#Thread
#RealMedicine
#GroundReality

A batchmate of mine settled in remote area of Maharashtra 25 years ago.
Financially well off family and intelligent chap. He had every opportunity to choose a more lucrative branch and city to settle down for practice.
He chose to go back to his family village. It was a Taluka place but really a largish village. His training as pediatrician in Mumbai was grossly inadequate to work in realities of rural Maharashtra.

He persisted. Became a successful practitioner.
In a recent phone chat he told me that he shut down his pediatric ICU and gave away all the equipment to whoever was willing.

I was surprised and pulled his leg about third wave and child patients of covid. And also about him abandoning the iminent battleground.
My friend chuckled, "I don't know who started this rumour about child wave of covid, I don't want to be part of it."

He used a marathi proverb about wisdom of not standing in the way of excited donkey.
"my hospital will be swamped by local VIPs, politicians and govt officers. It is sheer harassment. Nobody will be willing for my advice of paracetamol and hydration. If anything goes wrong, I will be beaten up on road where I practiced for 25 years. I don't want any part of this"
A quiet, unassuming dedicated doctor steps back in his usual quiet, non-noisy way.

Community that benefitted from his sensible, minimal intervention, ethical practice will not even notice his withdrawal from action.

In fact he may be mocked by the same people he served.
This is probably happening all over India in small numbers. Numbers may look small, but these are individuals of integrity who have no desire to face torture in unsupported environment of present day India.

Who is John Galt?

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More from @docbhooshan

30 May
#Thread
#Schizophrenia

A series of 7 short posts about schizophrenia. Written for Schizophrenia awareness week.
1
Is it one single well defined, well understood illness?
2
Some common types of schizophrenia described in #Marathi by fellow psychiatrist Dr Atul Dhage
Read 9 tweets
29 May
Is India listening?
We have started our love affair with insurance driven healthcare in earnest.

We WILL suffer.
Japanese System of healthcare

en.m.wikipedia.org/wiki/Health_ca…
Singapore model of healthcare.

commonwealthfund.org/international-…
Read 5 tweets
22 May
#Thread

Amphotericin B and Mucormycosis bring up uncomfortable memory.

Memory of a family that was ruined because of cost of treatment

Jan1996.
I started my first house job in Nashik after finishing internship.
My very first patient was a middle aged man on ICU bed no 1.
He was operated for removal of mucormycosis balls from his maxillary sinus. He lost one eye to that fungus.
Uncontrolled diabetes caused by misconceptions about illness, insulin and faith in "alternative" ultimately led to this fungal infection.

I met him 4 days after operation.
Amphotericin B was not avaialble in Nashik then. It has to be brought from Mumbai.
Read 11 tweets
19 May
One family or a few families together can not change curriculum or "system".

It is possible to neutralize toxicity of school system by clever use of time and choice.

It needs a deaf year for friends and family.

How to go about it?

A thread -
1. Choose a school that is closest to your home. Preferably walking distance. Commute is a killer.
2. Time is most important tool. Choose a school that engages kids for minimum time. State board schools are best in this area. Esp schools that run in 2 shifts.
3. Getting marks in school exams should not be a priority. Only 12th std matters to an extent.
4. Self learning + help from parents, internet should be preferred way. No tuition classes at all.
5. Understanding questions and trying to get into examiners mind is essential skill in
Read 12 tweets
16 May
#Covid #Learning
#change

There is lot of learning from Covid pandemic. I am hoping for following three changes to become part of Indian medical system.

I am eternal optimist.

a thread -
Change 1 -

I would like to see doctors following guidelines in treating ALL illnesses. Not getting straight jacketed but respecting research driven guidance.
Too many doctors claim to be geniuses and create cocktails that are useless at best and deadly at worst.
This would not only safeguard good doctors in litigation but put responsibility on bodies that form guidelines. If they want to bask in glory, they need to be accountable as well.
A sensible doctor finds good guidelines supportive, protective, uses them to rationalize treatment.
Read 10 tweets
13 May
#India
#covidvolunteers
If you are a non-professional volunteer during Covid times in India,
your own mental health may be under challenge.

Few thoughts on how to look after yourself and continue to be a valuable member of volunteer force.
1/n
Many telephone helplines and on ground help groups are working towards - advice on course of disease, finding beds/meds/food/support, arranging funerals and host of other services for the affected and their families.
This is excellent work. Much needed. People volunteering for such work online/on phone/on ground are noble souls.
They face uphill and sometimes hopeless task.
Manytimes their efforts draw a blank and sometimes patient passes away.
Read 20 tweets

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