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?