DENTIST’S FEE: WHY SO MUCH VARIATION??

Dental treatment is considered to be a very expensive affair, which is something most of the people would agree with. To cap it all, there is a lot of variation between the fees of different dentists. Many persons are not sure about the reason behind this wide variability, and some naïve patients tend to select their dentist based upon the fact that his consultation and treatment fee is the least among all. This is not the smartest way to make such an important decision. The person might be able to save some of his hard-earned money, but he might actually be doing more harm to his own body, which may lead to an exponential expenditure in the future. When a patient goes to a dental surgeon who tends to cut his costs, it needs no rocket science to figure out that to make the most out of his low fee; the quality of the treatment could be compromised. This, of course, does not mean that a dentist who charges the most is the best one. Patients need to do their homework diligently before choosing their dentists, and analyze thoroughly the reasons a dental surgeon is charging the amount he is.

Sometimes it is hard to compare fees of different dental surgeons. More often than not, it is like comparing apples and oranges. Patients need to read the fine print and figure out what all is included in their treatment charges and what’s not.

Some dental surgeons tend to provide an itemized list of the full treatment. For every additional procedure which is to be performed, be it an x-ray or the fee of a visiting specialist, the charges would increase accordingly. Other dentists offer a package deal which includes everything so that patients don’t need to worry that they will be charged extra for each additional procedure. There are pros and cons of both these options, and it is important that patients understand exactly what the best option for them is.

Unfortunately, most of the patients are not experienced enough to ask important questions. The questions the patients need to ask their dentist are, “What would happen if, during the course of treatment, it is felt that the tooth cannot be saved, and would have to be extracted? Do I lose all my money? Or would I get a part of it refunded?” Once a patient gets the treatment of his teeth started and during the course of the treatment, the doctor feels that the tooth cannot be saved, not only it means a wastage of time of both the dentist as well as the patient, but the patient’s money also, in a way, seems to go down the drain.

It is equally important to find out whether the dentist’s clinic charges extra for additional procedures such as fillings and capping after Root Canal Treatment (RCT), or is it included in the deal. A dental surgeon should explain the complete treatment plan to the patient in detail before starting any procedure, along with the possible obstacles, so that there is no misunderstanding between the dentist and the patient, and also to maximize the chances of a successful treatment.

The patient also needs to find out whether the dentist charges the same amount for treating a number of teeth. Some clinics charge exactly the same, irrespective of the number of teeth, while others tend to offer a loyalty discount and reduce the fees for subsequent visits.

If patients ask all these questions up front, they would have the answers they need, so that there are no unpleasant surprises afterwards. Patients should also note that clinics offer additional options such as money back packages or refund programs, which tend to minimize some of their financial risks.  Patients should explore all these options.

What a majority of dental surgeons have learnt over time is that most patients in urban areas are not looking for the cheapest dental clinics, or the ones which offer the lowest fees, because they do understand that treatment is expensive. What patients are really looking for is value for money and the only way for patients to get this is with their due attentiveness. The key is to compare different clinics before opting for the one that suits one’s needs, to find out exactly what all is included in the treatment and what is not, and then make a decision as to what suits best.

FUTURE OF MEDICAL PROFESSION IN INDIA IN THE EYES OF A CHILD

Once there was a question in tenth standard examination, “What do you want to become in future and why, explain in detail?” What one student wrote would move even the strongest ones.

I do not know what I want to become in the future, but I surely know what I do not want to be, and I am writing on that. I do not want to become a doctor. This is due to number of reasons, which I am explaining below.

Since the time I was old enough to understand things, I have been hearing everywhere that doctors fleece their patients, that doctors are robbers. But whenever I was not well and required the services of a doctor, I never found it to be true. The doctor just examined me, asked a few questions, ordered a couple of tests and prescribed me medicines for some days. And I became well. This took place quite a number of times with me, and my friends also have the same experience. I fail to understand till now that why someone who takes away our pain and sickness is called a robber. If I too would have to hear the same things from the society, then I definitely do not want to be a doctor.

After going through a lot on this matter and collecting a lot of information, the facts I have come across prevent me from becoming a doctor, which I am writing down.

No other field in this country requires the amount of study and hard work required to become a doctor. There is fierce competition over a handful of seats after putting in a lot of hard work. It is indeed painful not to get knowledge even after such an uphill struggle. Most of the cities do not have medical colleges. A child has to stay away from his parents and leaves his home at a tender age of 17 years. The condition of hostels in medical colleges is more like stables meant for cattle. No fixed time to eat, no fixed time to eat. I am made aware that medical education in India is considered to be the hardest among the whole world. No way, I do not want to become a doctor.

I have also come to know that simply doing graduation in medical field is of no use. One only gets superficial knowledge, or in other words, gets sensitized, after putting in five to six years of his life. One cannot treat even his own family members properly, what to talk about treating patients. There is a rat race going on for post graduation seats, and post graduation in clinical subjects is considered superior. The society even refuses to acknowledge those who did their post graduation in non-clinical subjects as doctors. Why should I become a doctor when people would not recognize me as one?

After putting in ten years full of hardship, what does one get, just a degree? There is still no experience. One cannot be expected to treat patients straightaway. To gain some experience, one would have to work under a senior doctor for another 3-4 years, which makes up a total of 13-14 years before one can finally start earning. I can start earning way earlier by doing some other work and bring my life on track.

Following post graduation come the needs for a job. There is a dearth of government jobs. Nothing is possible without bribery. And even if one does get a job without bribing, he is sent to such a place where there is nothing in the name of resources. I had heard that there was a place called “Kaala paani (Black waters)” somewhere on an island far off from the country, but for a government doctor, most of the villages are Kaala paani. There is a just a site and nothing else. A rusty old building in the name of a Primary Health Care (PHC) centre, few resources like electricity, water, accommodation, medicines, operation theatres, instruments, and the list seems to continue till perpetuity. I have heard that in a government setup, things work at the discretion of the administration and not the doctor. No matter how much study one has done, how much hard work one has put in, only those medicines can be prescribed that are provided by the government, whose quality has also not been checked. If such medicines fail to present the required results or do some kind of harm to the patient, the doctor is to be blamed. In some instances the doctor has even been put behind bars.

Getting into private practice after post graduation is like hitting one’s own foot with an axe. There are ‘n’ numbers of laws and ‘n’ number of hands which seem to loot the doctors. I now understand that the society, calling doctors robbers, is itself robbing off the doctor and, to hide this fact, is putting the blame on this noble profession. Along with the daily hassles of life, a doctor also has to deal with various medical laws. Countless laws and acts like CPA/ CEA/ Nursing Home Act/ Biomedical Waste Act/ PCPNDT/ MTP/ Drug and Cosmetic Act are meant only for the medical fraternity. Add to these others that grapple the whole society, such as the Shop and Establishment Act/ Income Tax/ Motor Vehicle Act/ Property tax, among others. This is just too much to ask for, and the reason I do not want to become a doctor.

We keep on hearing cases in which a doctor has to pay a compensation amounting in crores. To add to these, doctors are not even allowed to raise their voice against the administration, like everybody else, if their demands are not being met. Does this mean that doctors are not a part of democracy, that too in the largest democracy of the world? Doctors are more like bonded laborers. Opting for medical profession in this country is like opting for slavery. It is like one has chosen a wrong path in his life. Doctors have dissimilar laws for them, like they are some social outcasts, a sinner, of no use to the society, every order is against them. That is why I do not want to become a doctor.

I think a new regulation is not too far off which would state that a doctor is not entitled to any salary. They are just there for the betterment of the society. They should not get up for any work, no matter how urgent it may be, while examining patients, neither to attend nature’s call, whether they are feeling thirsty, or even to relax or stretch a bit after a long day. What’s more, a doctor should not even be allowed to have food as he is not a human being. He is a robot, after all. Maybe a law is also passed that a doctor is not required to marry and settle down in life as it will cause a conflict in his responsibilities, and would result in a lack of interest while treating patients. Similarly, the government could also ban the doctor from procuring a decent house as he is supposed to be in the hospital, with his patients, round the clock. And to cater for the doctor’s hungry stomach, as he would be drawing no salary, he’d be given some bread with curd and vegetables two times a day, just like the mid-day meal for school children. This means that in coming times, a doctor might have to even live the life of a prison inmate. That is why I do not wish to become a doctor.

Today’s government, administration and judiciary are hell bent on downgrade the medical profession. Attacks from all the strata of the society probably illustrate the fact that the medical fraternity has no power of any sort. Media has the power of pen, judiciary has the power of law, administration has the power of force and society has the power of numbers. All these people tend to look down on the powerless and un-unified medical fraternity. What is the society’s motive behind this is beyond my reckoning. But after learning all this, I cannot see myself as a doctor.

The final outcome of a disease depends upon a number of factors, like the symptoms told by the patient, for how long did a patient wait before visiting the doctor or whether he visited some quack prior to showing up at the doctor’s, whether the patient even got himself investigated as per the doctor’s instructions or the investigations ordered by the doctor were precisely performed, whether the medicine dispensed by the chemist was of superior quality or did the patient even bother to take the medicines as prescribed, and whether the patient followed all the doctor’s instructions properly. If the patient is not cured then the doctor is held responsible, all other factors are negated. What is more, if the attendants of some patient become enraged, then God only save the poor soul. Doctors routinely get manhandled, leading to grievous injury, or even death. In a society where somebody else’s mistakes are planted over the doctor, I do not wish to become a doctor in such a scenario.

Doctors are more like a manual worker. Just like a daily wage laborer picks up his shovel, working continuously for 8-10 hours and then getting his remuneration, likewise if a doctor does not attend patients or perform a surgery for a day, he would get nothing. It is nothing like a business where the businessman, not even being in town, carries out his trade and keeps on accumulating profits. What I fail to understand is why the society keeps on calling a job equivalent to manual labor as a business. I feel that it is better to do some other job which involves money and power. Government officials, bureaucrats and politicians can earn lakhs through various means, with their one foot always abroad. Media persons have also made themselves so powerful these days. A person, with his bag, holding a camera or a microphone, calling himself media’s agent, can also acquire bungalows and gifts worth crores. Even the biggest and the richest doctors of the country do not anywhere near the likes of such people. So, whatever I might become, it is definitely not going to be a doctor.

Sir, with all due respect to you, I swear by God that I would never become a doctor, and neither would advise anybody to do the same. I might become a government official, or opt to open an STD/ PCO booth, or even a shop recharging mobile phones, BUT DEFINITELY NOT A DOCTOR.

PATIENT’S COMPLAINTS: A BLESSING IN DISGUISE

As a dedicated doctor, it is not always easy to hear criticism from patients. However, if a doctor changes his mind set so as to view complaints as free advice about how to make his medical practice the very best it can be, both his business as well as the patients would benefit.

Some of the most common patient complaints include that the doctor is not easily accessible, patients have to wait too long after coming in for an appointment, the doctor not giving enough time to the patient, the doctor not returning back the patient’s calls, or does not explain properly what is going on to with the patient.

In fact, the complaints of the patients can prove to be a lot beneficial for the doctor. A doctor should even encourage the patients to share their feedback, which includes both constructive complaints as well as compliments. In any case, a doctor would rather have patients come directly to him and/or his staff to discuss their concerns and proposed solutions, rather than bottling up their displeasure. If the patients do not vent out their displeasure and their concerns are not resolved, then in due course of time, they would end up either switching their doctor and/or bad-mouthing the doctor to potential patients.

If a patient is unhappy with the doctor or his services, the doctor should encourage him to tell what the problem is so that the doctor can try fixing it. While it is true that it is not possible to fix all problems as the doctor does not have unlimited resources of time, money, energy, and staff, the doctor can at least try to address the fixable points so that the patient is happier in the future.

The best complaints are the ones that are accompanied by possible solutions. Therefore, the doctor should always encourage his patients to propose a solution while they are telling the problem being faced by them. This increases the chances that the doctor would be able to do something productive to address the patient’s concern.

Quite a few times, doctors have to deal with patients who are unhappy with a previous doctor. When asked whether they discussed their dissatisfaction with that doctor, mostly the reply is in negative. Dissatisfied patients do not complain to their doctors, which is basic human nature. Patients are worried that if they complain, the doctor or his staff might get angry and would not provide them with good medical care. Also, patients often feel powerless and helpless in front of their doctors, thinking that the doctor would not pay heed to their issue and would ignore them. So they do not feel it worthwhile to complain. However, doctors would rather have happy, satisfied patients who recommend them to their family and friends than unhappy, disgruntled patients who leave the doctor’s practice and tell others about their dissatisfaction.

Patients with complaints should be encouraged to talk with the doctor and/or his staff about their concerns. This can be done through a scheduled phone call or in-person visit, a feedback form that could be dropped into a box designated for the same, or an email.

The doctor should be sure in developing in-person or online feedback forms that all the important aspects of the feedback are covered, viz. asking for complaints/criticism, proposed solutions, as well as compliments (as it is also important to know what one is doing right so that he can keep on doing the same).

The doctor should also be sure to follow up with patients who submit feedback to let them know that their opinions matter, and that the patients taking out their time to comment is appreciated. While not all the issues that patients complain about are valid or fixable, most of them are, and that’s where one should focus his attention. This would empower the patients and send them a message that their opinions matter.

By being responsive to a specific patient’s concerns, one is also likely to resolve issues that are troubling other patients who might not have spoken up, and would have an exponentially greater positive impact.

By working in collaboration with one’s patients, a doctor can build a stronger practice, thus creating a win-win situation for both himself as well as his patients.

MISTAKES BY PATIENTS: ARE THEY REALLY THAT BAD??

When there is talk about medical errors, the spotlight is always on the mistakes doctors or the medical staff. No emphasis is given on the mistakes committed by the patient, either knowingly or unknowingly, during the course of his treatment. The truth is that patients often make mistakes as well. There can be a number of reasons for these mistakes.

At times, the patients are confused, as they did not get the things explained by the doctor clearly. They do not understand the doctor’s medical jargon. Many patients are scared to cross question the doctor as they are reluctant to display their lack of knowledge to the doctor. They continue to simply nod their heads, with the doctor being misled into thinking that the patient has understood what is being told to him.

For example, a patient has been prescribed 0.5 mg of a particular medicine, and he ends-up taking 5 mg by mistake. This can be attributed to the fact that he did not understand what the decimal point meant. Mistakes like these can be both upsetting as well as irritating for the patient and the doctor. The patient is scared that in taking more than the recommended dose, he can harm his health as he has messed up with his medications.

The doctor is irritated, because he feels that he did an excellent job with giving all the right instructions and explaining how the medicine has to be taken. If the patient did not understand, he could have simply asked the doctor for clarification and cross-check with the doctor, rather than pretending to understand. Doctors sometimes tend to forget that patients can be quite intimidated by them.

It is important to understand that anyone can make mistakes, and being charitable and understanding is the best way to move beyond the situation. After all, a mistake is a mistake, and it has not been done deliberately. Rather than starting to assume that all patients are idiots, these mistakes can prove to be ideal learning opportunities. The fact is that patients make mistakes more often than doctors realize. They just tend to cover their mistakes up as they are scared that it would upset the doctor and make him angry, that the doctor will admonish them for the slip up.

The patient should have enough confidence in the doctor to let him know when a mistake is made. Then it would be up to the doctor to resolve it. Sometimes these are not much more than minor issues, which can be safely ignored. Of course there can be times when these mistakes can create major problems. However, in most of the cases, these too can be tackled, but only if the patient is willing to confide in the doctor. Interestingly, sometimes these mistakes can lead to some unforeseen events, which can actually help to advance medical science.

For instance, if the patient takes a lower dose than the one prescribed, and still has a good therapeutic response, the doctor might just start prescribing the lower dose to all his patients, because it may be as effective as the standard recommended dose. This is especially true when patients are taking alternative medicines.

Patients often tend to hide this information from their doctor, because they are scared he may get upset with them for doing non-standard treatment. However, if they get better and share this information, the doctor can learn from their experience, if he is willing to keep an open mind. Maybe he can even start advising other patients to try out alternative medicines.

Patient education can play a very important role in reducing the errors which patients inadvertently make, and it is imperative that the doctors and hospitals invest in tools and techniques that will help patients become better informed.

DENTAL INSURANCE: NEED OF THE HOUR

Taking proper care of one’s teeth and gums requires more than just brushing every day. One also needs to visit a dentist at least twice a year for a thorough check-up and treatment, if required. Dental procedures are presumed to be quite costly, leading quite many people to avoid a dental surgeon and land up in the hands of quacks.

One of the more common dental procedures, fillings, can cost several hundreds of rupees, depending on the charges of a particular dentist, based upon his specialty and experience. Likewise, procedures such as root canals and dental extractions can cost up to several thousands of rupees. If a dentist determines that these procedures are necessary, putting them off because of lack of funds can be detrimental to the teeth and gums in particular, and the overall health in general.

Many people skip a visit to the dentist because they cannot afford it. What they do not know is that something as simple as a decayed tooth or a poor dental health can lead to something as serious as a heart disease. A dental insurance plan, therefore, is the need of the hour.

Without insurance, the cost of these procedures quickly adds up. Also, with the ever increasing dental problems due to a rise in unhealthy eating habits, more treatment is required than simple preventative measures, making one look at a very high bill.

A dental insurance plan can help pay for some, most or all of the cost associated with these procedures. It can also provide one with access to care he may not have been able to afford otherwise. Without dental insurance, people are less likely to take proper care of their teeth. This is usually because they cannot afford to go to the dentist, or would rather spend their money elsewhere. Knowing that at least a part of one’s dental treatment will be covered is an incentive to seek out that treatment. Preventative treatment not only helps you safeguard against future problems, but also provides the opportunity to catch potential problems before they become too serious and require more extensive and expensive procedures.

It is not uncommon to find quacks or some not-so-honest doctors executing some crude treatment in order to earn easy money. These people tend to get away easily with these unfair practices as no proper treatment notes are put in the patient’s O.P.D. card. With the advent of dental insurance, such practices would be a thing of the past as proper notes have to be written for each and every work done in order to get claims from the insurance companies.

If the government starts offering dental insurance benefits, then there would be nothing like it. That would be the best insurance one can get. Because the government can subsidize a part of or the entire premium, one would be able to have access to more insurance coverage. Even if the government does not start any dental insurance plans in the near future, the private companies can come up with dental insurance plans of their own, and one can still get affordable and cost-effective dental treatment.

Dental insurance, looking at the rapidity of spread of dental diseases, is a must for everyone. Even if one opts for lesser coverage in order to pay a lower premium, it would still be better than nothing. But like with any type of insurance, before going to take any policy, it has to be first made sure that the insurance company is properly licensed for the same and is registered with the Insurance Regulatory and Development Authority (IRDA) of India, and not a fraudulent one.

Dental insurance does save one a lot of money. A middle class family man should keep dental insurance as a priority. With proper care, a person’s teeth and that of his children can and should last a lifetime. And with dental insurance, huge expenses are expected not to stand between a person and good overall health.

TIME FOR “CORRUPT” DOCTORS TO IMPROVE

There is a lot of anguish about the deplorable state of medical profession in the country these days. People do not hold doctors in the same high regard the way they used to do a few decades ago. More than half of the general population still respects their personal doctor. But looking at the broader perspective, it is now a very common belief that doctors, mostly the younger generation, are corrupt (they make underhand deals with pharmaceutical companies), unethical (they take cuts from medical representatives) and greedy (they over-test and over-treat in order to make more money). The reputation of the entire medical fraternity is in a state of free fall.

Nowadays, the society tends to prioritize professionalism over money which, in turn, puts medical profession more and more under the scanner. Commercialism is rampant and is affecting the society as a whole. And medical practitioners are equally affected by this trend of the society.

Another fact is that a large number of private medical colleges are set up by politicians and businessmen, wanting to make quick money. These colleges charge an exorbitant fee and in order to recover their expenses, fresh graduates end up overcharging their patients. To them, this seems to be the only way they would be able to get a return of their investment on the capitation fee they coughed up to ensure that the word “Dr.” gets prefixed to their names.

These days, numerous examples of unacceptable activities on the part of such medical practitioners can be seen when one looks around. It is now common for young doctors to be involved in under-the-table dealings. Most of them do not provide patients with any receipts or any documentation of the treatment provided. It is now also common for young, “fresh-blooded” doctors to make patients wait for hours on end even after giving an appointment, just to look busy. Doctors these days are uncommunicative, not bothering to explain the patient what exactly is happening to his body. They also tend to cover up and hide facts when there is any complication or error on their part.

The brunt of such practices by a corrupt few has to be taken by the whole medical fraternity. When numerous efforts of a meticulous doctor are unable to fetch the desired results, the “corrupt” reputation of doctors surfaces, leading to a catastrophe. No matter how much these doctors rationalize and justify their aberrant behavior, the fact is that it is both unethical and illegal. A doctor indulging in such practices needs to put himself back on the right track.

Many patients feel helpless and powerless in front of their doctors, leading to an imbalance in the doctor-patient relationship. When one is sick, the last thing he wants to do is to challenge and confront his doctor. It is true that one should have faith on his doctor, but it is one’s right to be informed about his own body. By allowing doctors to get away with such unacceptable behavior, patients are inadvertently encouraging them and the doctor also is not deterred from behaving badly with other patients either.

The doctor-patient relationship is a mutual one and one just cannot survive without the other. A person needs to know when to put his foot down. If patients are able to shrug off the cloak of complacency and muster up a bit of courage, changes are meant to take place.

The next time before complaining about a doctor, one should ask himself whether any steps were taken by him to alleviate the situation. If nothing of the sort was done, it also means the person is equally a part of the problem. The only way to expect some improvement in the way things around progress is to be a part of the change. The only reason a person can sit atop a pedestal is because the other one is on his knees.

WHAT DOCTORS EXPECT FROM PATIENTS

As a doctor, we do our best to help our patients but we often need help from our patients in order to help them. Here are some of our requests to our patients.

Please don’t hide stuff from us

We are not judgemental. If we tell you what to do and what not to do, it is for your betterment only. But if there is something which is important, please let us know. We cannot read your minds. We promise you that even if you tell us your deepest and darkest secret, we will not get shocked or be judgmental. We have most probably encountered a patient with a similar problem in the past. If you don’t tell us, it would just compromise the quality of the care provided to you. For example, if you have had a disease in the past you are ashamed to share, if you were or are into drugs or even had sexual relations or pregnancy before marriage which you had to terminate, just let us know.  This would help us to craft the right treatment plan. This sort of information is very valuable to us, which we have no way of knowing until you tell us.

Please trust us

It is important that you trust us and it is important that we trust you. This way we can work together to help you.  If you are not happy with any of our recommendations, do let us know. Our egos are not that fragile that we are going to get offended if you don’t agree with us. Since we cannot read your minds, if we tell you something and you just nod your heads, we assume that you are going to carry out our instructions. If for some reason you don’t think our advice is not good enough or you would not be able to follow it, it would be helpful if you tell us. Otherwise, this lack of compliance is going to harm both you and us.  It is even possible that we probably are not the right doctors for you, and if you prefer, we can refer you to someone else, or maybe think of another plan. But there is little point if we craft a plan for you are you do not pay any heed to it.  You do not have to agree with everything we say. And if you don’t, please be courteous enough to let us know what you don’t agree about and why, so that we can think of an alternative solution together.

Please give us feedback

If there is something we or our team is doing which you do not agree with, or there is something that we could improve on, please let us know, so that we can try to fix the problem before it becomes worse.  There is no point in bottling up your resentment or being unhappy and not telling us. Because if you do not tell us, we are not going to be able to fix the problem.

Please let us know how we can delight you

If we have done a good job in taking care of you, please let us know.  Positive feedback helps us do a better job and everyone likes being appreciated. Complaints are welcome, and we treat them as gifts which help us to improve. Compliments are also welcome, because they give us positive energy which helps us to do a better job in taking care of our patients.