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..

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

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 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;

Continue reading Where the Doctor’s Mind is without Fear

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:

Continue reading Old Strategies for a New Enemy

COVID Diaries

I often ask my patients to record their measurements at home in a diary, and bring them to the next appointment. I find that this improves the self-efficacy of the patients and their family members in taking care of their illnesses, and helps us doctors take better care of them! At the same time it’s an ideal, and reality loves to wash away our best laid plans..

Some patients do check their parameters, some don’t. Some of those patients who do go to the trouble of measuring them regularly, may not record them! And those who diligently record them may forget to bring those readings when they come for a follow-up consultation! And some of those who keep meticulous records, stop after a few months.

I often tell my patients, “Your proper treatment will only start when you start maintaining a record, till then we’re just playing with your illness!” And truly, the home record is vital in adequately managing Hypertension and Diabetes Mellitus, and I’ve found it useful in other illnesses too, like Typhoid fever, and Food allergies.

I keep wondering how to inspire patients and family members to keep better records. I think I got some answers last year..

Continue reading COVID Diaries

🩺 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:* (25 min, English)

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

🤔 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? 😪

Outsourcing vs In-house: Which path a Startup Entrepreneur should Take?

Our valuable client has demanded a new service – should we hire an outside agency to provide it?

Should we take care of transportation and logistics ourselves?

Should we outsource designing of logo, stationery and marketing material to a freelancer?

These are all common question startup founders face frequently and often struggle with. We need to make many more similar decisions, almost daily, which require us to choose from one out of the three options below:

  1. Hire Staff on Salary and provide the service in-house
  2. Hire Contract Staff or Freelancers to provide the service on your behalf
  3. Outsource to an external agency

Let’s break this problem down, and consider the various aspects one by one.

Continue reading Outsourcing vs In-house: Which path a Startup Entrepreneur should Take?

📝 Salient points from the Telemedicine guidelines for Family Physicians 🖱️

📜 General

  • A Registered Medical Practitioner is entitled to provide telemedicine consultation to patients from any part of India
  • The RMPs should exercise their professional judgment to decide whether a telemedicine consultation is appropriate in a given situation or an in-person consultation is needed in the interest of the patient.
  • The RMP shall uphold the same standard of care as in an in-person consultation but within the intrinsic limits of telemedicine.
Continue reading 📝 Salient points from the Telemedicine guidelines for Family Physicians 🖱️

MBBS Done, Didn’t Get PG. What Next?

Here’s Some Unsolicited Advice from a Docpreneur..

1. For a fresh MBBS graduate, the best option is to become a Family Physician and start your own clinic. The pendulum is swinging from specialists and corporate hospitals to primary care and small clinics. A lot of doctors started their practices right after MBBS, and are doing phenomenally great!

Continue reading MBBS Done, Didn’t Get PG. What Next?