Can't doctors care for their money?

I have not ear marked my blog to doctors only and therefore this blog may not create the same response in everyone reading it. Anyway as a doctor and that too an anaesthetist whose names will not figure in payroll of most of the hospitals I think its hightime to share my view. I had received e mail update from medscape.com,-"Why Aren't Doctors Allowed to Care About Money? Part 2"by Leslie Kane- a few days back. It was a blog on the new health policy of USA and how it affects the payment of doctors. Many of the doctors had said their views.Here I like to mention some of them.

An anesthesiologist commented, "My plumber with no student loans, no education, and accepting only cash payments has an easier and more profitable career. Yes, medicine is a very altruistic career, but altruism doesn't pay for college, graduate schools, mortgages, food, etc..



Another anesthesiologist said, "Doctors are allowed to care about money, as long as no one's life depends on the service they provide. No one is proposing that plastic surgeons be required to provide a certain level of free care. That's the paradox -- the more life critical one's specialty is, the less they are afforded the opportunity to care about what they make."

"What really concerns me amongst people who are critics of physician salaries is the notion that physicians shouldn't care about their incomes," said a general surgeon. "This is a disrespectful and ignorant point of view that serves only to dissuade capable individuals from choosing a career as a physician in the first place."

An emergency medicine physician said, "The two bases of human emotions are envy and greed. Joe Average is envious of physicians' status and earning ability, although he knows he was not smart enough to get the required training or disciplined enough to complete it. The latter emotion, greed, is simpler: He wants everything for free...We can't overcome these basic instincts.

An endocrinologist asked, "For all these patients who think that doctors make too much money, I would like some answers. Why is it okay for the entertainment world (athletes, movie stars, television personalities) to be millionaires? Is it not okay that your doctor who had to endure twelve or more years in medical school and residency be compensated for this?

One family physician summarizes the irony of actually being an altruistic doctor: "It seems I help treat the needy and we see patients milking the system. We are in danger of being sued by the 'cannot make happy group.'
It surprised me that as most of us, doctors in India, think that USA is paradise for doctors and when we go there we will become millionaires. But I am sure that not only in USA but in any country the payment to doctors is very less when compared their service. The other side is always green, isn't it? When such a question is asked to our doctors I am sure the answers will be the same. May be the payment system in USA is different from our country. There,patient is not directly paying to the treating doctor but to the insurance company. The doctors there left the ordeal of collecting money to the insurance people for many years and are now feeling for it.
In the above said article one doctor had said,"Doctors have allowed the insurance companies and other payers to substitute for their own collection efforts," said an emergency medicine physician. "Because of this, they have become even more uncomfortable with receiving payment in any other way. We have suckered in for 'the only ethical way to receive money is if others just GIVE it to us.' We didn't take responsibility for our own incomes and that is why we are here. It was just easier to let 'the big daddy' do it -- albeit with huge pressure from 'the big daddy.'"


But here the story is differnt but effect is the same. Can you tell with confidence that you get what you think is your reasonable professional fee from your patients? How many doctors get their money without bargain? Is there a uniform fee system here? People are ready to spend on things that make them happy or they think they are happy when they are doing such things. A common man can shell out Rs 200 to buy a movie ticket but he thinks its a waste if he give Rs 50 to his doctor. After all these tiring years of medical college, residency, PG preparation time, toiling PG period and loans to set up a small practice place, you have work till midnight to get that Rs 50. A teashop owner earns on an average Rs 1.5 lakh per month believe it or not. He sells coffee worth just a rupee for Rs 6. Just imagine what we are doing? What is the electrician bill per day - Rs 300! That if you call him two days earlier, if its a emergency it escalates.But even if you are called at midnight you can't charge it high yet there is a provision to do so. Because you are a doctor and you are there to treat a patient in need but your needs won't be met. I don't think it makes sense. I agree this is a service but can't I be allowed to ask my fee which I think reasonable. Of course I am not demanding it before my service. Is it not like cheating? Why people pelt stones at a hospital alleging demand of excess fee? Is there a code to collect same money at all hospitals? Why people keep mum at hotels charging excess bills , way high for what they provide? Why people throng theatres even if ticket fee is Rs 200? Why lawyers are not beaten up if they lose their case? Why it is not the same case with doctors? So we think that it is easy to get money from insurance company rather from our patient. People here including doctors are crying for insurance cover for mediacl treatment and the trend is slowly changing here too. But we have look at what happened in US when doctors handed over the 'collection responsibility' to insurance companies and I am sure insurance companies are same everywhere. Now they are chasing us but in few years we will be chasing them for our money.

An old Russian proverb:"The doctor is an angel when he tenders his cure and a devil when he tenders his bill."

Rahmanism- Where it is going?

I thought of writing this blog much earlier than previous the one about Tendulkar. But I refrained from doing so since I don't know whether I am right. I am not the one who is having first hand knowledge about music. I don't even know the basics about it but I can smell the goodness or the catching aura of a song in the first instance itself. Idon't have to hear it repeatedly. I am sure many of you will have a feeling of joy or something enjoyable or something pleasant or something which reminds you your childhood on hearing good tunes. But on hearing the songs of Raavanan(Raavan inHindi) I had no such feeling in my heart. In fact I struggled to follow them uninterruptedly. Except Usire Poguthe( Behne De Mujhe in Hindi) sung by Karthik I surely can't digest any song.

They say how cleverly Rahman mixes his tunes with beats, blends the voices of his singers( sometimes he changes them too !), how he deviates from the standard compositions and things like that. But what is the use if he can't give a song which common man can't hum when he is in good mood of the day. What is the use when it doesn't kindle your heart? What is the use when it doesn't serve its purpose? I think he no longers belongs to the place where he originally belonged to. Or he thinks people will like his work in whatever way he gives. Or probably he thinks it is enough if he satisfies a select audience. Where is the Rahman who gave us excellant tunes like Porale...(Karuthamma and later in his path breaking album Vande matharam), Ennavale...(Kadalan), Minnale....(May Mdham).As Bhradwaj Rangan in The New Indian Express put it he produces more head music than a heart music.Oh! Rahman! We the common people of India want something simple, sweet and cherishable.We can't understand your musical genius all the time!

Master Blaster On & Off Field

Hai Friends! I am blogging after a long long time. No specific reasons for that and I don't want to escape by saying that I had no time.The early morning rain and the cool breeze pleased me after the scorching summer of all these days and I am on week off today and hence this blog. Suddenly it striked to me that instead of writing about hard realities I could write about something or someone which or whom everyone relishes. And I decided to write about this man. The man who is darling of millions infact a billion people of Indian republic. The man who belongs to every house in India. The man who has won hearts of everybody including his critics. The man whose words are keenly watched by common as well as high profile politicians . The man who stood the 'test' of time. The man who is far away from his contemporaries in professional as well as personal life. Yes!The man is none other than Sachin Ramesh Tendulkar. Born to a middle class family in Mumbai on 24th April 1973 he rose to stardom or demigod status purely by his talent and hardwork. No one can forget his staying at the crease at Sialkot in the final test of his first test series after having been badly hit on his nose. You are well aware of his records and no can deny his ability to adapt to the situation quickly. When most of critics raised questions about his ability to play in T20 format he silenced them all with his bat in recent IPL by becoming leading run scorer .Apart from all his on field records,which impresses me most is his pious personal life not deviating from Indian culture as we know it.
For his status and his earning he can do whatever he wants and can always defend it. But he sticks to moral values of our culture and so far not caught in any controversy.I think this one thing puts him apart from all other players of his calibre of any sport around the world. Don't forget what Tiger woods said after he was caught in sex scandal-' I thought I have the previlage to do like this after all my hard work '- This was what he had said in his apology. And everyday players act in a nonsense way in the public but not this man. Above all Sachin acts as a binding force of our people. He has no boundaries and every Indian believes that he belongs to him. That is something great. At 37 he still plays for India after all these 20 long years of international cricket. He hopes to win a world cup for India next year and we also do hope. All the best Sachin!

'Vinnai Thaandi Varuvaayaa'

Hai Friends! Sometimes we think that we are very busy but we know that we are not! Sometimes we feel that there is so much pressure from family and friends but we know that it is not true! Sometimes we feel that someone is too close us but we know that they are far away! Sometimes we feel that someone is far away from us but we know that they are actually too close us! Hey whats happening to me? Yes! I had watched VTV recently and stuck with the emotional turmoil of the lead characters Karthik and Jessie in the film. Its rare that a tamil film portrays urban love in a decent and subtle manner and there are very few directors in that genre, Gowtham Menon is one among them I reckon. Staying away from cliches of tamil cinema in most of its part VTV too have them in few instances, e.g the boxing scene. And I think the differences between the girl and the boy who falls in love with her are artificial in certain aspects and created just to make the ripples in their relationship bigger and bigger. One who is watching the film will realise at certain point of time what will happen to this relationship at the end. Gowtham is clever in that he has two climaxes?! for the movie, one the original and other for the movie inside the movie and I think he wanted to satisfy audiences of both fantasy and reality. The viewer can get satisfied with what he liked as the ending. Also I like to mention that Gowtham Vasudev Menon, as he liked to be called like this only after his initial successes( in his earlier films he contended with himself called as Gowtham only) is depicting more of malayali characters and their habits. In Vaaram Ayiram too the rituals of marriage and death of hero's father belonged to malayalis. I don't know whether these are casual or deliberate. And he criticises himself in this film that he likes to make movies of western style and he drags production for two years. In this movie he drags the second half to yawning length and sometimes boring.The highlight of the film is A.R.Rahman whose mesmerising music will make you busted and speechless. No song fits in a particular genre and they sound simply superb. Even Tirukural fits like hand in glove in his tune. The cinematography by Manoj Paramahamsa is excellent. Most surprising is Silambarasan that he attracts you in his subtle but suitable emotion, his underplaying to lead actress and his decent day to day costumes. Trisha who plays Jessie follows suit to Silambarasan. Babu Antony who played the murderer in Fossil's " Poovizhi Vaasalile" plays Joseph who is father of Jessie and attracts you. But in the end the viewer gets confusion that if Jessie knows very well about fate of her love what was she doing all the time when Karthik woes her often. When Karthik is so adamant about his love then why he refuses the call from Jessie when she was to take a decision. When Gowtham is so clear about his characters why he depicts two climaxes though cleverly blend one in one. Answer me if you have one!

Rural Doctors- Will they be a reality?

I was taking a long break for nearly ten days from writing a blog. I think it was not because I had become procrastinator but because I didn't know what to write about- Sri Lanakan elections, Padma Awards, Ruchika's case etc..etc. But suddenly the announcement came from Union health minister Sri Gulam Nabi Asad that the govt has a proposal to introduce a new course named as Bachelor of Rural Medicine & Surgery shortly which is a 3 1/2 years duration that will teach basic medical and surgical procedures suitable to villages. I found potent blog material in this announcement that it will kindle a lot of criticism among the doctors community and general public. These so called Doctors?! can't treat the patients in the towns and cities. Those will be treated by the regular ones with a proper 5 1/2 years training.
The pitfalls in this system are:-
1.As doctors we are aware that even that stipulated 5 1/2 years is not enough to sail the sea of medicine. How could one with a 3 1/2 years will master the basics and so called rural clinical knowledge and be ready to face the patients?
2.When the Union health minister had told this policy decision didn't he realise that the people in villages also belong to Homosapiens and not a different species?
3.If he considers them as fellow humans is it not inhumane to subject them for treatment by half baked doctors? National Human Rights Commission(NHRC) had strongly stressed this point recently.
4.Shall we consider that it is failure of our medical system that it can't persuade fully qualified doctors to work in rural areas?
5.On the contrary shall we consider that it is failure of fully qualified doctors to accept the decision made by Ex union health minister Dr.Anbumani to make rural service compulsory to newly recruited doctors? That Union govt has denied chances for those with 5 1/2 years degree to work and earn in the rural areas.
6.What are higher studies options of these rural doctors? Is it possible to switch to Urban?! medicine in the future?
7. The Union Health Minister had boasted that the system of rural doctors is a great success in the states of Jarkhand, Uttranchal. He had forgotten one thing that there are no doctors at all in those states which are newly created recently. Hence it was a run away it in those states. India is a diverse nation with each state posing different problems that same result cannot be expected in all states.
8. Also already in most of the rural areas in South India especially in Tamilnadu doctors are doing great service to the people. I don't know how many of you know that there is an "Association Of Rural Surgeons of India" for years together in our country which itself shows that there are like minded doctors who are dedicating their life to people in villages.
9. Again there are lot of doctors who had enrolled their names in Executive and Professional Employment Exchange and waiting for the governments call. They can very well be called for posts in rural areas. This point was endorsed by Director of Public Health of Tamilnadu in a weekly. He had also said that the system of rural doctors is not suitable for Tamilnadu.
10.A great joke is that the rural doctors will treat common ailments and refer the complicated ones to cities. That is what happening now at PHCs. PHC has to give primary health care and health education and do a timely referral if the case warrants. No doctor can treat decompensated liver failure at a PHC.

Of reading the above story one can judge that creating rural doctors will create confusion in our society.We don't know whether people will know the qualification of the doctor treating them. Where will I go? My own doctor or the one at town?, will be his question.It will create confusion among the rural doctors. Who am I? A doctor? A nurse?, will be his question.It will create confusion among the government. How much we have to pay?, will be its question. How long will it go we don't know.

We hope that before implementing this system govt will analyse the pros and cons and act judiciously. As for as I am concerned there are lot of cons than pros. What is your view?

Solar Eclipse 2010

Dear Friends! You would have seen the most fascinating celestial phenomenon of this century, Annular Solar Eclipse! The specialities of this were that it appeared after a period of 108 years. Again we will have the same on 2019 only. Further it was the longest annular solar eclipse that it lasted 11 minutes(approx). We will have the same duration on 2186 only. Hence in one sense we were lucky. Also ISRO had launched as many as 11 small rockets to research the changes in the atmosphere on 14th & 15th January. Again we Tamils are lucky that annular solar eclipse was seen for the full 11 minutes at our own Kanyakumari. The positive aspects are Science Forum at Vellore had issued special glasses at a cost Rs 10 each, all of those were sold and were not enough. School students numbering around 2000 were taught about the phenomenon of Solar eclipse, methods to see it safely and myths about it by the scientists at Kanyakumari. Food was provided at the venue to break the myth that eating during the eclipse is not good for oneself. Inspite of repeated attempts by the scientists to clear the myths and misconceptions about the solar eclipse people were still not ready to receive them. Temples were closed for worship during 11.00 am to 3.00 pm. People thronged holy tanks of temples after the eclipse to wash out the evil. Women, carrying mothers and children stayed indoors most of the time. Food was not cooked in most of their homes( including mine!). Special poojas after the eclipse at temples and homes. I wish that more and more eclipses of this kind should happen in India to clear out the myths and misconceptions from our minds.

Just to add, here is a simple way to watch the solar eclipse. You don't need special glasses. You don't need to go to Kanyakumari where special telescopes were kept. All you should have is a mirror and a cardboard. Make a pinhole in the cardboard and paste it on the mirror. Place the mirror now so that it reflects the sunlight on a screen or on to a white wall. Just sit and relax as you will see the eclipse on the screen or on the wall. Have some snacks and tea to break the myth. If you have time you can capture those images on your camera like me. Enjoy!

p.s: Please see the pictures in anti clockwise from below upwards

'Avatar' - Do you like it?

I am sure most of you have seen the multi crore movie 'AVATAR' directed by James Cameron. I had watched it on the day of its premiere 18 Dec 2009, the same day on which our own 'Vettaikaaran' released. The problem was both movies were released on the same theatre complex. So those who didn't get tickets for the Vijay's starrer thronged box office of the 'Avatar'- The result- We were among the group who unexpectedly and unwillingly paid for a movie which they didn't like. Everybody started smoking from the very first scene( I wonder whether the law against smoking at public places is followed). Just imagine you are sitting at the top of a chimney, that was my situation. With irritation of eyes, Avatar added headache. I don't think the movie is worth Rs 1200 crores which is its budget, four years time which is the production period of the movie and James Cameron who had given us 'Titanic' the epic movie of our times. It lacks the basic tone- Emotions which is vital for any story not necessarily a cinema. Just remove the backdrop of the movie Pandora planet & its inhabitants, Avatar has elements which are not new to cinema. Here is a story of tamil cinema in the 1960s- A soldier is sent as a spy to his enemy country. He mingles with the people of that country, falls in love of its girl, realises the innocence of its people and switches his side and starts his fight for them against his home country and finally wins over them. Just fit the enemy country as another planet and its people as having different phenotype. You get the movie Avatar. Except the hard work made by its technical experts( first 3D animation images), innovative flora and fauna you get nothing. I went with lot of expectations but was very much disappointed. This shows one thing. Whatever money you are spending if there is no strong story no movie will be interesting. Avatar is no exception.

p.s: O.K. friends! Are you happy? I have purposefully avoided day to day issues and had written my comments about a movie that too from hollywood.