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.

Reasons

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.

Conclusion

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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online consultaion

How to have online consultation with doctor : Important tips for patients

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Online consultation with the doctors is getting more and more common, as everybody is busy and has a credit card. If  you have any medical problem , just log in any online doctor search and consultation websites and consult a doctor on phone. The important tips to make best out of every online consultation with doctor.

There are many different sites which are offering online medical consultation  in different formats

  • Chat/text bases
  • Voice
  • Video
  • Provided are both free and paid
Prefer video if available, or at least phone call. Avoid text based consultation if possible.
 
Its to risky to have the free medical advice from anyone.
  

 

1. Best sites for online consultation with doctor

  • Lybrate is the site which is focused on the online consultation format. Most favoured 
  • Consultation in chat, voice and video.
  • Doctors are mostly from the metros only but now they are slowly moving in tier 2 and tier 3 cities as well. 
  • Doctors  in all specialities like gynecology and psychiatry and nutritionist.
  • Biggest player among doctor search websites, have pan India presence.
  • Only text based consultation
  • Advantage of finding a relvent doctor in proximity
  • Provides medication and tests.

 

  • Provide online consultations with doctors associated at different facilities of Apollo hospitals in metro cities.
  • Website shows the credentials of the consulate doctors 
  • Advantage of follow up consolation physically

 

 

  • Primary business is online drugs and medication delivery.
  • Online consultation as add on service.

2. which medical conditions to be consulted in online doctor consultation

The popular specialities/ doctor consulted are

  1. nutritionist/dietitian and health
  2. mental health and psychologist
  3. skin and dermatology
  4. sexologist
  5. Ayurveda and homeopathy

3. Advantages of online consultation with doctor

  1. Convenience.   the biggest reason for the people opting for online consultation is the access  of medical advise by mobile phone which is ubiquitous and you do not  have to visit the doctor in person.
  2. cheap : lack of overheads like clinic and staff for attending to patients and larger number of patients help the doctor to give advice at lower cost.
  3. Availability of a doctor. Non availability of a specialist in proximity is not an issue as you can assess from a distance.

4. Conditions to be avoided for having online consultation with the doctors.

Medical emergency

medical emergency is defined as  an acute injury or illness that poses an immediate risk to a person’s life or long-term health.

Never waste your precious time in having online consultation. you should immediately contact to nearest health facility/clinic/doctor/ hospital which can provide first aid and advise regarding further management.

You need advice medical advise for children

Children , in general can not articulate their physical and mental complains and express it accurately to others . In these cases, doctor has to examine the patient in great details , so as to get an idea about the disease. A simple low grade fever can be a sign of a sinister medical condition like urinary tract infection. Online consultation is more likely to miss the diagnosis that physical office consultation.

 You need medical advice for an elderly

Just like children , elderly have very small margin of error in cases of clinical diagnosis and treatment. They are also more likely to have drug overdoses and infections. 

You need a medical advise for patients with hearing, visual impairment and mental retardation.

These patients have communication problems , both in reporting a problem and any drug complication. Doctor are trained to physically examine these patients to decide the clinical condition and treatment.

You have a disease/ medical condition, and develops a new related or unrelated complain.

If you are known to have blood pressure for many years , for which you may or may not be taking treatment, you have a complain of difficulty in reading fine print of newspaper for few days. It is quite likely that you may need to change glasses, but you may have more sinister retinal disease. Online consultation should be the last thing , you should have.

You have a disease/ medical condition, and need to start a medication or change the existing medication.

All medications,  even those taken for pain, blood pressure and diabetes have known side effects. These medications have higher risk of  complications if given in combinations. Doctor advise the single or combination of medications  after through medical examinations only.

You  have a disease/ medical condition, and need any surgery or procedure.

The decision to carry out a surgery or procedure should not be done on asking complains or seeing the records or reports. later has to be clinically correlated with patients physical findings. same hold good if you need a second opinion for your medical condition or its treatment. the second doctor must examine the patient and than correlate the records to give his opinion.

4. Risk of having online consultation doctor.

  1. Risk of wrong treatment or advice. When you take an online consultation with a doctor, it is presumed that you are knowingly taking the risk of having   wrong or inaccurate treatment in exchange of the connivance of having it without seeing the doctor physically.
  2. Delayed physical consultation ;You may actually delaying seeing the doctor in person as you have already received some medical advice. This may delay the identification or treatment of more serious medical conditions.

5. Other important issues related to online consultation with the doctors

All companies take measures to protect the personal and medical data of the patients as per prevalent norms and regulations.

All websites providing online consultation clearly state that  they do not own  responsibility of the adverse outcome of the consultation or the treatment that patient receive from/through  the website. They further clearly state that patient is aware of the risk involved with having online consultation in which treatment is been advised by the doctor without seeing the patient. Details can seen in the ” terms of use” or ” terms and conditions” link available in the website footer.

Must read ” terms of use” before availing the services.

Comment below if find any point missing. Please share it if you think it is 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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Chikungunya

Chikungunya fever: are you ready for it ?

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Credit : Pixabay

 

Rainy season is marked by diseases like malaria and dengue. there are additions to this list, which are Chikungunya and Zika virus. These are some basic tips about what exactly is this disease and what has to be done for it.

What is Chikungunya?

Chikungunya is a viral disease which people get , when they are bitten by a infected mosquitoes – including Aedes aegypti and Aedes albopictus. The name chikungunya originates from a verb in the Kimakonde language, meaning ‘to become contorted’. This refers to the ‘stooped’ appearance of those suffering with joint pain.

 

Credit: Center for Infectious Disease Dynamics

 

ALSO READ

Dengue: an ultimate patient’s guide

Dengue : are we ready for it ?

 

Who are at risk?

  1. Everyone who is living in disease prone area.
  2. Transmission from blood is possible, but no reports of such incidence.

What happens to the patient?

  • Fever and joint pain. for a week.
  •  Headache, muscle pain, joint swelling, or rash. for a month or so.

What to do if you think you have chikungunya disease?

  1. Consult doctors, if required, doctor will advise chikungunya test. It is not necessary in every patient.
  2. Take lot of fluids
  3. Take rest. No hard work.
  4. Paracetamol to reduce fever and pain.
  5. Do not take aspirin and other non-steroidal anti-inflammatory drugs.
  6. Prevent mosquito bites.

 

Credit :  NDTV India

How to prevent Chikungunya disease ?

  1. Preventing mosquito bites : GUIDE

 

Things to remember ?
  • Preventing mosquito bites is most effective way to avoid  Chikungunya disease
  • The mosquitoes that spread the chikungunya virus bite during the day and at night.
  • No vaccine available for chikungunya virus disease yet.
  • No treatment available for chikungunya virus disease.
Cataract

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.”

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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.

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.