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Dr K K Aggarwal

100 ways to improve patient doctor relationship

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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.

Neti Neti (Not This Not This)

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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.

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.

Facts about Soul and the Spirit

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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.

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]

What are three great sentences of importance other than mahavakyas?

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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

Fecal Microbial Transplantation for Ulcerative Colitis

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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)

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

Understanding who we are…………..

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The classical description of ‘who we are comes’ from Adi Shankaracharya’s Bhaja Govindam, where he says that even the wife refuses to touch the same physical body after death, with which she has been fondling all these years and if she touches it, a ritual bath has to be taken. This means physical body is not what we are.

If we weigh physical body before and after death there will be no difference. The life force also called consciousness or atman has no weight, shape or dimensions.

In Bhagavad Gita,Krishnain Chapter 2 describes its characteristics as “fire cannot burn it, air cannot dry it, weapons cannot cut it, and water cannot wet it. It is omnipotent, omnipresence and omniscient”.

Though modern medicine may not talk about soul but it does differentiate life and death based on certain parameters.

Vedic description describes five different movement forces in the body: apana vayu expulses urine, stool, baby and menses; samana vayu controls the intestinal movements; vyana vayu controls the circulatory system; udana vayu controls the neurological impulses and the connection between soul and spirit; and prana vayu controls the brain stem reflexes.

Soul or consciousness is linked to udana vayu and prana vayu. The best description of these five forces apart from Ayurveda text comes from prasannopanishad.

A patient with brain stem death can be kept on ventilator for months together, as the body has normal vyana vayu, sana vayu and apana vayus. The patient will therefore, maintain blood pressure, GI functions, urinary functions and reproductive functions. These three vayus are controlled by the atmospheric oxygen and not by the life force.

Can anyone remember the weight, height, abdominal circumference or size of collar, waist or shoes of Lord Krishna? He is only known only from his actions and the soul profile.

All of us have physical, mental, intellectual, ego and soul characteristics. Soul characteristics in all are same & are positive. The examples are love, compassion, care, humility, etc. These soul characteristics are influenced by the subtle mind, intellect and ego characteristics.

While introducing ourselves, most of the times we talk about define our intellectual or ego profile and not the soul profile. When we describe our status, house, car or money, we are describing our ego profile and not the soul profile. Our aim in life should be to understand our soul profile, as without the soul nobody will come near us. The same very people will dispose off our body at the earliest opportunity they get.

Most of us co-relate life span with the life span of the physical body, which has to perish sooner or later. When we ask people how long they want to live their usual  answers are 60 yrs, 70 yrs, 80 yrs or 90 yrs. Nobody thinks beyond physical death. People like Mahatma Gandhi, Indira Gandhi, Mother Teresa are not dead. Though their physical body does not exist, their good karmas, work, memories and the soul profiles are still alive.

The purpose of life should be to create an atmosphere or an aura in such a way that the society remembers us after the death of our physical body. This is only possible when we shift our thinking from the ego profile to the soul profile.

Soul is nothing but an energized field of information and can be equated to the live information fed in any computer or mobile phone. Both computer and mobile phones with and without information weigh the same. Similarly, weight of radio does not change weather the radio is on or off. The live data information in the TV, radio or mobile phone can be termed as their soul. A computer without this soul is useless, so are the mobile and radio sets.

The information is always static and still without any movements. This information in a computer requires a software to run. The static soul in our body also requires a software called life force.

Soul, thus van be described as a combination of the life force and the static information. In Hindu mythology this is called shiva and shakti. Some people describe them as prana and chitta. In vedic philosophy by controlling prana one can control chitta and vice versa.

For a computer to operate one requires two softwares: operational software and application software. Operational software makes the computer do basic work and application software helps one to manipulate the data the way one wants.

All of us our born with the operational software or the life force. We develop and create our own application software over a period of time by using the triad of action, memory and desires.

To understand oneself, therefore, one needs to control our own application software and do not let them go beyond its desired scope of work.

Women who eat lot of meat prone to weight gain

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Women who eat a lot of meat are apt to weigh more than those who do not. Previous studies have consistently shown that vegetarians are lighter and have a lower body mass index than their omnivorous counterparts.

A study from Brigham Young, evaluated 284 premenopausal women, an average of 40 years old and did not smoke. The researchers separated the women into groups classified by low, moderate, and high meat intake per 1,000 calories consumed per day.

Over the 7-day study, the investigators found that the low-intake group ate less than 1.9 three-ounce servings of meat per day, as opposed to more than 3.18 servings for the high-intake group.

More than half (52.8%) of the women classified as having a high meat intake were obese, defined in this study as having greater than 35 % body fat. Conversely, 37.3% of women in the moderate meat intake group were obese and only 15.6% of those in the low meat intake group were obese.

This was a cross-sectional study, so the findings do not show that meat causes obesity, while that could be the case, it could also be that obesity caused women to eat more meat – like more obese women following the Atkins diet, which is rich in meat.

There are a number of physiological mechanisms by which meat could fuel weight gain. Meat proteins, may elevate insulin levels, and thereby growth factors, that could influence weight and percent body fat. It has also been shown that consumption of saturated fat – most of which comes from animal products – is associated with obesity.

To sum up, it may be worth recognizing that eating less meat may be beneficial in a weight management program. It is possible to eat a healthy diet that is limited in meat. Alternative protein sources such as, lentils, nuts and legumes can provide sufficient protein and actually be beneficial in dieting.

Definition of Health

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Health is not mere absence of disease; it is a state of physical, mental, social, spiritual, environmental and financial well being. All aspects of health are not defined in allopathy.

During MBBS, medical students are taught more about the physical health. Social and mental healthcare covered only in few lectures. Community health is a separate subject but never given its due importance. Spiritual health is not defined at all and financial health is hardly covered.

Yet, in day today practice it is the social, financial, spiritual and community health which is the most important during patient-doctor communication. It is incorporated in the four basic purposes: dharma, artha,kamaand moksha.

Dharma and artha together forms the basis of karma which righteous earning. You are what your deep rooted desires are. Most of the diseases today can be traced to a particular emotion, positive or negative. Anger and jealously are related with heart attack, fear with blood pressure, greed & possessiveness with heart failure. Unless the mind is healthy, one cannot be free of diseases.

The best description of health comes from Ayurveda. In Sanskrit health means swasthya, which means establishment in the self. One is established in the self when there is a union of mind, body and soul. Most symbols of health are established around a shaft with two snakes and two wings. The shaft represents the body, two snakes represent the duality of mind and the two wings represent the freedom of soul.

Sushrut Samhita in Chapter 15 shloka 10 defines the ayurvedic person as under:

Samadosha, samagnischa, Samadhatumalkriyah,Prasannatmendriyamanah, Swastha iti abhidhiyate.

From ayurvedic point of view for a person to be healthy must have balanced doshas, balanced agni, balanced dhatus, normal functioning of malkriyas and mind, body, spirit and indriyas full of bliss and happiness.

Human body is made up of structures (Kapha) which have two basic functions to perform; firstly, metabolism (pitta) and movement (vata). Vata, pitta and kapha are called doshas in ayurveda. Samana dosha means balance of structures, metabolism and movement functions in the body. Agni in Ayurveda is said to be in balance when a person has normal tejas and a good appetite.

Ayurveda describes seven dhatus: rasa, rakta, mamsa, medha, asthi,majja, shukra and they are required to be in balance. They are equivalent to various tissues in the human body.

Ayurveda necessitates proper functioning of natural urges like urination, stool, sweating and breathing and that is what balances in malakriya means.

Ayurveda says for a person to be healthy he has to be mentally and spiritually healthy which will only happen when his or her indriyas are cheerful, full of bliss and devoid of any negativities. For indriyas to be in balance one has to learn to control over the lust cum desires, greed and ego. This can be done by learning regular pranayama, learning the do’s and don’ts in life, living in a disciplined atmosphere and learn to live in the present.

Regular pranayama shifts one from sympathetic to para sympathetic mode, balances the mind and thoughts and helps in removing negative thoughts from the mind. For living a disabled life one can follow the yama and niyama of yoga sutras of patanjali or do’s and don’ts taught by various religious gurus, leaders and principles of naturopathy. Living in the present means conscious or meditative living. This involves either learning meditation 20 minutes twice a day or learning subtle mental exercises like mind-body relaxation, yogic shavasana, self-hypnotic exercises, etc.

According to Yoga Sutras of Patanjali a person who eats thrice a day is a rogi, twice a day is a bhogi and once a day is yogi. The take home message is: to live more one has to eat less.

Swar yoga defines the importance of respiration and longevity. According to this yoga shastra, everybody has a fixed number of breaths to be taken during the life span. Lesser the number a person takes in a minute more is the life. It also forms the basis of pranayama which is nothing but longer and deeper breathing with reduced respiratory rate. To be healthy one can remember to follow the principle of moderation and variety in diet & exercise, regular pranayama & meditation and positive thinking.

 

Smell check, scratch and sniff, a new test for Parkinson’s disease

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Olfactory dysfunction presenting as odor detection, discrimination, and identification is a common finding in patients with early non vascular Parkinson’s disease..

 As per a study of 2,267 men published in the Annals of Neurology, an impaired sense of smell could be an early indicator of Parkinson’s disease, occurring up to four years before motor skill problems appear.

In the study decreased odor identification was associated with older age, smoking, more coffee consumption, less frequent bowel movements, lower cognitive function and excessive daytime sleepiness, but even after adjusting for these factors, those with the lowest odor identification scores had a five time greater risk of developing Parkinson’s disease than those with the highest scores.

Nerve loss and the formation of Lewy bodies — abnormal clumps of proteins inside nerve cells that are thought to be a marker of the disease — are known to take place in the olfactory structures of patients with the disease.

An impaired sense of smell could also be caused by impaired sniffing, which may be another motor symptom of Parkinson’s.

Early indicators of Parkinson’s disease are olfactory abnormality, constipation and sleep disturbances.

Besides Parkinson’s disease, obesity, diabetes, hypertension, malnutrition, Alzheimer’s disease, multiple sclerosis and Korsakoff’s psychosis are all accompanied or signaled by smell disorders.

Values, Morals and Ethics

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1. Values are our fundamental beliefs.

a. They are the principles we use to define that which is right, good and just.

b. Values provide guidance to determine the right versus the wrong, the good versus the bad.

c. They are our standards.

d. When we evaluate anything we compare it to a standard.

e. Typical values include: honesty, integrity, compassion, courage, honor, responsibility, patriotism, respect and fairness.

f. Ethics are universal

2. Morals

a. Morals are values which we attribute to a system of beliefs, typically a religious system, but it could be a political system of some other set of beliefs.

b. These values get their authority from outside the individual- a higher being or higher authority (e.g. society).

c. Right as defined by a higher authority.

d. By that definition one could categorize the values listed above (honesty, integrity, compassion …) as “moral values” – values derived from a higher authority.

3. Ethics

a. Ethics is about our actions and decisions.

b. When one acts in ways which are consistent with our beliefs (whether secular or derived from a moral authority) we will characterize that as acting ethically.

c. When one’s actions are not congruent with our values – our sense of right, good and just – we will view that as acting unethically.

d. The ethics of our decisions and actions is defined socially, not individually.

CT not required in appendicitis

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When a patient has all the signs of acute appendicitis, waiting to get a CT scan to confirm the diagnosis is not required.

Compared with a straight-to-surgery approach, the CT strategy is linked to delayed surgery and increased risk of a burst appendix.

Pre-operative CT is not necessary in cases with straightforward signs and symptoms of appendicitis. If, after a thorough physical examination, the diagnosis is still in question, then patients should be scanned. These patients tend to be older, female and have symptoms that are not typical for acute appendicitis.

In dealing with patients the traditional Patient-Doctor relationship model has been that doctor should remain cool, calm and collected at all times.

Doctor’s approach needs to be strictly scientific, logical, objective, methodical precise and dispassionate.  This model has been since the era of William Osler, the father of modern medicine.  The term used is imperturbability which means coolness and presence of mind under all circumstances.

Osler said a rare and precious gift to doctor is right of detachment.  The right of detachment insulates the doctors and protects them from the powerful emotions that patients display in their presence like anger, frustration, grief, rage and bewilderment.  It also insulates patients from the rolling emotions that doctors may at times feel towards them.

However, a detached attitude also insulates doctors from empathizing with patients.  A detached doctor may talk in a language that is over patient’s head.

Detachment is not like a light switch that you can turn on and off to suit the situation.  Detachment as a practice cannot be in isolation if it becomes your personal style of distracting from the world, it may not be just for the patients but also from your colleague, family friends and even yourself.

I recall when I joined by hospital the first lesson given to me by my boss was not to get unduly attached with patients.  As etiquette, we were taught not to socialize with patients.  Even today the new American Guidelines talk that doctors should not socialize with their patients on social media including Facebook.  Even doctors are human beings and their personal life should not be known to the patients.  As far as law suits are concerned, it is equally true that known close patient’s file a law suit much more than unknown people because over a period of time they know your weakness.  One should learn to empathize with the patients and yet be detached from its results.  Doctors who follow Bhagwat Geeta understand this concept very well.