind sent,
Through strings of a still instrument,
Or moonlight on a midnight stream
Gives grace and truth to life’s unquiet dream.
Shelley
My patients seem to die more frequently now. Don’t be under the impression it is because of my doing, it is because of old age and related issues. Unlike younger doctors older doctors like me have more number of geriatrics. These have been my patients since their younger days and I have been a party who has watched their life’s drama [melodrama] unfold over the years, like they have watched mine. Yesterday I saw a deeply jaundiced patient of mine of 70 years who underwent rescective surgery for carcinoma gall bladder. We including the dynamic young surgeon thought we had achieved a cure as the problem was detected very early. Not more than five months have passed and she is back and almost certainly with liver mets. I have been her friend in the days she suffered looking after her husband who died after a prolonged struggle against restrictive lung disease and IHD. No sooner he went she developed this problem and now she is on her way out. Both have been my patients of over twenty years.
These episodes are becoming common and as I said earlier leaves me emotionally drained. They say in youth the emotions are brittle, but I feel it is so when one grows old. What made me write these few lines and share these feelings is the hope that by doing so I may lighten this burden.
B.C.Rao
Miscellany
Any naturalist who is lucky enough to travel, at certain moments has experienced a feeling of overwhelming exultation at the beauty and complexity of life, and a feeling of depression that there is so much to see, to observe, to learn, that one life time is too short a time to be allotted for such a paradise of enigmas as the world is. You get it when, for the first time you see the beauty, variety and exuberance of the tropical rain forest, with its cathedral maze of thousand different trees, each bedecked with gardens of orchids, epiphytes, enmeshed in a web of creepers: an interlocking of so many species that you can not believe that the number of different forms have evolved. You get it when you see a vast concourse of mammals living together, or a vast, restless conglomeration of birds. You get it when you see a butterfly emerge from a chrysalis; a dragon fly from its pupa; when you observe the delicate and multifarious courtship displays, the rituals and taboos that go into making of the continuation of species. You get it when you see a stick of leaf turn into an insect, or a piece of dappled shade into a herd of zebras. You get it when you see a gigantic school of dolphins stretching as far as the eye can see, rocking and leaping exuberantly through their blue world; or a microscopic spider manufacturing from its frail body a transparent, apparently never ending line that will act as a transport as it sets on its aerial exploration of the vast world that surrounds it.
Gerald Durrel. Naturalist, zoo keeper and writer.
From his book, ‘golden bats and pink pigeons.’
Truth and Beauty
The light alone, like the mist over the mountain driven,
Or music by the night wind sent,
Through strings of a still instrument,
Or moonlight on a midnight stream
Gives grace and truth to life’s unquiet dream.
Shelley
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