ATTENTION- FORMER CHIEF JUSTICE, SUPREME COURT OF INDIA

To,

Justice R S Lodha,

Supreme Court committee,

Overseeing working of Medical Council of India,

Delhi.

Subject-  Requesting your intervention in matter of ‘cut- practice’ in medicine

Respected Sir,

I read in the newspaper that a committee under your able chairmanship has been set up to study and monitor the working of Medical Council of India, with particular reference to corrupt practices. I am writing this letter with the hope that something may be done about  ‘cut- practice’ in the medical profession.

‘Cut practice’ is the system of earning commission for referring patients to a particular doctor or medical organisation. It undermines medical care and harms the patient. Hence, it must be stopped as soon as possible. Cut- practice is labelled ‘unethical’ but the MCI or Maharashtra Medical Council have no set procedures to investigate or punish violations. It is not ‘illegal’ as there is no law against it.

 In 2013 Dr Bawaskar filed a complaint in the Maharashtra Medical Council about one such instance. Though the fact of giving cuts in this case was proved and admitted to by the defendent, no action can be taken on basis of a technicality- that the cut was issued not by an individual doctor but by a medical organisation. In effect, it seems that cut-practice is unethical for individuals but a legitimate business practice for groups of individuals. This can only be termed as a travesty. The case is now stuck at this point at the Mumbai High Court. Meanwhile, the Medical Council of India has passed a circular stating expressly that its mandate is only to act against individual registered doctors and not against organised group of doctors, further bolstering the above case. (I can provide you the details, if you wish. Meanwhile, you may see them on my blog mentordoc@blogspot.com)

 These developments are dangerous for the public. It endangers the ability to choose medical treatment that is competent and affordable. The most important intervention would be to bring medical organisations, associations and commercial healthcare entities under regulation by making registration under medical councils mandatory. Medical ethics and laws should be the same for individuals and groups.

I, therefore request you to study this matter deeply. With your knowledge, experience and authority you may be able to suggest a suitable remedy to stem this rot. Sir, an effective action will bring succour to all Indians. I exhort you to please do something in this matter.

I also request you to kindly acknowledge this letter, at least through email.

With much anticipation

Sincerely,

Dr Vani Kulhalli

(I HAVE POSTED ON BLOG BECAUSE EVEN AFTER 3 mts of SEARCHING I WAS UNABLE TO GET THE POSTAL OR MAIL ADDRESS. I JUST HOPE THIS WORKS.)

TIME MANAGEMENT IN PRACTICE

http://bmjopen.bmj.com/content/4/5/e004679.full

This is a continuation of my previous piece about time management in medical practice.

There is a lot of anger among the public over waiting in the doctor’s clinic. As  patient is in discomfort and pain, there is an expectation of relief at the earliest. When this expectation is not met- anger is likely. Some doctors do not care to organise their practice leading to time mismanagement and delays. The worst offenders are doctors who call all patients at the same time, so that they can arrive after a sizeable number assembles and then proceed to rush through the que. This is wilful waste of the patient’s time which is completely unforgiveable. Some doctors have given up on time management thinking it is a hopeless attempt and just announce their working hours. Any patient arriving within that time is seen on a first come first served basis. So essentially there is no appointment given. In all these scenarios the doctor has designed a schedule which is heavily weighted in the doctor’s favour and in favour of a patient who is disorganised consumer. Yes, some patients do feel reassured taking treatment from a busy doctor who makes them wait for hours- these patients are welcome to wait.

Working by appointments is by far the best way to work. It is good for the doctor as well as for the patient. It is the doctor’s responsibility to implement a system that ensures time management. The most important intervention to reserve the first two slots of the day to patients who are known to be punctual. Work must BEGIN ON TIME.  Second important intervention is to turn back and reschedule appointments of patients who come late. Patients should be accommodated for reasonable delay which may be upto 15 mins. Beyond that appointment stands cancelled. Thirdly, after every 4-5 appointments, an empty slot should be kept to accommodate delays and extended sessions. On certain days, when time- consuming interventions like therapy are to be done , patients come prepared to wait because I inform them in advance- so that is okay by them. I keep my side of the deal by not charging patients if I make them wait excessively, irrespective of who is at fault. Majority of patients appreciate the doctor’s punctuality. There are some patients who cannot understand all the fuss- but well the doctor has to take responsibility for clinic management not the patient.

After doing this for 15 years, I have a beautiful practice which allows me to start my day as planned and end it on time. 

UPDATE ON CASE

The case Dr Bawaskar vs N M Medical Centre reached the hearing stage this Saturday, that is on 16th April afternoon.

Justice Kanade and Justice Dharmadhikari heard the case and admitted the petition and have granted a stay to the defendent.

I can only hope for an outcome that benefits the common person who is unable to take any measures to protect himself/ herself from the systematic crime of cut- practice.

MCI, PLEASE OBLIGE

When we were students, we had to learn medicine, surgery, obstetrics and gynecology, ophthalmology, ear-nose-throat diseases, orthopediacs and paediatrics as separate clinical subjects. Psychiatry was dealt with in 1-2 lectures, 15 days in the second year and about 15 days of posting in internship. The medicine paper was supposed to have a question on Psychiatry which was usually a short note on one of five favourite topics (which unfortunately did not include depression).

This was 15 years ago. Now when I meet my classmates, irrespective of speciality or area of practice or even if some of them have switched their professions- all my classmates rue the lack of special training in Psychiatry. Most of my non- psychiatry colleagues have told me how a significant portion of their practice is actually psychological intervention or psychiatric treatment. One family physician joked to me that he will have very minimal practice left if he begins to refer patients with psychological problems to Psychiatrists instead of treating them himself! Considering all these experiences, it is very clear that a special training in Psychology and Psychiatry would have been indispensible.

All things cannot be covered in undergraduate medical education because of the vast and changing nature of medical science. Invariably, some amount of learning happens on the job when the doctor actually settles down to start work. So some authorities have argued that psychology and psychiatry will be ‘automatically’ learned by doctors when they need it. So we see a good attendance at CME programs of medical associations when the topics are related to psychiatry. But what about clinical skills? CME programes are only lectures and I don’t know how doctors will learn the clinical skills of mental health care.

Unless the MCI mandates that clinical skills have to be learned, the students will not be able to do so during MBBS. After MBBS, even if they want to pick up these skills, who will teach them? Technical knowledge in psychiatry can be picked up in the CMEs but clinical skills have to be learnt during undergraduate clinical training only. So our MCI should include testing of clinical skills in psychiatry and psychology during exams. Then there is a higher probability that students will imbibe these skills. Leaving market forces to create motivation for this learning is not the right approach. I hope the MCI will oblige.

" Depression in young adolescents" A review

CITED AS-

KULHALLI, V.. Depression in Young Adolescents. The Indian Practitioner, [S.l.], p. 63-65, aug. 2015. ISSN 2394-3017. Available at: <http://theindianpractitioner.com/index.php/tip/article/view/77499>. Date accessed: 14 Sep. 2015.

http://theindianpractitioner.com/index.php/tip/article/view/77499

CHIKITSA AROGYASEVANCHI

This book is written by my respected colleague Dr Shyam Ashtekar.

It is a well researched, logically thought out book about the problems and possible solutions for improvement of health sector in Maharashtra.

I rate the book very highly in terms of its presentation, scholasticism and timeliness. This is not only due to my personal regard towards Dr Ashtekar. I welcome other persons to read the book and give the review.

The content of the book is very practical and utilitarian- a sort of field guide for politicians, policy makers, observers, researchers and students of health care sector. A superficial reading can also inform the reader about many facts and facets. A deeper reading can give a snapshot of todays reality.

Dr Ashtekar's effort is commendable. Rarely does anybody take so much effort- if taken up early and in the right spirit- the system can really be improved beyond imagination- Yours and mine.

Book details- CHIKITSA AROGYASEVANCHI
Granthali publication.
Available in most book shops in Pune and Mumbai and by order from www.bookganga.com

Writing for a news-paper

Nowadays I am writing a regular column for the newspaper 'Loksatta' and my colleagues want to know more about this writing process.

About 3 years ago, I wrote my first article for a newspaper and it was on 'depression in menopausal women'. I think my first boss, Dr Harish Shetty refered my name to the editor. I was very hesitant to write in Marathi. So the first time I sent the material in English and she translated it for me. The article came out very well. My concepts and her translation- an excellent combination.

Thereafter slowly I began to get requests to write more articles. But now I had to write in Marathi itself- another challenge. I speak Marathi very well but writing and typing was another thing. Generous use of dictionary and Google transliterate solved the problem. And the excellent editing inputs- 'kept the technical points at the same time maintaining the readability of the article' (in the words of one of my colleagues who was kind enough to review and give feedback).

I get a small honorarium for my efforts. I have never had to pay for getting articles published. In the initial years I did approach some newspapers with articles; but I learnt that writing is their job and they really dont need any articles from us. So I stopped sending such requests.

After writing articles, many persons and patients have contacted me for their troubles. This works both ways- I get some work and patients get to know where to find the person who can understand their problem and give them treatment. Somehow it adds to my credibility, so just by writing articles now I am supposed to be a better doctor also. Maybe now, that my thinking and knowledge are public- the judgement about my competence is easier. Or that the public is counting on the newspaper to have chosen 'only a competant doctor' to write.

I take my writing very seriously. I read all material on the subject. I review all patient histories relevant to the topic. I am meticulous about sticking to deadlines and word- limit. And I check what I have written. But of course I am not a writer- and my editor always manages to give a wonderful makeover to the article, putting the most appropriate words and phrases. Journalists are wordsmiths- and I have been lucky to have been guided by the best of them in writing my articles.

I feel it is a very good opportunity to revise the topic, learn new things and a different way of serving patients. I have really learnt a lot and will continue to learn from this experience. And I really agree that the written word has the unique power to communicate, impress, give relief and bring change.