Dr.Bhooshan Shukla MD डॉ. भूषण शुक्ल Profile picture
Psychiatrist (Child & Adolescent), Parenting Coach, Preventing Child Sex Abuse since 2000. Member @rcpsych #Marathi #Sanskrit #animals Earth is family
Rajendra Alapaty Profile picture 4 added to My Authors
13 Jun 20
#Teenager
#India
#teenager

#Thread

Few weeks ago a 15 year old came to see me in clinic. She has just finished her 10th std exam.
She heard me in a school seminar last year and decided to approach me in time of difficulty.
Her difficulty is quite typical of a 15yr old urban indian teenager. So I decided to write about it.

She attended a school where "everyone" scores above 90% and "atleast half of them" score above 95%. in 10th std exams.
By her own assessment she will score around 75-80%. Which is utter disgrace from point of view of school, family and her own expectations as well.

She remembered that for years she and her friends have laughed at people who score less than this grade in her school.
Read 12 tweets
9 Jun 20
Thread.
#India
#onlineschools

If your kid's school has started online classes for this academic year and you are wondering how this is "new normal" is voting to help him/her, i have few suggestions for you to try out.
Firstly - online school is temporary. Eventually regular school will start again. May be in few months. But start they will. So leta not lose habits of school.
So if you can follow some basics that school environment enforces, it can help.

1. Child should get "ready" for school. Get up, get ready, do morning rituals and half decent clothes atleast. No bed clothes for online classes.
Read 7 tweets
7 Jun 20
Unpopular opinion.
You have been warned.

Thread.

WFH and distance education over zoom should have convinced most parents about how their money is wasted on schools. But there is no alternative.
Most schools, no matter how reputed, are essentially quite same.
Other than one or two ideas propagated by management , there is no REAL difference among them.
Literacy, Numeracy and some socialization are real benefits of organised education system. It is not education, it is literacy.
Schools/teachers/management have no chance of change in rotten boards driven system.
Read 12 tweets
19 May 20
Debunking of "there is no treatment for Covid19 in modern medicine (MM)"

1. Due to use of scientific methodology MM knows that 80-90% of infected people have no symptoms or very mild symptoms. They can rest at home in isolation and they will be fine. - NO treatment needed.
2. Remaining infected people develop moderate or severe respiratory or multi system symptoms. They are treated by prone position, oxygen therapy and ventilation support when needed. Most of them recover.
3. Secondary infections and pre existing diseases are treated to save life.
4. Healthcare staff is protected by use of PPE - invention due to modern scientific methods of research.

What MM doesn't have yet -
Specific antiviral medication and vaccine for this virus
Read 5 tweets
13 May 20
Since #COVIDー19 pandemic, indian media is buzzing with news about "(some govt institute/pvt co) made (x) in 10,000 rupees. Imported (x) costs 100000"

For someone like me it means a few things -
1. These govt institutes were sitting on their asses just polishing off fat salaries till now, not even thinking about how can they contribute to nation development.
2. We can barely make low tech things like mechanical ambu bags and sell them as ventilators ONLY during pandemics. Not fulfill real need of excellent quality reliable equipment.
Read 7 tweets
5 May 20
#Thread

Legacy of "paperwork" is a millstone tied around India's neck.
Latest example -
Migrant workers who need to travel , now need a "medical certificate" to declare that there are no active symptoms of flu or SARI.

Govt or pvt practitioner can issue this certificate.
This has resulted in a run on clinics + fights over charging for the certificate.

First question, any sensible person should have asked, "is there any way to do this screening WITHOUT using precious and expensive resource i.e. medical practitioners?"
Any doctor worth her training would tell you that - body temp, pulseoxymeter reading, breathing rate and 2-3 screening questions can do the job.

Which among these require a doctor or nurse?
Read 6 tweets
29 Apr 20
#Thread
"To shut down/lock/de register the establishment" and "de-licence" the establishment is THE most powerful tool in the hand of government officers. And they use their "discretionary powers" to lethal effect.
Indian shopkeeper, small businessman and small industry owners worked under these "licence-permit raj" conditions since Independence.

This gave rise to nepotism, black economy, attempt at huge profit margins to compensate for corruption and elimination of genuine competition.
This ultimately hurts the consumer by reducing choice, quality, innovation and ultimately making services/products of substandard quality and unreasonable price.
Read 12 tweets
22 Apr 20
#Thread
#ChildDevelopment
#India

This is a thread about most interesting question about children (from parent's point of view) - How to spot talent in a child as early as possible.

Read on (quit here if you are looking for ways to make champion of your child no matter what.)
Most parents believe (quite wrongly) that spotting talent early will help you "develop" that skill into a fantastic vocational opportunity and subsequent glory.
Most important question to ask is - Is it possible to spot talent early on?

Answer is - Depends!

Depends on which talent you are looking for.

Let me elaborate.
Read 17 tweets
18 Apr 20
#Thread
#healthcare
"Private practitioners must step in..." says newspaper headline.
This kind of quote is usually by a govt official who sees difficulties on the ground; by NGO who find it difficult to recruit doctors for their ventures or by senior doctors who are
already working in their own clinics.

Let's look at what is happening on the ground.
Healthcare in India is 4 layered.
1. Family doctor/GP - single doctor clinic set up
2. Specialists - one or more doctors + paramedical staff - clinic set up
3. Hospitals - for admitting
patients for more care/ investigations/surgeries, etc. - small, medium or large sized. - Private or Govt set up.
4. Laboratories - for investigations of blood, urine, xray, monograph, scan, etc - small private set up and large corporates.
Read 19 tweets
14 Apr 20
I hope Indians will realize a few things due to CoVid19 pandemic -
1. Healthcare is everyone's responsibility not just doctors'
2. It takes years to build manpower and in India, hospitals too.
3. Government healthcare facilities are perpetually ignored.
4. Science should trump politics and inform action but that is NOT allowed due to ego and vested interests.
5. Medicine is a subset of healthcare. Healthcare is affected by EVERY action of EVERY ministry of government.
6. Indian public has little scientific attitude
expectations of our founding fathers about "scientific attitude" have been ignored to our own detriment.
7. People need to think, support and enable healthcare ALL THE TIME, not just during crisis.
8. Don't trust Bollywood Divas about healthcare advice.
Read 4 tweets
13 Apr 20
Lot of messages circulating about how there is very little illness around (except covid) when all dispensaries are closed so doctors make up diseases to fleece you.

Let me offer you alternate explanations -
1. A significant percentage of illhealth or not feeling "well" probably doesn't need medical attention. All these people visit doctors to make sure "it is okay"
2. Many follow up appointments are to make sure things remain on track and to pick up early signs of complications
3. If you are in better health because you are at home then may be cause of your illhealth is traffic, commute, accidents, pollution, job stress, unhealthy lifestyle, alcohol and smoking, poor sleep, eating out, fatigue, etc. Blame modern life not doctors.
Read 7 tweets
12 Apr 20
#Thread
#careeradvice #parenting #India

In India lot of parents are interested in future career choices of their kids from a very early age. This desire to find out "gifted" domain of child drives parents to many irrational and outright harmful paths.
This thread is to help you if this question about child's future keeps you awake at night.

i want to stop you from being an emotional idiot and be harmed by scams.
Most parents tend to believe following things (traps)-
1. Everyone we know is doing it. Yes. Most Indians buy money back policies too. we are hardly a sensible herd!
Read 19 tweets
9 Apr 20
#Thread
#Education #MentalHealth

This is the time of year when i get phone calls from parents about promoting child to next academic year.

In most cases children are asked by school to stay back for a year and parents are opposed to it. Sometimes it is the other way round.
Ideally child should have had 6th birthday before starting Std 1 in India. Rules vary according to state and board and this causes lot of turbulence.

If given a choice, being the youngest child in the class is to be avoided. Because a child if squeezed into such class
can be as much as 13 month or more younger than oldest kid in the class. That's almost 15-20% of their lifetime. It is a lot of developmental time esp for a young child.
Read 10 tweets
8 Apr 20
#IndiaFightsCorona
#Masks4All
If you are not looking after #Covid19 patients or are not part of healthcare workforce, please don't try to get N95 masks. You don't need them. They are not re-usable with home cleaning.

Wear a cloth mask every time you step out of home.
MOST important part about wearing mask is - once you put it on, DON'T touch it. remove it directly when you reach home, put it for soak in soap water (for 30min) and wash your hands with soap BEFORE you touch ANYTHING else (after removing mask).
After a good soak, cloth mask can be washed and thoroughly dried in sun/dry place before using again. DO NOT reuse cloth mask without washing even on same day.

A handkerchief is a good option to cloth mask too as most of us have at least half a dozen of those.
Read 6 tweets
4 Apr 20
#Thread
#Bharat specific problems.
A friend runs a hospital in a town in Maharashtra.
His staff is on WhatsApp all the time, receiving "news" (essentially rumors) from district.

New patient entering OPD, hospital is questioned by staff even before making case paper.
Nothing unusual there as people in India make deep inquiries even with strangers.

Now the tragedy starts,

When patient is from a village or area from where (according to WhatsApp gossip) a CoVID19 patient was detected/ taken into isolation, staff pressurizes him to "avoid"
seeing/treating/admitting that patient.

Frustrated with this behavior of anxiety driven hyper vigilance and pressure on doctor, my friend finally called a team meeting to discuss this and reduce their anxiety.
Read 13 tweets
31 Mar 20
If this hypothesis about BCG vaccination leading to reduced susceptibility to #Covid19 proves right, i am giving myself a special pat on the back.

A real story in Thread.
Year 2006. I was working as doctor with NHS at a hospital in West Sussex in England. My younger daughter was born late in the evening (normal delivery) and She was about to be discharged in the morning.
I asked for BCG vaccination. In India it is given to all new borns before discharge from hospital.

I was told, whats the hurry. She can get it anytime in next 6 months.
Read 13 tweets
23 Mar 20
I hope whole world now realises that "disposable" is actually not the best thing to happen to medical equipment.

Most PPE is not reusable it seems.

In fact "disposable" everything is a terrible idea for the world as whole.

#COVIDー19
Now that we are in crunch situation, we realize how far deep we are into expensive medicine. Locked in to expensive life saving instruments with their patented, exclusive and disposable daily use components.

All makes it prohibitively expensive.
Will #COVIDー19 force medical systems to consider "running cost" and have a te look at our choices?

Unlikely. As these "choices" don't rest with patients and treating doctors anymore.
Read 6 tweets
19 Mar 20
Yesterday @heytal asked me some questions about kids and play during this phase. Parents are at home (mostly). House helps are given off (hopefully) and schools, tuitions, sports is shutdown (definitely).

What are ground rules?
Should kids play with other kids?
Are non touch games okay?

I will try to answer these questions.

1. Present advisory is about avoiding social contact. This can flatten the curve of outbreak. So playing games with friends is definitely a no no.
2. Children usually don't follow don't touch and keep distance rule in play. It can't remain play with such rules.

3. Regular hand washing is advised. Following steps in this photo is the correct way to wash hands.
Read 7 tweets
9 Mar 20
#Thread

This is special post to say thanks to a brave couple.
I am treating their teenage son. He presented with an episode of mania. Responded well to outpatient treatment with Lithium.

Unfortunately, he had unacceptably high blood levels of lithium and developed early signs
of lithium toxicity. As soon as I reduced lithium to a safe level, manic symptoms returned with severity.
He was admitted and treated with antipsychotic meds. Within 24 hours, he developed fever and CPK value was 9000+
This is serious. This is called Neuroleptic Malignant Syndrome (NMS) and can be life threatening.

He needed ICU care for one week and almost 6 weeks of hospital admission after that.

Now he is well for a while on medicines.
Read 11 tweets
31 Jan 20
A marriage invitation arrived on whatsapp today.
Nothing new about it.
Except the story behind it.

1997-99 i was treating psychiatry resident for a young man who had recently been confirmed on job as armed railway police.

He developed Schizophrenia (paranoid type) .
Fortunately, it was detected early and he was referred to govt hospital psychiatry dept (my place of work) by railway doctors.

He had a severe type of difficulty and it took almost 2 months of treatment (including electroconvulsive therapy) to achieve full resolution of symptoms
He was sent on a long medical leave with regular follow up.
Along with his wife, a baby daughter and his uneducated father, he would visit OPD every week.
His father would talk to all other patients waiting there, motivating them to take regular meds.
Read 10 tweets
23 Dec 19
#Thread
#Healthcare #Startup #India

Every month i meet at least one healthcare start up founder (in India). They all have ideas that can make patient care more efficient, quick, reduce harm and offer better monitoring of essential health/disease parameters, etc.
None of these ideas get really anywhere.

Why does this happen?

My take -
1. All healthcare in India is driven by doctors. They are gatekeepers for almost everything.
2. Unlike developed countries, regulatory changes and insurance co driven changes don't work in India.
3. Sadly, all start ups face insurmountable hurdle in India - Doctors!
4. Unless doctor benefits directly or gets more patients due to use of this start up's idea, he/she is not going to make any effort to make that change.
5. To convince individual doctors, you need an army
Read 7 tweets