Reminiscence

1 year and 4 months since I actively participated in this blog.I am returning back officially today.And I realise,I am a changed person who used to write and express oneself freely not long back.There is a lot of apprehension,thoughts,what to reveal and how much to reveal.You will find a change in the tone of posts I write.Only time will tell whether I have changed for good or have become one of the so many fake people around,who don't have the courage to express the truth as truth is not always pleasant.It is not always diplomatic.And I do remember it is a social media where I am being read by so many ......some known,some unknown and some who are just trying to Judge me by reading my posts.

When writing a post there has to be a meaning to why am I writing and as of now I just feel that I am back as, I wish to share my experiences of down under with my fellow doctors as well as patients to help them if they too wish to have an Australian experience which hasn't been bad overall.I will start month wise since May 2014 and very soon we will be in Nov 2015.

Last but one day of October and here I am sitting in a nice suburb of Sydney writing this Post.Had I thought in May 2014? No not really.Neither was it an agenda.To give a background,way back in 2007 when I was planning to leave UK I had applied for the post of registrar in Australia with few recruitment agencies.I also appeared for a telephonic interview while still in UK and never heard back.That interview didn't involve any academic question but just  the reason for my movement from UK to Australia .In 2010,I was contacted by one of the recruiters for placement in Australia.I was doing too well by that time in India in a span of 3 years and told clearly that only as a consultant.He agreed and then started enormous amount of paper work which I did quarter heartdly :) Time constrains as well as I was quite comfortable in what I was doing.

For those doctors who wish to have a taste of Australian Health care system,it is a lengthy process .Please visit the website of your respective college,look for the requirements of being assessed as a specialist at par with your Australian counterparts and do the necessary paperwork as directed.For me,my PLAB,British experience and degree came handy and after an hour and a half long interview I was assessed to be comparable to my Australian counterparts subject to successful completion of 12 months oversight working as consultant in Australia.That was in feb 2013.And eventually my placement agent got me a consultant job too ,as promised.But it wasn't an easy decision to leave the Indian practice which by May 2014 was thriving and too busy.I hardly had time to eat,sleep or even relax and that was perhaps one of the reasons I left too.I don't think ,I can be busier than I was then.

To cut the long story short 2nd of June 2014 was the last day by when I was supposed to report to my job with an AHPRA registration and mid may I still hadn't got my working Visa.It was all a part of the long drown paper work.I was still not sure if I wished to leave my private practice neither was I sure that I wished to uproot myself once again.At the same time it was perhaps professional 7 year itch which was forcing me to start a new relation.To explore the world,to see what I missed if I left this job.Even to say that what you missed wasn't worth it,you need to try it first,otherwise it becomes a case of sour grapes.And I did leave my well set practice to taste the deep waters of down under.To keep myself motivated I showed myself the carrot of FRANZCOG ( Australian Fellowship) at the end of 12 months.One more Degree to my kitty.I felt sorry to leave my patients behind ,but I knew they will find a replacement.No one is indispensable and neither am I(It is a different story that after I left I found ,that there were true lovers amongst these women for whom my moving was an emotional shock.I still am sorry for how I made you feel then but at the same time I would shamelessly admit I don't really regret my selfishness ;-) We all are selfish.My selfishness BTW wasn't monetary.....it was more exploratory.

Quite a long Post and I think we will start next post from June 2014.

Return

It has been more than an year.......Yup I didn't blog.I didn't contributed anything to my blog....simply I was and am committed not to write on health issues as I represemt Queensland health and what I say has to be endorsed by a peer reviewed group.Fair enough.So I decide to write on non health related issues,which doesn't need any review.

So On Friday.....it came from my College.....in my 12 months ( or rather 14 months) I have worked satisfactorly as a specalist in Australia to be a Fellow of the prestigeous RANZCOG.Was chasing this dream too since 2006.Dreams are meant to be chased and fulfilled.

Sounds resonable MD,MRCOG.FRANZCOG .Will be a FRCOG in couple of years hope fully....need to complete the stipulated years post MRCOG.

Life in Australia was a mixed back Initial 3 months.........tedious........a lifestyle very different to what i was used to.But it grew on me  slowly and steadily.........now I love it.Now I know why it is known for the perfect balance of lifestyle.I love most of the things about this country.WHAT
I don't like I will leave for another day.

It has been a beautiful journey........was able to discover me..........many facets of life and also there is much more to life than rat race.

A short Break

Dear Friends,


Life is Change and change for good.Stagnation isn't acceptable to me.....I felt I was stagnating and to further my skills,training,academics and teaching I have taken a break from my private Practice at Gurgaon.
I am moving abroad for an year to further my skills and to complete my Fellowship from Australia.I am sorry for the inconvenience caused to all my patients who have given me their immense love and made me what I am today.
I promise I will be back.Back as a better doctor and better human being.
In the meantime I can suggest you few doctors whom I find ethical and Good in no particular order.

Dr Deepa Maheshwari - Max Hospital ,Gurgaon.
Dr Veena Bhat - Artemis
Dr Urvashi Rathee - Artemis

For the time being the Blog will be taken care of my other adminstrators and not me( That is the requiement of my current job)

See you all soon......Miss you.

Kaushiki

It is same everywhere......Cost cutting

On a busy saturday one of by patient came to meet me.She has been a regular since 5 to 6 years now.Probably the very few patients I had in my initial months of joining the Max Hospital,Gurgaon.
Quite a jovial couple.And in her 1st pregnancy her husband and I would joke on all the possible family myths.What his dad said and what her mom said and so on and so forth and thus 40 weeks were over and she delivery a bonny baby boy.

Then we met in between as well ........for various small issues.

Now Pregnant again we were talking about her pregnancy and the working condition etc.Her husband is a senior banker and I was surprised to know the kind of conditions in which the bankers are working due to cost cutting,internal politics and other corporate issues and heavy load of demanding clients.It sounded so similar to our organisation and myself.

I was shocked and then reassured myself that this cost cutting hasn't just affected the healthcare system.I can't deny that.

Overall the mantra is make the employee work as much as possible (numbers) and before he starts to settle down unsettle him.This cost cutting leads to inefficient or over exerted front desk staff,guard,nurses,doctors (Not talking just about my hospital but is a trend every where).Mediocrity is encouraged as some one with more intellect would demand more.

Ultimately came to know that many bankers have become resto owners as couldn't cope up with the pressure of the job they were trained for.

Hmmmm.........He showed me a vision...........if bored or tired open a Dhabba!!

Thinking the menu already

Why doctors leave you confused?

I think of late my favourite topic has been patient doctor relationship.The most probable reason is probably an accusation made by a Woman ,doing media rounds, which other unsatisfied patients have quoted off and on whenever they wish to make me come across as a negligent doctor. It hurts as there was no negligence of mine anywhere. I will give the answer i.e , the way it should be given legally.

I have still kept a silence on this issue ,due to two reasons

one : the matter is under investigation

Second : Patient's confidentiality. I don't wish to go on a social media commenting about an unmarried woman which mars her future life  if I speak the total truth. But yes false allegations or rather half told truths become difficult to handle at times,when you wish to speak out loud but you can't as of now.

Once sorted ,I promise to come clear on this story, how it affected me and my colleagues who where implicated ,the media, the hospitals, doctors, nurses and also the friends, patients and relatives who have been immense support.( I dream of becoming a Chetan Bhagat.....doctor turned author :-)

It is a fact that I am a changed person.Not the same young enthusiast doctor who started practice seven years back.A stronger and wiser person but I  now strongly believes in defensive practice.First save yourself and then see what you can do for others.The number of investigations prescribed have gone up a little.I know there is always a risk as doctor can never be correct.If you don't write too many investigations,the allegation would be:doctor under investigated.And God forbid if things go wrong-----Doctor is Lynched.The allegation would be,we never stopped from getting investigated.

If you try to be defensive and get investigated,then of course,you are getting the patient over investigated then it is to make 'money'  from cuts and kickbacks.

A difficult situation indeed as a doctor. This isn't just my frustration but majority of the doctors feel the same and it is a matter of frequent discussion between doctors at the lunch time. SAVE YOURSELF FIRST. 

If you think me,I am the only one thinking so, then you a mistaken. Let me tell you a very recent incident. A young couple came to me.The Lady had early pregnancy.Had been diagnosed with hypothyroidism which was now under control.They had visited the Gynaecology department of a famous hospitalThe senior doctor clearly declined to help hem out in taking any decision regarding whether to continue or not to continue with the pregnancy as the TSH was high. She told them clearly to take their own decision. The couple questioned that they were lay person after all and needed medical opinion.And the answer was ,take your own decision.That is a different issue that endocrinologist at Medanata,one more gynaecologist from Fortis and myself helped them take a decision but yes our answers were also guarded too.

Why???

So Why did that senior doctor of a great Super specality hospital declined to help that couple.She saved her skin.She would not have got any brownie points to take the decision for that couple but a rare possibility of the baby having mental retardation would been a cause of litigation.Who wants it?

I am sure the couple who shared this story with me must be reading my post.Do you agree,it was confusing or rather highly confusing and stressful to take the decision of your own. was any google search helping out??.

Me as a single person can't stop anyone's thought process by writing my blog. But surely I can try before you start loosing good doctors who are burnt out of stress turning into a writer, businessman ,politicians  and administrators etc. I can surely see a crashing healthcare system in India where you will have mediocre students opting for medicine. We are not even a rich country who can get overseas doctor to fulfill our  health sector needs.

Think........

Cold and cough in pregnancy

Have you ever felt irritated if your Gynaecologist asks you to refer a physician if you ask for medicines for cold and flu while pregnant.I am sure many of you would relate to this situation.You might feel after all,it is just a flu.Why can't the doctor just tell me antibiotic and cough syrup telephonically.There is a specific reason to that.

While you are not pregnant,naturally you would visit a physician or GP who would get you investigated properly and then prescribe medicine as appropriate.While pregnant if you get a Viral infection,it might be a simple viral infection with no implication on the foetus or actually the viral infection might be sinister enough to cause problem to the foetus.Unless properly investigated acute problems can be missed.

Majority of times say 98% times it would be simple beingn virus but what happens then on the rest of two occassions. It might actually be something more serious.So why take a chance ?

I have mentioned in one of the posts about hydrops foetalis in a foetus.After detailed investigation it was found that the mother had got infected with a condition called cytomegalovirus which is transferred to the foetus as well.This cytomegalovirus usually either doesn't have a symptom or leads to chronic cough.In her case she had chronic cough and I did ask her to meet a physician or ENT specialist.Poor thing met the physician/ENT specialist as well but as CMV is such an uncommon condition it wasn't picked up and even if it was picked there is no treatment.It could be diagnosed only after the autopsy of the foetus.Sad it is.They are heart broken.Unfortunate !!

Another patient visited with chronic cough.Again asked them to meet a physician.I don't treat these non obstetric conditions myself as I am not the correct person to do so.They were luckier.The physician got an ultrasound of lung done and found fluid collected around the lung.The fluid was drained and now she is on quite strong antibiotics.Fortunately her condition isn't what will affect the baby.

So next time if your Obstetrician asks you to meet a physician for just a small 'flu',do so.It actually might be more than just a mere flu.

Increasing rate of caesarean section.Does that worries you?

As the delivery date starts approaching,one of the commonest question asked by the pregnant woman is,'Í have heard that in Max Hospital the incidence of caesarean is very high'.They are apprehensive and so are their partners.Very anxiously they wait for me to answer their question.

Previously I used to get defensive about the whole thing.Answers like I can't comment about others......my rate is not more than 20% for caesareans......I can assure you that if anywhere in the world you can achieve a safe vaginal delivery ,you can achieve that with my team......

Now I ask a different question.To tell me a hospital which they have heard god about and i will deliver them there.To my surprise they don't have an answer.They say that,that we don't know.Strange....isn't it.

What you read online or what you hear from your friends are half truths.Most of the time those who have good experience they get too busy with the life and don't have time for such feedbacks.Those who had an unexpected outcome or below expected outcome,they are the one's who leave strong feedbacks.They are a very small minority of people but as they are the most vocal,they scare you.

Now the question,why is the caesarean rate increasing?It is multifactorial.I will give you an example.

I work in a team with consultants and registrars etc as every person in the team has got a delegated duty and we all know that as a team we perform better.That is the whole idea of making the team that if I am busy  with one patient another patient under my care shouldn't suffer if any medical need arises.Now a patient who has come to show me for 9 months wants me to be present with them through every step,which isn't possible.How can I or any doctor be present through out if the trials are as long as 24 to 36 hours?I try my best to be present for all the vaginal deliveries.It is easy in nights or early morning as the roads are vacant,but it can be a problem during the daytime if the traffic is heavy.So at times ( once or twice in a month it so happens that by the time I reach baby has been delivered and attended by Dr Deepa Maheshwari as she lives across the hospital and has 13 years of experience in obstetrics and gynaecology.So ultimately you have a achieved a safe vaginal delivery due to our team work even if I am delayed by few minutes.

Now last week a Lady with high risk pregnancy with both Diabetes and blood pressure of pregnancy was induced at 39 weeks by me.In most likelihood they would have been offered a caesarean section had they visited anywhere else.So we started the process and followed it as per the protocol with team members including me visiting her at regular interval.All going well.At around 3 Pm she was 4 cms dilated i.e at least 6 hours to be fully dilated and then suddenly at 4 pm I was called that she had progressed very fast and is fully dilated and pushing the baby.So she travelled 6 hours journey in one hour.Totally unexpected.So I left my home and Deepa left hers.Naturally Deepa reached earlier than me and delivered the baby safely.I reached in another 5 minutes.Naturally south City 2 is farther than south city1. 

Now what I got for the patient's husband wasn't a thanks but a complaint that I didn't reach in time and no one came in between to keep the moral up of my wife by giving her false hopes that only few minutes are remaining etc.Then he went ahead to leave this feedback/complain somewhere that Dr Kaushiki Dwivedee didn't come to attend my WIVE'S delivery not mentioning that what a high risk delivery it was,how nicely my team under my supervision managed it to let his wife have a normal delivery and even a precipitate labour like hers was nicely managed because it was or team and Max Hospital.

Now if despite working so hard and ethically one gets such brickbats,is there a reason for a doctor to try 24 /36 hours of normal delivery where there is always a possibility that heavy traffic might be a problem.Isn't performing caesarean at some pretext like baby's heart beat is getting low,fluid is low,no progress of labour is a better option for the doctor?

THE BALL LIES IN YOUR COURT.DO YOU WISH THE DOCTOR TO BE HONEST AND ETHICAL WITH YOU TO TRY NORMAL DELIVERY SINCERELY WITH AN OCCASSIONAL CHANCE THAT IT WON'T BE HER BUT HER TRAINED TEAM MEMBER MIGHT ATTEND YOUR VAGINAL DELIVERY OR WOULD YOU PREFER A CAESAREAN TO BE PERFORMED BY THE MAIN GYNAECOLOGIST AT THE TIME OF HER CONVENIENCE.CHOICE IS YOURS!!