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Showing posts from May, 2019

The Case of Dr Payal Tadvi or the Case of India's Healthcare System?

Dr Payal Tadvi committed suicide exactly a week ago. She was a postgraduate student in Obstetrics & Gynecology. Investigation is going on about the death. There are quotes from family members that she was being harassed on the basis of caste by seniors. Those seniors have written their side blaming workload. (Please go through the links if you do not know the details)



Let us leave them aside and ask ourselves a few questions now.

Is their discrimination in medical colleges?
There is. All kinds of it. Economic capacity. Skin tone. Age. Seniority. Language. Region. Residence in the state where the medical college is in. Category of seat. Every damn kind of discrimination. There is discrimination in medical colleges.

Is their caste-based discrimination in medical colleges?
I think the answer is yes. I haven't seen much first hand. But, there is definitely discrimination based on reservation. And since reservation is based on caste, it can indirectly be told that this is caste-base…

The Power and Limits of Classification

Link to journal article: https://www.nejm.org/doi/full/10.1056/NEJMp1811491?query=TOC

My comment: 
In our work with transgender men and women and other gender minorities, this was the common opinion among all "categories" of people - to stop categorizing them.

Here is another illustration. HIV prevention and control efforts in India has a certain stress on prevention among high risk groups. For many people in the field, "LGBTQ" is a high risk group. If you look at it, the only thing common among the members of this "category" is that they are all gender minorities. By using the term "LGBTQ" many lesbians and transgender men who are actually "low risk groups" get mischaracterized as people with risk of HIV and gets repeatedly asked to do HIV testing.

The people we talk to have all been affected by the medical system's lack of ability to deal with the full spectrum of gender. They strongly ask for developing a framework for healthcare pro…

The Ideal Physician AI Assistant

When I hear "Artificial Intelligence" and "Healthcare" together in a sentence, it is usually never a pleasant thing I'm listening to. There almost always is some kind of reinvention of wheel where Google's hardware cycles are spent in trying to solve something meaningless.

For example, it is futile to differentiate between tuberculosis and cancer from an image of the chest where the answer may never lie in the image, but rather in the symptoms of the patient. Even if AI tells the physician that the ECG it is reading is normal (which the physician probably noticed on their own), the physician still has many reasons to refer the patient to a higher center.

These are isolated examples. But it is the isolation that makes these good examples. AI's role is not in isolation. AI's role is in integration. AI (or computers) should come in and fill in where humans struggle - processing large amounts of data. (Processing data, not for the sake of figuring out p…

On Libraries

Sunil K Pandya asked on NMJI "Are Libraries in Our Medical Institutes Dead?"
Badakere Rao responded to it with his memories of physical books.
I had this response:
The article on libraries and your response to it was a sweet read to me. The school in Mattanur that I studied from 1st standard till 10th standard had a large library (when I went back last month, it felt small. Maybe everything was much bigger when we were smaller). If my memory serves me right it had 4000+ books. The most beautiful thing was that when any student has a birthday they would celebrate it by donating a book (or more books) to the library and their names would be announced in the school assembly. This kept the number of books keep increasing. Perhaps it became a prestige issue for parents to send only quality books with their kids for their birthday, because all the books so donated were usually good and new books. From as far as I remember my favorite pastime after school (and free hours…

Why "Regulations" Are Often Not Helpful Solutions

The other day I saw an impassioned plea from a doctor asking associations to "regulate the profession". The reason they cited was that healthcare is turning commercial and often this goes against the best interest of the patient.

One of the many things I learned in National Law School listening to Prof Nandimath and others is that "regulations" come with their own set of problems.

Let us look at it more closely.

First, what is the problem we are trying to solve? The healthcare system in our country (many other countries too, perhaps) have huge flaws in it that lead to suffering and poor quality of care for the end user (the patient). Medical training is focused on the wrong parameters (recent change of UG curriculum to a competency based curriculum is proof of this). Distribution of healthcare providers is disproportionately concentrated in urban areas. Healthcare is episodic. Government policies are weakening public health system. (Public health system, even o…