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Dr K K Aggarwal

Happy Doctors Day
Dr K K Aggarwal

In India doctors has always been considered and given the status of God but with the inclusion of medical services under consumer protection act consumer relationship has started between a patient and a doctor.

In the US and UK the patient is considered God and in Japan a King. In India the patient is now considered as a boss. As the boss can fire his employee so can the patient in today’s consumer health industry. The patient, therefore, should never be taken for a ride or for granted.

Patient should, therefore, be treated like a consumer and all the principles of consumer industry should apply to medical fraternity. Unfortunately, the medical professionals are not taught how to attend, treat and provide services.

Following are a gist of the principles which can help better patient doctor relationship.

1. In a consumer industry, consumer is always given the top importance and in health industry, therefore, the patient should be given the top importance.
2. Follow the principle. “Patient is always right”. He may or may not like arguments and can walk away if not satisfied.

3. The famous marketing law also applies to patient-doctor relationship. A satisfied patient (customer) will talk about you to 10 more people but an unsatisfied patient will talk to 100 people against you.

4. Patients like customers can be equated to sheep. They blindly follow each other. Generally, all sheep follow a particular one & so does the patients.

5. Patients like customers require very little to get satisfied. In one of our survey 90% of patients were satisfied when waiting for their turn when the doctor came & said “that I will be with you in a minute”.

6. As a part of medical training always do self role-play studies. Imagine yourself as a patient and imagine what wouldyou expect from a doctor. Give the same to your patients. Always put yourself in the patient’s shoe and then take actions. This is what Bharat in Ramayana did with Ram’s shoes.

7. Patient like a customer is the profit. Rest everything is overhead. Without patients no establishment has any value. He is your asset.

8. Believe in excellence: Eliminate all those in the establishment who are not related to or are not going to help the patients. The purpose of medical practice should be to create more patients. No patients no business. Carpets, chrome and chandeliers do not impress patients. They want good service. In one of our survey sixty percent of the people put their faith in the capabilities of their doctor and not on their dress code.

9. Patients do not want to be over charged: They don’t want to be over charged both in terms of money and time.

10. Patients want your 100% all the time. They are not bothered whether you are tired, not slept the previous night or have been busy the whole day. If you are attending they want your 100%.

11. Do not loose old patients: Remember, getting a new patient may cost you six times more than to serve the existing one. Always make sure that your existing patients are satisfied. The easiest way to get new patients is to look after your existing patients well.

12. Always meet your patients personally, greet them shake hands with them and try to call them by name. The law is ”If I don’t go I don’t get”.

13. Communicate continuously with your patients. This can be through phone, email, letters, post cards, your personal newsletters and updating their knowledge with updates and warnings.

14. In a medical establishment always insist that each of your healthcare providers visits the patient.

15. Always talk to a patient in a language they can understand and never talk in front of them with a colleague in a language, which they cannot understand.

16. Always look after your regular patients with special care. Give your patients the best service. Always anticipate their problems and provide them early solutions.

17. Patients like to have answers for their queries. Always get the facts from them. Analyze the facts and arrive at a decision. Never forget to listen, listen & listen to your patients.

18. Remember, success in life as a journey and not a destination. Be consistent in your behavior and efforts in long run you will be the winner. Always improve your CGR (character, goodwill and reputation).

19. A good doctor always follows ABC in sequence. Where A stands for Availability, B for Behavior and C for Competence. Without availability competence has no value.

20. While talking a decision remember, 3H. Head, Heart & Hand. Always think from your Head, then listen from the Heart (take a conscious decision), and then take an action (Hand). For example you are facing a problem. The head will give you 6 options but the heart will choose only one.

21. In an establishment always fight for your patients.

22. It is a good idea checking about the attitude of your health care providers on a regular basis from the patients.

23. Prompt action: Always solve the small problems of your patient now. Never wait for the problems to become urgent.

24. A dissatisfied patient is the best teacher. Listen to him He or she may have a solution or a suggestion. Most people who complain are educated and have an answer to the question they are raising.

25. Never have a meeting with dis-satisfied patients together. It may be detrimental to your interest.

26. Do not promise anything, which you cannot give. Learn when to say “No”.

27. Learn patience: When listening to patients try not to interpret them. Be sympathetic to them. Listen patiently, do not confront and always find a solution or give them alternative suggestions. While finding a solution, seek & discuss alternatives.

28. Always help patients in analyzing a problem and solving it.

29. Always compare yourself with yourself and not with other doctors. Remember GOD never made junks. Have confidence in yourself.

30. Instead of making people change, change yourself.

31. Do small things greatly. And do different things differently.

32. Instead of firing your employee put fire in him and motivate him.

33. Always build good thoughts. Always be positive. Remember, mistakes can always be better teachers. Treat every adversity as an opportunity to improve further.

34. Stress is the body reaction to the interpretation of a situation. Change the situation, change your interpretation or prepare your body to withstand the stress.

35. Stress is absence of ideas. Devote time to yourself and have a flow of ideas.

36. The age of your patient is not number of years lived but 100-number of years lived. He has come to you for the future and not for what he ahs lived already. Always be positive in life.

37. Always look at the positive aspects in life. Be happy that the glass is still half full and not worry that it has become half empty.

38. You may be correct in your argument but the other may not be wrong from his or her perceptive. 6 or 9 depends from which direction you are looking at.

39. Do not get angry with errant patients. Find out their end of story too. Remember, the system may be wrong in your training.

40. Never get angry with your employees. If a worker was as good as you he would not have been your worker.

41. Eustress is positive stress. It’s required for life. Always accept challenges. Distress is negative stress. It’s harmful. Learn to manage it.

42. Do not believe in KFP but in BFP. KFP is kee pharak penda hae (what difference it makes) and BFP is bada pharak penda ha (it makes a lot of difference). The “chalta hae” attitude is not good for any establishment.

43. Remember, Parkinson’s Law. “the more people you have, less will be the output”. Do not believe in making committees or appointing new people under the existing ones. Have a horizontal chain with many people reporting to the same head.

44. You are a role model to the society and your employees. Do not do any thing in public, which you asking them not to do. Do not smoke or drink in front of your patients.

45. Always train your juniors. Learn to spend 6 hours in sharpening an axe and 1 hour in cutting it. So that next time you save 6 hours.

46. Be a uniter and not a divider. Do not believe in the divide and rule politics. Remember you can only build house on rocks and not sands.

47. What do you want to become? An ape or a monkey? Be an ape and not a monkey. Monkey represents wandering mind and ape the intellect.

48. Washbasin vs. vacuum: The washbasin cleans the dirt while a vacuum sucks the dirt. The approach in life should be the washbasin one.

49. Understand the word NURSE: you are basically nursing a patient. Nobility, Understanding, Responsibility, Simple and Efficiency. A nurse is a noble, understanding, responsible, simple and efficient health care provider.

50. SERVICE, remember the word SERVE: Service, Excellent, Respect, Value and Enthusiasm. Provide excellent service full of value and respect in an atmosphere of enthusiasm.

51. A matchstick has a head but no intelligence. Always think. Take a conscious decision. Do not just be a follower.

52. When ever you are making a statement ask your self: is it the truth, is it necessary and is it kind. If any one of the answer is no do not speak.

53. When ever you are going to take a action ask your self, Is it true, is it necessary, will it bring happiness to me and to others? If the answer is no to any one do not attempt.

54. Always believe in non-violent communication. The principles are observation, feelings, need and request.

55. When narrating or conversing always use “quote unquote”. Always give the actual observations and not your interpretations.

56. Give your feelings and not the analysis. Instead of saying he hurt me say I got hurt.

57. Put a board “thanks for not smoking ” instead of“ any smoking”.

58. In your office write a sign board “ my answer is yes, now tell me your problem”

59. Satisfy your needs and not what you want.

60. You get what you deserve and not what you want. Be contended.

61. Always request and not order. Even a safai karamchari has self-esteem.

62. Creativity is diversity. The cycles involve intended intention, information gathering, information reshuffling, break (incubation period), insight, inspiration and implementation.

63. Smile it costs nothing. Always greet with a smile. A smiling photo in the clinic always helps.

64. Never criticize others in their absence: have the courage to speak in their presence. Your criticism will reach them in no minutes.

65. Do not believe in gossip. Tell a sentence and ask the person to pass it on till it comes back to you. And see how much it has been distorted. Gossip is something talked about a third person in his or her absence and not based on truth or without a reference.

66. Dirty linen or a dirty fish. Take it out. Do not keep people who create nuisance in the organization.

67. Do not believe new comers at first instance. Think before making a deal. Do not get attracted with new proposals. They may not get finalized.

68. Do not make patient as friends. Always keep a distance. When visiting their house do not sit with them and have a dinner on the dining table.

69. Always have a female attendant when examining a female patient.

70. Respect patient privacy. Do not talk about the illness to others without patients consent.

71. Never resist second opinion. The patient has the right for the same

72. Never deny case records to the patient. Every patient has a right to receive them legally within 72 hours.

73. Never ignore an emergency. You cannot refuse to see or attend an emergency. Weather you get your fees or not. It can have criminal implications.

74. Never give telephonic or email consult: You are legally bound as if it was a regular consult.

75. If prescribing a medicine on phone pronounce the alphabets. Remember two drugs may sound similar.

76. Write legibly. Write drugs in bold letters so that there are no mistakes.

77. Never write 4U insulin. In one instance he received 40 units. Always write units and not U.

78. Never write .25 mg always write as 0.25 mg. Other wise there are chances the patient may take 25 mg in the first instance.

79. Never write a prescription “paracetamol 8-2-8” instead write “paracetamol 8am 2pm 8pm”. There are chances the person may take 8 tab in the morning, 2 in the afternoon and 8 at night.

80. Give the option of generic named drugs from a standard company to the patient. They may be cheaper.

81. When writing a prescription write the most important drugs on the top and not otherwise. This is how the patient is used to.

82. Write clearly when you want the patient to take the medicines. Otherwise his assumption will be not to take empty stomach.

83. Explain the patient about the charges. They think hospital as a hotel not realizing that all charges vary according to the category chosen in a hospital.

84. Never argue with you seniors in others presence. You may win arguments but loose relationships.

85. Never criticize your colleagues in front of the patient. Even if they have made a mistake.

86. Negligence is not error of judgment but inability to provide average degree of care.

87. Remember the magnitude of care may vary but the standards of care should be the same.

88. Do not call your colleague as a trainee, student or a junior. The patient may not understand that language.

89. You have a right to refuse a patient provide it was not an emergency.

90. You have a right to choose your fees.

91. The business laws are: Profit, policy, happiness. Your policies should be such they not only ends in savings but also provides happiness to you, your patients and your employees.

92. Even to your relations give consults in your chamber. You will have a better respect.

93. Do not give walking consults in parties. Insist them to come to your chamber.

94. Always update your knowledge. The patient is well read today.

95. Never shy of saying, “ let me read about the subject”. Even judges do the same.

96. Always ask the patient about other doctors he or she is seeing. There are chances he or she may be taking drugs from dentist, ortho or gynae doctor already for different ailments.

97. Always ask for the old records. No one will excuse you of missing drug reactions mentioned in the old records.

98. Never hurt the religious sentiments of patients. Respect all aspects of their emotions.

99. Remember the Vedantic phrase:

Watch your thoughts, they become your words.

Watch your words, they become your action.

Watch your action, they become your habits.

Watch your habits, they become your character.

100. Sow an action and reap a habit.

Sow a habit and reap a character.

Sow a character and reap a destiny.

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(The Main Principle of Knowing the Truth)

The main figure in the Upanishads is that of the sage Yajnavalkya. Most of the great teachings of later Hindu and Buddhist philosophy and derived from him. He taught the great doctrine of “neti-neti”, the view that truth can be found only through the negation of all thoughts about it.

Brhadaranyaka Upanishad is the oldest and recognized as the most important of all the Upanishads, Brhadaranyaka derives its name from the “great forest-book”.

The greatest of Upanishadic philosophers, sage Yajnavalkya’s dialogues with his wife, Maitreyi are featured in the Muni Kanda or Yajnavalkya Kanda. The doctrine of “Neti, Neti” in this Upanishad suggests the indescribability of the Brahman, the Absolute. It is possible to describe Brahman as what ‘It’ is not but not as to what ‘It’ is. Yajnavalkaya makes an effort to define Brahman. The three cardinal virtues of self-restraint (DSmana), alms giving (DAna) and compassion (DAya) are also mentioned here (the three ‘DA’s).

Atman is “neither this, nor this” (“Neti, neti”). The Self cannot be described in any way. “Na-iti” – that is “Neti”. It is through this process of “Neti, neti” that you give up everything – the cosmos, the body, the mind and everything – to realise the Self.

After knowing the Atman in this manner, you will develop the attitude that the phenomenal world and all its creatures are made up of the same essence of bliss.

Brahman is infinite, amorphous, colorless, characterless and formless Universal Spirit which is omnipresent and omnipotent, and like cosmic energy, it is pervasive, unseen and indescribable.

1. Neti-neti Meditation: The principle of Neti Neti has been used in meditation involving gnana yoga. Whenever a thought or feeling which is not the goal of the meditation — which is not the soul or the inner self — comes to the mind, the meditator simply has to say, “Not this, not this,” and dismiss the thought, image, concept, sound, or sense distraction. Any thought, any feeling, is discarded — patiently discarded — again and again if necessary, until the mind is clear and the soul/or the self is revealed.

2. Neti Neti and the mind: When you get into the habit of “neti-neti,” you can also discard thoughts of worry, doubt, or fear, and become established in the light of your inner self. You can, then, look back at worries and fears with deep insight and handle them.

3. Neti-Neti and Medical Profession: One of the basic medical teaching is to diagnose a condition by way of excluding other similar conditions. This is called differential diagnosis and this is the main stay of allopathy. This also makes one investigative-oriented but is the only scientific way of knowing the truth.

4. Neti neti and multiple-choice questions: In any modern exam today, the principle of Net Neti is used. A question has about four nearly similar answers and the student has to answer the correct one. He can only answer by the principle of negation.

5. Neti Neti and police investigations: This principle is also used while handling a criminal case. One suspects everyone on the crime and then starts elimination one by one.

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Diet is linked to the diabetes epidemic

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A study published in the journal Diabetes Care, highlights the importance of the whole diet rather than focusing on certain foods or food groups that might be beneficial..

A diet rich in whole grains, fruits and vegetables (leafy green), nuts and low–fat dairy may help people lower their risk of type 2 diabetes by 15% over 5 years than those who ate the lowest amounts of these foods.

Also, a diet which contains high amounts of red meat, high–fat dairy and refined grains like white bread may boost the odds of diabetes development by 18%.

Type 2 diabetes is closely linked to obesity and it is well–known that maintaining a healthy weight through diet and exercise reduces the risk of developing the disease. Diet affects diabetes risk independent of a person’s weight.

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1. Energy is the raw material of the universe.

2. Information is the organization of energy into reproducible patterns.

3. Consciousness is living information and energy (living energized

information)

4. Consciousness is, therefore, intelligence.

5. Intelligence is information and energy that has self-referral or the ability to

learn through experiences and the ability to reinterpret and influence

one’s own information and energy states.

6. Consciousness is live, advanced, software-driven energized information.

Nearest example: Advanced computer software which can type, correct, interpret, edit and store spoken or read information.

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5 Ways to Use less Salt

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1. Use spices and other flavor enhancers such as spices, dried and fresh herbs, garlic and ginger, citrus, vinegars and wine. Flavors can be black pepper, cinnamon and turmeric to fresh basil, chili peppers, and lemon juice.
2. Use the right healthy fats — from roasted nuts and avocados to olive, canola, soybean and other oils.
3. Searing and sautéing foods in a pan builds flavor. Roasting brings out the natural sweetness of many vegetables and the taste of fish and chicken. If you do steam or microwave food, perk up these dishes with a finishing drizzle of flavorful oil and a squeeze of citrus.
4. Get your whole grains from sources other than bread. White bread contains salt, not just for flavor but to ensure that the dough rises properly.
5. Shop for raw ingredients with maximum natural flavor, thereby avoiding the need to add as much (if any) sodium. [Harvard]

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1.Brahma Satyam Jagan Mithya Jivo Brahmaiva Na Aparah means – Brahman only exists truly, the world is false, and the individual soul is Brahman only and no other.

2.Ekam evadvitiyam brahma means Brahman is one, without a second (There is one absolute reality, without any secondary parts)

3.Sarvam khalvidam brahma means all of this is brahman

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Fecal microbial transplantation (FMT) via enema is shown to be effective, tolerable, and feasible for treating children with ulcerative colitis (UC), according to findings from a phase 1 pilot study published online March 29 and in the June issue of the Journal of Pediatric Gastroenterology and Nutrition.

It involves infusion of human stool from a healthy adult donor into the patient’s intestine and has been proposed as an option for recurrent [Clostridium] difficile infection and possibly for ulcerative colitis as per Sachin Kunde, MD, MPH, from Spectrum Health Medical Group, Helen DeVos Children’s Hospital in Grand Rapids, Michigan. The procedure may restore ‘abnormal’ bacteria to ‘normal’ in patients with [UC].

Ten children, aged 7 to 21 years, who had mild to moderate UC, received freshly prepared fecal enemas daily for 5 days.
The investigators collected data on tolerability, adverse events, and disease activity during FMT and weekly for 4 weeks thereafter. At baseline, pediatric UC activity index ranged from 15 to 65. The investigators considered a reduction in PUCAI by more than 15 to be clinical response, and PUCAI lower than 10 to be clinical remission.

There were no serious adverse events. Self-limiting adverse events were mild cramping, fullness, flatulence, bloating, diarrhea, blood in the stool, and moderate fever. Although 1 child could not retain fecal enemas, average tolerated enema volume in the other 9 children was 165 mL/day.

Clinical response within 1 week occurred in 7 (78%) of the 9 children, including 3 (33%) who had clinical remission and 6 (67%) who maintained clinical response at 1 month. Compared with baseline, median PUCAI significantly improved after FMT.
(Medscape)

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New Delhi : 27th June, Thursday 2013: This year’s MTNL Perfect Health Mela will have its activities extending over a month. Announcing this in a press conference, Padma Shri and Dr B C Roy National Awardee Dr. KK Aggarwal president Heart care foundation of India said that the activities will start on 29th September World Heart day with a Dil ka Darbar and end on 31st October with CPR Utsav atDPS Mathura Road. The main traditional mela will be held at Constitution Club of India from 23-26th October which will have exhibitions, competitions entertainment, checkups and workshops about all aspects of health incorporating all pathies under one roof.

Co addressing the conference  Mr Vinod Kumar, GM Marketing MTNL, Delhi; Mr Deepak Chanduka, GM Marketing MTNL Corporate; Dr. N V Kamath, and Dr. K S Baghotia from DHS; Dr. N K Yadav MHO MCD South, Dr. Ramesh Kumar, CMO NDMC and Dr Shally Kamra, CMO, PNDT said that the mela will focus on disaster management and prevention.

Celebrity guest for the event Pandit Jwala Prasad a music legend released the dates and the theme. He said that music and entertainment when combined with health can be more healing.

1st July doctors day

Sixty percent of people do not discuss their sexual behavior and performance with the doctor when they go for consultation

A survey of 452 people was conducted by Heart Care Foundation of India and eMedinewS on the occasion of Doctors Day. The objective of the survey was to assess the perception of doctor-patient relationship among the people.

The survey included patients, social workers, RWAs, morning walkers, college students and government employees fromDelhi.  Data was collected using a questionnaire, which the survey participants were asked to answer.

Elaborating on the observations of the survey, Padma Shri & Dr. BC Roy National Awardee,
Dr. K K Aggarwal, President Heart Care Foundation of India said that the data came up with some interesting changing trends among the people with regard to doctor-patient relationship.

Sexual preferences, choices and behaviors

a. The survey revealed that only 42% had a family physician.

b. When suffering from an illness 52% of the people would directly opt to visit a specialist and not a family physician, which is not a good trend.

c. The traditional concept of a ‘family physician’, who looked after all the health needs of a family regardless of his/her specialization, is now changing. Everybody should have a family physician for better patient care.

d. Even today, 60% people do not discuss their sexual behavior and performance with the doctor when they go for consultation.

e. 80% of the ties doctors also do not ask them about their sexual preferences, behaviors and problems.

f.  This brings them to seek help from sex quacks and advise from friends and neighborhood.

g. People are sexually active even at elderly age. The proportion of man reporting no sex is 20% at age 51-60 and 87.5% at age above 75.  In women, reporting no se is 100% after the age of seventy. 16.17% of men reported that they are facing erectile dysfunction and 17.64% are having premature ejaculation during sexual act.

h. It is customary in US medical schools to be taught, when taking a sexual history, to ask whether someone is sexually active, and if so, what are his sexual preferences?

i. The questions asked in the history include as a routine:

Sexual history: “Do you feel comfortable with your sexuality?”

Sexual preference:  “Are you sexually attracted to men, women, or both?”

Sexual high risk behavior: Do you have multiple partners

Young vs old doctors

a. 57% of people check the credentials and qualifications of a doctor before visiting them for consultation. This is a new trend in the society.

b. But, even today 63% of people put their faith in the capabilities of their doctor and not on their dress code.

c. Only 37% felt that their doctors should be well dressed in a suit and tie.

d. While 65% still feel that senior doctors with white hair can provide better patient care than their younger fashionable counterparts as they have more clinical experience.

e.  100% said that if you cannot practice “ compassion based medicine” at least practice etiquette based medicine”

Patients want privacy

40% of people did not want doctors to be their friends on Facebook. New International guidelines also warn doctors not to be connected with their patients on face book.

Doc, no smoking please

Eighty-one percent people reported being disturbed when they saw their doctors smoking in public and would not like to be treated by a doctor who smoked in front of them.

Write legibly

67% felt that their doctors should have legible handwriting and favored an electronic prescription instead.

Please provide affordable, quality and safe medical care

78% people felt that that medical profession is becoming commercialized today and should be made more affordable for a common man. 59% felt that doctors’ charging less fee is not their concern. But, 41% were of the opinion that doctors should charge less as their profession is a noble one.

Patients want doctors to spend more time with them

a. 49% people I the survey reported being satisfied with less 15 minutes of a doctor’s time; 26% wanted their doctor to spend more than 15 minutes with them and the rest wanted time till they were satisfied.

b. Even today 44% percent doctors do not advise their patients about adult vaccination. This needs immediate attention.

c. 55% people reported that their blood pressure had never been checked in both arms.

d.49% people preferred to take a dietary advice from their doctor and not from a dietitian.

e. Forty-seven percent persons did not have any health insurance. 49% of the patients did not know that when they are hiring a room in a private hospital, the insurance covers only 1% of the sum amount ensured for the bed.

f.  52% of the people do not know that error of judgment or difference of opinion is not an act of negligence on the part of the doctor.

g.  48% are unaware of the fact that a doctor is supposed to possess only an average degree of skill and knowledge and not the maximum degree of skill and knowledge when treating a patient.

h. 30% still did not know that creating violence in the hospital premises is an offence.

Patient wants second opinion from the same doctor

1. 60% would get a second opinion from their regular doctor if they are not satisfied, while 40% would like to take another opinion from another doctor

2. 72% of people do not want doctors to treat them just on clinical grounds but prefer getting investigated first. When advised investigations, 57% would ask their doctor to suggest a lab, while the rest said that they would choose their own lab.

Patient etiquette

1. 46% people said that they preferred to call their doctor directly to fix an appointment and not the secretary.

2. When calling for an appointment, 53% would choose to call on a mobile number and not the landline, whether the call is to the doctor or the secretary.

ABC of a good doctor

Where A is availability, B is behavior and C is capability.  95% of the people said that the will be satisfied if the doctors is available and has practices etiquette based medicine.

Etiquette based medicine

Remember Mnemonic AIEDT

A: Acknowledge

I: Introduce yourself

E: Explain about your plan

D: define the time spam of your plan

T thank the patient

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