Medical practice

Scientifically proven health risks of excessive mobile phone use

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” The excessive use of mobile phones can be harmful” , is no more a mere hypothesis. Recent studies are strongly in favour that it has many harmful effects in humans , even the potential to cause cancer.

If you have any doubts that mobile phones are anyways lesser  important for human survival than the discovery of fire or invention of wheel, here are facts.

There are more than 7 billion mobile phones in use which account for 96 phones for every 100 people on earth. In India , there are 1.18 billion active mobile phones, which means one phone each for  87% of population.  Hong Kong has 2.4 active mobile phones for every citizen in the country.

We do not need to debate on the usefulness of these devices. We all have experienced how  hard is to pass a single day away from it. From learning dancing to diving, from finding a doctor to a date, If there is anything you can define in word, mobile device can help you do it online. 

How long do  we use our mobile phones? 

 An average American spends more than four hours a days on mobile phones. An average India is slightly behind their american counterparts with little over 3 hours per day. The social media account for the largest share ( half) of the time spent on the mobile phones. Most of the mobile phones in use are smart phones with big screens. India alone has about 300 million active smart phones. 

Long duration of mobile phone usage has always been expected to cause problems. Now the scientific reports have began to pour in , showing that mobile phones usage indeed has side- effects associated with it. 

Most of the risk are benign but some of those are really serious.We start with the most scary one.


Brain tumors

When a person talks on phone ,  ear and brain are the organs near  to the  mobile hand set. These two organ are in close contact with the radio-frequency electromagnetic fields, emitted by mobile phones. 

Research experiments of mice reveal that radio-frequency electromagnetic fields from mobile phones, may produce  changes at  cellular level that increases the risk of cell death and cancer development in mice. What is more  is worrisome is the fact that  it can be transmitted to subsequent generations . 

Fortunately  a recent meta-analysis of the available data on the genetic damage  in human cells has failed to validate this hypothesis. 

 Scientist suggest that children are at even  greater increased risk of damage  .  

Children have  thinner skull bone which offers lesser protection to their brain from radio-frequency electromagnetic fields. They have  smaller head  so they  receive higher  dose of exposure per unit volume of brain tissue and have  increased brain conductivity.


The expert panel for the International Agency for Research on Cancer (IARC),classify cell phones as  possibly carcinogenic (Group 2B) . Which means that   mobile phones  are as cancerous as  lead (also in catagory  Group 2B)

There are four types of brain tumors which are been found to have association with mobile phone usages

The current studies published in peer reviewed journal  support the hypothesis that long-term (over 10 years) use of mobile phones increases the risk of certain type of brain tumors, especially if the  exposure  have been predominantly on one side of the head . 

The studies also say that if you have started using the phone on a regular basis before you were 20 years old, than you have four times higher   risk of having glioma ( a type of brain tumor )than the normal population. 

The “lifetime exposure dose.”of the total mobile use is also important. If somebody has a total lifetime exposure of ≥ 1640 h, the person has the 2.55 times higher risk of  having acoustic neuroma ( another type of brain tumor) , than normal population, one side of use.

Next time , when you see your children talking on the phone, you know what to do next. 

Some useful links


In high- and middle-income countries , one in 7  couples have problem of infertility.  More over the semen quality males have been reported to be declining, for which researcher could not associate a cause. 

Recent research reports have reported that long term use mobile phones was associated with reduced sperm motility which is an important determinant if the sperms will be able to perform its role in conception. 

Now you have a good reason to take your phone out of your pant pocket and place it some where else , if you are a male and have any  reason to protect your sperms.

Mobile phone addiction

The mobile phones are not only getting cheaper day by day and these are also becoming more functional . Mobile phones are finding their usage in every facet of our social and professional life. 

No body gets addicted to the phone overnight. One often  starts  using the phone for  of routine use like shopping and social media interactions.

 Some of these become addicted  to shopping  or checking the social media updates  as a way to escape unpleasant feelings or boredom. The “high” experienced when shopping  or getting likes or comments  on social media  may become  strategy to cope up with the stress and discomforts of life. 

The process of addiction suggests a distinction between liking and wanting. People start the use  of phone because they  like the phone and its functionality but slowly the phone becomes something that they “want” . Later means that the person feels physically or psycologically uncomfortable if removed away from phone.

 The mobile phone addiction is  seen as  part of   technological addictions which  is defined as  “non-chemical (behavioral) addictions that involve human-machine interaction” .

Then people began to so called  the tell tale signs mobile phone-addiction.

1. Frequently checking the phone. An average American checks his/her phone 110 times a day.

2. Using phone in toilet,  before going to sleep, immediately getting up in morning, on weekend, even in shower.

3. Sleeping with the phone under the pillow or close to bed.

4.Feeling uneasy if phone is left at home.

5. Checking job related mails even when on vacations, etc.

Welcome to the club if you also have many of the above habits. 

links to few  helpful books 

Road traffic and other type of accidents

Unless you are in a driver less car, it is no rocket science to understand that ,a driver needs to pay attention to the driving task, to avoid accidents.

Even a momentary distraction of driver, away from road can lead to a crash. You can not have a better distraction than the mobile phones. A report by National Highway Traffic Safety Administration study, estimates that it contributes to 20 -30 percent of all road accidents

A recent research from Taiwan shows that

  1. drivers were less responsive when they were having a conversation over a handheld mobile phone.
  2. Female drivers were more adversely affected by mobile phone use than male drivers when faced with obstacles falling in front.
  3. Older drivers were more adversely affected by mobile phone use than younger drivers.


Insufficient sleep and sleep disturbances are common among youth and adolescents around the world. From from 2006 60 2011, number of adolescents in the United States , having the sleep less than eight hours a day rose from 45% to 60%. 

Ninty percent of recently punished studies   report  a significant association between screen time and reduced sleep duration and increased sleep problems. Studies report that use of mobile phone at bedtime reduce the total sleep time by 20-45 minutes.

Depression and other psychiatric disorders

Following psychiatric disorders are associated with the use of mobile phone

Headache, fatigue, irritability, dizziness, loss of appetite, sleepiness, sweating, difficulty of concentration, memory loss, depression, emotional instability, dermographism, tremorhallucinations and insomnia.

Mobile phone usage contributes to the obesity by following ways 

1. Children tend to eat more as they keep getting food related clues by the content viewed on the mobile phone.

2. Children tend to choose food which is rich in calories but poor in other  nutritious values , because of excessive advertisement of fast food. Some of the unhealthy food is outright promoted as healthy foods.

3.They tend to delegate more time in physically inactive work like screen viewing than physical activities like playing.

4. Changes in the sleep pattern may also have contribution in the over all issue of obesity in these children.

Concluding :  As it is scientifically established that excessive mobile phone usage is indeed harful, we should try to limitt its use, as is possible.

Please comment in the section below . share , if you find it useful for others.

Medical practice

4D Ultrasound for sex determination

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Four-dimensional (4D) ultrasound (real-time volume sonography), a technology, started in developed world for encouraging  bonding of the parents with the fetus. It  is  widely been perceived to be  used for sex determination during pregnancy in India.

4D ultrasound or live 3D ultrasound provides  real lifelike foetal images in real time,  . It help doctors to see  congenital uterine anomalies, the endometrial cavity and  ectopic pregnancy among other things . In during pregnancy , it can be used to asses foetal anomalies involving the face, brain, thorax, heart, spine and limbs.


The problem statement

In developed world, there is no such issue like selective sex abortion, so the prenatal gender determination( sex determination before birth) is legal. 4D imaging technology offers the option of “Meet the Baby” ultrasound scans, which allow the parents and relatives to watch the intrauterine foetus in a comfortable family environment which is supposed to help in parental – foetal bonding and gender determination.

 4D ultrasound has rapidly spread in India, which most of the ultrasound centers are offering  at a premium price. These 3-D and 4-D ultrasound scans, enable a pregnant woman and her relative/attendant to see the foetus and possibly it’s  genital organs on the TV screen displaying the footage realtime, as the scan is performed.. There are valid concern from different quarters that these machines are been used to disclose the gender of the foetus to the parents, genital organs of the feotus are displayed on large TV  screens, either inadvertently or purposefully.  The major concerning fact is that this new technology does not concur with the Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act. It is well known that sex determination is criminal according to the PCPNDT Act and punishable with imprisonment and a fine .

4D ultrasound known to be safe though valid the risk–benefit studies on acoustic damage to fetus are yet to be reported. 



Profiteering from the overcharging of the fee seem to be the main driving force for proliferation of these centers, and propagation of this practice. The radiologists performing the scan  are often the mere employees, consequently not in position to resist these practices. 


Four-dimensional (4D) ultrasound (real-time volume sonography), which has been used in the West for the determination of gender as well as for bonding and entertainment of the parents, is  widely available in India. Clearer policy  guidelines to prevent its misuse in sex determination of fetus is the need of the hour.

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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Medical practice

Medical Abortions in India : Need for a policy change

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In a study published in the prestigious journal,  Lancet Global Health, 2018, Kirti Iyengar and Kristina Gemzell Danielsson have called for need for overhaul of policy on contraception and abortion in India. 

The problem estimate

It points to the huge burden of unintended pregnancy in India as India’s family welfare programme has been sterilisation-focused and the contraceptive needs of a large proportion of people are largely ignore.

Authors report that in 2015, half of the all pregnancies in India were unintended and that 15·6 million (14·1–17·3 million) pregnancies ended in abortions. It is surprising to note that more than 75% of abortions were obtained outside of facilities. Medical abortion drugs sold off the counter by chemists and informal vendors without prescriptions were main sources how these abortions were conducted.


The reasons cited were, a shortage of number of trained providers, legal impediments, lack of privacy and confidentiality, and insistence on specific contraception as a precondition for providing abortion services

The authors call for needed in India to improve access to safe abortion services, especially medical abortion. One of the steps suggested was the simplification of service delivery guidelines for medical abortion  would also help increase access, even in rural areas.


As emphasized by the authors, improved policies to increase access to contraceptive services is an urgent priority in India to help millions of women avoid unintended pregnancies.

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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Do not miss the opportunity to receive best actionable insight on health issues which matter the most. Its absolutely free.

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Medical practice

How to use Social Media to increase your medical practice.

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Social media is the fastest trend in the world with more than  2 billion monthly active users as of first quarter of year 2018. These are some of the important tips , which can be used increase your medical practice using popular social media profile.

Promotion of practice : why is it important ?

It’s not about you , its about them

                                                         Clint Eastwood


The medical practice is always centred around the patient not the doctor. Promotion of the medical practice is all about the patients. It is all about protecting the interest of the patients , adding  value to his/her life and providing him/her the best possible services. If there no patients , there is no practice.

Practice must be promoted so that you are on the patients radar when he or she is in need. You should promote your practice to let him know that you have solution to his problem. Patient should know his/her problem and also that you are the best person to solve it. If you do not promote yourself, it’s quite likely the patient will end up with someone he/she should not.

Its common to see patients receiving wrong treatment from untrained doctors in spite of a competent doctor practicing just a block away. The untrained one had not had enough moral courage to say no to the patient and trained one was had not had enough time and energy to promote himself.

Good doctors often do not promote themselves. They think that so long as they are doing good job, there reputation will spread by word of the mouth. This was correct at times when the medical practice was not as competitive as it is today and we did not have the social media. There is so much of the noise around, it is difficult to have your voice heard. But it is impossible if you do not speak at all. Doctors should realise that he/she should speak so that interest of the patients can be protected. They should speak so that patient can differentiate a good doctor from an ordinary. It is not about you, it is about them.

Promotion of the practice becomes unethical when the it is directed to to the soul agenda of furthering the financial/ personal interest of the doctor or the hospital.  In today’s competitive landscape, medical practice is more of an investment, for which one needs an immediate return. As the return has to come from the patients one need them at all cost. If that means trapping the patients through wrong  information or false promises then so be it. Things become bad when doctor becomes party to it.

It may be profitable in a short run. Slowly the number of unsatisfied clients begin to swell and everybody know that you don’t know your job. Medical practice is all about to trust. Once you lose it you cannot get it back by giving the discounts. In the long run it is a poor business strategy.

Ethical promotion of medical practice is all about slowly building the pool of satisfied patients which in turn influence and bring in more more patients of similar social profile. The newer patients have clear idea of what you have to offer and have trust in you. The trust comes from the fact that you are recommended by someone patient know and trust. Ethical promotion of medical practice is the best business strategy.

How to ethically promote your practice?

So if you do not trust the messenger, 

Why would you trust the message?

  • Chris Martin

 Medical practice is all about the reputation of the practitioner. The sole purpose of the promotion is to build a good reputation of the practitioner in his field of practice. The dictionary defines it as “ the beliefs or opinions that are generally held about someone or something” or “ a widespread belief that someone or something has a particular characteristic” . Simply put, what comes to the mind of a patient, when he hears your name ?

  1. Patients views about you, your competence and clinical skills.
  2. Patient trust you and your facility.
  3. Patient hopes from your treatment.
  4. Patient experience  with your services.

And how do you do that ?

There are no magic tricks to do that. All you have to do is to keep the following points in your mind, and inculcate in your  day to day clinical routine.

1 : Define your identity

If you can not describe what you do in a single sentence of few simple words, how do you expect a patient to understand,  let alone remember it. Keep your introduction precise and simple for patient to remember.

Keep your looks strictly formal and professional. That is how people remember you, and your professional  looks help a patient to trust you.

Clearly define your identity in following headings

  • Specialty, subspeciality and  and area of expertise.
  • Geographic area of professional activity.
  • Demographic age group you are primarily targeting.
  • Socio-economic class of patients you plan to cater.
  • Working days and hours you are professionally active.
  • Social media platforms and professional groups in which you are active.

This will help you to avoid wasting your time and energy in low priority areas. In medical practice , time and energy are always  in short supply. Use them wisely.

2 : Be Consistent

Stay consistent in promoting your practice in the priority areas defined in your identity. Consistency is not only important in the field of specialisation but also in other defined spaces, like targeted patient profile and  social media platforms. Its is not important to be active on many social media platforms, but whichever you choose, its better you stick to it.

Consistency is also important in temporal sense. It matters how often you post on a social media platform, but it matters  more that you maintain the consistency.

People start posting on twitter daily for a month or so and then slowly lose the enthusiasm. They might be missing for next 3 months before coming back. A better strategy is to start slow, may be single post in a month and then slowly increase the count. Whatever frequency  is convenient, maintain it. Medical Practice is a marathon not a sprint.

3 : Speak for yourself

Books and publications

The importance of scientific publications cannot be emphasized enough. Publications in peer review journals and scientific text book gives you a distinct identity of an expert that goes beyond the geographic boundaries. If this is not in your priority, than you should have it as new year’s resolution for the next year.

Though the readership of the these type of scientific literature is limited to fellow doctors only, the  reputation finally diffuses to the patients. It takes long time but the returns worth the efforts. It requires lot of patience and hard work, if you can do it, there is nothing better than that.



Blogs has certain distinct advantages as a mean to attract the attention of the common people and doctor of other specialities to the issue you intend to highlight. It demands low investment as compared to textbooks and peer review journals and has larger readership. It is probably the best way to let everybody know that you can provide solution to a particular patients related issue, which you are discussing in the blog.

Social media

Participating in the debates going on on the social media is a great way to promote your name in your specialty of you practice. Make sure that you are focused on clearly define objectives related to your practice. One should avoid the temptation of participating trending topics especially controversies and politics.

4 : Listen what others has to say

Willingness to take feedback is very important to modulate your promotion to the changing landscape of medical practice. Its is important to listen what others are talking about you and your services. It is equally important to listen what they are talking about your fellow practitioner.

Social media : The fastest trend


Wikipedia defines it as “Social media are computer-mediated technologies that facilitate the creation and sharing of information, ideas, career interests and other forms of expression via virtual communities and networks

It has three important components

Rapidly spreading internet devices and usage , combined with multiple  social networking apps  has produced an absolutely  spectacular new medium for social interaction. The medium is fast, ubiquitous, addictive and very efficient.

Social media is the fastest trend in the world with more than  2 billion monthly active users as of first quarter of year 2018. Most of you will not be surprised to know that Facebook is the most popular social network worldwide, with a global usage penetration of 22.9 percent. But some of you may be surprised to know that India is at  first place with 270 million users in the list of countries with maximum number of users. It is ahead of the   United States which is at second-ranked with 240 million users. 

If Internet and Mobile Association of India (IAMAI), is to be believed, India has 478 million mobile internet user by the June of 2018. It also claim that 59 percent of the urban population has access to mobile internet and the rural population is fast catching up. Almost half  of the user are younger than 25.

India currently has in between 300-400 million smartphone users and those who do not have one are rapidly upgrading into smart phones

How can social media increase your medical practice ?

1  : Creating  a strong  brand identity 

As Amazon’s Jeff Bezos says  “branding is what people say about you when you’re not in the room.” As a medical practitioner , it basically means what perception the  people have about your reputation and  professional connectivity. The perception is significantly affected by the patient ‘s experience and services that you provide.  The social media is increasingly getting flooded with the content which is either directly about you, or a person you interacted with or an event you participated in. 

So its totally your choice. You can actively control it to shape the public perception the way you want to them perceive, or you can leave it to chance. Its unlikely that your competitors are would take this issue casually.

Greater is your engagement with patients in social media, easier will it be for you to achieve you targets of practice, be it in getting newer patients or their  willingness to accept your services.

 2 : Increased patient engagement

Your authority over the field of your specialization and activities on the social media will help users to find your content and if it is really engaging that might share it. It’s the sharing of your content which is ultimate litmus test of the quality of the content. It also shows how accurately have you  targeted your content. If the good quality content is targeted to wrong audience, the effort to create that content will go down the drain.

That bring us to the issue of users or audience. The doctor should have very clear ideas who are the people you are targeting. If you are a kidney transplant surgeon , naturally you will not Target your content to Young working female. But that will be the target population for a Lasik surgeon.

Social media promotion and visibility will help the user to engage with your content and will visit you website or clinics , and so on. But it is not a one way traffic. It also give you client a control to express and disseminate his or her view about you. It is for sure that user will share his or her experience on social media. What a practitioner can do is to provide a platform where at least the doctor can reply back. Failure to do that will result in dissemination of one side of story in isolated communities of social media. It may be out right misinformation about you, and worse still you may remain totally uninformed.

A tweet sharing an obvious over-prescription of drugs , by a practitioner. it’s retweeted by many who came across. Right or wrong, good or bad , a news spreads fast on social media.​

It’s not that the patient only have their grudges to share on social media. Satisfied patient use social media to share their good news among their communities. That’s is better promotion of your capabilities if a patient is sharing is good experience. All you have to do is to amplify it among the appropriate user.

Users share the information not only about you but also about your competitors. No business can decide a business strategy without factoring in the competition. In the competitive landscape of clinical practice, it’s even more relevant. Social media is a prefect tool to get accurate estimate of your competitors, not just what they are doing wrong, but also what is working for them.

In practice, patient is god, but a competent and loyal employee is no lesser god. People gather information  regarding the prospective employer before even thinking about applying. The social media also gives you an eagle eyes view of the professional landscape, if you are out for head hunting of new employee. Of course you can keep an eye on existing employee through their social media activities.

3 : Break physical boundaries

Seth Godin describe “

Revolutions destroy what is perfect and make the impossible a reality”.

Social media is a revolution which is not only spreading like a wild fire, it is disrupting every established business that is  coming it’s way.

If you think the music , retail and travel industries were vulnerable , and medical practice will be resilient for disruption, than it will be a mistake.

The online services are not limited to the doctor discover and ordering and delivery of medicine. On-line consultation and tele-medicine , with all it’s limitations are are slowly gaining the ground. It’s not limited to the teaching institution’s sponsored programs, it’s very much becoming a   business.

The US bases company doctor on demand has not only received a fresh round of funding, it has also been accepted by government to be included in the public funded health plans, there by giving it formal legitimacy. The reason is simple, the online services are cheaper, so more people can afford it. At least it’s better than absolutely no access to the doctor. Now it can be anybodies guess how would Indian government react if it gets any such proposal.

 If anything is online, it is on social media.

Social media offers a parallel channel to every possible service that is delivered online. It not only provide you with your own canvas to paint your own picture, it also guarantee that the canvas is big and choices of color are infinite.

Take the example of doctor search site Practo. You can have profile which the patient can access, so also your competitors. They have strict format of what can you can display and  what you can not. Anything that allows a direct communication between the patient and doctor is not allowed, because that will make the sites irrelevant.

The site ensure everyone looks the same. So user can choose the one who is cheap and easily accessible. But the doctor are not the same, just like any other field, there are good ones and exceptionally good ones. Now the question is how does an exceptionally good doctor stand out of the rest.

Now look at the Facebook page of doctor.You paint your picture the way you want. Have you photos,share you videos.let people post comments and connect. You can display everything that you want your client to know. They actually encourage you to communicate.  Facebook is no mediator, filtering every message.

Strategy: Best use of social media

1 : Focus

 Start focusing on social media, among the options of the promotion you have. In terms the demand for time and money, it’s still the cheapest. for the a beginner, there are plenty of the option which are totally free. If you are new in the practice, you don’t need to purchase any paid ads. Facebook profile, Facebook page, LinkedIn profile, Twitter and Instagram account are in them self best advertisement, for free.

If you are already using these medium than you should start taking it more seriously. Most of the social media network help you advertise . All the network help you target the ads to the user details. Facebook can help you pin point your ads not only to a geographic area, demographic parameters, but also on taste, preference and more.

2 : Integrity

Medical practice is among those profession which is greatly affected by the reputation of the the doctor. Like a film star you are known by you last hit. Or miss. People make a perception about you from the variety of the content they notice about you on different social media and communities. You can not be a reputed surgeon holding a scalpel on one site and contesting assembly elections donning khaki on other. You should clearly define what kind of image you want for yourself (scalpel or khaki) and stick to it across the media be it Facebook or Instagram. This holds good for photos, you post, comments you make and the content you share tweet ,tag or pin.

It’s not about you, it’s about them.

It can be used as a test to assess if you are posting is good. Ask yourself if this post will add any value to you patient or not. If yes, post it, If not, than you know what should be done with it. A simple post about how a patient can avoid falling in washroom is great. So is the arrival or a new CAT Scan in your facility, it must be shared with others. But can you say the same for the photos of the inauguration party of new CAT Scan , with cake smeared on the doctor’s face ? I will say it can be avoided as it’s not about them.

3 : Content

Everything that you share on social media is content. your profile photo, photo of your foreign trip, a comment on someone else photo, a video shared or tweeted, a blog written by you. every thing is content. an every type of content has its own utility depending on the platform you are using. 

4 : Consistency

No body likes someone who publishes in bursts for a week  than suddenly he/she is  nowhere to be seen for next three months. Its important to have good content , but its even more important to publish it consistently. Start with once a fortnight , if that is all you can manage in your busy practice. You can always increase it up to once a week or more, as is possible. Than stick to it.

5. Engagement 

It basically means the interaction of people with the content you publish on social media. It can be a like, a recommend, a comment, a share retweet or up-vote. Your target should be that others share your content, and that is the best gauge of its quality.

Not everyone is active on social media every second of the day, plus the there are millions of viewers and an equally staggering volume of the content uploaded on the social media, every second. How do you ensure you content meets the right eyes? The best policy is to share your media on multiple platforms and frequently. If you have published it once, it’s absolutely okay to post it again twice or few times a day. You also need to know how to target the content for a particular profile of users. 


HASHTAGS # though you will see it more frequently on twitter, they’re a very common used use to add meta information to your content. It helps in targeting the content to particular group of users using or searching the content using these hashtags.

There are more than 200 hundred social media networks and many are added to the list every week. Facebook  LinkedIn , twitter, Instagram ,  Pinterest , Google plus , Reddit and Quora  and the list goes on an on. You need whole team of skilled people who can professionally manage all of them together. But you can choose a few, depending on your taste and amount of time  you are willing to spent.

Facebook, LinkedIn and Twitter are three every doctor should invest in. add Instagram a if you have still more time and energy left with you.

Practice makes a man perfect.

Tweet , tweet and  tweet, to make a perfect practice.

It’s like a metro station, there are lot of people around, but everyone is busy and no one has time to listen to what you have to say.

There are more than 18000 new tweets posted on twitter every second, so you should have something interesting to say , for people to stop and listen. It’s no surprise that the average lifespan on a tweet  is less than quarter  of what a post last on facebook. Its difficult to make a ‘place for yourself and it’s easy to get lost in the crowd.

‘But it has a distinct advantage over others, which makes it so popular among marketers.

It’s a big party where everybody is there,  you can talk to anyone, even the strangers. You don’t have to introduce yourself, pursue or comment.  Just go and talk. All you have to do is to tag him in your content, to get a person’s attention, if you are lucky than a reply also. This makes it so valuable a platform, if you have right mix of talent and patience.

What can you  achieved with twitter ?

  1. Get more people visit your profile and learn about you and your services.
  2. Get more people who actual avail your services
  3. Better connectivity with patients
  4. Build followers.

These are few tact of the trades which will help your practice stand out, if done in a way the successful people have done it.

You cannot expect others to talk about you, when you yourself is not doing that. Use your profile to accurately display your qualification, abilities  and services that you provide in your facility. You can even use use it to display your contact details.

1 : Profile

Photos : Medical practice is all about trust. Photos should be identifiable and professional. The option of background photograph provides a good  opportunity to display your facility or brand.

Write your Twitter bio to address the audience you are targeting. keep it simple and include the information, which  what matter most your patient chest specialist. If the space allowed write about your achievements and associations medical practice is a serious business

 Practice is a serious business so casual photographs, funny pictures  and comments should be to be avoided

Add relevant hashtags so that people can find the account that looking for you.

These are few examples how profile photograph background photograph and fire can be used stipulate an excellent profile.

2 : Do basic research

Use the common hashtags for your specialty or the services to search for what is happening in your field. You can see the news, views,  people, clinics, hospitals and more.

A : Patients profile

Scanning the patient profile will let you decide what kind of issues the patients are raising in your filed of specialisation.

B : Service providers

Keeping an eye on the content posted by others especially the fellow doctors gives the best idea what type of content is working and how the users are reacting to it. Find out the influencers in your field and find the ways to connect them. Interact with other professionals related to the field who may not be your actual competitors like paramedics and other supporting staff. Following them not only gives you a great  Insight into practice but also helps build your brand.

4 : Content:

It’s not  about you , it’s about them.

    As already said, it’s like a party. One attribute that really helps twitter stand out among other social media platforms,  is that people can talk. You can start a discussion , or participate in debate already on. Only if you contribution is wise and positive , others will like it, and some will start following you. The best way to increase your following on twitter is to participate in the discussions. You can use hashtags to find what is being discussed on any topic. 

1 : Help others

Your posts should clearly demonstrate the value that you are trying to add to others, directly or indirectly. Showcasing that’s that you are trying to make people’s life better is always appreciated

2  : Educate others

One of the reasons why people come to social media is to find answers to their questions, which they may or may not accurately articulate. People will stop and listen you, if you have something important and useful  to say.

3 : Appreciate others

People always reciprocate by appreciating you back . Appreciate what others are doing, share and retweet what other are tweeting. It always help.

4 : Promote

Once you are done with everything, promote. Why should people come to see you unless you do not ask them? Clear call for action is very important for people to know what you and decide to avail your services. 

5 : Promote without pitching

You can promote even without saying so explicitly. Providing information to the usual patient related issues are the best way to attract the attention of the potential patients

6 : Share the happiness

Let others know if patients are happy. Positive experience shared by a fellow patient is one of the commonest way people use to decide their doctor. Use it whenever possible.

7 : Be interesting

There are no hard and fast rule , for what works on twitter, what doesn’t. Just make sure that it is interesting. Ensure that the topic is rightly timed and has the correct context.

8 : Count and frequency.

Ideal situation is to post as many post as you cana but that you will have no time for your practice. Best way is to start will minimum number you can manage. It may be once a day or once a week as is convenient. You can slowly increase the count as you manage or delegate someone else to do it, but consistency is important. As  an average tweet last only for few minutes, so it is advisable to retweet is as many times as possible so that it can be seen by maximum number people.

9 : Timing

It’s often advised that one should tweet daily at a fix time . We do not agree with that as everybody is not available at same time . At breakfast time, at lunch and in the evening are the three convenient slots which should be used interchangeably to tweet. That givens a tweet the bets changes of been seen by maximum number of users, at least, theoretically.


5 . Analyse how your tweets are performing

A : Profile views

Twitter provides you the tools to see how your tweets are doing. The total number of the tweets are directly related to the number of impressions it get, and more importantly the profile views. It is the profile views which matters for practice point of view. So more you tweet better it is. Unlike Facebook , twitter do not penalize you for tweeting more.


Regular tweeting not only attract the people you are following, it also attract the people who follow you.

Mentions tells us about how people are discussing about our tweets. It tell about how interesting out tweets are.

If you stop tweeting, people quickly forget you, as many new tweets are pouring in regularly. So tweet, tweet and tweet.

B:  Followers

Followers decide who you are. It is not only the numbers, but also the profile of followers. The most important fact is how popular they themself in their domain of influence. Your followers can not only introduce you to whole lot of new people but stamp their approval on what you are pitching.

C : Effective of Content

You need to look into what is working and what is not. The  well received content needs to be frequently tweeted and retweeted so that others may also see it


The best place on social media where doctors feel at home is LinkedIn. The discourse is serious and every body just mean business, exactly the way doctors  want.

There are few interesting points which worth to be mentioned hereT

1: Profile

One cannot emphasize it enough that you should have an updated profile on LinkedIn.

A report from  U.S. News survey from 2014 says more than one fourth  of Americans  searches online to find a doctor. We are observing a similar pattern from India as well. That is not surprising. What is amazing is the fact that they make their decisions on the basis of doctor’s education and medical training, and their hospital affiliation. 

LinkedIn profile provide the best online platform to do that. It has options to showcase your skills and scientific publications, patents and rewards. It’s quite understandable that all patients might not understand your publications and patents, but your colleagues and people from related fraternity can.

Contact details

Unlike the doctor discovery website, most social media websites allow, the user to display their contact details. Here you can show your clinic address, your website and contact number. Make the best use of it.

This bring us to the second important point in LinkedIn profile, your connections.

2 : Connectivity

More than third of the patients rely on recommendations from their friends to decide who they should consult. Patients think now they have enough information about a doctor to make an informed choice. So it really matters that you are well contented. What matters even more, that the people that you are connected with, know what you are best in. 

LinkedIn offers the options of the professional groups, which are similar to that of Facebook. Only difference is that people do not join LinkedIn group for fun and gossip. As people are basically there to do business, they appreciate if you showcase your skills, specialty services, newer observations and research. Use the groups to let everybody know your services and how do you stand out from your competition.

All this is possible if you know what type of content is popular on LinkedIn.


3 : Content 

Long form , detailed and well researched article, coming from a person of authority in the field,  have traditionally done well on LinkedIn. Length of the article is not an issue as  long as you know what you are talking about.  If targeted to appropriate audience and groups, engagement rates are good, as everybody here means business. 

The videos are also getting progressively popular on LinkedIn. If you stick to your core speciality , video do just as well on LinkedIn

Once in a while you will also come across the  motivational post, which are well  accepted by others. but these should always be the last choice of content to post, not the first.

4 : Content Sharing and Promotion

LinkedIn provide excellent tools to assess who are engaging with your content. LinkedIn has higher engagement rates than Facebook. LinkedIn also provide options of paid ads if you want your content to advertise.


Though , Facebook is supposed to be a social media site, but the shear number of user make it the first choice among the marketers as well. It is not surprising that the  number of Facebook users and the  Facebook advertisement rates are constantly rising .


As a practicing clinician,   Facebook should not be ignored as it is becoming primacy mean of communication and exchange of information , in our society. Its common to see people missing to take their medications, but  at the same time , people are finding it difficult to stay away from Facebook.

Facebook business page

It is common to see doctors being active Facebook but not having the Facebook business page of their practice.

You have the option of displaying the details of the services that you offer, including the price (if you wish to), and the contact details so that patient can contact use directly. This is beside the regular messaging services offered by Facebook. You can post the details about any event related to your practice and even create an entire community around it. This is far better that any doctor search and discovery website, you enrol with.

Facebook groups

Facebook groups offers two distinct advantages to the user.

  1. You can target your content to a very specific group of people with a clearly defined characteristics.
  2. Keep an eye on trends and activity of competitors.
  3. Interact with potential patients, as groups are commonly used by patients to inquire about health issues.

Groups are the best places to display and advertise your skill and services. Try to add value helping a patients by providing him with valuable information about any medical issue, so that others are encouraged to share. Avoid placing an overt sales pitch, as these are discouraged by admins and other users.


If you think that Instagram is only for the kids then you should think again. Not for nothing brands like Harvard Business Review and MasterCard promote their products on Instagram. And so also the doctors, clinics and hospitals.

Instagram provides a very little space to provide details in a profile, so use it smartly. Be short and precise in your introduction. Clearly define the services you wish to provide your clients. You can provide your contact address and website link. As Instagram does not differentiate between business and private profile, you can have your logo as your profile photo to advertise your brand.

Profile have option of giving your phone number email address and even the Google location. All you have to do is to draw the user’s attention so that it looks to your profile.


Instagram allows you to post pictures and short duration videos in the description segment there is no word limit but you cannot add a link to it.

It is not surprising that visually appealing photos, pictures with motivational text are very popular on Instagram so make sure that you published something which is very visual appealing.

People do not come to Instagram to for entertainment. Aesthetically unappealing photographs, photographs of patients during surgery or scary stuff related to the clinical practice should better be avoided. What might be okay for a doctor may simply be scary for a normal person.

1 : Promotion

Instagram the words do not mind continuous bombardment of advertisement after advertisement. As long as you can ensure that the post is visually appealing and can draw the attention of someone scrolling Instagram feed it is ok.

There are very limited options for the user in form of buttons to be distracted cluster post are displayed one by one. This is the reason why the conversion rate of the ads posted on Instagram is highest all social media. If user like the post, he or she explores it, and gets converted into a customer. As the description section does not allow you to add link, user has to actively check your profile to get converted, whatever you’re right in description must have clear call to action. 

2 : Type of post

  1. Informational/ motivational post for patients having images along with bold text on the image.
  2. Images of your facility oblique clinic or hospital.
  3. Avoid the photographs of the patients as it might disclose his/her identity, which is ethically wrong.


For practicing doctors , social media offers immense opportunities to show case their skills to a larger audience. what matters is how well you use it?

Share your experience in promoting your practice on the social media. Let us know what issues are you facing in this regard. Share this post with others if you find it useful.

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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Cataract Surgery

How much a Cataract surgery cost in India?

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Credit : Pixabay

Cataract surgery has no fixed formula to calculate a cost, but there are few rules which worth to be mentioned to help decide right place get operated. Having a relative getting operated is often a ‘once in a lifetime’ experience, and biggest question is how much is it going to cost. Am I been quoted a fair price or I am getting fooled. 

Surgery packages:

Most of the cataract surgeons in India practice what they call as surgical packages for what they charge for doing cataract surgeries. It is mainly limited to uncomplicated age related cataract done under without giving the general anesthesia.

The” Package” include, pre-operative examination, surgeons fee, surgery charges, anesthesia charges, medication given during and before surgery, cost implant (Lens) and hospital stay. it varies from, hospital to hospital , surgeon to surgeon, city to city, type of surgery ( SICS> Phaco> Femto Laser) , type of lens ( Indian Mono-Focal > Indian Multifocal> Multifocal )  and so on. Cost may vary from 10k -150k depending on the combination of doctor, hospital, surgery, lens you have chosen for you.

Cost of the post-operative drugs and additional intervention after the surgery are usually separate.

How to confirm that you have got what you have promised?

At the time of discharge, patient gets the discharge and treatment summary, which mentions name of surgeon, anesthesia, details of surgery and details (name and brand of lens) implanted in the eye. Brakes down of the charges for each item are usually not provided.

Can you bring the lens of your own and hospital to implant it?

Most of the hospital gives a fairly long list of Lens to choose from. One can choose from the available options. Hospitals usually do not allow surgical implants and disposables from outside. It is because hospital has to maintain a huge inventory of each and every disposable and lens in different sizes and numbers and often in multiple numbers as the backup. If a lens or any disposable gets damaged or contaminated while handling it during implantation, hospitals have multiple similar pieces in back up. It is not possible if patients bring a single piece from outside.

More over surgeons often have expertise and a certain comfort level with certain brands of lens, which they implant daily. Most of the surgeons have serious reservations against trying a new lens, in that event of stress of doing a surgery. So they usually do not agree for this.

Brands of Lens

There are many different types of intra-ocular lenses available in India. Most surgeon/hospitals offer surgical packages based on Indian (cheap) and imported (expensive) lenses. Imported lens are costlier than their Indian counterpart and are preferred by both patients (rich) and doctors alike. There are no scientific studies which validate the difference in the quality of the two, this notion continue due the common perception that imported goods are superior in quality.

Indian versus imported lenses

In eighties and nineties, when ophthalmologist began to switch to lens implantation (rather than leaving the eye without the lens and giving the patient thick glasses). At that time the lens needed to be imported from US and Europe, as there were no lens manufacturers in India. Though the imported lens were of good quality but were very expensive. In nineties some Indian companies started manufacturing lens in India. The lens manufactured were quite cheap, but the quality wan not as good as those of the imported once.

Now days there are many Indian companies who are manufacturing the lenses in India, and also exporting it to many other countries, which include US and Europe. Since they have to meet stringent FDA and EC guidelines for that, overall quality of lens manufactures in India matches with any of the manufacturers from abroad.

So in my view, it as far as the  quality  of the comparable lens (similar lens material and design) is concerned, there is no difference.  The imported Lens usually cost 3 to 5 times as much as an Indian lens. Various government bodies are raising concern of this pricing of the lens in India. Quite likely, we may have some government regulation on price control of lens, in day to come.

Imported: Alcon, AMO, Zeiss, Bausch & Lomb, Hoya.

Indian companies: Appasamy, Omni, Aurolabs, Biotech, Care,

Foldable lens versus non foldable (rigid) lens?

Foldable lenses are more popular and expensive that their non-foldable (rigid) counterparts if all other parameters are same (design, brand, country of origin). There are only two scientific studies (one from Thailand, other from France ) which were designed to see the difference  in the vision and other outcomes after the surgery, among these type of lenses. Neither of the two studies reported any difference among the two.

Tips regarding selecting lens packages in cataract surgery.

  • Surgery packages: 10K-150K INR chose as per your budget.
  • How to confirm that you have got what you have promised?  Discharge Summary 
  • Can you bring the lens by your own ? No 
  • Which Brands of Lens is better? All are same. 
  • Indian versus imported lenses, which are better? All are same
  • Fold-able lens versus non-fold-able (rigid) lens, which one is better? All are same

Also read

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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Inappropriate cataract surgery: is it a myth or reality ?

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Credit: Pixabay

There have been media reports in which the doctors and the hospitals have been accused of performing cataract surgeries when these are not actually required. The question is, are these really fake news or are actually happening?

Media reports a recent media report, attributed rapid rise in the number of certain type surgeries being done at various hospitals , to the fact that some of these surgeries are been done for economic reasons only. The patient may not have actually needed one. Among the many surgical procedure, the cataract was reported to be the commonest.

Targets to meet: News report say that in corporate hospitals, the doctors are pressurized to perform more surgeries to increase the corporate profits as surgeries offer greater financial return in shorter time. Consequently some of the patients are advised to undergo cataract surgery in spite of the fact the patient can manage without it. It further suggested that those who are advised to undergo surgery should better have a second opinion, which is very much concerning. Similar concern are also been reported from advanced counties as well.

The Optometric-Ophthalmic Kickback Scheme: Dr Robert P. Gervais reported the arrangement of kick back system practiced in US, in which patients are predominantly operated to make money, by ophthalmologist in cooperation with optometrist. It is surprising that it is practiced in a country like US where documentation and other regulations are so diligent followed. The scenario could be much worse in India where it is difficult to enforce government regulations.

Also read: 

cataract surgery : an ultimate patients guide
How much a Cataract surgery cost in India?


Scientific reports: a number of scientific publications have reported the documentation of performing unnecessary surgeries to be as high as 30 percent for certain type of surgeries. Practices of unnecessary surgical procedures in Indian scenario are been well documented in case of caesarean deliveries and hysterectomies under government insurance schemes .

Government stand: a senior government minister have expressed concern on this issue and share the perception that kick back, cut and commission is prevalent in some segment of practice. They have also ” considering to bring some type of oversight for pathological laboratories and diagnostic centers to end the corrupt practices including possible nexus between doctors and the laboratories, and cartelization among diagnostic centers

Doctors and representative medical bodies: They largely dismissed the concerns over profit-driven tests and procedures as a “perception,” saying corruption is less widespread than the media would have it appear. “The medical profession is noble and will remain noble,” “There are people who are corrupt, they are facing charges and they are being punished.”

Credit: Pixabay

Conclusion: Though the actual figures may actually be debated as what percentage of doctors are indulging in these kind of practices but these reports certainly points to the maligning of reputation of whole profession. These will only add to stricter government regulation and legal scrutiny of clinical practice and practitioners.

Please share your comments below.


Dengue : Mosquito control measures at home to avoid dengue ?

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Monsoon has arrived and so also the news reports of the dengue cases from the national capital. Its nothing new that cases has began to be reported in these month. Lives in the cities take its own course. People think that mosquitoes can only bite those living in slums and unhygienic localities. It is not true.


Disease of underprivileged:

 Though, dengue more common form urban poor areas  and the countryside but also affects more affluent neighborhoods. With poor urban planning, this  segregation is further blurred. Just because one is living in a posh locality is no protection.

What can be done about it ?

Don’t get bitten?

Best thing that can be done is to avoid getting bitten by the mosquitos. The mosquitos mostly bite in the day time, not the night. Things that can be done are

  1. Full sleeves cloths



These contain  natural ingredients like citronella oil, Eucalyptus oil & other herbal extracts (with Aloe Vera base) to keep mosquitoes at these do not contains harmful chemicals/DEET, these are presumed to be safer for all age groups (including children) . There are also associated with lesser risk of skin reactions.

Natural Anti Mosquito Repellent vaporiser

mosquito repelling or trapping devices

Ultraviolet light mosquito trapping machine

Mosquito trapping devices  trap or capture the mosquito using  light, taste, and wind technologies . As harmful chemicals are not used , these are safe for human health and are environmentally friendly. It capture and kill   female mosquitoes which are more common in indoor, thereby, interrupt the breeding cycle of mosquitoes in the surrounding space and making the area mosquito free.

Ultrasonic pest repelling machine

 It emits high frequency ultrasonic sound waves to create an acoustically hostile environment that repels rodents, cockroaches, spiders, ants .

Mosquito nets

Mosquito swatters

Don’t let mosquitoes breed

Management of Mosquito in breeding sites

Mosquito  larvae bacillus

It is made with koline and bacillus species. It is found to be safe for  fish , animal and human . It prevent breeding of mosquitoes in stagnant water.

Mosquito  larvicde

It contains Bacillus thuringiensis or Bt)  is a commonly used biological pesticide to destroy mosquito larvae.

Improvement of water supply and water-storage systems : 

Get the leaking pipes repaired in and around your house, including leaking taps, uncovered overhead tanks. It is often because of ignorance  than actual cost of repairs.

Making water-storage containers Mosquito-proof.

 Solid waste management : 

Ensure that solid waste is  Properly stored, collected and disposed. Discarded useless containers, particularly if  they can act as breeding ground for mosquitoes.

Keep Streets clean.

DENGUE VACCINE : It is still under clinical trail and government has not yet approved it for in India.

Few basic steps taken to keep environment clean can help us reduce the disease burden. so lets do it. please comment and share your views.

Also read

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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eye donation

Eye donations in India : Fewer and far apart.

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In spite of the fact that more than a  lac people are blind in our country and need corneal transplants , the cornea (eye) donations are very low in India. why ? 

If the statistics of   National Programme for Control of Blindness (NPCB) are to be believed, currently, India is home to around 120,000 corneal blind persons. It also says that we are adding 25,000-30,000 persons with  corneal blindness cases every year to this list. But that should not be an issue as we can easily help them by donating a cornea to them. After all, we all have a pair of it, which will anyway be useless for us once we are gone.

Now the question is, if it is that simple than why people in India do not donate their corneas.

Lack of awareness 

Large count of those who cannot see is a matter of concern.  So also the fact that rest of us who can actually see, are not aware of this fact. And those of us, who do know, do not how to proceed.

Cultural and spiritual notions 

In certain communities, people have emotional attachment for a body organ, which is why they are reluctant to donate it. The fact that eye is the only external organ that is donated, is also reason people find it hard to decide in favour of its donation.  In Britain, the person registering for the organ donation gives consent for all their organs and tissues for transplantation. Around 50% registered users, withhold their consent for eyes, followed by 40% for heart.

Myths and misconception

Disfigurement of corpse: it stems from the lack of the awareness of the cornea harvesting methods among the people. It is a misconception that whole of the eye will be removed which will leave the corpse disfigured for mourners to witness. Actually the process involves retrieval of the cornea only, and the contour of the lids after closure is very much maintained. Moreover it takes only few minutes so do not delay the funeral as well.

Lack of nationwide donor registration

Donors pledging for donation of the eyes contribute in spreading the concept of eye donation in the community. The conscious and informed decision taken by a living person makes it less difficult for relatives and friend to decide and consent for donating the eyes of the that deceased family member in the moment of immense tragedy, just after his/her death. It is seen that only half of families   approached for donation agree to donate a relative’s organs if they are unaware of their relative’s decision to be a donor.

National Organ & Tissue Transplant Organisation recently constituted to facilitate organ donation and transplantation in India. We are yet to have a centralized organ donor registry which can facilitate this work. The centralized donor registration agency in US is donate life america. It is a non-profit organization, is engaged in awareness and fund raising.  Around 56% of US citizens are registered with it. In India we have few NGO’s which are working in this field but their area of work is still limited.  We need more common organ donation  campaigns which target multiple organs rather than eyes only.

Lack of transplantation facilities.

In year 2011 approximately 150000, corneal transplants were done worldwide, out of which majority were done in US and Europe. Though we have largest number to people in need of this service, we could only do approximately 17,000 corneal transplants. This is primarily attributed to underdeveloped eye banking services. Though we have 700 registered eye banks, only an average of 25 corneas are transplanted by each per year. One of the media report said that out of 100 corneas retrieved from donor, only 50 % could actually be transplanted in a recipients.

Whatever the circumstances, we should all strive to increase the corneal donations in our country. As correctly said by someone,

 “It is easy not to donate; it is hard to be blind.”

Please share your comments, what more can be done about this.

Read also

Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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doctor discovery website

Online doctor search websites: risks for associated doctors.

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india-1034843__340 (2)Online doctor search websites offers the doctor good online visibility and availability, just like other streams; are there any risks associated with these kind of associations for doctors? I think risks are real and multiple.

I was looking for a dermatologist in the city, and i thought of giving a popular Online doctor search website   a trail. I typed initial alphabets of the word “dermatology”, it showed the list of 30 dermatologists in the city. In spite of the living in the city for 15 years, i could not identify most of them.

Most of the information was expected from Online doctor search website like fee, location, schedule and profile of the listed doctors.  There was enough information available online to actually decide who should be consulted. It has details of ones qualifications, affiliation of present and past and of course, the patient’s reviews. Plus it also had the assurance that if i am not been satisfies by the experience, i can at least write a negative review.

But there were some facts which actually drew my attention. The first 10 dermatologists had almost similar qualification (10 yes post MD) , fee ( 400-600 INR) and reviewer’s ratings (90-100%) and exactly same profile as there was no options of customization of profile for the doctor .

Online doctor search websites: Stay close and be cheap 

adventure-2178442__340Clinical practice has always been different from the online sales of the movie tickets. It’s never actually about the number, though  a good practice is always reflected in patients count. Patient comes to you with a medical issue, often in distress. You establish an emotional rapport and trust with him, and treat him.

A satisfied patient shares that emotional connection and trust with other people which help a doctor to build the reputation in the community.  New patients coming to him are often refereed by older patients.

He/she is already primed about the doctor’s capabilities and knows what to expect. Slowly but steadily doctor build a follower ship of these satisfied patients which maintains a steady flow of new patients and is called a practice.

These Online doctor search websites reduces a doctor to a commodity, presented in a grid fashion, where all are more or less same and meant to be chosen on who is cheaper and conveniently available. Patient has to give star rating about how he felt about the experience. Patient can have hundred reasons why he/she gave a particular review or star rating and the next user has hundred different interpretations of the same review and rating.

There is no room for standing out of the lot, and if you want yourself to be featured ahead of others, than you pay for it. Practice is all about establishing your distinct identity among your colleagues with a separate patient base. You do not compete with your colleagues; you complement them in areas of weakness.

Online doctor search websites are designed so that patients develop loyalty with the site and a long term patient doctor relation could not be established.  If the doctor’s clinic is at a distance, select closer one. If time is not convenient, select some one more convenient to you. If you are not willing to move out, get an online consultation. You cannot contact with the doctor directly, by any means.


Also read:

Must know facts for online doctor search.

Medical Tourism : Trends, reasons, and a lesson.


Online doctor search websites :Patient inflow

india-1723464__340Very design is such that is redistribute the users among the service provider. So if there are 1000 dermatology patients in a city with   30 registered dermatologists, site will ensure a distribution of these patients among the available doctors, is a way which is cost effective to the users. And how will the service providers compete with each other to increase the patient inflow.

You are available for longer hours and cheaper rates. Those who doubt it can have a lesson from recent OLA and UBER drivers’ strike. People initially joined these companies because they can get customers easily, but soon the number of drivers associated with the network sky rocketed without an associated increase in the number of customers. It forces the company to frame the policies so as equability distribute customers among the associated drives, significantly bringing down the monthly earning, making it non-viable indian-318643__340option for some.

Patient’s personal and health related data 

As of now there were no clear cut guidelines. With drafting of Digital Information Security in Health Care Act.(DISHA), government has defined the policies clearly. It says that Protected Health Information (PHI) includes individually identifiable information which in-turn includes ‘sensitive personal data or information’ (SPI).

The new guidelines state that Protected Health Information (PHI) is owned by the patients and it the duty of the doctor to protect and secure the stored health information on patient’s behalf. Individually identifiable information not only includes name, contact number and Adhar but also the voice recordings of communication between doctor and patient that are non-clinical in nature. The  policies of every doctor search and appointment site clearly state that they are not a party in the doctor-patients relations , which leaves doctor squarely responsible to every contact or communication that happen  between doctor and  patients.

Online doctor search websites :Medico-legal responsibilities

holi-2198066__340There are no legal agreement between Online doctor search websites and doctor regarding the distribution/sharing of the duties/role and information disclosure policies. Online doctor search websites do not take the responsibilities regarding verification of patient identity and obviously take no measures to ensure that.

Some clearly state that they are not responsible if the user provided the incorrect information regarding personal identity. This put the doctor at serious long term medical-legal risks. Most of the websites have the stated policy of sharing patients contact details to third parties, (health information providers, drug supplying companies, investigations labs, taxi companies and so on) or have sister concerns engaged in these business.

Some of the companies encourage doctors to give online consultations on phone, mail, whatapp or similar applications. New regulations clearly state the doctor’s responsibility of ensuring privacy and data protection of patients consulted as these website are clear that they are not a party in doctor – patient contract you are entering in, with the patients.

Online doctor search websites : What happens in developed countries?

This concept of Online doctor search websites, is been there in US and there are few popular websites as well ( zocdoc). HIPPA (1996) clearly define a set of national standards for the protection of health information in US. All the site providing online doctor search and appointment are supposed to be HIPPA compliant. A lack of similar regulation in India could be attributed to proliferation such websites in India, which provide single stop solution for getting everything, from consultation with a doctor to ordering medication and gym membership, and from a single window. A similar lack of awareness among doctors could be a reason for doctors joining them.

One does not need to be a lawyer to negotiate through these offers. The important of being aware of once professional responsibilities cannot be emphasized more. There are two simple rules which can save anyone from landing in any of these risky associations.

  1. Never associate with any online site without diligently reading and understanding the privacy policy and terms and conditions of the site. Later can easily be found on the header or footer section of the site.
  2. Be aware of you responsibilities for patient’s privacy and protection of health information. Complete information is available at  information at the website of ministry of health family welfare, govt of India.
Medical practice

Medical tourism: trends, reasons, and a lesson.

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Are the issue of cost and quality the only parameter which decides where a patient will go medical tourism? Are these trends of medical tourism, more universal ? Is there any lesson to be learned ?

I recent came across a YouTube video appreciating the health facilities in India, and discussing the difficulty faced by former Pakistan hokey player Mansoor Ahmed to come to India for treatment. It brought me to questions, why had he chose India and what other options he had beside India. A recent report points to the fact large numbers of medical tourists care coming to Asian countries for the treatment , due to cheaper costs and high-quality healthcare services. India holds the second place, after Thailand which is at first.

Regional trend of medical tourism.

International medical tourism: 

We all have heard politicians and film stars going abroad for medical treatment. For last two decades it has become a industry with an estimated business of 50 B US dollars. Americans, Canadians and Europeans are the mostly the patients who travel to India , Thailand, Singapore and other south east Asian countries. Bumrungrad International Hospital , in Thailand is world largest international. It see more than a million patients a year , half of them are foreigners coming from more than 190 countries.India mostly receives patients from Africa and middle east countries. Affluent people from across the world flock to US for treatment as the its standards of healthcare are still the bench mark.

Medical tourism in India:

New Delhi is an epicenter of the healthcare for people residing in north and central Indian states.similarly Hyderabad and Chennai act as similar epicenter for southern states. it is not uncommon to see people coming from Bihar and West Bengal , to AIIMS New Delhi for cardiac and paediatric surgeries.

Medical tourism within states 

people from far off districts commonly come to the hospitals in state capitals for surgeries and other modern medical treatment often not available in peripheral districts of a state. all highways coming to any capital cities have clusters of private hospitals in the periphery of cities limits , most of which primarily cater to peripheral patients only.

Specialty destinations of medical tourism.

The movement also follows a trend in the form of the destinations becoming popular for certain type of specialised medical care. Isreal is popular for in-vitro fertilization , Thailand for sex reassignment surgeryand India for bariatric surgery and cancer treatments . For cosmetic surgery popular destinations are ArgentinaBrazilCosta RicaCubaEcuadorMexicoTurkeyThailand and Ukraine. In India we all know that Chennai, New Delhi and Hyderabad are very popular destinations for Eye surgeries. Similarly New Delhi and Banguluru are for cardiac surgeries. This pattern of specialty destinations could also be witnessed at state level as well.

Shri Sadguru Seva Sangh Trust, a charity hospital located at a small town named Chitrakoot, in Madhya Pradesh, India is known to operate 1,43724 cataract patients in the year 2015-16. It attract lot of patients from many adjoining district of Uttar Pradesh and Madhya Pradesh and Rajasthan. Similar example can also be seen elsewhere in the country.

Reasons for Migration Of Patients

Cost of treatment of medical tourism.

Probably the most important reason for the international medical tourism is the difference in the cost of the treatment for the similar or comparable quality. It is well known that cost of treatment is very high in US. It is often higher than the combined of traveling and receiving medical care abroad. For example hip replacement surgery cost $40,000 to $65,000 in the USA, whereas it costs about $8,000 to $18,000, abroad, which is including traveling expenses. This is the main reason why patients come to countries like India and south East Asian countries. The comparable prices in India usually vary from 0.25 to one 0.1 of the price of a similar medical procedure in the USA.

Quality of services in medical tourism.

Many of the specialized medical centers which are popular among patients have developed state-of-the-art facilities that use cutting edge technology and equipment. The doctors in these facilities are trained in good institutions and have excellent skills because of large patient inflow. Bumrungrad International Hospital has 39 speciality subcentre and provide services using cutting technologies like Robotic assisted spine surgery. Shri Sadguru Seva Sangh Trust, has fully developed sub specialies of eye and has Operation Theater Complex having 25 modular OT and a LASIK LASER suite.

Patient’s affordability in medical tourism

The number of American people seeking treatment abroad is increasing because 1 out of six American is uninsured and there are many medical conditions which are not covered by the medical insurance. It is these types of people who make the bulk of those who travel abroad for treatment and hospitals like Bumrungrad International Hospital offers a good bargain. Shri Sadguru Seva Sangh Trust, offers services to the poor people living in adjoining area and most of the surgeries are done free of cost. Even those opting for the paid services, the rates are very affordable.

Superior brand value in medical tourism

Majority of foreign patients come to hospitals which have a great reputation in the their field. Bumrungrad International Hospital is the first hospital in Asia to be accredited by the American-based Joint Commission International (JCI), one of the groups providing international healthcare accreditation services. For consecutive three years, from 2004 to 2006, it was featured on CBS’s 60 Minutes and NBC’s Today Show as a leader in medical tourism and International hospitals. Among the patients which receive the treatment there, Shri Sadguru Seva Sangh Trust, enjoys the reputation second to none. The Lion Club International Humanitarian Award, 1993 is to name a one, the actual list is a page long. Former president of india, A P J Abdul kalam has written a testimonial of their mission.

Patient care in medical tourism

At Bumrungrad International Hospital they take care of each and every possible issue one can face if one is travelling to another place for treatment. That include, food, language, stay before and after hospital, finance, insurance, airport transfer etc. If their website is to be believed they provide cultural support services in as many as 18 languages. Shri Sadguru Seva Sangh Trust, provide free cataract surgical services through eye camps. Obviously the services may not actually match a corporate hospital, but it include transport to and fro from the home, lodging and boarding , food, surgery and post-operative medication. Even those opting for the paid services, patient has to arrange his/her own transport, and pay for the surgery and treatment, which a very much subsided. Services are appreciated by all.

Connectivity and outreach in medical tourism

 Bumrungrad International Hospital has its international offices in 22 counties across the world, even in Iraq and Pakistan. The website of the hospital is comparable to in functionality and details. Thailand is a major international tourist destination, which gives it an additional advantageShri Sadguru Seva Sangh Trust has simple but functional website which provide all the relevant information. One can have an online appointment. It even provides a contact number for patients to contact in emergency, something amazing for a charity eye hospital. They have 26 visions Centre, in 12 adjoining districts which is the main drainage area for the hospital. Plus it organizes 1500-2000 free screening eye camps to identify patients. Chitrakoot is an important religious tourist destination for adjoining Hindu population.

Lesson from medical tourism.

These migration pattern and underlying reasons offer insight in the way the health services delivery models should be planned. With increasing internet penetration , increasing disposable income , decreasing travel cost and free information flow, physical proximity of the services is not the actual criteria on which a patient access a health facility. This seems to be more valid in case of the public funded health care facilities. Majority of investment goes into construction of facility , manpower hiring and equipment purchase. The intangible qualities like patient care , connectivity , out reach and brand building are often ignored. I could not find a single government funded hospital in UP, in the list of NABH accredited hospitals. It is uncommon to see government hospital having a functional website. If at all there are one, it mostly displays the achievements of the office bearers rather that the services and contact details. It is very difficult to locate the facilities, services and service providers as most of the government hospital do not have anything like patients reception and information system. The patients care is unsatisfactory. All these services and accreditation do warrant an additional financial resources. These facilities continues to be underutilised in spite of significant budgetary outlay. Facilities lacking result oriented corporate work environment could not deliver the services demanded by the patients. Health care being very labour intensive , is difficult to manage in government setting because of administrative inertia.

A health facility is rated not by what it has, but by what it delivers.

What are the issue I failed to identify . Please share your views in the comments below.

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Artificial Intelligence

Artificial Intelligence (AI) in ophthalmology practice: Are Ophthalmologists ready ?

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From accurate clinical diagnosis to autonomously operating surgical robots, AI has more to offer than we have asked for.

The ophthalmic practice had changed with the advent of every new technological breakthrough. The intra-ocular lens in sixties and minimally invasive cataract surgeries in nineties had a significant impact on the practice. Both of these technologies revolutionized the clinical out come in the terms of speed and accuracy of visual restoration making it the ophthalmic surgeries, fast and predictable.

The idea of artificial intelligence (AI) to correctly identify diseases and then effectively treat patients as good as doctors do might be possible in the future. That idea will definitely take some time to take a shape, till than an ophthalmologist will be an indispensable cog in the wheel of patient care. Not many of us will reject the possibility of this revolution but we do believe that this is not happening any time soon.

Clinical diagnosis and management decisions

Reports about the upcoming AI related platforms in eye care, are painting an entirely different picture. Erping Long , China had tested An artificial intelligence platform  for the management of congenital cataracts. They used a deep-learning algorithms to create AI agent involving different functional networks to perform three important task (i) identify potential congenital cataracts patients in populations (Screening) (ii) Comprehensive evaluations of disease severity (lens opacity) with respect to three different indices (opacity area, density and location) (Risk stratification) (iii) Provide the final treatment decision (Surgery or follow-up). The researcher explored its feasibility, versatility and utility in management of congenial cataract and compared its real-world performance with an individual ophthalmologist. The training data for this deep-learning network included 410 ocular images of CC of varying severity and 476 images of normal eyes from children, categorized by an expert panel.

The results of the study were simply amazing. The AI machine could distinguish cataract patients from healthy individuals with an accuracy of 98.87%. It could provide a treatment suggestion (surgery or follow-up) with an accuracy of 97.56%. They further validated its  ability to identify the diseased patients in  a realistic  real-world ratio of rare-event disease to normal cases. In this case, the test data consisted of a total of 300 normal cases and 3 cataract cases of differing severity. The agent successfully excluded the normal cases, identified the three cataract cases and provided accurate evaluations and treatment decisions.

Its performance, when compared with individual ophthalmologists, was even more remarkable. In terms of accuracy, the AI agent out-performed individual ophthalmologists on every parameter analyzed, be it diagnosis or management decision.   The ophthalmologists were categorized in three degrees of expertise (expert, competent and novice) for comparison. The AI agent performed better that experts in terms of false positives and missed detections.

From the AI context, the results were on expected line. As data heterogeneity is inevitable in clinical practice, and AI has inherent advantage over human in their ability to tackle multi source and wide-format data. Increasing computational speed, evolving deep learning algorithms and increasing sophistication of image recognition capabilities have tilted the balance simply in the favour of the AI machines only.  In this particular case,  the phenotype of congenital cataract  has lot of variations , which makes the classification of congenital cataract  images difficult, influencing decision-making and patient prognosis. The illumination intensity, angle and image resolution, eyelids, eyelashes and pupil size etc., make the identification peculiarly complex for an ophthalmologist.  The AI machine with  advantages of deep-learning algorithms,  learns from the cumulative data and becomes more and more intelligent with increasing use and widening of the input base. Its predictions becomes  ever more accurate with every possible cycle of use. Though validated in case of congenital cataract, similar collaborative platforms will soon be  extended to the management of other  diseases, and find  validations  in different clinical scenarios. Google DeepMind,  in   collaboration with the NHS, is working on a machine learning system which will eventually be able to recognize sight-threatening conditions such as wet age-related macular degeneration and diabetic retinopathy, from a digital scan of the eye.   And very soon, we will have similar platforms for other diseases as well.

Available in market already available in market. Recently FDA has given clearance to an artificial intelligence-powered IDx-DR diabetic retinopathy detection system which is supposedly the first device cleared to diagnose a medical condition autonomously. What is more interesting is the fact that it is authorized to do so without requiring a review by a specially trained clinician. It will not only drastically increase the number of diabetic people receiving screenings but also reduce the requirement of an ophthalmologist.  This has also received a green signal in Europe and the initial trails are been reported to have encouraging results.

Surgical robots

The AI assisted robotic surgical devices setting newer standards in the field of ophthalmic surgery.   R2D2,  developed by Preceyes BV, a Dutch medical robotics firm can perform complex retinal surgeries like epiretinal peeling surgery. Though it was been guided by the surgeon during the surgery, the robot was capable of performing it autonomously as well.   It is not the only robot which is capable of operating on human eyes.   Axsis developed by  Cambridge Consultants, can precisely navigate in a small space as eye and could also be used to operate senile  cataract. What is more interesting is the facts that these robots  will enable surgeons to perform surgical procedures which are not yet possible, like  in sub retinal space and in and around   blood vessels in the eye.


It is evident that the role of an ophthalmologist will be redefined in practice,  by these upcoming technologies. Ophthalmologists will have to find their roles more important than diagnosis and surgery, as the AI will not have the element of human error and learning gaps. Now it is up to  us to identify how  we  adopt ?

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Medical practice

Myopia: What can we learn from the experience of developed World?

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Changing the glasses is not enough . Newer research shows that we can slow the myopia progression rather than being the mute spectators.

Your son is having difficulty in seeing the blackboard and is taken to the doctor. He says your son needs  glasses. Sorry, your son has myopia. He comes back with spectacles on his nose and you with the guilt of what went wrong on your part that he got this disease.

The story remains the same, only the character and the locations are different when it plays out in any part of the world. The only good news (if it can actually be called one) is that if you are living in India, your children are slightly lucky as the prevalence of the myopia here is less than what we have in south East Asia, and Europe, US and Canada. Better statement would be to say we do not have the correct data for Indian population to actually compare. What we do have is the advantage of knowing what is going on there and to an extant why is it happening and if possible learn a lesson or two.

why do we have myopia ?

A recent report from Canada says that nearly 30 per cent of their population is myopic. Not only the are rates  rising but it’s appearing in younger children. In a  study, reported from UK , scientist have we found a strong evidence that more your child time spend  in reading books , more is he/she at risk of developing  myopia. It also said that early start of schooling increases the length of time over which myopia can become severe. The researcher have reported an association between the amount of time a child spends outside playing, with  their likelihood of developing myopia. They could not explain why is this happening  but there are some evidence that sunlight itself has a beneficial effect on the eye and that the child effort to focus on a variety of objects near and far is also helpful in preventing myopia.


genetic study, from New York , done  160,420 individuals of European or Asian ancestry,  to study the role of genes in causing myopia. It  says that the  environmental and lifestyle factors have a role in myopia, but there is also evidence that genetic factors  also play their role . The researcher have attempted to look for potential genetic factors in individuals from European populations and from a population in East Asia, where myopia is particularly common. Authors reported “Our genetic observations add credence to the current notion that refractive errors are caused by a retina-to-sclera signaling cascade that induces scleral remodeling in response to light stimuli,”. That means that the pattern of light eye receives while   reading books or computer screen induces certain changes in the eye structure that results in myopia. Authors further added that their study   “provides a large number of new molecular candidates for this cascade and clearly implicates a wide range of neuronal cell types in the retina, the [retinal pigment epithelium], the vascular endothelium, and components of the extracellular matrix.”



We all are aware of the public perception that people who wear glasses are usually studious. The recent reports say that this  is not entirely unfounded.A study published in BMJ says  that more time the children  spent in education, is a causal risk factor to develop  myopia. Importantly, it also adds that more years in education one has, more  likely one has the risk of  having myopia.  Myopic children have problem in doing the kind of jobs which require better distance vision like driving and outdoor games, but have better near vision so it actually gives them an educational advantage.

Problem of myopia in china and south east Asia is more concerning, making it an important public health issue. Shanghai’s Health and Family Planning Commission report from China says that 47.2 percent of primary school students, 75.8 percent of middle school students and 89.3 percent of high school students suffer from myopia. The number of those affected grows as children get older. It is the lack of outdoor activity, a very  strong  pressure from family for academic achievements  and  widespread long duration use of mobile screen  are  the major reasons cited for why the incidence of myopia is so high in China.

Studies also report that children which spend less time in outdoor activities like playing consistently reports higher incidence of myopia . This difference is noticed in the incidence of myopia reported from countries like china and Singapore where the incidence of myopia is high as compared to countries like  Australia or the United States .  Children from developed East and South-East Asian countries are found to spend less time outdoor than their counterparts in Australia or US. So there is enough scientific evidence to suggest that time spent outdoors during childhood protects against the  develoment of myopia. 

Others scientists have  correlated lower  light exposure with high  myopia risk, and it is possible that those who spend more years in education spending most of their time indoor have had less exposure to natural light. The progression of myopia is also reported to be faster in winter months, which further gives credence to this theory. Later is also the reason why countries like China and Singapore have started the concept of  “bright light classrooms” which is supposed to  protect against myopia . To what extent this strategy is useful will be seen later. With the available evidence, what can be best recommended is for children to spend more time outside.

What nations are doing about it  ?

The pace with which the prevalence of the myopia is increasing, is  definitely alarming. Though the complain of blurred vision is redressed with the wearing of glasses, it is neither the cure of the disease, nor it stops its progression.


In Australia , the health organisations have started awareness programmes to change the public perception, especially how it can be prevented and  its long term consequences. Australia has started observing Myopia Awareness Week,  from 14 – 18 May, and china observess 6 june as  national Sight Day.

In Australia , Brien Holden Vision Institute (BHVI) Academy. organizes Program, which is directed to educate the ophthalmic practitioners to  change the way they manage myopia It is a self paced  Program that gives participants the  opportunity to connect with global leaders in myopia control, through a live webinar. It helps the profession to make an essential shift in myopia management strategies.

Outdoor activity

In China , the government is making a data base of the status of myopia in children by ensuring the regular eye checkup.  Doctors argue that over two-hours of outdoor activity every day can drop the risk of development of myopia in children so the  time allotted for  of outdoor activity in schools is been prolonged. As the ambient light is supposed to play a role in development of myopia, the local government is renovating lighting to make their classrooms brighter.


As the unnecessary mobile and other similar device usage as also been implicated in the  development of myopia, a company named  AntzWorkz has launched an application named Plano at an event at Singapore in October 2017. The company claims that Plano is the world’s first parental health management app which will help parents and teachers   to constantly  monitor the use of these devices by children

Newer lens

There are also efforts to develope better spectacles for myopic children as these are something they have to use anyways. A team of researchers from the Hong Kong Polytechnic University (PolyU) has claimed to have developed a lens that may slow down the progress of myopia in children. It is a Defocus Incorporated Multiple Segments (DIMS) Spectacle Lens that is claimed to correct myopia and astigmatism.  The DIMS Spectacle Lenses has a central optical zone surrounded by multiple segments of constant myopic defocus, there by using a homeostatic mechanism known as emmetropization, whereby the eyeball adapts to receive focused images. Again the benefits of this new technology are to be seen in future.

Cornea cross-linking

Another new technology is in  development phase at Columbia University in New York that is not only non-invasive but also claim to correct the myopia permanently.  According to Columbia university, the critical component of this new technology is low-density plasma which ionizes water molecules within the cornea resulting  in  cross-links. Later will induces changes in the mechanical properties of the treated corneal tissue. If carefully tailored, it can induce the required refractive changes in the eye. It offers advantages over the conventional laser treatment as the latter is invasive techniques, and is known to be associated with corneal thinning and other complications.

Now the question is what we can learn from their experience ?

where do we Indians stand ?

The 2016 Annual States of Education Report (ASER) survey  in India shows that over 25% of children in grades I to VIII were absent from school on the day a team visited the school. It raises a bigger question whether  we should actually be worried about myopia, when it is difficult for the government to keep the children in the schools. I would argue that we should be worried about both the issue. The development of a registry which documents various health parameters of children (including myopia) and the regular health assessment should be government’s priority. Myopia can also be included in various health awareness programs organized by governmental and non-governmental organizations. Parents should be made aware of the adverse effects of excessive mobile phone use by children and lack of outdoor activities. Doctor should start prescribing the modern spectacle lens having potential to reduce the progression of myopia. Parents should appreciate that outdoor games are just as important for children as getting good marks in exams. The access of mobile devices and similar screen based devised, to the children should be seriously monitored.

Currently our  spending on education   stands at 3.4 percent of the GDP which low by standards of developed countries. we hope that this spending will go up in days to come.  All schools will have classrooms,  and hopefully bright light ones.

Indian children will show the myopia trends similar to what some of  south east Asian countries are showing. Share your views on how we should address this issue in comments below.

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Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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Blindness control

Role of NPCB in control of preventable blindness in India

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India is also home to around 9 million blinds out of which one third have preventable blindness. Later means that we can treat it if we have capabilities and intention to treat. NPCB has done a great job in containing the problem of preventable blindness in India.

When comes to delivery of results in any social programs, people have serious doubt about the capabilities and intentions of government agencies. The suspicions are not entirely unfounded as corruption, inefficiency, lack of coordination, poor planning, and political interference are some attributes commonly associated with any government agency.

National Program for Control of Blindness, NPCB.

As a launch of any social benefit program attracts media attention, we often are in a hurry to do that. No surprise that India was the first country in the world to launch a 100% public funded programme for the control of blindness also called the National Program for Control of Blindness, NPCB. National Programme for Control of Blindness was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness in India.

As a launch of any social benefit program attracts media attention, we often are in a hurry to do that. No surprise that India was the first country in the world to launch a 100% public funded programme for the control of blindness also called the National Program for Control of Blindness, NPCB. National Programme for Control of Blindness was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness in India.

Experience of  China

Just to put things into perspective, in China, the estimated numbers of blind people in 1990 were 6.7 million.  The China population of people 50 years of age and older (who are at higher risk of blindness) in 2002 had increased by 27% compared to that in 1990. In 2002 there were an estimated 6.9 million blind people in China. That means that with all the efforts and resources the china invested in blindness control, an increase of 3% in the number of blind people was noticed in China, in the year 2002. The may well be attributed to the errors in estimations and projections to calculate these data.

Our achievements

In comparison with that, In India, the estimated numbers of blind people in 1990 was 8.9 million, which was around 2.2 million more blinds than what China had. Just like China, the Indian population of people 50 years of age and older (who are at higher risk of blindness) in 2002 had increased by around 30 % compared to that in 1990. But what’s most surprising is that in 2002 the total number of blind people estimated in India was 6.7 million. It was not only 0.2 million less than what China had,  but also that India reported a decrease of 25% blind people over the numbers published in 1990.

This achievement is partially attributed to factors like patient awareness, and socioeconomic development but the credit primarily goes to the concerted national efforts to control blindness sphere headed by NPCB. This success is attributed to an emphasis on evidence-based practice for planning and policy formulation besides the implementation and identification of strategies appropriate for local needs.

But the story is not over yet. Cataract surgical rate (CSR) is described as number of cataract surgeries done in a year per one million population. The cataract surgical rate (CSR) is one of the major WHO indicators used to assess overall level of blindness control efforts done in a country. WHO recommends an ideal CSR range of 3000-5000 per year per million population to meet the need. In India, CSR is estimated to be more than 5000. Under 11 five year plan (2008-12) around 3 million (2, 94, 07,355 to be exact) cataract cases were operated. From 2013 onward, with exception of few states like UP and Panjab, most of the states are regularly exceeding the target of cataract surgeries planned every year under NPCB.

But then these are just numbers, and often the actual needy is left behind and government funded benefits are taken by socially and economically strong sections of the society. A study reported from Madhya Pradesh, the female patient’s outnumbered males both is outdoor patients and operated patients in the eye camps organized under NPCB. Though this may be partially attributed to higher incidence of cataract in aged females, but it is no less achievement that government is able to deliver them the services. In one of the series of around 2200 cases, author reported that around 88% of the patients were from socially back ward communities. Author added that “A combination of these three factors – female gender, poverty, and backward class – lays an individual in utmost undesirable position. These camps were an immense aid to them”.


So next time when you are making a list of what India does better than the rest of the world, do not just include ISRO and Bollywood . Blindness control program NPCB, certainly deserve a place in that list.

Medical practice

Violence against doctors: law and order issue or sign of a greater malady.

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Do we need a reliable and effective Central Medicare Act or a policy to limit the number of patients a doctor should attend in a given facility and time? Maybe both.

At a recently held national seminar on “Violence against doctors,” hosted by the Indian Medical Association (IMA), a demand was to bring in a reliable and effective Central Medicare Act. Strong legal action against those who indulge in this kind of violence will hopefully deter people. Is it the lack of a competent legislature, the only reason why people indulge in violence at places they primarily come to seek help? Or it is more than that. And are these sporadic incidences or there lies an underlying pattern.

Deficient man power

Those of us who have associations with teaching hospitals can see a definite pattern in most of these. These events mostly happen in those departments which have a high inflow of critical patients presenting as an emergency.  Trauma centers, neurosurgery, medicine, pediatrics are most at risk. There are hardly any of these cases from the department not dealing with life-threatening conditions in an emergency. ENT, eye, skin psychiatry are the examples. Secondly, the episodes almost always take place after the prime working hours have passed, it is usually after five pm. In these hours most of the regular strength of doctors and support staff has left, and only the emergency team and support staff is there.