Thread: Indian understanding of quality & effectiveness of medicines.
Many moons ago, I was contacted by a father from Bihar for his 35 yr old son. Had schizophrenia for nearly 15 years & not getting better since many years. Had seen many Drs but no benefit. He had heard ++
of me from a relative in Pune. "Can I please get my son to see you" he sounded desperate. I normally dissuade people from making such long journeys esp when they have already seen so many Drs + chronic illness. Don't want to raise their hopes. In this case, the father ++
a senior government official was quite insistent. He also had relatives in Pune to stay with for few days.
He took an appointment & arrived (with his wife & son) a few weeks later.
We did our usual assessment for new patients incl checking past treatment papers & current +++
treatment. He was on a long list of medicines - everything under the sun, only thing missing was a birth control pill 😀
Father said he had spent lacs on Rx & current medicines were costing him ₹5k a month.
I wrote him q prescription & assured him we will try our best +++
Leaving, wife & he made repeated pranams & he insisted his son touch my feet. I told him if he did that - it's over, I am not doing his Rx. The father was not sure, but probably decided to humour 'great docotr' & told his son to back-off. I also told him to contact me on phone ++
in few weeks. Took the next patient in.
Few min later, receptionist peeps in through the door "Sir, that pt from Bihar is back & father is very angry"
Honestly I had no idea why he was upset. Finished the pt in front of me & then called family in again ++
"We had come to you with great hopes but you are making fun of us". I did not understand.
He threw the prescription & a few strips of medicines in front of me. I check the medicines & told him the chemist had given him right medicines ++
"kya Sir, these medicines only cost ₹500/- for a month's supply.
I have spent lacs on my son's treatment & you are writing such cheap medicines..what use I'll they be?"
That was the reason for his anger. So asked him to sit down & did a masterclass on the prescribed ++
medicine. Told him clozapine was one of the most effective medicine + I don't prescribe medicines based on cost.
He seemed sceptical and reluctantly picked the prescription & meds. "Chalo" he said to his wife & son & pushed them out of my consulting room.
I never ++
expected to see him again.
So I was surprised to get a call from him a month later. Sounded very cheerful - apparently son was doing better. Attributed it to my medicine. Didn't have the heart to tell him his son was better bcoz the side effects had gone down from ++
stopping the unnecessary cocktail of medicines.
Anyway to cut a long story short, son slowly got better, now holds down a simple job.
Moral of story: Expensive & lots of medicines are not necessarily better.
Remember this in #Covid times.

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Dr Soumitra Pathare সৌমিত্র சௌமித்ரா பாடாரே

Dr Soumitra Pathare সৌমিত্র சௌமித்ரா பாடாரே Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @netshrink

4 Apr
THREAD: My personal experience working in India's public health system.
Regular readers of this timeline will know I am a supporter of a public healthcare system.
So naturally I get asked, why don't you work in the public health system, if you think it is so good?
Here's why ++
I trained in a public medical school Seth GS Medical College & KEM Hospital 1982-91 & left in 1991 to go to UK having completed a MD (Psychiatry).
I worked in the NHS in UK from 1991-1999, when I returned to India.
During my time in UK, I got to see first hand & closely ++
what a treasure the NHS is. From the millionaire to the homeless, everyone got the same treatment - free of cost at point of delivery & based on medical need. The primary care GP system was amazing. Anyway, I was determined that when I return to India, I would ++
Read 19 tweets
21 Mar
Thread: I tweeted about Ekalavya & this Assistant Prof Savitribai Phule Pune University tweeted the reply below.
So let me tell you my own experience. I think 1st person accounts are important.
Disclaimer: I am not a savarna nor am I a Dalit. Honestly, I don't know my caste ++
I grew up in Mumbai in 70-80s studied medicine at G S Medical College (KEM Hospital). Proudly got in there with "merit". Reservations & caste really did not impinge on my life except occasionally when savarna classmates said I had "wasted" a seat by not taking admission++
under OBC category. I didn't much pay attention to it Had many savarna friends. I do remember a group of seniors referring to students who had come in through reservations as "bhangis" & laughing. To me this was all irrelevant. Didn't bother me at all. I had some great +++
Read 17 tweets
19 Feb
Thread: This is a long thread about my wife's grand-father: Vinayak Apte.
Born, brought up & lived in Pune. Aptewada, Sadashiv Peth. Qualified as an engineer in 1920s or so. Married around same time.
I promise you this is worth reading, so settle down with your cup of tea....1/n
Around 1921, young Vinayak writes to Mahatma Gandhi expressing his desire to join Bapu & work for freedom struggle.
Bapu writes back saying sending money for the ticket (₹5) & get your backside up here (not exactly these words, but you know what I mean!).
Bapu adds a PS...2/n
"If you change your mind, please return the ₹5 by money order to Sabarmati Ashram" Typical Bapu, you might say! Careful with money.
Vinayak quits his job & decides to go to Sabarmati. Entire extended Apte clan is horrified. Joining that fakir? Giving up your job? Ostracised.
Read 15 tweets
21 Nov 20
I find ppl have difficulty understanding #evidencebasedmedicine (EBM) & how Science works.
EBM doesn't try to "prove" anything but is focused on REFUTATION. Let's say u have a new medicine which you believe works better than previous medicine/no medicine. Thats your theory...1/n
#EBM sets out to refute this theory. Hence all trials start with a null hypothesis: New Treatment A is no better than placebo/treatment B.
You then use statistics to find out whether the difference between the two was likely to happen by chance. P < 0.05 only means that...2/n
there is less than 5% chance that the difference (if any) between the 2 treatments was likely to be due to chance, & is a real difference.
In this case, you reject the a priori Null hypothesis ( that there is no difference between 2 treatments) You accept...3/n
Read 4 tweets
31 Oct 20
THREAD: for academics & researchers wanting to influence policy makers. Mostly India specific advice. Based on my reading & experience of doing this stuff for > decade now.
At the end, I have also given a link to a very useful Nature paper on this subject
So let's begin..1/n
Rule 1: Policy makers are smart people, smarter than researchers/academics/clinicians. In most countries, its harder to become a senior civil servant than get admission to medical college or a proffesorship. Don't be fooled by the dumb look. That's training. So respect them..2/n
Rule 2: Civil servants/policy makers are busy people. If you do not get their attention in the first 5 min, you are never going to make it. So have a very sharp & effective "elevator pitch" ready before you step into their office. I practice in front of the mirror...3/n
Read 11 tweets
2 Aug 20
THREAD on patient confidentiality bcoz I am asked questions repeatedly. Read this & please stop tagging me on your tweets. My mentions can't cope! These are my opinions so please feel free to ignore!
1. Does confidentiality apply to counsellors/psychologists?
Ans: Yes ...1/n
2. Does confidentiality apply after death?
Ans: I am not aware of any precedent in Indian case law, but see box below. MPS is a malpractice insurance provider to Drs. Last point in Box suggests it does apply after death too. See this link for details ..2/n
medicalprotection.org/southafrica/ad…
3. What about "public interest" in the box above? That can be grounds for breaking confidentiality?
Ans: Yes. Even the Mental Healthcare Act makes this an exception to break confidentiality. However what is public interest is open to interpretation...3/n
Read 7 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!