dignity of risk

With life expectancy increasing we are grappling with chronic disabilities and atrophies. The needs for hospital care and home care givers have re-invented themselves.


The society is constantly being brainwashed to accept its own incompetency to handle either the young or the old. Our role as care givers is being shaken. Look at the parenting classes and magazines that mushroom.

The same is applied to the senior citizens. There is a lack of faith in the senior citizens to take care of themselves. I have come across many of my peers who assume judgemental errors from their parents, despite parents being perfectly capable of handling themselves. There is an increasing tendency to segregate them into old people’s homes or senior citizen’s settlement.

When it comes to senior citizens there is a need to let them take the dignity of risk and decide if they need to leave their familiar surrounding and relocate, from things they value particularly into institutes. Just as our parents had to prioritize and make choices while bringing us up we need to give the choice as long as the choice is possible.

The risks are enormous and sometimes in retrospect we might feel guilty of leaving them in a less conducive atmosphere, but the choice as far as possible should be left to them.

Medico-legal provisions have been made to define the extent of live saving procedures the decision to live in a home environment is more difficult.

We need to allow the elders in our life to live their remaining life as independently and as freely as they want. We will have to make time to listen to the scraping of knees sometimes even more serious things, but they will be living and not just waiting to die.

health care what exactly we mean

During the hospital stay there were some interesting things to observe and learn.


Morning rounds, rushing residents, some of them seem to think they were like the Cabots who only spoke to Gods.

Dr.Viraj Kandolkar was resident that every patient used to look forward, brusque yet the patients would look forward to him being in the ward. The answer was simple he took the trouble talking to the patient. He made the patient feel he cared.

When we now talk of health care we seem to be talking of two mutually elusive goals, one health which is techno driven, ensure the patients health no compromise on it. Yet the vital factor is missing which is the second goal.—CARE

• Careful attention or careful heed

• To take charge of, look after, provide for

• To feel concern about or interested in.

That is the actual reaching out, to the patient.

This could be a direct fall out of us taking on more patients than we can really handle, or it could be our increased trust in technology and reluctance to talk to people.

Easier to deliver health than healthcare.

But it is time to get our act right.

healthcare in transition

Health care transportation is a systemic process by which patients, critical materials like specimens pharmaceutical supplies and medical records are transported through multiple touch point within a healthcare organization or between healthcare organisations. In which health care during the transition plays a major role.


Healthcare in transition is the movement of patient between the healthcare settings. This particularly in the elderly becomes exacting.

When we talk of health care in transit we are addressing three different areas here.

• The care of a patient when being transported from one destination to other

• Patient information being handed from within organization and from the primary care centre to the health care centre.

• Transportation of specimens or health care products from research or production site to destination.

The increase in life expectancy increases chronic disease and the burden of care giving also proportionately increases. As extensive hospitalization would mean emotional disturbance to the patient and uptake of hospital resources to more acute cases the need to reduce the number of hospitalization days has come about.

Decreased days of hospitalization does not mean decreased healthcare cost. For this has given rise to the need for post hospitalization physician, professional caretakers, physiotherapists, after care and rehabilitation institutes.

Germany is one country which has tackled this by creating a chain of healthcare centres appropriately equipped, and covered with health care insurance. The government has made provisions for long-term professional homecare and assignments are made depending on the severity of need.

The transportation of patients involves transformation of information which is understandable to the healthcare expert who takes over. This not only becomes complex but there is also a need for standardization. Standardization would mean

• Information between the healthcare practioner and hospital should be precise and should mean the same thing to both.

• Checklist from the healthcare practioner,before handing the patient to the hospital

• Checklist for hospital discharge.

• Standard transition form

• Short but precise, standard discharge summary that is legible.

Many practioners tend to use their own check lists or short forms causing miscommunication. Standardization helps to overcome this.

A discharge interview is important so that both the patient and the caregiver are aware of the level of care giving needed.

In geriatric cases in addition to hospital and care centre maintenance of the patient’s independence also is an issue. Helping the patient retain his/her independence would mean helping him/her maintain his/her dignity. Curb to curb transport facility, home to destination care becomes important.

WHO has adopted towns worldwide as senior citizen friendly towns, these are designed to let senior citizens walk by placing open spaces with sitting felicities. A chain of emergency healthcare felicity is also provided with the citizen being assigned the nearest centre.

To be continued…

the family physician

Family physician.


Twenty year old Swati had problem, if she took anything before 9 am she would bring it out. For three years she went various specialists and alternate therapists nothing seemed to work. When she went to her hometown of Halsnaad, she went visiting Dr.Halsnaad a senior doctor who treated her family since the days of her great grandfather.

He told her a simple remedy, gargle with warm water first thing in the morning drink a glass of warm water after an hour you’ll be fine. Following his Swati has been rid of her symptoms five years now, her life is normal. Dr.Halsnaad says he could give the exact treatment as he knew the family history of nocturnal nasal drip resulting in fluid accumulation this would get dislodged and irritated when she took milk, coffee or tea, the gargling and warm water flushed out the secretion relieving her off the symptoms.

This is the need for a family physician many of you born post 1980 may not even the know the existing of this extinct tribe. They came home on calls, they knew your family and environment usually they belonged to the town where they practised. A kind of demi-god.

A family physician is a general practioner or doctor consulted by the family regularly.

The family medicine is re-invention of the family physician, though how much of sense it makes with the floating and migrating population one does not know.

Family medicine deals with the comprehensive health care of individuals of all age, and sex while placing particular emphasis on family.

Their basic aim is to provide persona, comprehensive and continuing care for individuals in the context of family and community.

Family medicine practioners are trained in all aspects of medicine.

They tend to know their patients on a personal level and are also are aware of their emotional and physiological state, they are also aware of the environment that the patient comes from. The practioner would refer a patient to a specialist only if the need arises, and with his knowledge he would guide the patient to the right specialist.

The tradition is the referring doctor sends the history to the specialist bringing down the consultation time.

Having a family physician and regular health check up would definitely keep your health care bills down.

When choosing your family physician it makes sense to keep in mind

• Location of the doctor

• Your comfort levels with doctor.

• Office hours

• Other doctors associated with the practise.

• Does he listen to you, and then explain options to your satisfaction

It is always a good idea to put down what actually bothers you health wise when you visit your doctor. It is also perfectly alright to ask your doctor questions.

You definitely need to check these with your doctor

• What is exactly wrong with you?

• What caused it?

• How serious is it?

• Will it require long term treatment and does it have other complications?

• Can I prevent it from recurring?

• What do the prescribed medicine do?

• How long should I take the medication?

• What are the side effects of the medications?

• When do I see you for a follow up?

Ultimately it’s our health we are talking about it makes more sense to talk to the person who knows it from prologue to epilogue than someone who reads it mid chapter.

Incidently this vaccum is being filled by the Ayurvedic and Homeopathy doctors in many places.