Second opinions: Is there a tactful way to handle them?

I gently refuse to give opinion if someone asks my ‘quick feedback’ based on just a single report or a single symptom. And give them the option of a detailed assessment.

If they’re family or a close friend, I try getting the whole picture over phone call, and for this they have to wait till I’m free.

For anyone else, they have to call the appointment number and follow the process. If they feel my advice would be valuable enough to justify the fee and the wait, they follow the process. If they don’t, they stop asking me random questions, and keep looking for some other willing soul.

After the consultation, it’s easy if my Assessment agrees with that of the other doctor. But if there’s conflict, there’s no easy way out of it..

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🧫 Mucormycosis: A symptom of everything that’s ailing our Healthcare System 🏨

💊 Rampant use of high doses of steroids is leading to uncontrolled blood sugar levels in many patients, suppressing their immune system, and encouraging this fungus called mucor to grow unchecked!

🤔 But is steroid overuse really the root cause?

🙈 Why should there be rampant use of high doses of steroids, with no monitoring of blood sugar levels?

🥵 Some of it may be attributable to the panicked patients and overworked doctors. However, there are deeper underlying causes why patients and doctors have been so deeply affected by this malady.

I see three causes:

Continue reading 🧫 Mucormycosis: A symptom of everything that’s ailing our Healthcare System 🏨

Who will calm down the patients when the doctors themselves are panicking?

Dear doctors, I can try to empathise with your concern..

Let’s consider a healthy 35 year old..

10-30 out of 1000 in this age group will land up in ICU, about 1 will die.. (ballpark figures based on current situation)..

This is unprecedented for an illness that starts as an innocuous viral URTI..

There’s no way, in the initial 5 days, for me as a doctor to know whether the patient sitting in front of me will be one of those 10-30 ICU admissions..

Does that justify over treating everyone I see?

Continue reading Who will calm down the patients when the doctors themselves are panicking?

Where the Doctor’s Mind is without Fear

Doctors’ poem for the 21st-century India:

WHERE THE (DOCTOR’S) MIND IS WITHOUT FEAR

Where doctors work without fear and their heads are held high;

Where quality treatment is free,
and for all strata of society;

Where healthcare has not been raped into submission,
by a few unscrupulous corporates’ “targets”;

Where care comes out from the depth of genuine concern
and led by the needs of every community;

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Old Strategies for a New Enemy

My big learning in this pandemic is that we need to use what we already know from years of managing respiratory diseases, rather than treat it like something very new.

We know that most viral infections get better with just supportive treatment.

We know that many doctors over investigate and over treat viral respiratory infections, including blood tests, X-rays, antibiotics, oral bronchodilators, alpha-agonists, and what not..

We know that many patients self-medicate, self-investigate, follow random advice from relatives and friends, and have many cultural taboos.

All of the above has just gotten much much more pronounced due to fear on all fronts..

At the same time, I know lots of doctors who are keeping the flame of rational empathetic medicine alive..

In my practice, only two things are new:

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🩺 Family Practice in the Next Decade: Leading from the Front! 💪🏽

Last month I got the opportunity to address a virtual gathering of Family Physicians, and share my predictions for the coming decade! 🤔

I believe that Family Physicians will be trusted and valued much more, as we continue to provide humane, personalised care, using appropriate technology and the Art of Medicine! 🤗👀

*Watch the session here:* https://youtu.be/B0Vcra10ezA (25 min, English)

Continue reading 🩺 Family Practice in the Next Decade: Leading from the Front! 💪🏽

🤔 The Dilemma of Evidence 💡

Therapy A for Medical Condition X was generally recommended by the evidence-based guidelines issued by several professional societies. It was the standard treatment for X for many years. 💊

Five years ago, the guidelines were changed (as often happens) to remove Therapy A from treatment recommendations of Condition X. ✂️

And then, recently, the guidelines were changed again to include once again, Therapy X in the recommendations. (This also happens commonly.) 📝

Now here’s the dilemma.. ⚖️

Continue reading 🤔 The Dilemma of Evidence 💡

🤔 What to do when someone asks you for a curbside consult? 😪

As doctors we often get cornered by people we know, in various social settings, asking for our “quick advice” on this rash, or that pain, or in recent times, the abnormal lab report that has been bothering them. 🥴

Without digging deeper, it’s not possible to determine whether they have already discussed this issue with another doctor (and only seeking a “harmless” quick second opinion from someone they trust). Or this is the first time they’ve ever disclosed this to any doctor! 👩🏻‍⚕️

We don’t want to answer these queries with limited information, as that would be a big disservice to the patient. Most conditions need a painstaking gathering of history, a scrupulous examination, and often some quick referencing of guidelines or other resources. Quick answers are usually wrong in medicine! 🙊

Continue reading 🤔 What to do when someone asks you for a curbside consult? 😪