Doc , I have a  shoulder surgery tomorrow .Can you clear me ? Doc , my son has a dental procedure tomorrow . Can you clear him?Doc, my son had a concussion on his head couple of days back .I hope he can resume his practice tomorrow 

These are very common scenarios in a primary care office . These appear to be  very simple issues and when patients are explained that it is not just a matter of filling forms , they are confounded 

But the responsibility of a primary care physician or for that matter any physician , who is giving any kind of clearance, is immense.

Because each life matters

Specially if you are clearing someone for any kind of transport industry

Last week , we saw a major train accident in Hoboken , where a bystander lost her life and hundreds  were injured .The driver was very experienced and had been on the job for quite some time . At this point , medical emergency cannot be ruled out .

Health is of utmost importance for every body and when on your well being depends the life of thousands of people .the importance cannot be understated

 

 

As the Presidential race gains  momentum , so does confusion galore .Every kind of media is spewing out their own statistics and in the process veering us away from making informed decisions . Its come to a point where the future electorate is like playing a Roulette . If you choose the right number , you are a winner otherwise , sorry . you loose .

The same questions stare at us , what we started the race with .

Are these promises for real? Are we  deciding for collective good ?Should be practice segregation or integration ?Does diplomacy give optimum results ?Would war bring peace ?

And so many more questions 

All we have is huge amount of unconfirmed data with no straight answers 

As my  gym instructor says – Dear , There are very few straight things left in life . But one of them has to be your right leg .So keep your right leg straight and then raise your left leg side ways with your both arms up .

Well , that’s not easy too 

As I said , Nothing is straight in this tough tough world .

HIPAA- in expanded form is Health Insurance Portability and Accountability Act which was enacted by Congress and signed by President Clinton in 1996 .It ensures that Medical information  remains protected and is a right of every patient .It is also the duty of the treating  Medical Organization to cooperate in the best possible  manner .

When we start the medical practice , as physicians , we have to do  HIPAA training .Its a part of standard care .We have to   update it every year as a part of oraganizational  CME. Failing to maintain HIPAA standards has dire consequences . 

As  per HIPAA – we can’t discuss patient details where other people have easy hearing access to it .We cannot let the computer on in the work area when we are not working on it . We cannot let the forms be placed face up  in the public area and so on and so forth 

But surprisingly as we reach higher echelon in public offices – all HIPAA goes out of the window .Every shred of your body is a public property . The whole world discusses your health prognosis , correctly or  incorrectly .

The recent uproar about Secretary Clinton’s pneumonia was  unfortunate .When we do not trust presidential  nominees,  whether they are physically or mentally  healthy enough to carry out their jobs , how  can you trust them with decisions , which are in the best possible interest for the country and the whole world ?

Well , that’s the way we are .

 

In today’s world of  web search , our patients are not left behind .By the time they come for their appointment , they already have a tentative diagnosis and a management plan.Most of the time , it is helpful for the physicians as patients and physicians are on the same page .

Another thing that has really infiltrated our lives are the various IT applications .I don’t think anybody is left untouched by them . For every problem , there is an app based solution .Booking a cab, Grocery shopping , getting the chores done , keeping an eye on kid or getting their homework completed …, you name it and their is an app in the market .

Same stands for medical field .Total Calorie count , healthy eating , ideal weight , fitness routine ,cardiac risk , stroke risk …

So, one of our app savvy patient decided to take it a step further .She confirmed her pregnancy with an app by downloading the app with $10 and then placing her iphone on her belly . And yeeah  it confirmed her pregnancy . When she wanted to register herself for prenatal clinic , we were all very amused . Our Obstetricians have not heard about it as yet 

Big surprise – She was really pregnant and it was her 9th pregnancy 

For a practicing physician , in order to practice in any state of the US , one needs a medical license . But for each state one has to have a state license .Besides  ton of paper work and being  expensive , it seems to be a ritualistic procedure where we are trying to keep some tradition alive .

In modern digital era , data storage and data sharing begins as soon as one joins the residency program .At that point we are supposed to submit information about our Medical education , work experience , any past mishaps and what not . We also have to obtain a temporary medical license of that particular state , where we finish residency .

But the moment we join a practice , we start the licensing procedure all over again , which makes no sense at all . All the information is a click away .

International medical graduates [IMGs] face the biggest hurdle as they have to get their paper work signed at their Alma Mater .Moving paper work in India is a herculean task .Besides getting a lecture from your office staff , that what a disservice you are doing to your nation by being a part of the brain drain , some times the paper work is not even traceable .Its specially difficult for those IMGs whose medical Colleges are away from their homes as one of their family members has to visit personally the Medical College to get the paper work signed .

I think its high time that such meaning less and antique excercise  should be abandoned . Past does not change for any body .

There should be a national licensing authority and any information the state board needs can be added on to it .

India happens to be the  world capital of skilled human resource .A lot of India’s improved economic situation is attributed to the diaspora and Governmental policy has  a major role to play  in it . Education is free  or subsidized and since childhood its ingrained in us that for an economically safe life , invest yourself in just education . The whole aim of the nation is to churn out clonal professionals .

But when being the 2 nd most populous country , it performs so dismally at the sports arena , we pause to introspect . 

Though,  there was a silver lining , as our women did us proud  and our nation celebrated them .More so , as we all know that a big part of the society still thinks female child as  a burden .Female Infanticide , grudged education , dowry problems , the social maladies are countless against women .

At this point ,we need government investment economically and policy wise in Sports .Also a  corruption  and  bureaucracy free selection process as countries like US  which has the highest medal tally ,does not  a   sports minister . As per Chinese media analysis , the rural India is   a  big human resource .

Scholarships, jobs , financial rewards would definitely tap an untapped part of society which we are currently loosing to anonymity 

 

 

As  I have mentioned multiple times in my blog ,primary care physician’s job is nothing to envy about .They  work in a pressure cooker environment sandwiched between litigious environment , administrative strangle and overwhelming workload with the lowest compensation

No wonder the burnout rate is maximum

In my residency days we were trained for almost all situations , but it was never made clear to us that a great part of practice would be dodging the lawyers by filling up the forms in a right manner

Every patient needs a form  to be filled up .Surprisingly every department has a form which needs  a countersignature from a doctor

School form , School medication form , school physical form , sports physical form , Grandma has  a problem …needs a change of school form

I  ride a horse ….need a disability parking ticket form , Jog all day , but need a ground floor accommodation form ,Go on vacations but need an electricity discount form , can’t work , don’t want to work ….

This is the icing on the cake

Don’t let my mother in law keep the parrots form

Is there  a give me break form ?????

There was a very disturbing revelation in the media that State of Washington tops the list of teen suicides and it has been the statistics for the last three decades . Among the top causes sited were , substance abuse , poverty and of course mental health issues

Behavioral health facilities have always been  found lacking in tackling mental health issues . There has been a drastic cut in  Federal funding since 1981 . In the face of ever increasing demand , specialized help is never ever received in time and specialists are far and few in between as the compensations are not very great as compared to other specialities .

EMR and meaningful use has been enforced  so that there  is a better justification of federal funding and medicare and medicaid payments . Physicians are  incentivized  and now there is a direct association of physician’s efforts to indicators of patient’s physical health .

But such  aggressive measures are not seen in Mental health . A bill has been introduced in the House of Representative in summer of 2015 for linking meaningful use to Medicare and Medicaid payments but its implementation has not been seen in a wide spread manner

Behavioral health needs more funding as physical health is incomplete without mental health.  A  mentally disturbed society has very tragic social ramifications .

Doping in sports is coming up as a huge stealth tool for winning medals in competitive sports .There was a disturbing news in the media that  a Country runs State orchestrated million dollars program to elevate sports people to winning pedestal .

We live in a period of ‘Overdrive’. We are Go getters  and we get them at any cost .For us no institution is pristine . We fake and fraud with elan .

Our highest offices are bid by  bigots , demagogues and liars . We acknowledge these and then react in a brain dead manner .

We segregate and discriminate .

We spread violence in the name of religion and peace

We have read about medieval  dark ages in history books as scientific knowledge was the deciding factor which was pushing certain nations back in dark alleys

Are we really far from there with all our wealth and  knowledge ???

My  Alma Mater , Lady Hardinge  Medical College ,  witnessed yet another incident of patient rage against physicians . There was a mob attack and the doctor was bitten by  the patient . In response to that , doctors retaliated by a flash strike .

These kind of hooliganism has been on an increase with any unfortunate outcome during the treatment process .

These incidents are always condemned and should never  be condoned

But if we look in depth  there are some facts that we need to take into consideration

There is a lopsided  physician centric milieu in India .How seriously they take their Hippocrates oath is entirely up to their own conscience . Physicians once  out of their medical school are not much under any scrutiny or under any regulatory body .

Medical litigation  are far and few and do not amount to a high pay off as compared to the loss incurred . Patient grievance forums are also not doing much justice to the patients

Again I  reiterate , these forms of violence is reprehensible .

But we need  a platform and an honest conversation about these issues