Saturday, October 29, 2016

Health awards for sale

The biggest issue with healthcare today is the trust deficit. Patients want to go to doctors whom they can trust. but the problem is that doctors and hospitals have lost all their credibility . All of medical care seems to be up for sale , and kick-backs and commissions are rampant. This has become an open secret, which is why patients try to look for reliable ways of finding a good hospital.

This is why health awards have become so popular in recent times. It's quite natural for lay people to use health awards as a standard of reliability. After all,  if a newspaper or magazine or TV channel gives an award to a particular hospital or doctor, then the patient is going to conclude that this hospital must be better than all the other hospitals. After all, didn't they win an award from a leading organization?

The hospital is very happy to tom-tom the fact that it has won all these awards , which is why the awards also start getting a lot of publicity !  The winning hospitals use these as a marketing tool to increase the confidence levels which patients have in the quality of care which they provide.

However, the tragedy is that these awards are also on sale. Most awardees are selected based on how much money they are willing to pay for the award !


The award sponsor will describe the "rigorous process " they follow in order to select the awardees , but the reality is that these awards are offered to the highest bidder. This is why we are seeing such a rash of awards and prizes for hospitals and doctors - it's a clever way of making easy money !

It's a great publicity stunt because it makes everyone feel good. The award company is seen to be promoting good health care because it claims to highlight the good work which doctors are doing. Hospitals and pharma companies are happy to pay for these awards, because it improves their public image.

The number of award ceremonies is increasing dramatically, because everyone wants a slice of the pie.  Also, each award company creates lots of  specialty specific awards, because it wants to give away lots of awards to lots of players - the more the merrier ! After all, the more the awards you present, the more the money the award sponsor earns.

The only loser in this entire game is the poor patient who gets mislead by these awards , because he doesn't understand their lack of credibility . However, patients are getting smarter, because the glut of awards has cheapened their value.

Once patients realize that these awards are also up for sale, why would they trust a hospital simply because they've got an award? In fact it's usually the honest, straight forward hospitals who aren't willing to play this marketing game and who refuse to buy the awards who are perhaps the most trustworthy .  They don't want to pay for this kind of cheap publicity, just in order to get their 10 minutes of fame at a conference or on a TV channel. Sadly, things just seem to be going from bad to worse in the healthcare industry , where everything seems to be up for grabs !


Friday, October 28, 2016

What millenials need to know about egg freezing

TheHealthOrange featured my interview where I answer the questions millennial women may have about freezing eggs. 

You can check it out here: https://goo.gl/eHlb1E

Thursday, October 27, 2016

The Negative beta HCG




A negative beta HCG can often be the hardest thing for an IVF patient to deal with. There are so many hopes and dreams riding on the IVF cycle, and when the result comes back as negative, it can be very hard to deal with this failure. You feel that you are a failure, and that if even an advanced treatment like IVF has failed, this means you will never be able to have a baby .

You need to understand that a negative beta HCG only means that those particular embryos which were transferred into your uterus did not implant. It doesn't mean that your uterus is defective; or that you are doomed to remain childless; or that you will never get pregnant; or that your doctor was careless or negligent. Don't start catastrophising based on a single negative beta HCG result.


While most patients are mature enough to accept the failure of their first cycle, the problem becomes far worse when they have multiple failures. This becomes very hard for them to deal with, and even though they are otherwise extremely rational and intelligent, when this happens repeatedly, they often lose their ability to think logically . They start becoming extremely emotional and when they get desperate , they do silly things like trying out all kinds of unproven and untested treatments.

A  lot of websites are happy to sell you all kinds of potions because they want to take advantage of your emotional vulnerability, so you need to be on your guard that you don't get take for a ride.

Sadly, sometimes IVF doctors will take advantage of this situation by proposing all kinds of expensive and unproven tests and treatments,  such as intravenous immunoglobulin infusions. They promise the patient that this " treatment" will increase their chances of getting pregnant in the next cycle, but unfortunately this is not true.  However, a lot of patients end up wasting a lot of money on false hopes, , simply because they are so desperate that they cannot accept the reality that doctors cannot control the biological process of implantation.

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !



 

Wednesday, October 26, 2016

Why are we wasting the wisdom of senior retired doctors ?

When judges retire, they are usually not put out to pasture. Some of them practice as lawyers, but many will be appointed by the government to head judicial committees or fact-findings bodies because they want to make good use of their lifetime of accumulated judicial experience. This is true for retired IAS officers as well.

I wonder why the government doesn't do exactly the same with senior retired doctors. These could be doctors who were in private practice; or medical college professors who are still in the prime of their life. These doctors are cognitively as sharp as ever, but no longer clinically active. Why not use them to provide medical inputs to the legislature when crafting medical laws; to bureaucrats when designing medical policy; and to the judiciary when they need a medical expert opinion ?

They could provide very valuable inputs because they would be unbiased and objective, and would be seen as giving back to society in the autumn of their life. They understand the way the system works, and would be able to craft win-win situations, because they could be the voice of the medical profession.

When judges retire, they are usually not put out to pasture. Some of them practice as lawyers, but many will be appointed by the government to head judicial committees or fact-findings bodies because they want to make good use of their lifetime of accumulated judicial experience. This is true for retired IAS officers as well. I wonder why the government doesn't do exactly the same with senior retired doctors. These could be doctors who were in private practice; or medical college professors who are still in the prime of their life. These doctors are cognitively as sharp as ever, but no longer clinically active. Why not use them to provide medical inputs to the legislature when crafting medical laws; to bureaucrats when designing medical policy; and to the judiciary when they need a medical expert opinion ? They could provide very valuable inputs because they would be unbiased and objective, and would be seen as giving back to society in the autumn of their life. They understand the way the system works, and would be able to craft win-win situations, because they could be the voice of the medical profession.

Read more at: https://www.docplexus.in/#/app/posts/6e00142e-0a3b-4279-9dd2-85ee7214e1b2?anchor=4b6d7c28-0e98-4ebf-8d69-d12e7eb62be8
Copyright 2016 © Docplexus
When judges retire, they are usually not put out to pasture. Some of them practice as lawyers, but many will be appointed by the government to head judicial committees or fact-findings bodies because they want to make good use of their lifetime of accumulated judicial experience. This is true for retired IAS officers as well. I wonder why the government doesn't do exactly the same with senior retired doctors. These could be doctors who were in private practice; or medical college professors who are still in the prime of their life. These doctors are cognitively as sharp as ever, but no longer clinically active. Why not use them to provide medical inputs to the legislature when crafting medical laws; to bureaucrats when designing medical policy; and to the judiciary when they need a medical expert opinion ? They could provide very valuable inputs because they would be unbiased and objective, and would be seen as giving back to society in the autumn of their life. They understand the way the system works, and would be able to craft win-win situations, because they could be the voice of the medical profession. How can we use the valuable experience of senior doctors in a better way?

Read more at: https://www.docplexus.in/#/app/posts/6e00142e-0a3b-4279-9dd2-85ee7214e1b2?anchor=4b6d7c28-0e98-4ebf-8d69-d12e7eb62be8
Copyright 2016 © Docplexus
When judges retire, they are usually not put out to pasture. Some of them practice as lawyers, but many will be appointed by the government to head judicial committees or fact-findings bodies because they want to make good use of their lifetime of accumulated judicial experience. This is true for retired IAS officers as well. I wonder why the government doesn't do exactly the same with senior retired doctors. These could be doctors who were in private practice; or medical college professors who are still in the prime of their life. These doctors are cognitively as sharp as ever, but no longer clinically active. Why not use them to provide medical inputs to the legislature when crafting medical laws; to bureaucrats when designing medical policy; and to the judiciary when they need a medical expert opinion ? They could provide very valuable inputs because they would be unbiased and objective, and would be seen as giving back to society in the autumn of their life. They understand the way the system works, and would be able to craft win-win situations, because they could be the voice of the medical profession. How can we use the valuable experience of senior doctors in a better way?

Read more at: https://www.docplexus.in/#/app/posts/6e00142e-0a3b-4279-9dd2-85ee7214e1b2?anchor=4b6d7c28-0e98-4ebf-8d69-d12e7eb62be8
Copyright 2016 © Docplexus

Tuesday, October 25, 2016

What not to do - a guide for doctors

Doctors love doing stuff - whether it's ordering tests; interpreting scans; prescribing medicines; or performing surgery. This is what they have been trained to do , and they are happy to continue doing this. And it doesn't hurt that this is exactly what patients expect !  After all, isn't that what patients go to doctors for ?

However, the truth is that doctors are so much  in love with intervening, that they forget  that sometimes their interventions cause more  harm than good. They forget to look at the big picture.

This is why this list of DO NOT DO medical interventions from NICE ( National Institute of Clinic Excellence), UK , is so helpful !


If your doctor tells you to do anything on this list, please get a second opinion !

Monday, October 24, 2016

Does sealing ultrasound machines improve the sex ratio ?




The PNDT Act was passed over twenty years ago with the intention of reducing female foeticide and improving the sex ratio at birth.  It's high time we evaluated the effect of this law scientifically and critically.
The hypothesis behind the PNDT Act was that it was the misuse of ultrasound scanning which was causing the sex ratio to decline .  This is why the PNDT Act empowers government officials to seal machines which are being misused . Once these machines are sealed, one would then expect that the sex ratio in that locality would improve in the following year - after all, this is the objective of the Act.  Since illegal ultrasound scanning has been stopped thanks to the Act in that area, female fetuses would no longer  be illegally terminated in that region, and more girls would be born in the subsequent year .

Now I understand that patients can travel from one area to another, but we can divide the country into well-defined areas, and it is reasonable to assume that if the PNDT Act is effective ,then the improvement of the sex ratio in any given area would be proportional  to the number of machines seized in that area .

Because there is so much variation in how the Act has been implemented across the country by different local Appropriate Authorities , we now have enough natural experiments to be able to crunch this data intelligently.  In order to study the impact of the PNDT Act, it would be interesting to see if there is any correlation between the number of ultrasound machines seized , and the sex ratio in the following year in well-defined geographical areas.  If there is, this means we are on the right track. If there isn't, then we need to accept the fact that the basic premise on  which the Act is based maybe wrong, and look for more effective measures to correct the sex ratio.

 An unbiased social science researcher needs to look at this unemotionally and dispassionately to answer this important question.

Sunday, October 23, 2016

The art and science of reading a book



All of us know how to read, so what's the big deal about learning how to read a book ? Didn't we learn this in nursery ?
You'll be surprised how many bad habits most of us have regarding reading.
The world changes rapidly , and we need to keep up with new advances. This is why we need to absorb information all the time. Now, it's true that everyone has different preferred modes of learning,  but reading a book is still the gold standard.
Yes, there are multiple additional options - for example, attending a conference ; talking to experts ; or watching a video, a book still remains the best way of absorbing a lot of concentrated information very quickly. Because an author is usually an expert who has taken the time and trouble to condense his knowledge into a book, the density of high quality information you will find within the covers of a well-written book  is far higher than you would find in any other resource.
This is why it's so important to learn how to read a book properly.
For many of us, reading remains a chore. We read books in school because we were forced to read them. They were assigned as homework, and we had to suffer through them. We were never taught how to read non-fiction efficiently, as  a result of which most of us remain mired in our bad habits.  For many people, being forced to read a book brings back a lot of unhappy memories, because they were compelled to ruin their summer holidays slogging through a dense tome as part of their homework.
 This can be such a shame , because a book is really a great tool which allows you to have a one-on-one conversation with a world-class expert , who is willing to share everything he knows about a particular topic with you.  You can tap into his brain for a few rupees. Imagine how much more you would have to spend if you had to fly down to listen to him speak at a conference !
 We deprive ourselves of a great opportunity of getting wiser by refusing to read. Really, what's the difference between someone who is illiterate and someone who refuses to read?
 The good news is it's not hard to acquire the right reading habits. You need to start off with being picky and choosy about what you read, so please don't waste your time reading trash . It's tempting to pick up the current nonfiction bestseller, but this is often not the best use of your time, because many of these are just hyped up to increase their sales. It's often better to stick to time-tested classics which have stood the test of time.
 Please also remember that you need different reading styles, depending upon what value you want to get out of the book. The way you read a fiction novel will be completely different from the way you read a textbook, which again will be different from the way you read a book written for a layman about what everyone needs to know about artificial intelligence.
 The trick is to read actively , not passively. What does that mean?  You need to be in the right frame of mind, and you need to prepare yourself for the task of absorbing wisdom from the book. It's like having a conversation with someone wise , because this is what a well-written book is all about. Just like the writer takes a lot of trouble to write down his thoughts, you as the reader need to take the time and effort to absorb and assimilate what he wants to share with you.
 Lots of people take pride in keeping their books in pristine condition, because they have been taught that you shouldn't make marks on a book - doing so means that you are disrespecting it. This is completely false. The whole point of owning a book means you need to own the knowledge in that book. The only way to do this is by making notes in the book. Feel free to highlight and to scribble in the margins - this will help to make sure that what you read will stick !
 A lot of people still believe that a book needs to be read from cover to cover, starting from page 1 all the way to the end. This is not true, and can actually  be counter-productive, because it slows you down.
Few books need to be read from cover to cover, so before you start, think about what you hope to get from that book.  What do you already know about that topic ?  what are your existing mental models ? what  do you hope that this book will teach you? You will then be able to absorb what you need to know from the book far more efficiently and quickly.
You first need to start by skim-reading. In order to understand the overall layout of the book , read the chapter headings . You may find that you already know a lot of the stuff in many of the chapters, so you can skip these. You don't need to plow through stuff you already know - you can go directly to where the gold is.
 Lots of books are well-structured. They will often have a summary at the start of each chapter which lay out the highlights, and you may choose to read just those. You can then selectively read only those chapters which you feel will tell you stuff you didn't already know. It is important to read with a pencil or a pen in your hand so you can annotate the book. This is the only way of making sure that the book becomes yours - that the knowledge has passed from the author's brain into yours.
 It's important that you share this knowledge with other people.  This is the best way to ensuring that you  remember the author's message - by being able to put it in your own words.
 This will allow you really master the art of reading a book, so that you become smarter and more well-informed.
 There are lots of tools online which can help you to read books more intelligently.  Reading the reader's reviews on Amazon can give you a lot of insights into what other readers have gained from the book, and this will help you to put the book's information in the right context.
There are plenty of book abstracting services which provide book summaries, and these can be very helpful because they allow you to absorb the gist of the book quickly. There are lots of Youtube versions of book, so you can watch the video, if you are a visual learner. And you can always listen to the audio book version if your preferred  learning style is auditory.
 Do remember that well-written books have a well-defined structure, and you need to parse this if you want to extract the maximum value from the book. Understanding the structure will help you to make sense of what the author is trying to say. This is why chapter headings, chapter summaries, figures, tables, and the subheadings within the chapter are of such value, because they act as signposts and beacons. Not only do they help the writer, they're designed to help the reader as well, to extract what he needs. There is a reason why the author has laid out his book in a particular way, and you need to understand this.
There can be lots of gems hidden within a book, and you need to study these carefully. Thus, looking at the images is very helpful. Figures and their captions summarize a lot of information, and are much easier to remember. Tables are also remarkably valuable, because they condense a lot of wisdom , and you should not overlook these.
 The best way of making sure that you've mastered the information in the book is to be able to try to reconstruct the contents. This should be your own words - you don't have to be a slave to what the writer has used, because his mental model is going to be different from yours.
 If you need to learn something new, reading a book is often the best investment of your time , because your knowledge base is your most valuable personal asset, and you need to keep on honing this. Once you learn to enjoy reading books , just imagine the world of treasures which are now open before you !

Thursday, October 20, 2016

IVF success story for patient from Africa


After 7 year of infertility we came to Dr.  Malpani with hope of having a baby we felt empty as we always wanted a family. We put our trust in him that somehow he would help us overcome this incredible battle. Dr. Malpani gave us inspiration, support and love along the way.

We went to Egypt many times for normal treatment but all in vain, so after searching on internet for the best IVF clinic it happen I found Dr.  Malpani infertility clinic and every time I search it comes again then I pick interest, after word I start reading Dr.  Malpani newsletter every day, and it impressed me so must that if I didn’t go on Dr.  Malpani website one day I feel something is missing.

On May 2015 we decided to go to India to see my beloved Dr. and it happen that we meet him and he is so nice and since that time we know we are going to make it, the way he explain things are so clear and interesting. Then our miracle happened and I became pregnant with only one cycle of IVF.

We cannot thank you enough for making our family complete. We are beyond happy and extremely blessed with our bundles of joy! THANK YOU for your patience, dedication, professionalism and for the amazing support that we received!

“In our experience all we can say is that meeting with Dr. Malpani was the best decision we ever made because it resulted in us having the loveliest baby boy.”

I would recommend Malpani infertility clinic to anyone having trouble conceiving because the care and treatment we have received has been fantastic. We have been so lucky to have this on our doorstep.
Best regards

Emma Loro
From Africa

Emma's email address is juanjaja2000@hotmail.com

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !




Wednesday, October 19, 2016

Founders need to share their mistakes with their investors


Startup founders are supposed to provide regular updates to their investors so that they can track their progress. Sadly, this is not something which most founders are good at, because they think of this chore as being an irksome distraction. They would rather focus on creating a better product so that they can delight their customers , and engaging with their investors is a low priority for them.

However, a startup has two customers when it's in its early stages. One is the customer who buys your product; and the other is the investor who has given you the money to run your company. You need to treat your investors well by fulfilling their expectations, so that they will continue to help you to grow.

Part of the problem is that most founders are very  selective when sharing updates. They will only highlight what's gone well , and will gloss over all the difficulties which they are having a hard time dealing with.


This is because they are worried that if they share too many details of the problems they are having to tackle,  their investors will try to interfere and micromanage them in order to help them solve these. This is the one thing which a founder dreads, because he values his autonomy . After all, one of the reasons entrepreneurs choose to found a startup is because they prize their independence. They want to be left alone , and they don't want big brother breathing down their back all the time.

Founders need to learn to be upfront with the problems they are facing, and they should emphasize the low lights during their updates. They need to share the mistakes they've made; the regrets which they have; and more importantly , what they've learnt from those mistakes .

Not only this will disarm your investors, it will increase their confidence in you . They can see that you are being honest, transparent and thoughtful. Rather than trying to get defensive as to why you have not been able to meet your revenue projections , it's far better that you be frank and forthright. They will be able to see that you being focused, and have a strategy to deal with the problems you are facing. This will increase the respect which they have for you .

It is also useful to have a premortem slide, which emphasizes what can go wrong going forward as well, and what you plan to do in case things don't pan out the way you want them to.

One of the other concerns founders have is that if they share too much information about the difficulties they are facing, their investors may get spooked , and will be reluctant to continue providing support. This fear is misplaced . After all , investors are on your side, and want you to succeed, so please don't think of them as being adversaries - your interests are aligned !

When things are going well, you don't need help from anyone , and you can continue to grow on your own . Your funders may help you to grow faster, but you can manage well for yourself when things are going well. You need their help the most when you encounter difficulties, and this is why you should not try to hide your problems. They often have a lot of experience, and may be able to provide solutions you may not have thought of.

Good angels are likely to be forgiving, especially if you are upfront about your problems, and have not tried to hide them. They will respect your honesty - after all, sharing your mistakes and telling us how you plan to recover from them helps us to become smarter as well !

We understand that things go wrong  with any startup - after all, that's the nature of the beast. As Ray Dalio says, mistakes are good things. You need to be radically  honest and transparent about your goofups  , and this should be an integral part of the culture of your startup. If you practise this, it will be engrained in your employees as well. This will help you to recover from mistakes much faster , because it will allow you to learn from them, rather than waste energy trying to cover up your  errors.

When you are bouncing back , you should explain to your funders what leading indicators you are tracking during your pivot , and how these will help you identify what could go wrong before too much damage is done. What key metrics are you monitoring and why? It's helpful to have a template which covers the key areas: money/ cash flow; employees; product  ; customers; competition; and regulation. Raw data is helpful , so please share this. This is best done online, so we can track your past performance as well.

If you've shared information openly with your investors - both the ups and downs - they will trust and respect you, and are much more likely to be helpful in your time of need . Funders hate it when founders hide information from them, and then ask for help at the last minute , when they find that the company is sinking , and the damage is beyond repair.  Sadly, there is little we can do at this time to help you turn things around.



Tuesday, October 18, 2016

Are Indian corporate lab chains selling confidential patient data?


We all know that patient data can be worth its weight in gold. It contains a treasure trove of information, and lots of companies will be happy to give an arm and a leg to get access to this.

When patients go to a clinic, they expect that their information will be kept private and secure. However, I find that private labs in India seem to be selling this data to corporate healthcare customers to create an additional source of revenue. While I don't have any proof, I have strong circumstantial evidence based on what my patients have shared.

For example, I recent had a patient who had a negative beta-hCG result , which means her IVF cycle had failed. The test was done at a reputed lab, and after two days, she got a phone call from an agency  which said - We are  so sorry to hear your IVF cycle failed - would you like us to refer you to another reputed IVF clinic?

Then there was another patient who went to the same lab who had a positive hCG test. She received a call from a cord blood stem cell company saying - Congrats, we heard that you are pregnant ! Would you like us to store your baby's cord blood cells after delivery ?

How , why and where is this confidential patient data getting leaked ? Is the lab monetising this by selling  leads to companies ?  Or is this data being sold on the sly by their employees ?


This may just be the tip of the iceberg. It's high time checks and balances are put in place to make sure that confidential patient data is not sold. It's not just labs - we all know that pharmaceutical companies buy this data from chemist shops so that they can keep track of doctors' prescribing habits. Similarly, digital health companies which provide electronic medical record services as well as Practice Management Software to doctors also have access to a lot of patient data, and we don't know how they well they protect this.

Everyone in the US healthcare system has to follow strict HIPAA laws, and this is an important safeguard. Both doctors and patients are confident that their patient's  data is secure .  Most Indian companies don't seem to follow any guidelines, and I am very worried that patient confidentiality is being breached.  Others say they do, but they need to be audited to prove their claims.

Before the situation goes from bad to worse, this needs to be looked into seriously. As it is , the credibility of the healthcare system is poor, and this will just increase the trust deficit even further. This is an important topic, and it's very disappointing that the quality of investigative journalism in India is so poor that no one is willing to explore this topic in greater depth.

Are there checks in place to ensure that labs and digital healthcare companies do not share the patient data which they have access to without the patient's specific permission and consent? And how is this being verified ?


Why PGS testing is unreliable

Lots of IVF clinic are pushing PGS ( preimplantation genetic screening)  testing. They claim that it can help to improve pregnancy rates by reducing the chances of transferring chromosomally abnormal ( aneuploid) embryos.

This seems logical, but as this article points out , PGS testing can be inaccurate. The lab reports are not always reliable, which means we may be throwing away embryos which could have become completely healthy babies.  This means PGS may actually reduce the chances of a pregnancy !

Monday, October 17, 2016

The Negative beta HCG

A negative beta HCG can often be the hardest thing for an IVF patient to deal with. There are so many hopes and dreams riding on the IVF cycle, and when the result comes back as negative, it can be very hard to deal with this failure. You feel that you are a failure, and that if even an advanced treatment like IVF has failed, this means you will never be able to have a baby .

You need to understand that a negative beta HCG only means that those particular embryos which were transferred into your uterus did not implant. It doesn't mean that your uterus is defective; or that you are doomed to remain childless; or that you will never get pregnant; or that your doctor was careless or negligent. Don't start catastrophising from one single negative beta HCG.


While most patients are mature enough to accept the failure of their first cycle, the problem becomes far worse when they have multiple failures. This becomes very hard for them to deal with, and even though they are otherwise extremely rational and intelligent, when this happens repeatedly, they often lose their ability to think logically . They start becoming extremely emotional and when they get desperate , they do silly things like trying out all kinds of unproven and untested treatments.

A  lot of websites are happy to sell you all kinds of potions because they want to take advantage of your emotional vulnerability, so you need to be on your guard that you don't get take for a ride.

Sadly, sometimes IVF doctors will take advantage of this situation by proposing all kinds of expensive and unproven tests and treatments,  such as intravenous immunoglobulin infusions. They promise the patient that this " treatment" will increase their chances of getting pregnant in the next cycle, but unfortunately this is not true.  However, a lot of patients end up wasting a lot of money on false hopes, , simply because they are so desperate that they cannot accept the reality that doctors cannot control the biological process of implantation.

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !




Sunday, October 16, 2016

How Practo is taking doctors for a ride

This is the experience of one Endocrinologist with Practo which is being shared amongst Indian doctors.

Dear Doctors,
Respected Colleagues,

I am Dr Lakshmi Lavanya Alapati, Consultant Endocrinologist, have returned from USA to live in India and practice endocrinology in Hyderabad, started with banner of American Institute of Diabetes and Endocrinology in Madhapur Hitech City area.

Initially Practo.com marketing  urged me to take a membership in their website for marketing purpose which I did so for 6 months and later I refused to do so. I refused because they told me to pay double the amount to market my banner on the top of the list in their search for best endocrinologist in Hyderabad, I did not think that I needed to pay money extra to be on top. I felt he was doing some wrong business by keeping some ridiculous competition between colleagues and doing business among ourselves, so I refused to sign up a renewal of existing contract for extending the marketing services. I clearly Conveyed to him that I no longer am his client and I want my information to be taken out completely from the practo .com website and I do not require any kind of marketing at all through them. Since after that conversation , they continued my name in their website and and also displaying my name in general physician list and not in endocrinologist list, they changed my degrees to only MBBS. So now my patients are calling my staff to find out my degrees and my qualifications and asking if I am a general physician. I think this is wrong and despite calling them, they have not corrected this error. I am informing you all so you can understand how these marketing people jeopardize our proffession and can  be a hinderance to our progress when we don't use their services any more.

Also I want to inform you all that Practo .com people have started a business of selling medications with online buy meds  website , they send medications to patients homes with free delivery and a discounted price, and they take information of our own patients. the information is taken  from those doctor`s practices, for whom practo has given services for the entire services such as  running there consultations and there pharmacy and there electronic medical record. Thank goodness I only used practo for public marketing but not for entire website running  of my clinic, due to my father`s advise. My father being a retired Indian Army Colonel, suggested me that these businesses like practo can steal our patient information and do there own business such as giving information to third party such as to apollo pharmacy or thyrocare or  they may sell medicines as a wholesaler quietly on the backend. This has now become true, as Practo is selling medications  to our clients, we fed them with our information of our clients.

I hope you all understand the problem, it is not just my problem, it can affect all of us. please think with cool mind about this and give me your suggestions. I have practiced in theUSA for 9 yrs and after living in the USA for 14 years , returned to India  and practicing in India from last 4 years. Being fairly new in India, I need your suggestion on how to proceed.
I know that you all are with me! We all spent more time with books and patients all our life than with any thing else, our hearts beat alike.
Regards,
your humble colleague,
Dr Lakshmi Lavanya Alapati,MBBS,FACP,FACE Consultant Endocrinologist American Institute of Diabetes and Endocrinologist Madhapur, Hyderabad






This first-person account clearly shows the dodgy tactics Practo is using to try to grow. 

They claim that they don't allow advertising on their site, but  as this doctor points out, their executives try to get doctors to pay them a fee for being listed on top in their  search results . So much for the " algorithm " which they use to rank doctors !

They are now also abusing patient confidentiality by misusing the patient data they are acquiring from the EMRs and practise management websites which they sell to doctors.

How infertile patients make life harder for themselves


There is no question that infertility can cause a lot of stress, but sometimes infertile patients make a bad situation worse by increasing their own stress levels. They start to catastrophize and worry  about how they will cope in case the IVF cycle fails, even before starting the treatment.

They worry about how much money they've spent , and that they may not be able to afford another cycle. Their biggest fear is that their world will come to an end if they're not able to have a baby; that life will not be worth living if they remain childless; or that their husband may desert them if they remain infertile.

Yes, being infertile creates lots of worries and concerns, and everyone on the infertility journey has to deal with these. Most patients handle the uncertainty maturely. They understand that life is full of problems, and that they have successfully dealt with similar problems in the past . They have tackled the slingshots of ill-fortune, and have emerged stronger as a result of these battles. They understand that infertility will be another of the obstacles they will have to learn to handle.

However, some couples just go to pieces, especially if they have a shaky marriage to start with , because infertility can often be the last straw which breaks the camel's back.

It's important to learn simple tools to make sure that you don't drive yourself crazy during your IVF treatment . Not only will they help you to retain your sanity, they will also prevent you from anatgonising the clinic staff  by asking the same questions again and again . Why didn't the embryos implant? Why are the eggs of poor quality? Why is the sperm count poor?  The truth is that we don't have answers to lots of these questions, and asking them repeatedly will not change this fact. In any case, these are poor quality questions because they don't really change your treatment options - and what you need to be thinking about are your next action steps.

Yes, I understand that infertility can break your heart, but you still need to deal with this objectively . If you don't, you'll find yourself getting sucked into a negative vicious cycle , and it can be very hard for you to cope with this. Not only will you end up making the journey much harder for yourself, you'll make it much harder for everyone who is around you - your friends who love you and who want to support you. You may end up driving them away , because they will find that you have become obsessive about your single-minded pursuit to have a baby. You keep on thinking and talking about the same issues ( for example, about how unfair life is and how unkind God is ), and playing them back again and again. At some point you need to snap out of this funk. While it's okay to feel sorry for yourself, you can't immerse yourself in self-pity because this is not a very constructive way of dealing with life's problems.

The problem is that some infertile patients feel that they are entitled to have a baby - that the world owes them a baby. They dump their anger and unhappiness on their friends, and just end up distancing them . This just makes matters worse !  They need to learn that life is not always fair, and the sooner they accept this, the easier it will be for them to cope with their feelings as mature adults.

The good news is there are lots of useful tools available to deal with this distress . For example, you could go to a counselor ; or learn self-awareness and other mindfulness techniques , such as meditation and yoga.


A sense of humour will help you retain your sanity, so that you can keep a detached perspective. Another method  which many infertile patients find very helpful , is to step out of themselves, and behave as an observer. For example, they can pretend that it's not them but their friend who is infertile, and that they are counselling them how to cope. It's much easier to advice someone else than to follow your own advice !

Always remember that other infertile couples have dealt with this problem in the past successfully, and you can find the inner strength to deal with it yourself as well.

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !




Saturday, October 15, 2016

Why the National Medical Commission is doomed to fail





Everyone is excited about the fact that the Medical Council of India is being scrapped and that the Government is setting up a brand new National Medical Commission ( NMC).

We all acknowledge that the Indian medical system is broken because it is riddled with corruption. The hope is that a new broom will help to clean up some of the illnesses which riddle the ailing healthcare system, so that we can start afresh , and hopefully do a better job this time around.  This is why there's so much optimism that this change will enable us to get a better system.

The truth is that we're fooling ourselves. GIGO ( garbage in = garbage out) still applies , and as long as we continue to allow reservations within the medical education system, nothing will improve.

We reserve over 50% of medical undergraduate and postgraduate seats for people whose forefathers used to be economically disadvantaged, but who now have no reason to continue demanding this reservation , except for the fact that they're entitled to it. If we continue with this reservation mentality where we force deserving students to  see their dreams and aspirations of becoming a good doctor go up in smoke because there aren't enough seats to go around , how will we ever create good doctors ?

The best way to get more good doctors is not to open more medical colleges or to create a National Medical Commission, but to stop the reservation process completely - whether it's undergraduate medical education, postgraduate seats , or medical college teachers posts. Unless we do this, I think we are just putting lipstick on a pig and fooling ourselves.

Creating a new NMC does not address the underlying reason for why the system has become so completely broken today. After all, if over half of new doctors are academically incompetent, how can you expect them to provide high quality medical care to their patients ?  The Niti Aayog can do precious little about this, because of political compulsions, but why should they be allowed to fool us that they are making useful changes ? All we will end up doing is wasting a lot of time, money on energy on rearranging the deck chairs on the Titanic !

Unless we treat the underlying infection, just applying cold compresses is never going to allow us to treat the fever ! We will continue having to suffer , and in another 20 or 30 years, instead of the National Medical Commission, we will have a BNIMC or a Brand New and Improved National Medical Commission, which will again come up with a few cosmetic changes which are doomed to fail. This will become a story will repeat itself every few decades.

The tragedy is that the medical students who become doctors because of a reservation quota are exactly the people whom you don't want to be treated by when you are ill . Unfortunately, once they graduate, you have no way of making out whether they got in on the reserved quota , or by their own merit. This is true, whether they got into medical college because they belong to the backward classes, or because they are very rich and could afford to pay for a private medical college capitation seat.

At the rate at which we are going , we will end up reserving all the medical seats because of political compulsions, and soon there will be no open merit seats left.  We will then end up getting the doctors we deserve, and no amount of redesigning the Medical Council will solve the problem.



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