Tuesday, 21 February 2012

You have every right to a second opinion - Health

“There are many ways to skin a cat,” is a metaphorical expression often heard at professional conferences when opinions differ on the management of a medical problem. Thus, medicine remains both a science and an art. Opinions will differ and, in certain circumstances, cause considerable confusion and anxiety in the patient's mind.

In the last 50 years, medicine has advanced so rapidly no one doctor can claim to have a full grasp of his own domain of specialisation, much less the various branches of medicine. Other influences that have impacted the way medicine is delivered to the patient include the lack of finance/insurance support, the loss of the family doctor, and more recently, the corporatisation of medicine where a patient becomes a client.


In this milieu, a patient, already at a disadvantage from ill health and conflicting influences, often wishes he could have a second opinion. This means having another consultant or set of doctors re-examine the patient, review the data and suggest a plan of treatment. It may agree with the one in place, or be entirely new. A cross reference, however, is the request of the primary doctor to another colleague for an expert opinion on a particular issue in the patient's management.

Usually, when there is loss of confidence and trust in the opinion or treatment advocated by the doctor — the patient is not getting better, or a certain procedure or investigation is being forced upon the patient.

Or when it comes to a life-changing treatment, e.g., cancer, amputation of a limb, or withdrawal of life support.

The doctor may suggest one if unsure of the diagnosis.

In this information age, the patient may have researched the problem and may wish to see another consultant. However, remember that information on the Internet is often not peer-reviewed and can be misleading.

In health systems where the state bears the burden of health care, like the National Health Service in the United Kingdom, the patient does not have the right to a second opinion but is permitted to seek one.

Similarly, in the organised sector like the government or the military or where medical insurance pays for healthcare, logistically it becomes near impossible to get a second opinion unless the treating doctor allows and/or recommends one. In all other cases the patient reserves the right to a second opinion.

“Shopping for an opinion” is a very sorry practice in the country. Rather, the patient should have a clear objective and proper preparation before seeking a second opinion. A good approach would be: Inform the doctor that a second opinion is being sought. It builds trust; the doctor may suggest someone of equal or superior ability and provide all the documents and investigation reports. This will save time and money.

Identify a consultant of equal or superior training or stature. It is pointless to have a generalist opine on a specialist's opinion. Beware of unsolicited advice.

Collect originals and reports of all investigations, including imaging, and have them carefully tabbed. All of these rightfully belong to the patient.

Ensure that the new consultant interviews and examines the patient and then reviews the reports. The patient should be seen as a whole person and not only as a medical report.

Communicate openly and clearly and share the second opinion with the primary consultant. Doctors cannot deny a patient the right to seek a second opinion and should preferably suggest one where appropriate.

Notwithstanding our egos and prejudices, we must be sensitive to patients' rights and be willing to help in every way.

Hopefully, the development of standard treatment guidelines (under way in many specialties) and peer-reviewed, evidence-based protocols if made easily available to the public will empower them to make better informed decisions. Our only objective should be to make patients better: if we cannot, then we must respect their inalienable right to a second opinion.

(The author is the Director and Senior Consultant Paediatric Surgeon/Urologist at the Narayana Hrudayalaya Woman and Child Institute. He is also the Past President Indian Association of Paediatric Surgeons.). Thanks hindu

Friday, 11 November 2011

Kareena and I are extremely compatible - Saif

Saif Ali Khan hasn't spoken about his impending wedding to Kareena Kapoor, till now. Contrary to stories doing the rounds that the wedding - to be held in his ancestral Pataudi Palace - has been postponed thanks to delays with Agent Vinod and his father Mansur Ali Khan's recent death, Saif confirms for the first time that they will marry early next year.

Kareena had always maintained that she and Saif would tie the knot in 2012 but there was some confusion if it would be early 2012 or end of the year. Saif's mother Sharmila Tagore has also declared that her son is planning to marry Kareena "very soon." The plan was to get married after the release of Saif's home production Agent Vinod, which was to release on December 9 but the film got delayed, which sparked speculation that the wedding would be postponed.

Saif confirms, "Kareena and I will definitely get married by early next year. We plan to get married in February 2012 after Agent Vinod releases, but if the film's release gets delayed we will still get married by March. We won't postpone the marriage beyond that anymore." He adds, "Kareena is a wonderful girl and we are extremely compatible. My family and she have always got along well. We share the same values in life, love each other completely and I want to spend more time with her. I am looking forward to the marriage now." The wedding at Pataudi Palace will be a traditional and grand one, attended by the couple's family and friends.

Tuesday, 20 September 2011

Facebook Launches Subscribe Button for Following Anyone’s Public Updates

Facebook has launched a Subscribe button that lets you follow the public updates of others, regardless of whether you’re Facebook friends. Don’t chase them to be your friend, still you can see their entire wall and what not. But be careful when you choose the options SUBSCRIBE and FRIENDS or else every information will leak to the people who don’t deserve it. The new subscription options are part of Facebook’s effort to give users more control over their Facebook accounts and their News Feeds. “Facebook has always been working on giving users more control,” said Facebook Product Manager Naomi Gleit. Starting Wednesday, users will begin seeing a Subscribe button alongside the “Message” and “Poke” button on Facebook profiles. The button gives you a way to follow the content others are posting without actually becoming Facebook friends with them. In a lot of ways, it’s like following somebody on Twitter. This button works a bit differently based on whether you’re looking at a friend’s profile. If you subscribe to the profile of somebody who is not your friend, you will get access to his or her public status updates in your News Feed. You can fine tune what type of updates you see. For example, you could subscribe to my Facebook Page and choose only to see my status updates and ignore my game or photo updates.

This button works a bit differently based on whether you’re looking at a friend’s profile. If you subscribe to the profile of somebody who is not your friend, you will get access to his or her public status updates in your News Feed. You can fine tune what type of updates you see. For example, you could subscribe to my Facebook Page and choose only to see my status updates and ignore my game or photo updates.

If the user is your friend, subscribing gives you the ability to granularly control how much of his or her content enters your stream. If you want to see every post your significant other is posting to Facebook, you can set the Subscribe button to show “All Updates” in your News Feed. On the other hand, if you want to ignore one of your acquaintances unless he gets engaged, then you can select the “Only Important” option under the Subscribe button.

The Subscribe feature is totally optional — you can choose not to subscribe to anybody, and you can choose to turn off the Subscribe button on your profile if you don’t want to gain any subscribers.

Much like Twitter, the total number of people subscribing to your public posts and the number of people you’re subscribed to appear on your profile. This number does not include pending friend requests. Existing friend requests will not turn into subscribers automatically, but Gleit says that going forward anybody who sends you a friend request will automatically be subscribed to your public updates (unless you turn the Subscribe button off).

The Subscribe option makes public Facebook posts more useful, especially if you start gaining an audience. However, it provides yet another layer of complexity on top of an already complex product. It could spur more public sharing a la Twitter, or it could raise more privacy concerns for a social network that has had its share of privacy controversies.