Shortage of Rooms and waiting list

This season has been quite bad with lot many cases of Dengue,Malaria and all sorts of viral fever.All the hospital beds have been occupied and there has been shortage of beds in almost all the Gurgaon hospitals.There are many angles to this shortage or crisis of bed. Angle of patients……,Angle of doctors……and angle of hospital administration.

I as a gynaecologist with many patients in labour and with gynaecology operative cases would grumbe when informed by the front desk of their inability to provide the desired category of room to my patients. I would fight with them. The Ladies in labour come to the hospital for the ‘experience’ and they are also not happy with a crowded hospital and they want the single room they are entitled to as per their insurance. They feel cheated if they have been given a room which is double sharing or triple sharing room till the single room is vacated for them to be allocated their desired room and rightly so(After all they are paying for it). The payment is as per the room cap they are entitled too .Their complaint is but natural.
 I recently read a review on a blog to the same effect. The review said that the bills of a pregnant Lady were made to show some targets. They found the reception staff to be rude, which I doubt as I have seen them taking a lot of  misbehaviour, anger and very unkind words from anxious relatives day in and day out. We also should realize that the front desk staff is also over worked when there are so many discharges and admissions are happening round the clock. Hospital is making money but then they never said they were in the business for charity.Front desk staff don’t have any such targets as to inflate the bill. They are paid salaries and just do their job.They are not supposed to generate any revenue.Except for the Managers and HODs no one has to show any numbers or reach any targets,Rest of us work peacefully.

Another angle to this shortage of bed problem. A person who has come to the hospital as they are really unwell .A perspective is now of a mother whose child has dengue and is running 105 degree F temperature since last 3 days and hardly been  able to stand  or eat.He is acutely dehydrated and needs a hospital bed. This mother is me and the patient is my son……….and my fronk desk is helpless as they don’t have beds .I am upset and my front desk is upset too……..they like me and wish to find a bed for my son as soon as possible but how can they create a room?To me at that point of time his need to get admitted looked more important than the need of a pregnant mother who is there for an experience.She needs a bed but my son need a bed before him.That is how exactly the relatives of other sick patients must be feeling. As a mother ,I felt I damn care if the lady in labour is admitted or not but my sick son should be admitted .I just needed a bed. Luxury was the last thing in my mind.

Now coming to the hospital……..they do make money once patients are admitted .But they make much less money from a dengue patient occupying bed for a week than from a vaginal delivery patient in just 2 days.If the hospital was just for making money they would have just given preference to pregnant ladies and let sick serious Dengue patient go back and find ways to manage themselves.

Before writing a review it is important to understand the complete picture,my humble request to all the bloggers etc.Please just don’t write,Max Cheats…please elaborate and give evidences.Don't just presume.

Now another incident.I was constantly working since 8 am in the morning on last Saturday without even a pee break and with 101 degree fever.( Why was I working? For money……..as some of you would say. Yes for money but that was not the only reason. Suppose I get my OPD cancelled the same day, it will cause discomfort to you only when you get an unceremonious call from the hospital telling that I have blocked my OPD .And even if I am unwell and my patient is in labour,do I have the Liberty to say I am sick won’t take care of you at the end of nine months??)Someone was shouting outside my OPD around 4 pm.Came to know that an appointment patient had been waiting for 30 to 35 minuts and was getting restless.Husband  had called the duty manager and was blasting him with suggestions like lengthen the slots allocated to the patients if patients take more time than allocated .lessen the number of appointments then!! Simple….that person has shown his wisdom. Now there are few practical problems. Suppose you have 15 minutes appointment with the doctor.But you wish to talk to the doctor and understand the doctors advice and till you aren’t satisfied even if it takes 45 minutes you won’t mind even if you realize that you have taken much more than your share........………..if a doctor interrupts the doctor is labelled a money minded doctor who doesn't give enough time to the patient. .Should I be asking that female to leave me as 15 minutes are over?I will find it very rude!!Now if one patient has taken 45 minutes extra the OPD as a whole gets delayed by 45 minutes .Now who is at fault?You,me or front desk.In my opinion no one actually.

As far as decreasing the number of slots for appointment………….a BRIGHT idea as an individual patient. But there are quite some downside

That would mean I should see 2 patients in 1 hour. And in this manner the patients who have to come for follow ups will have a long waiting list of 6 to 7 months as in NHS.Are you willing for that?And I can’t survive if I work at a pace like to see 4 patients in a day.

I did try to make the couple understand why these delays.I hope they understood and took it positively,At 101 temp even I don’t feel like talking non stop to patients from 8am to 9pm with two high risk caesareans in between without any time for food or drink.
PLEASE USE  public forum sensibly know every aspect of the the topic covered by you and then only can it be a useful Max Hospital Feedback other wise it just comes across as a medium to vent out your frustration.

Construction of new Vagina following a 'mutilating' surgery

I wish to share with my blog readers are very unusual case,not very commonly seen.
A Lady in her late twenties visited me from Panipat.Her relative who is an old patient of mine had brought her to me.
The history was that this Lady had a Normal Vaginal delivery about 2 years back.After that some obstruction was foundat the vaginal opening which the gynaecologist conducting normal delivery had agreed to correct.Having lost their faith,the couple went to another doctor and then never took any treatment for two years till when they started planning for second child.The Lady found the sex excruciatingly painful and penetration wasn't adequate and thus they came to Max hospital ,Gurgaon to meet me.
When I examined I found a very shallow vagina with some curtain or wall kind of structure within an inch of the mouth of the vagina.
I planned to operate her next day and what I found was amazing.There was a thick secondary septum due to fibrosed tissue with a pin head size opening.Perineum was tight.I slowly dilated,corrected and refashioned her vagina along with correcting the perineal tightness by Fentons procedure.After clearing the septum,I found that the cervix was also stuch to the vaginal wall.

I don't know the reason why something like this should happen in a lady who had a vaginal delivery not long back unless she had some severe infection or the vagina was closed too tight.So whatever might be the reason.I felt happy after correcting her problem as it must have been a living hell for her.

Here we start at clinic Nirvana

I am pleased to inform that my clinic at clinic Nirvana at C 209,Nirvana Courtyard,Nirvana Country,South city II will start from 22nd october 2012.  We have already started taking the appointments.How thing will work is as follows:

For my clinic appointment please call my practice Manager Ms Sarah at 9899559807.

For my appointment at Max ,please call Max reception.

My timings at clinic Nirvana would be

Monday 5 to 8 pm
Tuesday  10am to 1 pm
Wednesday 5 to 8 pm
Thursday 10am to 1 pm
Friday 6 to 8 pm
Saturday 10 am to 1 pm.

Hope this would be a convenience for people living in Nirvana Country,South City 2,Sohna Road,Sector 56 ,Sector 57 etc.

Dengue

Dengue is rampant in India in this season.In my household,first it was my house keepers 21 years old son and then the 16 years old boy who works at my home and now my 12 years old son.

Currently my son is under hospital care and doing well.Why I  felt the need to write this post was to share a little bit more information about the condition.The word dengue spreads a feeling of fear and a dropping platelet and platelet transfusion to a common persons mind.And rightly so.

A golden rule.......see a physician or a doctor who understands the whole dengue disease and the associated management.One or rather two very competent surgeons questioned the need for hospitalization in dengue as it has no cure.Sorry to say but then these guys might be very good in their respective speciality but not masters of all medical field.Why I am mentioning this line at the risk of irking them is that as a common man,for you all doctors are doctors and you tend to ask a 'big doctor' of unrelated speciality who also happens to be a family friend......what to do?If not knowing the disease process well you might be made to think.....no big deal with disastrous results.People do loose life with it.

It is a viral fever which doesn't have any cure as I have already mentioned and body slowly comes out of the infection.While the infection is ongoing it can be very mild with just fever with little changes in the blood tests and patient though with fever is over all not lethargic,not having any bleeding tendency etc.But at the same time it can be quite bad.Initial 3 or 4 days the patient has very high grade fever.There is a phenomenon called   haemo concenteration taking place,which I would say in lay man term is that body is severely dehydrated and fluid requirement goes tremendously high.If not compensated for could be one of the reason of collapse and shock seen in patients with not very low levels of platelets. Not all patients showing downward trends  of platelets will need platelet transfusion.
To summarize ...don't panic but take it seriously.Consult only a specialist and not a doctor family member of doctor family friend who doesn't understands the interpretation of such subtle blood test.

Take care.

The mystry of Ovarian Cyst

I love movies with happy endings.You might say,what is so special about it we all do!!As a child I used to enjoy all the horror movies and tear jerkers...........but not anymore.Don't watch such movies any longer.
But can't control the real life.It is a mixed bag.
So yesterday there was a young unmarried lady who I operated for a suspected Ovarian cancer but on putting the laparoscope turned out to be a dermoid. Histopathology is still awaited but the clinical sense says that she will have an happy ending.But not everyone is so lucky.
There are patients whom you never forget in your life for some reason or other.There was one such girl called Pooja.Many years back when I was a registrar ,almost 12 years to be precise.A girl around 20 yrs came to the OPD of my aunt Dr Shakti Bhan Khanna. An angelic looking girl.Her beautiful eyes were filled with tear as she gave her history.She told ,I have a swelling in my abdomen and my parents think I am pregnant while I have never been sexually active.We assured her that it was very easy to prove that she isn't pregnant.An ultrasound later it was found that she had dermoid cysts in her both ovaries.The girl was not sure whether to be be happy with a proven point that she isn't pregnant or to cry with ovarian cysts as the reason of her swelling.Her next visit was with her parents who were very tense.They were reassured that though she would need a surgery but dermoids are not so sinister after all.
And then she was operated.Beautiful Bilateral  cyst removal done.For some reason despite a beautiful surgery she had mild post operative ileus ( her guts were slow to recover and tolerate food).
Fine and finally came her histopathology report.It suggested 'immature teratoma',a variant of dermoid with borderline malignant potential.A frozen section was done at the time of surgery as tumour marker were normal and CT scan suggested a dermoid. It was sad.Then she underwent chemotherapy,lost her hair (though temporarily) .It was the beginning of my career and not used to such tragedies,I was also found it difficult to deal with.I am not sure what happened later as ever since I moved to so many places and didn't ask my aunt about Pooja's follow ups.Later on I came across and still continue to come across many other such stories with not so happy endings.......but Pooja is the one whom I will never forget and any young girl with ovarian cyst reminds me of her....always.

Should a pregnant Ladies husband be allowed inside the OT?

When I had my caesrean my masi Dr Shakti Bhan Khanna was the suregon ( Couldn't have asked for a more competent person,who can perform an internal iliacc artery ligation in seconds if needed),the anaesthetists were doctors whom I had been calling mama and masis since I was a child.And I was a qualified Gynaecologist.I felt like the whole family was there with me.It made me very much relaxed.I chatted with the anaesthetist as my boy was delivered.So over all a very nice experience.

Now imagine a Lady in labour,in one of the most vulnerable states of her life shifted to OT and surrounded by all men/women in green and blue.It must be little scary.Every one in rush to get the things done in order and meticulously.I have seen by my own eyes that once the husband is allowed in the become calmer and cooperate better.Even many scientific papers in pubmed recommend presence of the birthing partner during delivery.
In Uk it was kind of rule.Lady and her birthing partner would be present in LR as well as OR.After 4 years of mu Uk training when I returned back to me it was pretty cool if a husband wished to be inside the OT or LR.Then once my dear friend Dr Rohit Jaswal who was the anaesthesia HOD then,objected to it.He said that neither any other gynaecologist wishes to encourage this practice nor was he in favour of the partner being inside the OT.We discussed and on the basis of evidence I could prove my point and got the permission for my patient's partners.
Slowly others also had to agree as in the same hospital patient start asking about the dichotomy of behaviour and rules.
After so many months ,why am I talking about it?
There is this very nice OBGY Forum on FB where doctors were discussing the same issue.
Even now all the partners are most welcome inside but as long as they understand that they are allowed in to give the emotional support to the wife.Clicking a picture or two is Ok but if the doctor requests you not to do that please listen to him or her.Reason being your effort to get best angle might just distract the doctor from the operating field,which can be dangerous.
Even when it comes to caesareans many doctors feel conscious about letting the partner in.The doctor has a right to say no to you.You as a patient has a right to ask for letting you partner in.If it works fine that is great but if not it is your right to change your doctor just like it is the right of the doctor to say no to you if they don't like any intrusion in the OT.
If caesarean is done under GA then there is no sense anyways for the partner to be in as the wife would be knocked off and will not need any emotional support.

Many a times during non child birth surgeries partners whish to be present inside the OT.That serves no purpose because a lady under General anaesthesia won't need your support. 

I thought I was very intelligent......but not any further

My head is spinning badly.It is 54 minutes past midnight and I am here solving a real life drama and mystreyIt looks some suspense movie starring Kareena and saif..As if I already hadn't enough on my platter.
On 15th of september after interview of two young ladies around 25yrs of age ,I employed a well qualified girl to be my practice manager ( Secretary).She was from Banglore and a MSc in Biotechnology and wishing to make it big in the corporate world.Both these girls were fine but the one I selected looked every inch a Hizab covered Muslim Girl from Banglore as she should have looked,Very decent and degnified.My clinic wasn't yet ready so I started bringing her to Max.The idea was to make her understand the working of corporate hospital as well as patient handling while sitting at the reception.With me at times it can be quite late before one is free from the OPD. So her cousin used to come and pick and take her home or PG where she used to stay.
Can't deny she was picking the things well.Had made friends at the help desk and nurses.She looked a 'shareef,siidhi saadhi,as I said Hizab covered girl.I was also protective about her as I felt her to be too innocent for our Gurgaon.
Now today she sent me a text.....Mam will be delayed.Will come by 11.30 am.I didn't like it as it hasn't been long since she has started working but then Ok.......Then after finishing the first half of my work at Max when I reached home she wasn't still there.Then around 12.30 she came to me and was crying.Crying at the tyranny of her parents.How she didn't wish to go to Bangalore and how her father was compelling her to come back home today itself .She was crying and constantly saying sorry to me.And then she got a call and I could see her anguish.She was requesting papa don't taking me back,I wish to work.I know you will not send me back.I offered to talk to the papa.A old man's voice came from the other end.Let her come for 3 days and then I will return her.Her mom is unwell.Emergencies don't come after informing and so on and so forth.And again this girl was like...no papa no.
Well I asked her to sit at the office till papa actually came.An hour later I realized that she was missing.I said few bad words for her parents for making such a nice girl so upset.
During my evening OPD her cousin came to the hospital searching for her as she wasn't picking the phone.I blamed him as well for not being kind to the girl.
As the story unfolded........I was shocked to know that I was made to speak to some man who wasn't the PAPA.Original Papa called just now to tell that she was sent to Gurgaon so that she can be away from a boy from Bangalore and had never asked her to come back.He was talking to me for the first time.
It hit me like a thunderbolt........so she created a fake papa to make me believe her.God.Damn it.Who can one trust.At the moment his Cousin is searching the reservation list of Karnataka express at Delhi railway station to find if she is one of the passenger eloping with some one.Another theory is that her Bangalore friend has taken her to Bangalore already by flight...........A shattered father and mother,crazy going Cousin and bewildered employer i.e me......Kaushiki don't judge the book be it's cover........actually you don't.What happened this time? 

My new website

Dear Blog Readers,

I have updated my website www.drkaushikidwivedee.com  and would request you to visit the site to know the changes that would be there in my practice timings and places.

• My personal clinic at Nirvana Courtyard (CLINIC NIRVANA) would become functional latest by 3rd week of this month.I hope that will help in streamlining my appointments as most of you have complained of unavalibility of slots at Max Gurgaon.
• I intend to spend my OPD timings equally between the two places i.e Max Hospital Gurgaon and Clinic Nirvana.
• For appointments please call 9899559807.
• For clinical queries you can use my personal mobile number and would prefer a text to a call.I find it more convenient.

                                                                                     

                                                                                               Love

                                                                                              Kaushiki

                                                    

What are Leaders made of ?

On 6th of October there was an offsite organized by Max healthcare which was called clinical leader offsite.It was my good luck to be a part of it . Not because I was 'chosen' as one of the 'clinical leader'but because I could meet and see and observe some such great leaders closely.
       
          This is a general human tendency to dismiss a successful Industrialist or a politician or writer,as being 'you know it was because he/she was born with a golden spoon.His kismat was very good.He is cunning .He is corrupt...so on and so forth.

           It is not just Kismat or corruption.One has to be different from the crowd...... from the rest of us to be great.They are different.Working in the organisation since last 5 years I met Mr Analjeet Singh for the first time and heard him speak for the first time.It was an extempore speech which were basically answers to the questions put by the audience.I heard him and boy I was impressed.During 99 % of the speeches I fall asleep but I was mesmerized. He doesn't need my acknowledgement to be considered for what he is or who he is,but I think I gained a lot listening to him.Successful people are clear in their vision and thought and they are able to express it plain and simple to the audience.They dare to think different and they work hard,up to 16 to 18 hours a day and they have the capacity to convince you of their thoughts..

         Then it was the turn of Max MD Mr Rahul Khosla .He spoke two or three lines.And again ,you knew what he wanted to convey and he conveyed clearly in not many words.Here was a leader .....you knew.

        I am impressed......I wish to learn from people who are Leaders with their pluses and their minuses.Just searching for a person around my working place who is a leader and from whom I can imbibe some tips.........

But then I think such leaders are born and not made :-)

Intra uterine foetal Death ( IUFD)

Intra uterine foetal death is a morbid topic to talk.But it is a fact of life and pregnancy.No gynaecologist can escape it and neither could have I.
Yesterday I was revising my RCOG Guidelines on IUFD.It is always good to study.Keeps you up to date and makes you a confident doctor.You know what your talking or dealing with.
And slowly as I was reading my mind wandered to all those IUFDs which (Late Pregnancy losses inside the womb) my patients had in my last 5 years of private Practice as senior Consultant at Max Gurgaon.I could recollect 3 of them very vividly.
First one was in the very first year of my practice.I am not sure wether it was IUFD or fresh still birth which happened after the admission .That is an enigma to me still.There was this lady who had PCOD,had conceived under my treatment for PCOD.Her scans till level 2 scan were reportedly fine.She was obese and was gaining constant weight as pregnancy advanced.It looked like an avg size baby.She was gaining 1,5 to 2 kgs every month.And then she came in labour at terh.I as well as my registrar put a CTG machine and thought there was the foetal heart beat which vanished suddenly.Asked for scan.Showed a loss of heart beat.Baby was growth retarded.I had failed to pick the growth retardation it seemed due to belly fat.The liquor around the baby was hardly any.Baby had potters syndrome.The ultrasonologist had missed it.So I delivered a dead baby.I don't know whether the baby was live on arrival and died after the CTG machine was put in or actually we mistook the MOTHER'S PULSE FOR BABY'S HEART BEAT,
 The baby's father then mentioned that ultrasonologist suspected some problem with bladder filling but she never mentioned it on paper.The HOD radiology came to the defence of his team witha book which suggested that for bladder problem a repeat scan at 24 to 26 weeks was needed.So if I didn't ask for it ,it wan't  his team who was at fault.My HOD tried to 'save' me by saying the baby had died before the mother came to the hospital.I like a stupid fool kept on insisting....I did hear the heart beat on admission.Any ways the parents wished to sue the radiology team.I insisted'the fault was mine if I took body fat for baby's growth'.Sue me if you have to.And despite their grief they said a big NO.Doctor.......you can't be wrong.I felt their pain.And then for a short while till they left the town they always came back to me for any gynaecological advice.I was the blessed one.My patient's trusted me.Atleast they trusted my intentions.
Second one was even more sudden.A on going healthy pregnancy.C/o sudden loss of foetal movement at 32 weeks.She kept on waiting for 24 hours of loss of foetal movements.Primigravida.Usg later.....No heart beat.Was actually difficult to break the news.I cried and they cried.It was bad.Anyways....terminated the pregnancy.6 weeks later showed antiphospholiid antibody positive.I had a reason and a treatment to offer.They never returned back to me for their second pregnancy.But it was painful.
Third one had a happy ending.There was this too well read a lady with PCOD with GDM who had big fights with her husband and her in laws.In my opinion all of them were contributing to the fight.At 34 weeks,reported to Max emergency with no foetal moveents.USG.IUFD.Counselling wasn't too difficult.She was prepaired for the worse due to loss of foetal movements and being a well read person as she was.Her in laws thought me to be an unlcky doctor for her,suggested change of doctor and suggested me to do a hysteroromy.Challenged their daughter in law if her doctor would be able to deliver the baby vaginally.Anyways she did deliver vaginally.Even I thought she was someway responsible for foetal death due self induced hypoglycemias with insulin leading  to foetal hypoglycemia.But baby was born it had 5 to 6 tight loops of cord around the neck.I felt ashamed to have been judgemental.Anyways despite her family's objection she returned back to the doctor i.e me whom her family had declared unlucky.She had her whole pregnancy on insulin.At 38 weeks I induced her and she had a bonny baby girl.
It was a roller coaster ride for me all the three times.
Usually following an IUFD the doctor is considered unlucky whether actually contributing to it or not.It was good that my patiets showed faith and returned back to give themselves and me a second chance.

Believe me IUFDS are no less traumatic for a doctor.....