Speed dial - Redial

Tired by the day’s work, I parked my car on a rainy night, I got a text saying, “I’ve been trying to call you since a long time, call me, its URGENT”. While I heard 5 missed calls (back to back), I don’t pick up the calls while I drive. It was some time past midnight and I thought it would be a medical emergency. I called back and the person on the other end asks, “Doctor, are you available on 28^th November at 7 pm in xyz clinic?”

                I think all of us have our share of such calls when people call you back to back for a reason best understood by them. It seems as if they have your number on speed-dial and keep hitting redial till you answer back!

                Communication has brought the world closer, I can talk to my friend in US or South Africa as if they were right here in pune or something. But it comes at a price of privacy. Whatsapp, sms, wechat , email have made communication easy but nobody cares about the unwritten rules that come along with it. No matter how close a friend is you always have your “own time” or “family time”, where you can politely decline to talk. I remember calling up a BMC office employee in the lunch break and though he did not pick my call, but he fired me afterwards for disturbing him during lunch. People are always scared of govt employees, bank employees and give them and “their time” utmost respect. We all the know the reasons, getting a work done from a govt babu is like getting a wish granted from The Almighty!

                But when it comes to doctors, the rules change. As doctor I always thought it was polite and helpful to give your cell number to patients, so that they contact you in case of an emergency. Well, the definition of “emergency” is different for all of us, but we should understand the definition of “time”. A doctor is also a human being, he could be busy with an emergency case, might be operating on someone, might be driving, sleeping or just maybe in the bathroom when he/she doesn’t pick your call.

People nowadays feel its their “right” to get a doctor’s cell number and the one who doesn’t give is rude and arrogant!! It may not be always true. People don’t respect other persons time when they need an info from them. I feel this is the case with every professional but more so with doctors because everything associated with health is always “an emergency”. I say it’s a myth.

 What I told that gentleman who kept hitting speed-dial-redial was that, I am not sure at this time and he can call me tomorrow in the morning to check again. What I also told him POLITELY that this is the most inappropriate time to call for such a thing. Well, then came a flurry of words (of anger and feeling of betrayal) and last I could hear was, FINE! That guy never called up in the morning, or the morning day after. I think he got offended.I may have been deleted from his speed dial list.  Did I do the right thing?

Hey doctor, no discounts?!?

Yes, you heard it right! This is what one of my patients asked, “Hey doctor, no discount?” probably he might be mistaking me for a salesman or something…I don’t know! What do you think should have been my appropriate response? I smiled and politely said “no”! Initially wanted to tell him, “see, when you come next time with 4 problems, I’ll treat one problem for free, Happy?” But that would be rude, wouldn’t it?

People don’t understand that treating patients is a doctor’s profession. I agree it’s a noble profession (and I love my job for that), but that’s our livelihood. Even we are human, we have families to take care of. It’s natural for anyone to expect some charity from us and many of us do, but we ought to be paid for the services we provide. People don’t consider us working in charitable institutes as enough charity. 

Amongst us, physicians suffer the worst. Surgeons always have something flashy to show, they take care of your broken bones, maybe remove a part of your organ and people are happy to pay them. But here is a common scenario at a physician’s clinic -

Doctor- here take these medicines for a week and you should be okay.

Patient X- thank you doc, I am having a bad cough, I hope I’ll be ok in a week.

Doctor - you will be, just take your medicines on time.

Patient X - do I have to pay anything?

Doctor - yes.

Patient X – (thinks for a while and reluctantly says) uh…ok. (Probably wondering- I have to pay him for the two lines he wrote?)

You would be happy to buy an extra shirt when sales are on, go for an outing or a movie on a weekend (even if they overcharge you on weekends), but when it comes to your health you wonder why do you have to pay. I have seen certain people complain about how some doctors overcharge, but hey doctors are also human, you find such people (who overcharge) in every field, don’t you?  I am not saying anybody has the right to overcharge or order unnecessary investigations or surgeries (which they might do for whatever reasons they have), but you can’t place everyone in same category. A student who aspires to be a doctor has to study hard (as in any other field), bear the expenses of college, books, hostel etc (as in any other field), slog day in-day out to gain adequate experience (as in any other field) then why not get his/her due when they come out to practice.

Nobody has the right to play with a human life no matter whether that life is of a poor person or anyone, but time and again you find such people in the medical faculty. They should be punished for what they do, no doubts but that doesn’t preclude the good work done by others.

You may have enough bad experiences to disagree or be angry with what I just said, but hey not all fingers are alike. All I want to say that doctors are only human. 

You are welcome to disagree or comment.

No country for poor men (and women)

The title may sound familiar but frankly I couldn’t think of a better one for my thoughts today. I had a bad habit of watching news daily which I started skipping coz of work. But that habit is back to haunt me again!! In this era of smart phones and internet, you are never alone, and never out of the loop.

Pick up any newspaper or watch any news channel and you will agree with me today, that this is no country for poor people. The “rich and connected” can, say whatever they want, whenever they want, to whomsoever and even if someone or everyone opposes them, they can get away by apologizing or shrugging it off!! They can (accidently) kill people or (accidently) be a part of major conspiracy or a terrorist attack and stay away from jail (people may find you being human for that). They can hit anyone (even a policeman) and be supported for that! They have access to best of social and medical facilities even if you don’t require (or in many cases don’t deserve them). You don’t have to stand in line anywhere if you are rich, come on why should you!  The country has rules and law but only for the middle class and poor. If you stop at a traffic signal when its red, you are considered a fool. In fact at night you have a risk of being hit by someone  if you dare to do so!

If you are poor you cant expect people to care about you. Why should they? Why should they help you even if you are injured (and dying) on road? If you don’t get clean water to drink, that’s your problem, install a water purifier! If your area has nuisance of thieves or serial killers, that’s your problem, hire private patrolling (as in few areas of some countries). If you buy a home in an illegal building which can’t stand even for few years, that’s your fault. People will make such building, its their right, why did you buy a flat there? You cant expect anyone to give you good public transport facilities, get a car for yourself. If women are being harassed (or molested or even raped), it’s their fault! If everything has become costly, its nobodys fault!!

I cant even write any further. Nowadays, I don’t even feel like running thru the headlines in the newspapers. Of course I am interested in who is going to become the next head of my country, but that’s not the only thing I wanna hear from my leaders. I don’t want to know whose fault is it, I am tired of the blame game, I want to know what is being done about it!

Frankly you cant blame anyone trying to earn more money by hook or by crook, coz this is no country for poor men (and women).

p.s. -  tomorrow if you find me missing or in the hospital then please understand that someone got offended by what I wrote!! But kya karoon cannot stop myself from writing (as one of the cheesy lines in one of the movies – Indian hun, senti ho jaata hun)

“Quitting smoking is easy. I’ve done it many times.”

I overheard a senior chain-smoker quoting Mark Twain to a newbie, “Quitting smoking is easy. I’ve done it hundreds of times”. I am saying senior because he is very experienced in smoking and attempting to quit smoking. Many of my patients feel the same. One of them said, it’s easier said than done. I agree.

I never said quitting will be easy, but there will never be a better time to start quitting smoking than today. The choices you make today design your future. Smoking not only reduces your healthy life years but also of your wife, kids and other family members. Second hand smoke that you gift them slowly destroys their lungs also! There is one golden rule for getting rid of any addiction, “your desire to quit”. If you don’t have it, no medicines or counseling will help you.

I pursue all of my smoker patients to quit. All had different social and psychological issues. All of them had difficulties, many succeeded and with some, still work is in progress. I would like to share some scenarios.

Mr. D - I have desire to quit, but I’ve failed, so I have accepted my fate.

Me- there is no such thing. Every time you try to quit smoking you are actually getting closer to staying smoke free. Reduce it day by day. Know why you want to quit and keep reminding yourself those reasons.  It’s all in your head you have the power to make things seem hard or easy or even amusing. The choice is yours.

Mrs. A – I have too much work pressure, and most of my colleagues smoke. Its impossible for me to quit.

Me – nothing is impossible. Divert your mind, take a walk, drink a glass of water take a nap, get a cup of coffee or tea, practice your deep breathing and so on. Make your own list of things which you can do when you get a desire to smoke. Most helpful is to develop a new hobby which you love doing.

Mr. J - I have such a strong will power, I can leave any habit from today itself! But I tend to smoke one cigarette off and on.

Me- The process of quitting smoking doesn’t end with the last cigarette. It’s not quitting itself, the real key is staying quit. Smoking in any amount is dangerous. Whenever you feel like smoking, read the list of things it can damage in your body. Keep yourself motivated; tell your family/friends to help you stay quit. The more help you have, the better are your chances.

Mast. P (a 15 yr boy)- I have to smoke, else I’ll be social outcast. All my friends smoke. I have to fit in!

Me- “with a smoke in my hand I felt like a man”, it says right that you are a dead man. You feel you are smoking the cigarette; sadly it’s the other way around. You may enjoy the effects now, but when you will be so breathless that you have to hold someone’s hand to go to the bathroom, none of your friends will be there. If cancer doesn’t kill you fast, you will consider yourself unlucky to survive the horror of the life that will remain.

There are many such stories of success and failure to quit. It is said that, some people have to quit as many as eight times before they are successful. You will have difficulty, you may start smoking again after quitting, but don’t lose hope. Don’t quit, quitting. There are a lot of people, websites, drugs that can help you. They can help you as long as “you have the desire to quit”. 

Now why should I quit smoking???

Some questions are tricky to answer. Like the one I got from a 45 year old gentleman whom I diagnosed with lung cancer. I caught him smoking just after he completing his chemotherapy session (to treat his cancer!). I was unhappy that he had not learned his lesson, after having a life threatening cancer, and he had still not quit smoking! He said he was puffing his worries away and blatantly asked me “Now why should I quit smoking? Jo hona tha woh toh ho gaya! “

Some people would walk away from this scene and leave him to his luck. But I decided to persuade him. “Do you think this is it? You feel this is the worst thing that could happen? No!!” Sadly this is a common misconception. Smoking in any form (and any amount) - cigarette, bidi, hukkah, chillum etc is highly dangerous. Smoking results in a very high chance of getting cancer of almost all organs of the body. It can cause hundreds of different illnesses related to one’s vital organs, i.e. heart, lungs, stomach, bones, brain etc. “I know all this!” he exclaimed. I began to think, “This is not helping”. I asked him why people smoke. He said it was for pleasure, arousal, enhanced vigilance, an improved performance, relief of anxiety or stress but also mostly out of habit. I started wondering what started this vicious habit. Was it peer pressure, and observing people smoke around especially in movies that encouraged these smokers? “Why should I worry about these things”, he said. I replied, “you should”. You may be able to control your cancer and live longer thanks to the good treatment available, but breathing problems, cough, and chest pains will make your life miserable. Your heart and lungs which have already been weakened will start going into organ failure. Breathing may become difficult without medicines or sometimes without a ventilator. A paralytic stroke may leave you so helpless that you wouldn’t be able to lift a cigarette, leave alone other tasks. You can get cancers of other organs, which can make even daily chores of swallowing food and water, passing urine, defecating extremely difficult. Cigarette burns every part of your body like itself and may leave you bedridden and helpless without support. This lung cancer may not kill you before you experience any of the other dreadful consequences of smoking. Every pack of cigarette says it can cause cancer, you thought it will never affect you, but it did, and so can any of the other organ problems. Quitting smoke at any age will only add to health benefits. Chemical disturbances in your body may take a few weeks to resolve, but you have to try.

                You will never be prepared for the suffering it can cause and the economic impact it has on you and your family. Also did you ever think that, when you see your 14 year old son emulating you what will say to him?

“Ouch” he said, as the cigarette burned his finger. This burn will heal but other problems may not. Quit today, right now, you’ll get all the help you need from doctors, but everything depends on whether you are motivated enough to quit.

I left the scene, with the hope that not only will he stop smoking but also motivate others to stop. But the question always troubles me when someone asks now why should I quit smoking? Jo hona tha who toh ho gaya! 

Stop TB in My Lifetime

We doctors have a bad habit of giving knowledge (or as some would say- lecture), as a part of health education. I am saying bad habit because one of the fellows listening to my talk said, “Why should I care about TB? Neither I nor any of my family/friend had it. I have other things to worry about.”

Well, he was right on one thing. He has other things to worry about, but TB deserves a thought. Like every year, we celebrated the World TB day on 24^th March. This year is the second year of a two-year campaign for World TB Day, with the slogan “Stop TB in My Lifetime”.  Why is the World Health Organization and Indian government worried so much as to spend crores of rupees into giving you free treatment and including celebrities to campaign and make you understand the importance of early diagnosis and complete treatment? I’ll tell you why. Have a look at some statistics –

Worldwide, there are an estimated 87 lakh new cases of TB every year and 14 lakh people die from TB; TB is among the top three causes of death for women aged 15 to 44; there were an estimated 5 lakh cases and 64,000 deaths among children in 2011; 60,000 patients with multi-drug resistant TB (MDR-TB) enrolled in treatment by end 2011 – but estimated number is 5 times more! Among infections, TB is second biggest killer after HIV/AIDS. A recent article in a leading newspaper stated that doctors estimate more than 200 children with multi-drug resistant tuberculosis (MDR-TB) in Delhi alone!

So what? How does it affect you? Like it is said that illiteracy is a root cause for many social problems so is illiteracy regarding your health a major obstacle to eliminating certain diseases. India could achieve polio free year because of the extreme efforts by the health officials and people who helped spread awareness. Similarly the best way to tackle the TB problem is awareness, health education, knowledge. More the number of people knowing about the symptoms and treatment options, better will be case detection and cure rates. Cough for a long period, fever, loss of appetite, unexplained weight loss, especially when you have a close contact with TB, could mean that you could have this infection. There are certain diagnostic tests which can detect TB in less than 12 hours (some even in 2 hours!) and also detect drug resistance in a short time. Also treatment available can completely cure you of this disease. MDR tuberculosis has long treatment duration and many patients stop their treatment prematurely due to various reasons. Delaying treatment, wrong/inadequate treatment can not only harm the patient but also his/her contacts. No person is totally immune to TB so whenever you see a person suspected to have TB, urge him/her to get themselves thoroughly examined by a specialist and to take complete treatment. Being aware and spreading this awareness can bring this menace under control. Many of us know these things but don’t help out people who don’t. Help spread the awareness, so that one day all of us can proudly say, “I saved a life today, I made a difference!”

Apart from doing my duty as a doctor, I do my part by giving knowledge (or you can say a lecture!). I want to stop TB in my lifetime, do you?

Do you guarantee cure???

One of my patients asked “Do you guarantee cure?” And I wondered what do I say? Is there a guarantee that if you take the shortcut you will reach your home faster? Or once you move outside my clinic you won’t meet with an accident? or our neighboring nation wont attack us? The answer to all is “NO”.

Last week I answered the question, “How can “I” get TB? Today I answer the second question and talk about the dreadful form of resistant TB, MDR (multidrug resistant) and XDR (Extensively drug resistant) TB. Labeling a person as a TB patient makes some of them depressed, but if it doesn’t, labeling them MDR or XDR surely does! Well as I said earlier, TB is an infection and can be treated if doctor’s advice is followed. When a patient doesn’t respond adequately or totally fails to respond to the standard first line treatment (drugs used to treat patients having the disease for the first time), he/she is called to have something called as resistant TB. It is a more dreadful form of TB because the treatment is prolonged (and sometimes unsatisfactory); drugs are costly and have quite a few side-effects.

            So how do you get this dreadful form? How do you confirm its MDR? What’s so dreadful about it? How long does one take the medicines? Can it be treated completely? Can a person die due to it? And many more questions linger around the topic.

            As they say, man is the most dangerous animal and this dreadful disease is sometimes called man-made. What I mean to say is that one of the most common causes of getting this disease is improper treatment of TB, by the patient or the doctor. If you do not take your TB treatment medicines regularly or adequately, the TB bacteria may become resistant to the treatment you took making those medicines useless for you. Also, you may also spread the resistant TB bacteria to other people. A person can acquire such resistant TB bacteria and for no fault of his/her get this dreadful form of the disease from the beginning. The dreadful thing is that the treatment is longer, the drugs required to manage it are costlier and with quite a few side-effects. If untreated or poorly treated IT CAN KILL a patient, (usually slowly). The sad part is that even in the best of scenarios, not every patient can be cured. The choice of drugs, their dosages and frequency and duration of treatment varies from patient to patient and it is always good to take a specialist opinion. Follow your doctor’s advice, take a healthy diet and you have the best chance of cure.

Once I see such a patient I explain them the whole process of treatment, the expected cost and side-effects and chances of success and answer their 1001 questions that they usually have. But still in the end, nearly every patient asks, “Do you guarantee cure?”. I am still searching for an appropriate response to that question.

How can “I” get TB?

Many a times I have said those three words which causes even an optimistic and cheerful person to frown, worry, anxious, be depressed, angry and most commonly in denial… “You have tuberculosis”.  What follows is a series of questions and doubts on the doctor who dared to utter these words.

How can “I” get TB? I eat well, exercise regularly, live in a plush home with excellent facilities, no dust or dirt exposure and no contact with sick people…basically what they mean to say is I am very rich… How can “I” get TB?

Lets get some facts straight. Tuberculosis aka TB aka kshay rog, is an infection caused by a bug called Mycobacterium tuberculosis. It commonly affects the lung, but can present in any form whatsoever in any organ. You have to take a combination of drugs for 6-9 months to be cured.  So what is so dreadful about it? Why are people afraid of it?

Some studies say that more than 2/3^rd of our Indian population is infected with this bug. But just by infection it does not cause disease. It stays with you and dies with you. It causes disease when your body immunity goes low. Say because of diabetes, kidney disease, certain medicines taken, and most commonly in today’s fast life, poor attention to regular healthy diet and exercise. Even if you follow everything correctly you may still get the disease if the bacterial load to which you are exposed is high. TB is NOT spread through shaking someone’s hand, sharing food, touching bed linens or toilet seats. Most common route of spread is when you inhale the bug from person suffering from TB. TB bug can sometimes stay alive in the air for a few hours, especially in small places with no fresh air. Fresh air and sunlight make it harder for TB germs to stay alive. The fresh air scatters the germs and the sunlight kills them. So that’s why it is common in overcrowded areas, and people with poor nutritional status.

But again, how can “I” get TB? Probably the bug was in your body since a long time and was waiting for the right time to cause the disease.

Now what do I do?

Firstly, accept the fact that you have TB. Trust your doctor. Take a second opinion if you like, but accept it. The diagnosis of TB is based on a series of tests, first to confirm and secondly, (if required) to identify the type of TB bug and whether it is the dreadful “Resistant TB bug”. Ask your doctor about the appropriate tests required, about the disease, whether you can spread it to others, treatment options and possible side effects of the medicines. Some lifestyle and dietary changes may be required. Your doctor will be more than happy to clear all your doubts. Cultivate good habits like covering your mouth and nose while coughing or sneezing (do it even if you don’t have TB). Take your medicines regularly and for the duration advised. Report to the doctor immediately in case you experience any side effects of the medicines taken. TB is an infection which can be treated, if you take appropriate and regular treatment. Even the dreadful “drug resistant TB”, has better outcomes with regular treatment.

I am sure that whenever I utter those “three words” again, I will still get that big question with a doubtful expression on the face, and many more questions, as I usually get, but now you know some of the answers.

What specialist are you?

When I visited my village Jakhau (in Kutch, Gujarat), few months back, I introduced myself to a few people and said that I am a chest physician. One of them pondered for a while and said, “oh, so you are a cardiologist”.  I said “no no, I am a lung specialist, a pulmonologist, a respiratory physician”. After a couple of minutes he came back and asked what specialist are you exactly?  So I asked him what is Sachin Tendulkar’s specialty? He gave a shocked look (questioning my intelligence) and said that he is probably the best batsman world has ever seen. So I went on explaining that like in cricket we have specialist batsman, bowlers, wicket keepers, for human body we have specialists for every organ-system. Then I realized that this question is not limited to my remote village!

Today every new thing, new discovery, new inventions have global reach via the newspapers, internet, television and print media. New ideas and upcoming specialties in any field becomes visible to the world in no time. But unfortunately, some things still go unnoticed. In medicine (as a whole) there are newer and newer specialties and sub specialties coming up, in short you will get specialist for every organ in nearby future. Most organs of your body have the privilege of a specialist looking after them. Likewise me and doctors like me are specialists which take care of your lungs. When you get chest pain you rush to doctor thinking (and worried) that it might be related to your heart. You shower them with 100 questions about “your heart”. But what you forget that there is another organ besides “your heart” which needs equal importance, “your lungs”. They are your source of oxygen, probably the most element for your survival!

Lungs not only provide you oxygen, but filter out a lot of impurities (like kidney). It is probably the most exposed organ of your body, to the external environment. Today with rising pollution, overcrowding, poor ventilation, increasing vehicular traffic, and less time to exercise, all your organ systems are getting affected. I feel that the lungs bear the most damage. Thankfully, God has made them miraculously resilient to damage but they are not invincible. Smoking, either by you or your friend/colleague can damage your lungs the most. Improper diet, both in terms of quality and quantity, are making people more prone to infections and lungs are getting affected the most. Tuberculosis, an ancient illness, still ranks in the top ten causes that kills youth. World Health Organization has projected COPD, i.e. chronic obstructive lung disease, to be the number 3^rd killer globally in coming years. Asthma, such a common (and easily managaeble) problem goes un-noticed for many years, been regarded as cough/allergy and many other names. I can go on and on about the lung diseases which kill or atleast reduce your quality of life. But most of you know all this, right?

Then why am I talking to you about it? Sadly, when I see a patient with a respiratory problem, the disease is in its advanced stage and I am left with very few options to treat (most of the chest physicians will agree with me on this). Respiratory medicine is one of the newest specialties and it is growing day by day. Newer inventions and developments in this field are making life easier for patients with respiratory problems.

After a long discussion, finally that gentleman in my village understood who I am, and what I do. I know I still have to be prepared for the same question again “What specialist are you?”, but, well, now you know my answer!