Hospitals as corporate entities

There was a program in Satyamev Jayate regarding medical malpractices. It reminded me about various such stories that I had heard.

1. When I was admitted to the hospital following the stroke, we had to purchase medicines and consumables like cotton from the hospital medical shop. When I was discharged, Jaya found a wholesale shop nearby which sold the items at upto 1/3 of the hospital prices. We could make out no difference in quality. I don't know the costing and obviously retail prices will be higher than wholesale prices but  will it be 3 times as high?
2. It seems that in some hospitals, the doctors are given revenue targets so they have to prescribe various irrelevant tests in order to meet those targets. Doctors who meet their revenue targets are close to the management. Doctors who are uncomfortable with such practises and don't meet the targets run the risk of being transferred to a department that they don't fancy, akin to the punishment postings that bureaucrats get when they don't toe the line of their political masters.
3. When I had been in hospital for about 6 months, a doctor friend told us that I could have been discharged 2 months earlier and that whatever was being done in the hospital could also be done at home. When Jaya asked the hospital management about discharge, she was told that it would be better to continue in the hospital since any emergencies can be dealt with easily. We were offered a room at concessional rates to continue to stay in the hospital. We finally bit the bullet and got discharged and there has never been an occasion where we felt that we would have been better off in a hospital.
4. When in the hospital, I used to hear nurses talk about how low their pay was, from 1000 to 1300 rupees per month which was low even by the standards of the day especially considering that they had 12 hour shifts. And I was hardly admitted to a hospital renowned for charity work.
5. Rs. 50-60 lakhs have to be paid as donation for a seat in many private medical colleges. (I heard that in PSG Medical College this year, it is 70 lakhs.) If that kind of money has to be paid for getting a seat, doctors will obviously charge more when they set up practise in order to recoup their costs. They will set up practise in the richer sections of cities thus leaving many areas under-served. Also, in their quest for turnover, doctors don't spend much time with the patients. 
6. Apparently, there is something called a 'basin test' - a perfectly normal person is asked to do a blood test and is charged for it. He is given a normal report and the blood is thrown into a basin.
7. Since ICU charges are higher, I heard that a dead patient was kept in the ICU and the attenders were only informed the next day.
8. I heard that the  head of some hospital conducts pujas to get more patients if there were unoccupied beds in his hospital. Can you beat that for hypocrisy? 

The problem is that the increasing healthcare costs will not affect a person like me who can afford to pay the bills, who has access to different sources of information and who is probably looked at through a different lens by many medical personnel compared to other people who have not had the same privileges. As it is explained in this post, there are 3 major reasons why patients are not consumers:

1. Health care is generally not a refusable or elective service.
2. There is an asymmetry of information
3. Purchasing power is concentrated in the hands of a very small number of "consumers".(I don't know the figures for India.)

The widespread distrust of doctors means that self-medication is widespread. People consume antibiotics as a preventive thus exacerbated the problem of antibiotic resistance. I saw in the news that doctors were demanding Aamir Khan's apology for some inaccuracy in the program. They are missing the wood for the trees. The perception of medical malpractice is widespread and if I  had got the idea of writing this post a couple of years ago and kept notes about everything that I had heard, I would have had a much longer list of malpractices. Why blame the mirror when the face is ugly?

PS: A TED talk by Atul Gawande: How do we heal medicine?

I am a credit risk

The older members of my family tend to mention my stroke to everybody while Jaya picks and chooses to whom she can speak about it.  I am temperamentally more inclined towards the latter approach but there is a practical reason for this apart from the one I had mentioned earlier.

When people first hear about my  stroke they are shocked.  Then, if there is a business transaction to be concluded (say, a house to be taken on rent or an item to be purchased on credit), the person will switch to a more practical mode and start wondering how we will settle our obligations if no one is working .

A recent incident illustrates this point. My mother was staying in a rented house not far from here. When she had initially negotiated the rent, the landlord had said that she could stay as long as she liked, she just had to renew the agreement every year   and that the increase in rent will be marginal. After a couple of years, the landlord asked her if she could vacate the house as he had decided not to give the house on rent any more. He said that he had built the house for his son who had now decided to settle down in Coimbatore and was going to stay in the house. So my mother took another house on rent nearby.

Jaya immediately told me that this must be some tall story designed to get my mother to vacate the house. Perhaps the landlord was feeling awkward about increasing the rent. Perhaps he had doubts about her ability to pay if he did increase the rent. Anyway, it was no surprise when he let out the house to someone else after a month, presumably for a higher rent.

This is why Jaya prefers not to bargain using my name. Being a privileged guy, I have not faced major problems because of this line of thinking but it must be causing problems for people a lot less lucky than me.

No. 1 fear

While scouring the Internet for information regarding a future post to be inflicted on you, I came across a quote that fits me to a 'T':

According to most studies, people's number one fear is public speaking. Number two is death. Death is number two! Does that sound right? This means to the average person, if you go to a funeral, you're better off in the casket than doing the eulogy. - Jerry Seinfeld 

Himalayan triumph of the human race

While reading Here Be Dragons, I saw a paragraph whose sentiment I agree with completely:

If an extraterrestrial were to land in my backyard and ask to be taken to the most significant achievement of the human race, I would very likely lead the alien not to the Louvre or to Giza or to London or Manhattan, but to my bookshelves, and I would hand him On the Origin of Species. So colossal in its significance, so sweeping in its explanatory power, so painstakingly erected upon countless empirical facts, On the Origin of Species stands as the Himalayan triumph of the human race.  But, unfortunately, the bright glare of Darwin's masterpiece tends to obscure the importance of Alfred Russel Wallace, who had independently discovered the theory of evolution but whose name, like Elisha Greay, the co-developer of the telephone, is ever consigned to foot-notes and parentheses.

I don't think I had heard of Wallace before my stroke. And, like Sherlock Holmes refers to Irene Adler as the woman in A Scandal In Bohemia, I refer to Darwin as the man. I came to know of an amusing incident regarding On the Origin of Species in this book review:

When he received the manuscript of The Origin of Species, John Murray, the publisher, sent it to a referee who suggested that Darwin should jettison all that evolution stuff and concentrate on pigeons.

I think too little importance is paid to evolution in the school syllabus. I had one chapter on evolution in Std. X and never heard of it again although I had Biology till Std. XII. I think evolution should be introduced much earlier and regularly referred to throughout the course. Otherwise biology is a collection of facts with nothing to tie them together. Evolution is not only to satisfy intellectual curiosity but also has practical applications.

PS: You had a welcome break for a couple of weeks because my mother-in-law had knee replacement surgeries so Jaya was mostly in the hospital and now has many additional responsibilities.

A startling truth

I watched the 1st episode of Satyayamev Jayate (I don't watch much T.V. so I came to know about the episode some days after it was telecast and downloaded it from YouTube) in which it was pointed out that the incidence of female foeticide is higher among city-bred, educated, economically well-off people than among illiterate, poor rural folk. Even though I was aware of this, the revelations still shocked me.

I first came to to know of this counter-intuitive piece of information in The Argumentative Indian by Amartya Sen.He analyses the data for children from 0-5 yrs. He takes the German figure of 94.8 girls per hundred boys as the benchmark. He finds a clear regional divide with the East and South being above the benchmark while the West and North were below the benchmark. Within this divide, there were revealing trends.

...the contrast does  not seem to have any immediate and clearly explicable economic connection. The states with strong anti-female bias include rich ones (Punjab and Haryana) as well as poor (Madhya Pradesh and Uttar Pradesh), and fast-growing states (Gujarat and Maharashtra) as well as growth failures (Bihar and Uttar Pradesh). It is clear that we have to look beyond material prosperity or economic success or GNP growth into broadly cultural and social influences.

[SNIP]

... even in the eastern and southern states in which the over all female-male ratio is still within the European range, there are signs that urban centres have, by and large, a somewhat lower ratio than rural parts of those very states. For example, the female-children ratio per 100 boys is 93.7 in urban Orissa as opposed to the ratio for rural  Orissa of 95.4. Karnataka’s urban ratio  is 93.9, compared with its rural ratio of 95.4. West Bengal’s  urban ration of 94.8, while much the same as the German cut-off line, is still below its rural ratio of 96.7

A Lancet study pointed out the disturbing possibility that recent increases in literacy and Indian per-person income might have contributed to increased selective abortion of girls. There have been other disquieting reports. What it shows is that eradicating this blot on Indian society is not a matter of economics but of changing mindsets in a patriarchal society. How much blame for this and other horrors can be attributed to the 'Devi paradox'?

Laguage as a window to the mind

Remember the notes I keep to remind me of various blogging material? While writing my previous post, I noticed that I had noted page no. 29 of The Language Instinct and I wondered what it was. It was a passage where Steven Pinker shows that even so-called unsophisticated languages follow sophisticated rules.

Here is an example, from an interview conducted by the linguist William Labov on a stoop in Harelm.  The interviewee is Larry, the roughest member of a teenage gang called the Jets. (Labov observes in his scholarly article that "for most readers of this paper, first contact with Larry would produce some fairly negative reactions on both sides.")

You know, like some people say if you're good an' shit, your spirit goin't heaven...'n' if you bad, your spirit goin' to hell. Well, bullishit! Your spirit goin' to hell anyway, good or bad. 

[Why?]

Why? I'll tell you why, 'Cause, you see, doesn' nobody really know that it's a God, y'know, 'cause I mean I have seen black gods, white gods, all color gods, and don't nobody know it's really a God. An' when they be sayin' if you good, you goin't' heaven, tha's bullshit, 'cause you ain't goin' to no heaven, 'cause it ain't no heaven for you to go to.

[... jus' suppose that there is a God, would he be white or black?]

He'd be white, man.

[Why?]

Why? I'll tell you why. 'Cause the average whitey out here got everything, you dig? And the nigger ain't got shit,y'know? Y'understand'? So-um-for-in order for that to happen, you know it ain't no black God that's doing' that bullshit.

Pinker then goes on to analyse auxiliaries, non-declarative statements and other grammatical paraphernalia.

In this BBC interview, the presenter says that Pinker and his wife Rebecca Goldstein have been called the brainiest couple in the US. Pinker is an excellent speaker. For eg., see his TED talks.

Just like ours

New Guinea is the second largest island in the world. It has a line of mountains at its centre which are surrounded  by plains. Till the 1920s, it was thought that people only lived in the plains and the mountains were too inhospitable for people to live. It was then discovered that there were actually two mountain ranges at the center running parallel to each other. In-between them was a plateau with many fertile valleys where lived about a million Stone Age people who had been cut-off from the rest of the world for thousands of years. Both the highlanders and plains people were equally surprised to meet each other. In The Language Instinct, there is a description of what the highlanders thought about their discoverers:

The highlanders conferred intensively, trying  to agree upon the nature of the pallid apparitions.  The leading conjecture was that they were reincarnated ancestors or other spirits in human form, perhaps ones that turned back into skeletons at night. They agreed upon an empirical test that would settle the matter."one of the people hid," recalls the highlander Kirupano Eza'e, "and watched them going to excrete.  He came back and said, 'Those men from heaven went to excrete over there.' Once they had left many men went to take a look. When they saw that it smelt bad, they said, 'Their skin might be different, but their shit smells bad like ours.'"

I often resort to the 'Feynman manoeuvre' when watching Indian politicians on T.V. I watch their minions clapping their hands for some standard pablum. I will look at the large crowds listening attentively to the speeches and wonder how many have been brought in by the truckload, how many fit Gabbar Singh's description of Jai and Veeru in the film Sholay - kiraye ke tattoo. There will be numerous people falling at the feet of The Leader and I  will keep thinking how embarrassed I would be if people kept falling at my
feet.

I will do similar things while watching American politicians. I will not pay much attention to the speeches. Instead I look at the crowd clapping rapturously at the thunderous bromides of their messiah. I watched the State of the Union address of the American President a couple of times. The fun part for me was the sight of the rich and powerful of Washington standing up to clap and sitting down every couple of minutes. I wonder how those with dodgy knees manage.

You must be wondering what some remote New Guinea tribe has to do with Indian and American politicians. It occurred to me  that their skin might be different, but their shit is just like ours (that is, if you ignore the elephantine statues). Stimulating democratic debate is not what you get.

when the obsequiousness goes to extreme lengths, one witnesses the strange scenes seen in North Korea after the death of Kim Jong il. Actually it is difficult to interpret the scenes of sobbing. On the one hand , the grief might be genuine because the people are so brainwashed and cut off from the rest of the world that they actually seem to believe that their country is paradise on earth. (The video at that link is surreal.) On the other hand, they may be acting because if they don't sob in front of the cameras, they may be thrown into the dungeons.

I heard that when Kim Jong-il was  alive, his father, Kim Il-sung, who had died in 1994 was President. (I heard this in a speech by Hitchens.) According to Wikipedia, Kim Jong il was proclaimed the Eternal General Secretary of the Workers' Party of Korea and Eternal Chairman of the National Defence Commission in 2012.