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Personal Is Political in Professional Practice

"Should a doctor treat an alcoholic who is injured due to drunk driving? Would your opinion change if it were just a solo accident v/s injuring/killing other people on the road?" asked @arshiet . The regular controversy. Should doctors judge their patients? Is it ethical to even ask the question of whether it is ethical for doctors to withhold treatment to anyone? What are the social determinants of alcohol use? The issue is straightforward in the emergency room. You save life first and worry about alcohol and justice later. But what about elective issues? If you are an obstetrician and you are pro-life, do you avoid elective abortions? If you are a pediatric surgeon and you consider circumcision as genital mutilation, do you avoid ritual circumcisions? Conscientious Objection - apparently that's what it is called. One of the solutions offered is that the healthcare provider can be upfront about the moral position and arrange a different provider. This helps the patient

History is to Practice

I've been in many debates where "science" is accused of being wrong. As if science is a set of things written down in a book or a set of ideas that are arrived at by a group of people. Something that has to be consumed by others. I'm baffled by this argument because, to me, science is a tool available for every human being to practice. It is my use of science to understand the world that matters to me. When I say "scientific method" I am talking about the method *I* use to arrive at the truth. It might be the same method that a professional scientist used, but I have to replicate that method and arrive at the truth on my own. When chatting with Ravi Narayan (RN) yesterday about the SOCHARA archives, I had a very interesting realization. The way I used to look at history was the way these people looked at science. I thought about history as a set of facts written down in many books, as a scholarly consensus available to those who are in the elite universities

The Overcompensating Sociologists of Public Health

Reflexivity. That's a word very dear to sociologists. It just means how we look at the world is influenced by who we are. But like many things sociology, you give it a word and then you make a big deal out of it. So much that some of the sociologists reading this post are already raising their hand saying "Hey, but you're talking about 'positionality'. Reflexivity is actually about how we take into consideration our positionality in our research". Shouldn't the fact that how we look at the world is influenced by who we are automatically also mean that we should be cognizant of that and take that into consideration in our research? Apparently sociologists can't do that automatically without having a different word for it. Or maybe they can and I'm just stereotyping them. After all, my identities put me in the positionality of an anti-academic-sociologist. This post is not about sociologists who don't care about the world. And therefore I am not

Does Medicine Need a Paradigm Shift?

Let's start with physics As my brother's T-shirt says "The Pulse of the Earth is in Physics". Physics is a fundamental science. Also called "pure" science. That is a fancy way of saying it is reductionist. When you think of an apple falling to Earth in physics, all you think about is its mass and the forces acting on it. Everything else is immaterial to physics, including the questions like "Is the apple rotten/ripe?", "What is the probability of the apple falling on a rabbit and killing it?", "Are there hungry people waiting for the apple who won't get to eat it?", and "Is the apple cursed?" The question whether apple is rotten can be answered by another branch of science called biology. Physics and biology are called natural sciences. These are branches of science which rely on observation of the universe to reach at inferences on how the universe works. The question on probability would fall under mathematics.

By Doing "Government's Work", Are We Making It Easier for The Government and Worse for the People?

At the end of the CHLP session today Akshay (not me) asked something like: "When we do work that the government should be doing, are we making it easier for the government in some ways, and also making it more difficult to hold the government accountable?" This is a question that only someone who is truly invested in community work can ask. They are worried that the government is going to invest less in that particular problem, that in the long run it becomes harder and complicated because of the reliance on "bespoke" solutions. (The example given was how government relies on the voluntary effort of data by / to get COVID related counts and how there is no other system to track these counts) I do not claim enough experience to answer this question. But if we break down this question, the concerns we have are: How sustainable are such bespoke solutions? If we could keep doing it forever, then why should we not do it forever? Shou

What Can An MBBS Doctor Do?

In the protest surrounding suspension of Dr Saibal Jana and Dr Dipankar Sengupta, a debate has emerged around what an MBBS doctor can and cannot do, especially in rural settings. This is a very complex question that requires a complex legal answer. There are several relevant case laws and even acts like Clinical Establishments Act which talk about some aspects of this debate. But let us look at it from a more fundamental and fresh perspective. Law is not static. It is subject to continuous change. Law is not blind either. It is acutely aware of context. Therefore, there is no need to frame a universal, absolute, strict law regarding a nuanced question like this. What are some of the considerations that must be kept in mind when framing a law on this question? - How to bring equitable healthcare to the people of our country? - How to protect people from harm? - What is the situation with respect to human resource availability in rural healthcare? - How do referral pathways work in our

Essential Digital Literacy for Community Health Folks: Part 1

Whether one likes it or not, everything is getting digitized. And it is often a good idea for human beings to keep abreast of changes. This is a series of posts designed with community health folks in mind to help them develop mental models around the technologies that make up the digital world. In this post, we will look at certain foundational terms like "information", "data", "communication", and "computer". Then we will connect it to words like "internet", "server", and "cloud". *** Information / Content / Data Anything that is meaningful is "information". Emails, videos, textbooks, numbers, anything that you can imagine and represent or store in some form. "Content" is just another word for information used in specific contexts. Like if I'm sending you an email, the body of that email would be called "content". An article has content. A youtube video has content. An instagram po

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Akshay S Dinesh
I am a general practitioner rooted in the principles of primary healthcare. I am also a deep generalist and hold many other interests. If you want a medical consultation, please book an appointment When I'm not seeing patients, I code software, advise health-tech startups, and write blogs. Follow me by subscribing to my writings