A reply from Wockhardt, Bangalore
Posted by: vijayashankar on: June 14, 2009
Here is a reply posted on my WordPress blog , by a doctor, supposed to be from a doctor working there.
Note – no one is maligning anybody. Just as media published both sides, I am publishing this reply.
===============================================
The author of this reply is Dr. Akhilesh Pateraya. akhilesh.pateraya@wockhardthospitals.com
Reputations take a lifetime to build, is it right to destroy them without understanding true facts and make a hospital and its doctors look inhuman? The true facts of Ms Rashmi BT’s case
Ms. Rashmi B.T. was under the care of a senior gynaecologist in Bangalore for her second pregnancy. She had a breech presentation (where the legs of the baby present itself first instead of the head during the time of delivery) in the earlier pregnancy which required a C-Section. She made a conscious decision to shift under Dr. Latha Venkatram’s care at Wockhardt Hospitals, Bangalore in the 35th week of her pregnancy largely because she was aware that Vaginal Birth after Caesarian Section (VBAC) was an option and wanted to select that option for her second delivery. She had collected information that Dr. Latha Venkatram was one of the senior gynecologists in the city who offered this option to her patients. From the OPD records filed by Dr Latha Venkatram it is evident that Rashmi was counseled and given ample information about the procedure and the risks associated with it and she took an informed choice to select this procedure.
Vaginal Birth after Caesarian Section (VBAC) is the term used when a woman gives birth vaginally, having had a caesarian delivery in the past. Worldwide VBAC, if possible, is being recommended and preferred over repeat C-Sections as its advantages substantially outweigh the disadvantages. According to the Royal College of Obstetricians and Gynaecologists patient information guideline 2008 “Birth after previous Caesarian Section”, overall three out of four women with an uncomplicated pregnancy would give birth vaginally following one caesarian section delivery. The short-term and long term complications inherent in a C-Section make it preferable that a woman is offered the choice of a VBAC. The American College of Obstetricians and Gynecologists and have set a goal of 37% VBAC deliveries by 2010
Repeat Caesarian sections are associated with:
o A possibly more difficult operation
o Longer recovery period
o Possibility of injury to bladder or bowel
o Possibility of blood clots developing in legs and pulmonary thrombosis
o Breathing problems for the baby. Higher in C-Section than in VBAC
o Serious risks increase with every Caesarian delivery
o Higher chance of infection
o Future complications for the mother who has had repeated opening of the abdomen
o Higher costs
VBAC has a shorter stay in the hospital, faster recovery as well as lower cost for the patient. There is a risk of uterine rupture but this risk is approximately 0.5%. In spite of this risk the benefits of VBAC far outweigh the risks. As in all medical procedures there is no way to predict which patient would fall under the 0.5% risk of uterine rupture or any way by which this rupture can be prevented. A VBAC delivery is more demanding of the gynaecologist, as it takes 6-8 hours as compared to a C-Section, which in a planned fashion would be over in less than 40-45 minutes. Also the mother and child need close monitoring it is estimated that one will have to do as many as 200+ unnecessary C-Sections to prevent the occurrence of 1 uterine rupture. In most cases a uterine rupture is not fatal. However in the best interest of Ms Rashmi, Latha Venkatram gave her both the choices and Ms Rashmi chose to opt for the VBAC option.
Ms. Rashmi B.T. was a fit candidate for a VBAC. She had a breech presentation in the earlier pregnancy which required a C-Section. A breech presentation in the earlier pregnancy which necessitated a C-Section is in fact an indication to offer a VBAC to the patient in the subsequent pregnancies. An age of 35 is not a contraindication to a VBAC. The fact that she was 5 days past her due date was also not a contraindication to a VBAC because less than 5% of patients deliver on their due date.
During her antenatal visits to Dr. Latha Venkatram, Ms Rashmi B.T. was explained in detail about the pros and cons of VBAC and she agreed to undergo the procedure. The OPD case records have these notations. She was also clearly informed by Dr. Latha Venkatraman that she works along with Dr. Prabha Ramakrishna as a team and either of them would be present during her delivery. Doctors particularly in the area of obstetrics frequently prefer to work as a team since many times an emergency may hold one of them which would make it possible for the other team member to attend to the delivery as the date and time of delivery cannot be predicted. In a VBAC considering that a consultant needs to be around for most of the labor period it is prudent that a team takes care of the patient. Both Consultants of the team Dr. Latha Venkatram and Dr. Prabha Ramakrishna are Fellows and Members of the Royal College of Obstetricians UK.
Ms Rashmi B.T was admitted to the hospital early morning on the 4th of March 2009 in spontaneous labour. She was connected to monitors for a close monitoring of both maternal and fetal parameters. She was visited by Dr. Latha Venkatram soon after admission. An experienced nurse and a fully qualified gynaecology registrar were monitoring her constantly. The Consultant Dr. Prabha Ramakrishna was also available on the same floor and repeatedly examined her. She was kept informed about the progress of the labour.
The labour progressed normally until 1.50 p.m when a sudden decrease in the fetal heart rate was noted (fetal bradycardia). The tracings before 1.50 p.m were normal. The moment fetal bradycardia occurred, the consultant Dr. Prabha Ramakrishna who was on the same floor was called in by the gynecology registrar. When Dr. Prabha Ramkrishna examined Ms Rashmi, the baby’s head position was a little high. She was asked to push to see if the baby’s head would come to +2 position in which case she could do a forceps in the labor room itself and deliver the child. When the baby’s head did not descend as required she asked for the patient to be shifted to the Operating room. After this Ms.Rashmi was not asked to bear down any further.
Shift to the OT was rapid since the dedicated Operation Theatre for Caesarian sections is situated within the labour room complex and this theatre is not used for any other procedure. Within 7-8 mins the patient was in the theatre. The anesthetist had a choice of going in for an emergency general anesthesia which has inherent risks for a pregnant woman or to go in for epidural anesthesia. Since the patient was already receiving pain medication (epidural analgesia) it was decided that for the safety of the mother increasing this analgesia to achieve anesthesia was the preferred option. In the OT the fetal heart rate was recorded as 180 b.p.m on the Doppler. On the OT table an examination was done and it was found that the head had receded and a forceps delivery was not attempted. An immediate emergency C-section was then performed.
The anesthetists, Neo-Natologists and the surgical nursing team had assembled in the theatre within a few minutes of the emergency being declared. The hospital has full- time anesthetists, Neo-Natologists and a surgical nursing team working round the clock to attend to all kinds of medical emergencies.
At the time of birth the baby did not have a heart beat or respiration. Resuscitation was started and the heart beat started about half a minute later. The child was immediately shifted to the Neonatal ICU and put on the ventilator. The baby’s weight at birth has been recorded in the NICU as about 3 Kg. The only reason an exact weight could not be taken in the NICU was that the child was already attached to various lifesaving equipments and the neonatologist had to make the closest estimate. However it must be noted here that a birth weight of 4 KG is not a contraindication for a VBAC.
In the neonatal ICU the clinical team met the family on a daily basis and kept them informed about the status of the baby and the prognosis. The poor prognosis was explained to the parents on the 2nd day itself. An opinion from an external eminent neonatologist was also sought who concurred with the poor prognosis. All decisions regarding further care were made only after extensive discussions with the parents of the baby. Dr.Prakash Vemgal our Neo-Natologist is not only highly experienced but has also gone through some of the highest training in Neo- Natology in high patient volume and reputed international centres.
The doctors and the management (including senior management personnel) of the Wockhardt Hospitals group spent long hours with the parents understanding and trying to address their concerns. As is the normal practice in such a case a complete internal review was done. The family sent to us a detailed list of areas they wanted us to look into during our investigation. We did go into each of these areas and sent them a detailed reply addressing most of these issues including taking the opinion of two leading and senior external gynecologists of the city who do substantial VBAC work. It is unfortunate to note that inspite of providing her all clarifications Ms Rashmi has been projecting an extremely poor image of Dr. Latha Venkatram and the hospital.
Our internal review involved discussions with our own team of gynaecologists, meetings with two external gynaecologists who practice VBAC and the entire clinical care team. Our findings after this detailed internal review are summarized below.
a. Ms Rashmi BT was a fit candidate for a VBAC. She would have been offered this procedure as a first choice by any gynecologist or hospital which practices advanced obstetrics anywhere in the world. Her age or the week of pregnancy were not contraindications to go in for a VBAC.
b. She had made a conscious and informed decision about going in for a VBAC. She had changed her senior gynecologist whom she was consulting until the 35th week of her pregnancy primarily because that gynaecologist was not in a position to offer VBAC.
c. The OPD case notes of which she was given the duplicate copy recorded that she was willing for VBAC and she was informed about all risks of her decision.
d. Both the mother and the child had been monitored carefully right through the labour
e. All medications used for progressing labor were prescribed agents and safe for use in VBAC
f. She did have a uterine rupture which in VBAC carries a risk of 0.5%. This rupture could in no way be predicted or prevented. In spite of the rupture the gynecology team was able to save the uterus for future child bearing.
g. The Operation theatre was ready at the time it was required.
h. All the staff were present in the Operation Theatre within a few minutes of the emergency being declared
i. While the baby was in the NICU Dr.Prakash Vemgal the head of Neo-Natology met up with the parents at regular intervals and kept the family clearly informed about the status and prognosis. All major decisions were taken only after discussion with the parents.
j. Senior management of the organization met up with the family on multiple occasions to understand and address their concerns
A minute by minute account of her story as is being spread through the various emails circulated by various people who were neither physically present during her admission to the hospital nor were involved in her care process exhibits to us a determined effort to harm the reputation of the gynecologist and the hospital without having any understanding of the clinical facts of the case.
Is medicine now going to be judged through the lens of only opinions running across chain mails or through the untiring efforts of institutions and doctors which toil endlessly to save lives but remain spectators to their actions being judged by emotive outbursts?
We do understand the pain and suffering of Ms Rashmi BT. As a hospital every life is precious to us but we are also are in the world of medicine where unfortunate rare complications can be counteracted but every procedure cannot be made risk free. There are many lives which we save each day when all has been given up and each such case teaches us that to pursue medicine is to pursue the limits of the unknown but does that mean that we become victims of public misinformation
We have taken all necessary care and followed every medical protocol that any reputed institution across the globe would have followed. However it is unfortunate that even though Ms Rashmi has not been a victim of any medical negligence she has chosen by this random spread of irrational mails to use a redressal system that is purposely harming the reputation of Dr Latha Venkatram, Dr.Prabha Ramakrisha and our institution.
The case can be subjected to analysis by any competent authority.
83 Responses to "A reply from Wockhardt, Bangalore"
[...] Here is the original post: A reply from Wockhardt, Bangalore [...]
[...] A reply from Wockhardt, Bangalore « Vijayashankar's WeblogShe made a conscious decision to shift under Dr. Latha Venkatram’s care at Wockhardt Hospitals, Bangalore in the 35th week of her pregnancy largely because she was aware that Vaginal Birth after Caesarian Section (VBAC) was an … o Possibility of injury to bladder or bowel o Possibility of blood clots developing in legs and pulmonary thrombosis o Breathing problems for the baby. Higher in C-Section than in VBAC o Serious risks increase with every Caesarian delivery … [...]
June 15, 2009 at 7:42 PM
//However it is unfortunate that even though Ms Rashmi has not been a victim of any medical negligence she has chosen by this random spread of irrational mails//
Yes
I feel what Rashmi is doing is not fair
At any point of time, she could have refused VBAC
Or she could have gone to another doctor, may be even the one who was treating her till 35 weeks
The very fact that she has avoided telling the reason why she changed doctor at 35 weeks tilts my judgement
June 15, 2009 at 7:42 PM
//However it is unfortunate that even though Ms Rashmi has not been a victim of any medical negligence she has chosen by this random spread of irrational mails//
Yes
I feel what Rashmi is doing is not fair
At any point of time, she could have refused VBAC
Or she could have gone to another doctor, may be even the one who was treating her till 35 weeks
The very fact that she has avoided telling the reason why she changed doctor at 35 weeks tilts my judgement
June 15, 2009 at 10:03 PM
Sigh. Here we go again. Have posted this response to Dr. Whatsisname of Wockhardt so many times now that my ctrl V is beginning to fall off:
I have personally met with the medical services director and the customer services head of Wockhardt regarding this case. Disagree with Wockhardt’s rebuttal on a couple of points:
1. Rashmi did not shift to Dr. Latha in her 35th week because she “wanted” a VBAC. She shifted because she was until that time in Jammu, where her husband was posted. A cousin of Dr. Latha’s referred her to Dr. Latha. Rashmi had never heard the term “VBAC” until Dr. Latha brought it up.
2. Although the ROCG does prescribe certain guidelines they are meant for women with the build of a Caucasian, not for Indian women; also, we lack the kind of processes and facilities that are available in the West, as this case clearly indicates.
3. The so-called “notations” in the OPD file indicating that risks, pros and cons were discussed with her is simply a scrawl on a prescription pad which says “VBAC discussed with patient”. In fact, I had asked Dr. Lloyd Nazareth, the Medical Services Director, the specific question: “What is the process Wockhardt follows for ensuring that a patient has understood the risks of a particular procedure? For example, do you hand out a pamphlet that explains the process and then take a signature saying “read and understood”? His answer: “We have no such process. In this case, the words “procedure discussed” have been written on a prescription pad by the consultant gynaecologist, and we as hospital management take this to imply that the consultant has explained a procedure in-depth, discussed its risks, and addressed a patient’s concerns regarding the procedure.” I then asked how the word “discussed” could measure the quality of a discussion, and got no response. The hospital lacks basic processes for obtaining a patient’s informed consent.
I won’t even bother further refuting Wockhardt’s response, except to ask why the poster has not addressed the following issues:
Fraudulent billing; post-facto notations on patient records (in different colored inks, no less!); lack of basic working apparatus…
Makes me want to either laugh, or be sick.
Oh and BTW, Wockhardt has gone to Digg with their version… URL digg.com/health/Rashmi_BT_Real_Story_Revealed
Diggers please BURY IT!!
June 16, 2009 at 3:17 PM
//We stick to Rashmi’s version. We believe her.//
So you are suggesting that there shall be no more normal deliveries for mothers who has had a previous LSCS
And then there is a hue and cry that doctors are doing caesarean section and not allowing normal deliveries “for money sake”
The tendency to blame each and everything that a doctor does is very sad
//During my 35th week, I decided to consult Dr. Latha Venkataraman at The Nest, Wockhardt’s Bannerghatta Road maternity facility to see me through the rest of my pregnancy.//
So who was this lady consulting till that time
Why did she change the doctor
Was it because the previous doctor said “Caesarean only” and she changed because this doctor agreed for a VBAC
Questions to Rashmi
1. Was she aware of the risks of VBAC
2. Did she ever opt for LSCS
3. If so why she did not consult a doctor who could have done LSCS
It is a common thing we see on the roads when a two wheeler and a pedestrian dash, the illiterate rowdy mob just thrash the two wheeler driver
When a two wheeler and a four wheeler dash, the four wheeler is immediately thrashed, even without trying to find who is at fault
Similarly in this case as Rashmi has lost her baby, everyone is training the guns on the hospital, conveniently forgetting other facts
June 16, 2009 at 3:22 PM
/Please do your bit to see that as many people as possible read it. Circulate it via email, via Facebook, and any other means you can think of. Talk about it. If it can help prevent even one more incident like this, it will have done its job. Hopefully, someone, somewhere will lend their voice to Rashmi’s.//
So you are suggesting that there shall be no more normal deliveries for mothers who has had a previous LSCS
And then there is a hue and cry that doctors are doing caesarean section and not allowing normal deliveries “for money sake”
The tendency to blame each and everything that a doctor does is very sad
June 16, 2009 at 3:23 PM
//During my 35th week, I decided to consult Dr. Latha Venkataraman at The Nest, Wockhardt’s Bannerghatta Road maternity facility to see me through the rest of my pregnancy.//
So who was this lady consulting till that time
Why did she change the doctor
Was it because the previous doctor said “Caesarean only” and she changed because this doctor agreed for a VBAC
June 16, 2009 at 3:23 PM
Question to everyone
Do you say that once a woman has delivered by LSCS, Vaginal Delivery should not be attempted the second time
June 16, 2009 at 3:25 PM
To the previous poster: I am an impartial third party. I met Rashmi for the first time on Apr 2, and encouraged her to put things behind her and move on with her life, telling her that doctors are only human and that there’s only so much they can do. However, on looking into the details and showing the records to several leading doctors, I have come to believe the hospital is at fault.
It would help immensely if Wockhardt could publicly answer the following 10 questions:
1. Why is Dr. Latha’s notation in the OPD record regarding Dr. Prabha as her “co-consultant” made only on the 28th of Feb., AFTER Rashmi’s predicted due date? Would that be a good time for a patient who is past her due date to switch her obstetrician, or even make enquiries about the qualifications and credentials of the co-consultant?
2. Since Dr. Latha is such an experienced VBAC practitioner who follows ROCG and other foreign-body guidelines, please publish the guidelines she followed, and match Rashmi’s records against them.
3. Rashmi’s key question: “If I have paid for doctors who were fellows and members of the Royal College of Obstetricians, why was the registrar attempting to deliver me?”
4. Another key question from Rashmi: “Why did an experienced doctor like Dr. Prabha not recognize signs of uterine rupture? I was yelling with pain in the labour ward and kept pointing at my stomach and telling her that there was a ripping pain in my stomach. I complained of shoulder pain and chest pain in the OT she still did not recognize the rupture. She admitted that she knew of the rupture only when she opened me? Why?”
5. Registrar Dr. Shirley had announced that Rashmi would deliver by 1.30 p.m. What was Dr. Prabha doing in OPD at that time? Uterine rupture does not happen suddenly but over a period of time… during which Rashmi was attended by a registrar who is NOT an ROCG-qualified doctor.
6. Why did it take 43 mins to conduct an emergency C-section? Baby fetal heart rate was down to 58 bpm at 1.50 p.m. and baby was extracted at 2.33 p.m.
7. Why was the fetal monitor not connected in the OT? Is this what VBAC guidelines specify?
8. If the baby had a heartbeat of 180 bmp, how is it possible for the outcome to be a baby without heartbeat and respiration at birth?
9. Would an internal review with your own gynecologists and external gynecologists who are close aides of Dr. Latha be unbiased? Why have you refused to conduct a transparent review that includes the inputs of Dr. Prakash Kini and Dr. Narayanan, two obstetricians widely recognized as Bangalore’s seniormost obstetricians, as requested by Rashmi?
10. Finally: Please have this case put up for review in the next conference of BSOG and FOGSI and have the proceedings covered by the press.
June 16, 2009 at 3:34 PM
Oh and as to why she changed her doctor in week 35… she’s an army officer’s wife. He is posted in Jammu. She moved to her parents’ place in Bangalore for delivery. As simple as that!
June 16, 2009 at 3:37 PM
To sumanbolar
I am an impartial third party.
Since I am not from Wockhardt , I cannot answer these questions
But I can give you one comment
VBAC as a procedure is associated with certain risks. Uterine Rupture and Fetal death are among the documented risks and are bound to happen in few cases
If you want to avoid those, go for LSCS. If the doctor whom you consult is not for LSCS, go to another doctor.
It is very very simple.
–
On the other hand, to have accepted the procedure in the beginning and then start mud slinging when there is a complication is very very pathetic
–
As I have already pointed out (2 wheeler vs 4 wheeler analogy) the mother has lost a baby. So all of you emotionally will only thrash the hospital like the people on the road who thrash the 4 wheeler driver. Of course you use orkut, facebook and wordpress 
June 16, 2009 at 4:20 PM
“Uterine Rupture and Fetal death are among the documented risks and are bound to happen in few cases”
Yes – and if that had been communicated by Dr. Latha Venkataraman in the first place, Rashmi would never, ever, have accepted this procedure. No mother would.
To reiterate from my post above, “In fact, I had asked Dr. Lloyd Nazareth, the Medical Services Director, the specific question: “What is the process Wockhardt follows for ensuring that a patient has understood the risks of a particular procedure? For example, do you hand out a pamphlet that explains the process and then take a signature saying “read and understood”? His answer: “We have no such process.”
June 16, 2009 at 4:29 PM
//Yes – and if that had been communicated by Dr. Latha Venkataraman in the first place, Rashmi would never, ever, have accepted this procedure. No mother would.//
Yes
I agree
–
Many doctors do not communicate the risks properly
For example, in one case a mother was given Rubella Vaccine during pregancy. The doctor had of course told her that the vaccines have “complications” and the mother agreed
But had he told that the child could be blind and deaf and have a malformed heart (http://en.wikipedia.org/wiki/Congenital_rubella_syndrome) the mother would have never agreed 
–
For a doctor, a fetal death is just a “failure” in a case. For the family, it is a loss of a family member. For the mother who has carried the child for 40 weeks, this would be terrible
–
There is something to be known with the word “risk” that is used in medicine
For example, if a process has 1 % risk that does not mean that it is going to affect all children 1 %
It means that it is going to affect 1 in 100 child and FOR THAT ONE CHILD, that is 100 % risk
–
All said and done, the mother should have seen the net and consulted experts, either before opting for the procedure or at the least atleast before her due date
–
The mudslinging happening now is totally not warranted
–
If you are going to treat a complication arising due to the IGNORANCE of the mother in the same way as a medical malpractice, more and more doctors are going to prefer to LSCS (to escape the smear campaign in facebook and orkut) in future and that is not going to be good for the society
June 16, 2009 at 4:33 PM
//Yes – and if that had been communicated by Dr. Latha Venkataraman in the first place, Rashmi would never, ever, have accepted this procedure. No mother would.//
No that is wishful thinking
I have show you places where the mothers are explained the complications of LSCS and VBAC and they choose VBAC
I agree that Rashmi may not have opted for this, but you cannot decide on the basis of all mothers
Heck
Even Pregnancy is associated with complications. Don’t go to the extent and tell no mother will accept to be pregnant
June 16, 2009 at 4:35 PM
To clarify
The Yes I Agree was for the “if that had been communicated by Dr. Latha Venkataraman in the first place, Rashmi would never, ever, have accepted this procedure.”
The No is for ” if that had been communicated by Dr. Latha Venkataraman in the first place, Rashmi would never, ever, have accepted this procedure.”
June 16, 2009 at 4:36 PM
To clarify
The Yes I Agree was for the “if that had been communicated by Dr. Latha Venkataraman in the first place, Rashmi would never, ever, have accepted this procedure.”
The No is for ”No mother would.”
June 16, 2009 at 4:37 PM
VBAC or Not, LSCS has less risks than Normal Delivery. Still most people opt for Normal Delivery !!!
June 16, 2009 at 4:41 PM
“All said and done, the mother should have seen the net and consulted experts, either before opting for the procedure or at the least atleast before her due date”
Sorry – the onus of providing medical information is on the doctor, not the patient. If the Internet was a reliable source of information, we wouldn’t need you doctors at all! End of conversation, Dr. Bruno.
June 16, 2009 at 6:06 PM
//Sorry – the onus of providing medical information is on the doctor, not the patient. If the Internet was a reliable source of information, we wouldn’t need you doctors at all! End of conversation, Dr. Bruno.//
Sorry
I did not ask the mother to consult the net for medical advice. Only idiots and mentally retarded people consult net for medical advice. And I find the incidence of such retardation higher among one profession !!
//All said and done, the mother should have seen the net and consulted experts//
I mentioned net just as a directory, to know the name of the experts. Read it again
Read things with open mind and not biased mind
When you see things with biased mind, you will be far from truth.
//the onus of providing medical information is on the doctor,//
The Doctor has already told that about the complications and after that only the mother has agreed for the procedure.
But now for some reasons (which is very easy to guess), she is indulging in this mud slinging
//If the Internet was a reliable source of information, we wouldn’t need you doctors at all! //
Internet is not at all a reliable source of information for the PATIENT.
//End of conversation, Dr. Bruno.//
This is what usually happens when people who run smear campaigns confront some one who speaks hard facts – They just run away
I am willing to continue till you stop spreading wrong information
June 16, 2009 at 7:27 PM
Dr. Bruno – your idea of “hard facts is very different from mine. Simply because I have seen the medical records, and you have not.
“The Doctor has already told that about the complications and after that only the mother has agreed for the procedure.”
Not a “hard fact”.
“I mentioned net just as a directory, to know the name of the experts.”
This doesn’t seem evident from your previous post. I am willing to concede that it may just be an English language issue, as you seem to have to explain everything you say several times for clarity. Even so, How would it have helped her to “know the name of the experts”?
“They just run away”
Absolutely – I am scared shitless that doctors have the kind of attitude that you do. Running NOW!!
June 16, 2009 at 7:33 PM
//Absolutely – I am scared shitless that doctors have the kind of attitude that you do.//
Thanks for the compliment !!
Thanks for accepting that you are scared that doctors have the kind of attitude to respond to the allegations with facts and counter questions. Not just you –> most of the people in the web are like that only
//Even so, How would it have helped her to “know the name of the experts”?//
And consult them and opt for LSCS which has less fetal complications instead of trying VBAC which has less morbidity for the mother
June 17, 2009 at 12:28 PM
Bruno,
First you have taken the “End of Converstaion” by Suman too seriously and holding on.. just to it to slander the people participating in the social medium.
If you see unbiased, you will understand that more ppl are having a concern of how this could happen, particularly in a “premium” place, where you pay extra to get yourself out of such troubles as you expect them to do exceptional. And the anger of these ppl comes in words against the hospital. I hope you can appreciate the sentiment behind the words and not hold on to just words and their literal meaning. If you think I have lost my sense of humor in your statements with smilies, then Bruno, your timing of humour couldnt have been more wrong.
And Suman and Rashmi have started this conversation on the social medium because the hospital has not been responsive with their stonewalled comments. The most they are expecting is for the hospital to accept error of judgement and the various mismanagements and take future steps of correction. Of all, their most valuable contribution in this post is increasing awareness among ppl to ask more questions on this VBAC during their pregnancy.
Now coming to your contribution Bruno, you have very easily said that since you are not from Wockhardt, you cannot comment on the questions that Suman asked. But you could have taken an idealist view and answered her questions, on what should have happened ideally given your education in this field. I am hoping you do that atleast now so that we non-medical ppl participating in this conversation can be educated through your views.
Now coming to your comments knowing of “names of experts” and consulting them. I believe that even the most net savvy of us, go more by personal recommendation than just medical directories and internet for doctors leave alone medical advice. How many percentage of ppl that you know go to a doctor after researching them on the net and how many go by word of mouth recommendations?
June 16, 2009 at 10:25 PM
This is a bunch of bull***!!! – on behalf of the hospital that is. That’s all I have to say.
God knows I would not let my wife give birth in India, even in the fanciest of facilities. They know how to give you a “birthing suite” and a mammoth plasma, but not even the minimal standard of care and expertise.
I do not have time of patience to go in to the many ways of how the hospitals here, I mean the “good” ones, are flawed. Fact is, by western standards, they are terrible.
June 21, 2009 at 9:22 AM
How can you say this? Its like saying all ‘Indian IT persons’ are Cyber thiefs! Some of the leading doctors and researchers in Medical field abroad are Indians. Most of the Indian doctors qualified abroad are moving in to India so much so that the Medical Council of India has now given recognition to ‘foreign degrees’.
People have personal experiences and outcomes that they were not happy with. This happens anywhere and everywhere. I trained abroad for several years and returned to India and God’s grace am doing better than I expected. Matter of fact, I have seen ‘white skin’ make blunders right under my nose and get away with it.
The one thing in Medical colleges of India we didnt get trained in was ‘communications skills’ which is very important I understand today. Hence if some doctors cant stand up and defend themselves doesnt make them guilty. Nor if some stand up and voice their defense doesnt make them non-guilty!
So Mr Joe, I dont know who you are angry with neither am I interested. But before you criticise all doctors and the medical fraternity of India as a group, look into your head and clarify as to what you are angry with first.
In this blog when one brave and ‘well versed’ doctor actually is defending the medical profession which is also happening even out of blogs in medical meetings its only a matter of time when people realise that unfair accusations will not be tolerated by the Medical fraternity any more!
June 16, 2009 at 11:15 PM
to Bruno: What do you suggest? that Rashmi, in the midst of her pain, should have told the doctor to do a C-section? Is that not the doctor’s responsibility: to monitor the progress and perform a C-section at the first hint of distress? Accoriding to the report here, that constant monitoring was not done. Putting the blame on Rashmi for choosing a VBAC is abdicating your reponsibility as a doctor. Look at this way: helathy woman, healthy pregnancy: dead baby beacuse of a botched procedure. And you are blaming the mother?
June 19, 2009 at 7:43 AM
//that Rashmi, in the midst of her pain, should have told the doctor to do a C-section? I//
Yes
//Is that not the doctor’s responsibility: to monitor the progress and perform a C-section at the first hint of distress? //
She was monitored
C section was done
Inspite of best care the baby has died. That does not mean that the hospital is to be blamed
–
Doctors are not GODs. They cannot save each and every patient. Human bodies are not machines to have a same outcome.
Just because a baby has died it does not mean that there is a negligence
June 17, 2009 at 11:01 AM
I have been with Dr. Latha as her patient and I believe that she is the best there is in her field. And Wockhardt would not have published this explanation without solid proof. It is not right to get emotionally vindictive against the Doctor for one’s personal misfortune. Doctors may not be gods, but lying in the Labour room with the tension and pain, I would certainly think they come close to it with their healing professions. Specially Dr. Latha and her colleagues.
June 17, 2009 at 12:06 PM
Why is this becoming about whether Rashmi should have had a LSCS or not? Let her have picked the VBAC, so what? Countless women do – I did. In my case, thank god, I had a cautious doctor who was constantly monitoring me so the moment I had fetal bradychardia I was sent to the OT.
Question is: Did the good doctors at Wockhardt do the same? Or were they negligent?
Someone else posted this link but I am posting it again here:
http://www.worldserver.com/turk/birthing/CatherineGrace.html
Please do read. This happened in 1986 in the US and the similarities between this case and what happened to Aarnav are chilling.
As for you Dr. Bruno, I do understand what you are trying to say. And to answer your questions, if not FB/internet etc how else are we mere human beings supposed to spread the message against the considerable might of an institution like Wockhardt.
Just like you feel empathy towards your fellow doctors and take up cudgels for them are we as fellow mothers not allowed to take Rashmi’s side? We are not raising a hue and cry, we are asking questions about our own babies and our health. Is that wrong? How sad for your medical community that finally we have ways and means to reach out to each other so we stopped treating you as God.
June 17, 2009 at 3:08 PM
//As for you Dr. Bruno, I do understand what you are trying to say. And to answer your questions, if not FB/internet etc how else are we mere human beings supposed to spread the message against the considerable might of an institution like Wockhardt.//
You can spread if there is a clear case of medical negligence (example retained gauze in abdomen, wrong blood group transfused etc). In that case, I would be more vociferous than you
But what has happened here is a consequence of the decision taken by the mother to go in for VBAC. And to have a smear campaign against the hospital is uncalled for
//Just like you feel empathy towards your fellow doctors and take up cudgels for them are we as fellow mothers not allowed to take Rashmi’s side?//
What is Rashmi\’s side here – She lost a baby. Agreed
Who is responsible – SHE. Her decision to opt for VBAC is responsible for it
But you are totally ignoring that and trying to portray this as a case of Medical Negligence
// We are not raising a hue and cry, we are asking questions about our own babies and our health. Is that wrong?//
Not at all wrong
To ask a question is different from smear campaign and mud slinging. Hope you are mature enough to know the difference
// How sad for your medical community that finally we have ways and means to reach out to each other so we stopped treating you as God.//
There is no need to treat doctors as GOD.
Accept that fact that doctors are professionals – That is what I am also telling
Accept the fact that inspite of the most accurate treatment and best of care, few patients are bound to have complications as Doctors are not GODS
And when such complications happen, don\’t just blindly jump into conclusion that it is due to the mistake on the part of the medical community
–
I have already given you an example. Have you read it. Most of you commenting here are so biased that you ignore all facts and just vent out the hatred here
It is a common thing we see on the roads when a two wheeler and a pedestrian dash, the illiterate rowdy mob just thrash the two wheeler driver
When a two wheeler and a four wheeler dash, the four wheeler is immediately thrashed, even without trying to find who is at fault
Similarly in this case as Rashmi has lost her baby, everyone is training the guns on the hospital, conveniently forgetting other facts
The illiterate people at the roadside use Sticks and Stones
You use facebook and blogs
But the underlying rowdyism, hatred is the same
So sad !!!
Stop behaving like rowdies and uncivilised persons and try to face facts with facts.
June 17, 2009 at 3:28 PM
Stop behaving like rowdies and uncivilised persons and try to face facts with facts.
If there is a medical negligence, tell it and prove
A mother loosing her baby is sad, heartwrenching, pathetic and so on, but it automatically does not prove medical negligence and give you full authority to behave like goons who thrash windows when their local rowdy has been arrested and start a smear campaign to just vent out your frustation
June 17, 2009 at 3:33 PM
//Someone else posted this link but I am posting it again here:
http://www.worldserver.com/turk/birthing/CatherineGrace.html
Please do read. This happened in 1986 in the US and the similarities between this case and what happened to Aarnav are chilling.//
Yes
When the mother opts for VBAC this complication is bound to happen
Sad but true
Truth is often bitter
June 17, 2009 at 5:41 PM
//Just like you feel empathy towards your fellow doctors and take up cudgels for them are we as fellow mothers not allowed to take Rashmi’s side?//
What is Rashmi’s side here – She lost a baby. Agreed
Who is responsible – SHE. Her decision to opt for VBAC is responsible for it
But you are totally ignoring that and trying to portray this as a case of Medical Negligence
// We are not raising a hue and cry, we are asking questions about our own babies and our health. Is that wrong?//
If there is a medical negligence, tell it and prove
A mother loosing her baby is sad, heartwrenching, pathetic and so on, but it automatically does not prove medical negligence and give you full authority to behave like goons who thrash windows when their local rowdy has been arrested and start a smear campaign to just vent out your frustation
Stop behaving like rowdies and uncivilised persons and try to face facts with facts.
If there is a medical negligence, specify it and prove it
June 17, 2009 at 8:19 PM
Dr. Bruno: blaming Rashmi for choosing a VBAC and hence losing her baby is the lowest form of defense. VBACs result in the death of the baby ONLY when they are not performed correctly. Since you asked for proof of medical negligence, here are 2: (1) inducing labor with medication and (2) not being prepared to do an emergency C-section quickly. From WebMD:
“The most serious risk of a VBAC is that a C-section scar could come open during labor. This is very rare, but when it does happen, it can be very serious for both the mother and the baby. The risk that a scar will tear open is very low during VBAC when you have just one low cesarean scar and your labor is not started with medicine. This risk is why VBAC is only offered by hospitals that can do a rapid emergency C-section.”
At the end of the day, the professional here is the doctor and if things do not go as planned, it is only professional for the doctor to accept part of the blame. Rashmi is only asking that the procedure be reviewed: if she had not been induced and an emergency C-section had been done in time, she would have her baby today, nost likely.
Choosing a VBAC DOES NOT mean that the hospital should not be prepared to do a C-section if needed. Citing statistics like 0.5 % as a defense is ridiculuous. The hospital was not prepared for an emergency C-section, period.
June 18, 2009 at 7:44 AM
//VBACs result in the death of the baby ONLY when they are not performed correctly. //
This exactly is my point of contention
VBACs result in the death of the baby EVEN when they are performed correctly.
VBACs result in the more percentage of death of the baby when they are performed correctly.
This is exactly what I am telling
Even when any procedure is performed perfectly, still there is a chance of complication. No procedure in medicine is 100 percent accurate.
Human Bodies are not made in factories.
Machines are made in factories.
Each and every human physiology is different
All machines are same
If you ask a calculator to add 2+3, all calculators will given only the same result
But when you give Paracetamol to everyone with 100 F fever, some may become normal in 5 minutes, some in 30 minutes, some in 1 hour. Some may become 99, some 98 etc
That is why you cannot equate machines and human body
VBACs result in the death of the baby EVEN when they are performed correctly.
//The risk that a scar will tear open is very low during VBAC when you have just one low cesarean scar and your labor is not started with medicine. //
Please note that the sentence is “very low ” and not “The risk that a scar will tear open is NIL during VBAC when you have just one low cesarean scar and your labor is not started with medicine.”
There is a difference between the two sentences
//At the end of the day, the professional here is the doctor and if things do not go as planned, it is only professional for the doctor to accept part of the blame.//
Absolutely ridiculous
This exactly is my part of the argument
If the things do not go because of the error on the part of the professional, the professional has to be blamed. This can be applied when the professional deals with machines, as the response of all machines are going to be the same
If the things to not go inspite of the fact that there is no mistake on the part of the professionals, it is absolute nonsense to blame the professional
I see no difference between your argument and the uncivilised, uncultured hooligan behaviour of the mob on the road who just thrash the fourwheeler driver inspite of the fact that the two wheeler driver is on fault
//Choosing a VBAC DOES NOT mean that the hospital should not be prepared to do a C-section if needed. Citing statistics like 0.5 % as a defense is ridiculuous. The hospital was not prepared for an emergency C-section, period.//
Did the hospital perform an emergency C Section or Not ??
Please clarify
James
//If you see unbiased, you will understand that more ppl are having a concern of how this could happen, particularly in a “premium” place, where you pay extra to get yourself out of such troubles as you expect them to do exceptional.//
If you see unbiased, since human bodies are not machines, THIS COULD HAPPEN in any place, even in premium place, even to kings and queens.
This exactly is my point of argument. Just because something has gone wrong, it is not correct to immediately blame the issue on the doctor as Human Physiology is different from Machine Response
You cannot put your blame on one side
// And the anger of these ppl comes in words against the hospital. I hope you can appreciate the sentiment behind the words and not hold on to just words and their literal meaning.//
I hope that you can also appreciate the simple fact that Rashmi’s baby could have died even if best treatment has been given and just because the baby died, it does not automatically mean medical negligence.
I am telling this for quite sometime, but no from your side is accepting this fact
Who is biased and who is unbiased
// If you think I have lost my sense of humor in your statements with smilies, then Bruno, your timing of humour couldnt have been more wrong.//
Did I tell it ??
//And Suman and Rashmi have started this conversation on the social medium because the hospital has not been responsive with their stonewalled comments.//
I don’t think so
// The most they are expecting is for the hospital to accept error of judgement and the various mismanagements and take future steps of correction.//
What if the hospital feels that there is no error of judgement. Just because a baby died, how do they come to conclusion. And how do you conclude that there was an error in judgement
What is the correction you are suggesting
Do you mean to say that Normal Deliveries have to be totally abandoned and only Caesars have to be done
Do you suggest that mothers hereafter should not be given the option of VBAC
WHat is the correction you are suggesting ??
// Of all, their most valuable contribution in this post is increasing awareness among ppl to ask more questions on this VBAC during their pregnancy.//
Is it ??
//Now coming to your contribution Bruno, you have very easily said that since you are not from Wockhardt, you cannot comment on the questions that Suman asked.//
What is wrong in this
//But you could have taken an idealist view and answered her questions, on what should have happened ideally given your education in this field.//
I have answered umpteen times.
1. Any complication can happen INSPITE of best medical care and just because a complication occurs, do not immediately blame it on the hospital
2. As per the 4 wheeler 2 wheeler analogy, now since the hospital appears to be the 4 wheeler (with no obvious damage) and Rashmi the two wheeler (with maximum damage) you guys are thrashing the 4 wheeler
// I am hoping you do that atleast now so that we non-medical ppl participating in this conversation can be educated through your views.//
Please read my postings. If you have doubts, you can ask me. But none has so far done any constructive argument. you are the first person to do so.
In fact, the aim of others have been to just slander and there is no interest seen to learn anything. It was the we know all attitude that that going on here till you asked this question
//Now coming to your comments knowing of “names of experts” and consulting them. I believe that even the most net savvy of us, go more by personal recommendation than just medical directories and internet for doctors leave alone medical advice. //
Exactly. But why use net for Slandering.
//How many percentage of ppl that you know go to a doctor after researching them on the net and how many go by word of mouth recommendations?//
How many percentage of people go to court and get proper remedy and how many percent of people use their leverage in net to slander an organisation and indirectly blackmail ??
Bruno: An emergency C-section that takes 40 minutes to deliver the baby is not, in my book, an “emergency section”. This should have taken less than 10 minutes, if the OT had been ready, which it was not This was “unprofessional” on the part of the hospital. The OT should have been absolutely ready when a VBAC is attempted. If the hospital is incapable of doing so, they should not offer the VBAC option.
I see that you did not address the issue of adminstering Syntocinon: something which is not recommended in a VBAC, especially since her labor had already started naturally. Who was the “professional” who prescribed this, and what was the reason? These are the questions that need to be answered “professionally” without trying to avoid the issue.
Also, please stop posting your ridiculous analogies repeatedly: they are absolutely irrelevant to the topic at hand. Let us debate the issues in a mature fashion, if you are capable of doing so.
June 18, 2009 at 10:17 PM
//I see that you did not address the issue of adminstering Syntocinon: something which is not recommended in a VBAC, especially since her labor had already started naturally. //
Please tell me the book which says that Oxytocin should not be given if labour has started naturally
Let us actually discuss this in a mature fashion
It is actually quite fun to see a person who does not have the guts to reveal his / her name asking for mature discussion
//Also, please stop posting your ridiculous analogies repeatedly: they are absolutely irrelevant to the topic at hand//
The analogies are actually very relevant to this discussion and that is why you are not ready to face them and explain against my points.
June 18, 2009 at 7:50 AM
//If the things do not go because of the error on the part of the professional, the professional has to be blamed.//
Also if the things do not go as per plan, because there was a “negligence” on the part of the hospital (example mismatched transfusion, giving wrong medicine, retained gauze or instruments in the abdomen) the hospital is to be blamed
But in this case, I see nothing of that sort
You can use sad, pathetic, heart rendering and other adjectives to describe the death of the baby. I fully support you. But I need evidence for the use of the word “negligence” here
As I have told umpteen times, just because the baby has died it does not automatically prove negligence, for reasons already mentioned many times above and for which there is no single reply regarding that
June 18, 2009 at 12:32 PM
A farmer is given 1000 seeds and he plants them
Inspite of the best care given by the farmer in accordance to the best practices, how many plants will finally bloom. Will it be 100 % Definitely not
Since seeds are not manufactured by a factory, but are instead a product of nature, One or two will never germinate. Of the seeds germinating, some will wither away
This is the law of nature
–
The same thing in medicine also
–
If untreated many will die
Even if treated properly, no doctor can assure you 100 % life, for the simple reasons that DOCTORS ARE NOT GOD
Got it
–
Open your minds and read. Then you will get this simple point.
Open Eyes with closed minds lead you to no where
–
//At the end of the day, the professional here is the doctor and if things do not go as planned, it is only professional for the doctor to accept part of the blame.//
Can you now understand why the above sentence is totally idiotic
And all arguments based on this stand is equally without merit
–
June 18, 2009 at 2:40 PM
Mr.Bruno,
The following 2 are your statements :
1. VBACs result in the death of the baby EVEN when they are performed correctly.
2. Do you suggest that mothers hereafter should not be given the option of VBAC ?
Now as a professional – these are the facts that you know.
Why would you then suggest the option of VBAC to any person ? Would it not be logical enough to just throw that procedure out of the window ?
June 18, 2009 at 3:21 PM
If I may take up some of your comment space to respond to “Angry Joe” –
Please don’t make this an issue of India vs the West.
There are a lot of wonderful doctors and hospitals in India too. Please don’t generalize and say all hospitals and doctors in India are “terrible”.
I had my first child in the US and the second one in India. All the facilities I had during my first delivery were available in the second one too…and no – I did not go to a corporate hospital here.
Its unfortunate that probably your interactions with the doctors here was not too good, but India too has its fair share of fantastics doctors !!
June 18, 2009 at 10:07 PM
//The following 2 are your statements :
1. VBACs result in the death of the baby EVEN when they are performed correctly.
2. Do you suggest that mothers hereafter should not be given the option of VBAC ?//
The first is my statement
Second is your statement
And now read your first line
–
I am amazed at the intelligent level of those commenting in this post against medical field
–
Why would you then suggest the option of VBAC to any person ? Would it not be logical enough to just throw that procedure out of the window ?
Yeah
Now your question makes sense
The alternatives to VBAC are
Alternative 1 : Caesarean Section
Alternative 2 : Not getting pregnant
Now taking Caesarean section, there is still a risk for the mother and fetus EVEN when the doctor has done his full part
So are you going to throw caesar procedure “out of window” and make sure that those women do not get pregnant again Definitely Not
–
I have already written very clearly at June 16, 2009 at 4:33 PM
Did you read it
Even Pregnancy is associated with complications. Don’t go to the extent and tell no mother will accept to be pregnant
A doctor can only DECREASE the risk associated with Pregnancy. A doctor cannot Totally NULLIFY the risk and bring it to zero
Only when GOD Becomes the Obstetrician will be all Pregnancy, VBAC, Caesarean Sections can be associated with zero risk.
Are you suggesting to throw Pregnancy out of the window
June 18, 2009 at 10:22 PM
Anony M,
Let us discuss point by point : Do you at least now accept that the following statement is wrong
//If the things do not go because of the error on the part of the professional, the professional has to be blamed.//
Expecting your comments in this
June 18, 2009 at 10:26 PM
Sorry for the previous typo :
Anony M,
Let us discuss point by point : Do you at least now accept that the following statement is wrong
//At the end of the day, the professional here is the doctor and if things do not go as planned, it is only professional for the doctor to accept part of the blame.//
Expecting your comments in this
My Stand : If the things do not go because of the error on the part of the professional, the professional has to be blamed.
June 18, 2009 at 11:14 PM
Dr. Bruno: Does it matter what my name is? Please address my comments, if you can. If you are indeed a medical doctor, your attitude is reprehensible.
Regarding the use of medication to induce labor for a VBAC, please go to this site: http://www.mayoclinic.com/health/vbac/VB99999/PAGE=VB00007This is a Mayo Clinic site and it clearly states:
“Labor-inducing drugs. Inducing labor with medication may increase the risk of uterine rupture. If your doctor decides that it’s best for your baby to be delivered before labor begins naturally, he or she will probably recommend a repeat C-section. ”
Again, why was medication prescribed, especially if labor had already started? There should be a good reason for this, and if there isn’t I would call it an error on the part of the doctor or hospital.
The only doctor who had seen her, Dr. Latha, was not present even ONCE during the whole ordeal. Did Dr. Prabha even know her medical history?
Also, it is clear from the Mayo Clinic website that the type of incision in the previous C-section is crucial to determining whether a VBAC will be successful or not. Did the doctor know what type of scar Rashmi had before deciding that VBAC would be a safe option for Rashmi?
A review of the entire incident will bring out answers to these, and other questions. Asking these questions, and expecting truthful answers is the right of every patient especially one who has lost a baby DUE TO NO FAULT OF HER OWN other than trusting her doctor’s judgement.
Sorry the link to the Mayo Clinic site shuold be:
http://www.mayoclinic.com/health/vbac/VB99999/PAGE=VB00007
June 18, 2009 at 11:19 PM
//Dr. Bruno: Does it matter what my name is?//
Of course. I have found cyber hooliganism high among anony posters. So I prefer a name.
Of course you have your right to remain anony :)
// Please address my comments, if you can.//
I have addressed all your comments
Also I explained in detail why your earlier comment made June 17, 2009 at 8:19 PM is wrong. You have not responded to it
Please respond whether at least now, after all these explanations, you do accept that your earlier statement that the doctor has to be blamed for each and every complication is wrong and unscientific
// If you are indeed a medical doctor, your attitude is reprehensible.//
What a great comment from an anony Ha Ha Ha
June 18, 2009 at 11:23 PM
//is a Mayo Clinic site and it clearly states://
Oops
I think I asked for a text book reference
//“Labor-inducing drugs. Inducing labor with medication may increase the risk of uterine rupture. If your doctor decides that it’s best for your baby to be delivered before labor begins naturally, he or she will probably recommend a repeat C-section. ”//
OK
Though I prefer a textbook reference, let us see your reference
Even in this please read what is given – Inducing labor
Now My Question
Was Rashmi’s labour induced by the hospital or did it start spontaneously or was the labour induced with Oxytocin
Please respond
June 18, 2009 at 11:28 PM
//A review of the entire incident will bring out answers to these, and other questions. //
I am ready for a review
But what I cannot tolerate is shifting the blame entirely on the hospital even before this review and Totally FOOLISH UNSCIENTIFIC Statements like this “At the end of the day, the professional here is the doctor and if things do not go as planned, it is only professional for the doctor to accept part of the blame.”
Hope you understand it
—
//Asking these questions, and expecting truthful answers is the right of every patient especially one who has lost a baby DUE TO NO FAULT OF HER OWN other than trusting her doctor’s judgement.//
Do The decision to undertake VBAC was taken the Rashmi. There is no twisting of these facts
June 18, 2009 at 11:34 PM
Anony M
I have proved conclusively that few of your statements are wrong
Wrong Statement 1 : “At the end of the day, the professional here is the doctor and if things do not go as planned, it is only professional for the doctor to accept part of the blame.”
Wrong Statement 2 : Oxytocin is not recommended especially since her labor had already started naturally.
If you answer my questions, one by one, everyone else can easily know that most of your statements are foolish, unscientific and figments of your own imagination
–
I think it is harmful for the society to let a cyber hooligan go on writing wrong facts about the Medical Field.
June 18, 2009 at 11:38 PM
After hearing all unscientific rubbish from an uncivilised-but net savvy, uncultured by english speaking rowdy who wrote wrong and fictious facts to defame a hospital, let us see some hard facts
–
The finding are based on eleven thousand cases
–
Obstet Gynecol 1991 Mar;77(3):465-70
Rosen MG, Dickinson JC, Westhoff CL
Department of Obstetrics and Gynecology, Sloane Hospital for Women, Presbyterian Hospital, New York, New York.
The authors looked at 31 studies giving a total of 11,417 attempts at VBAC. They found that:
* Maternal febrile morbidity (fevers) was significantly lower after a trial of labor than after an elective repeat cesarean
* The intended birth route made no difference in the rates of uterine dehiscence or rupture. This means that the rate of uterine ruptures found in mothers attempting VBAC was no different to that for mothers undergoing elective repeat caesareans.
* The use of oxytocin was not associated with an increased risk of either rupture or dehiscence.
* The presence of a recurrent indication for the previous cesarean was not associated with an increased risk of either rupture or dehiscence. This suggests that a mother whose first c/s was for suspected cephalopelvic disproportion (ie baby might be too big to come through the pelvis), was not at any extra risk even if her next baby appeared big too.
* The presence of an unknown uterine scar was unassociated with dehiscence or rupture. Thus it appeared to make no difference if doctors did not know whether the mother had a classical scar or a low transverse scar.
After excluding babies dead before labour started, those with deformities incompatible with life, and babies of extremely low birthweight, there was no difference in perinatal death rates between babies born after VBAC attempts and those born after elective repeat caesareans.
More babies had low 5-minute Apgar scores (6 or lower) after VBAC attempts, but the researchers were unable to exclude very low birth weight fetuses or those with congenital anomalies from this analysis.
The authors conclude: “Our findings argue for trials of labor for more women after a cesarean birth.”
June 18, 2009 at 11:38 PM
To Bruno:
From Wockhardt’s response:
“Ms Rashmi B.T was admitted to the hospital early morning on the 4th of March 2009 in spontaneous labour. ”
From Rashmi’s account:
“By 7.45 am, I was experiencing contractions less than a minute apart. ”
Labor had started already: so why was Oxytocin prescribed since it is clearly contraindicated in a VBAC?
It is clear to me that you have no interest in debating the facts, choosing instead to stew in your own rhetoric. This is my last reply to you.
By the way, Mayo Clinic is one of the best medical research institutions in the world and has way more up-to-date, relevant information than old “textbooks” that you might prefer refering to. Goobye to you.
I hope from the bottom of my heart that Rashmi has the courage to pursue this and expose the faulty and negligent care she received. I wish her all the best.
June 18, 2009 at 11:40 PM
Ok
Evidence 2
J Midwifery Womens Health. 2003;48(4) © 2003 Elsevier Science, Inc.
Risk of Uterine Rupture in Elective Repeat Cesarean Birth Versus VBAC-TOL
Author Type of Study N Uterine Rupture Rate (%)
Repeat C/S VBAC-TOL*
Gregory et al., 1999[26] Retrospective cohort 66,856 0.28 0.53
Rageth et al., 1999[10] Retrospective cohort 29,046 0.19 0.4
Lydon-Rochelle, 2001[12] Retrospective cohort 17,769 0.16 0.6
So
Whether there is VBAC or Repeat LSCS, there is still a possibility of Uterine Rupture
Hope you understand this
June 18, 2009 at 11:45 PM
//Labor had started already: so why was Oxytocin prescribed since it is clearly contraindicated in a VBAC?//
Dear Anony M
You have NOT yet shown that Oxytocin is contraindicated in VBAC
What you have shown is an unscientific patient education pamphlet that says that “Inducing labor with medication may increase the risk of uterine rupture.”
–
Now that Rashmi’s labour started spontaneously, your argument that her labour was induced has been proved to be wrong and foolish
This is your third substantial mistake in this post (I am not counting your minor mistakes)
–
Having clearly told that Rashmi’s labour was spontaneous, what is the use of your pamphlet reference about Induction
By the way, don’t you feel any shame for cheating the viewers with wrong and unrelated facts
Please address the issues here, if you can. I don’t know what profession you are, but with this much of misinformation and utter disregard to basic decency, unless your profession is ___________ , your attitude is reprehensible.
June 18, 2009 at 11:50 PM
//It is clear to me that you have no interest in debating the facts, choosing instead to stew in your own rhetoric.//
I have given evidence for my points
// This is my last reply to you.//
Of course having exposed your mistakes and taken your arguments apart, you have no way other than to retreat
//By the way, Mayo Clinic is one of the best medical research institutions in the world and has way more up-to-date, relevant information than old “textbooks” that you might prefer refering to. Goobye to you.//
Agreed about Mayo
But remember two facts
1. It is a patient pamphlet and not scientific paper
Even in that, the reference was for Induction of Labour. In Rashmi’s case labour was not at all induced. So your reference is totally useless
//I hope from the bottom of my heart that Rashmi has the courage to pursue this and expose the faulty and negligent care she received. I wish her all the best//
Only if she has received faulty and negligent care, she can expose
–
Other wise SHE WILL BE EXPOSED, exactly in the same way you were exposed by giving evidence about Induction from Mayo Pamphlet when in this case there was no induction at all
Shameful and Disgusting way to argue. Full of wrong facts or twisted facts or imaginary facts or irrelevant factss
And with such foolish logic you call others by name. Only one profession is fit for you
// This is my last reply to you.//
Good Bye. Go to your profession
June 18, 2009 at 11:59 PM
//so why was Oxytocin prescribed since it is clearly contraindicated in a VBAC?//
There is NO CONTRAINDICATION to Oxytocin in VBAC
All the studies in indexed journals only recommend “caution”, “Prudence” while using Oxytocin in VBAC and oxytocin augmentation is not contraindicated in VBAC as per the present scientific evidence
This is your mistake 4 (If we read again, all the main points on which you attempted your smear campaign stand exposed. )
Anony M
You don’t tell you name. OK
Why can’t you speak at least with a little sense instead of blabbering rubbish
So sad and pathetic
June 19, 2009 at 10:46 AM
Mr.Bruno,
It would be good if you can keep the discussions cordial and not be rude.
Infact I am amazed at your choice of words. Assuming you are a doctor and you interact daily with patients – how many people come back to you if you are so rude – as to question their intelligence when they ask you questions on topics that are supposed to be better knowledgeable than them.
All I am saying is if the probability of risk involved while performing a c-section is lesser than that of a VBAC – they why not always do that instead of VBAC.
Ofcourse – as you say “not getting pregnant” is the safest of the 3 options – but thankfully we don’t need the Dr’s advice on that decision.
June 19, 2009 at 1:35 PM
Bruno,
Well yes you have been saying what you are saying for quite sometime, but there are questions been asked by Suman and Rashmi, what about answering them. They arent getting answers from Wockhardt as well, other than just brushing it aside.
The discussion is not only of the VBAC procedure, but also in this case with the situations surrounding it. I agree that VBAC could go wrong on Kings and Queens as well. But the question here also is about what all did Wockhardt do or rather in this case did not do when the complications arosse.
There are some repeated questions on why the OT was not ready and why it took 40 odd minutes for the c section to happen? Any comments on this specifically, without drifting to any other topic/analogy?
So you say medical negligence is only when some gauge is left inside or wrong blood is transfused etc. What about hospitals basic equipments for labour not working, a nurse not knowing what medication for a patient and needs to be reminded to give medication, a doctor not keeping ready a OT at stand by when VBAC is being done. Which category do they fall under?
You have asked me for what correction I am suggesting..well I am not a doc, but I would still try to do the basic glaring mistakes that happened,like a doctor being available in OT along with a nurse at all time and no OPD for them during the time. An fully ready OT available everytime a VBAC is scheduled. Changing the procedure of visually guess weighing the babies and recording false bpm etc. to start with.
Well I see a lot of constructive argument here, that you dont..but am glad that you see mine as one. So I hope you answer my specific quesions. I completely buy your point that complications occur. But the question is how did this hospital and their staff respond to it. (I am mentioning “hospital” because the patient is complaining of basic infrastructure issues, which I cannot make the medical practitioner own the responsibility.). So we are here asking on why such lapses happened in a complication and is there a way to avoid them in future when a similar complication arises.
And we believe it is a lapse because from Suman’s and Rashmi’s account they have stated their opinion after checking with multiple doctors. And yes in the process of asking questions, there are fingers being pointed at Wockhardt, because we are directing the questions to them and this is not slandering. It is just a bunch of questions pointed at the hospital.
Now referring to
“//How many percentage of ppl that you know go to a doctor after researching them on the net and how many go by word of mouth recommendations?//
How many percentage of people go to court and get proper remedy and how many percent of people use their leverage in net to slander an organisation and indirectly blackmail ??”
Lets get to basic, when a question is asked to you, please dont respond back with another question. You respond back with an answer (be it your response or asking for clarification or saying you cannot answer etc.) and then augement that point with argument or asking a question back. So now please answer my question first in this regard.
Well regarding the smilies and sense of humour, I just tried to point out that in a serious discussion like this, I find it rather unnerving. I guess it more of a personal preference, and rather bear with it, than diluting the discussion with it.
Also when the analogy is deemed irrelevant by most, for reasons explained by many including me, try giving a better one or at best stop giving them again and again, its like a broken record playing, does not enrich the discussion. Just to be clear again, your analogy is irrelevant because we are here not to beat up 4 wheeler (Wockhardt) but asking them questions on things that we seem to have lapsed and could be done to avoid it.
Dude,revealing an identity does not matter, their questions matter and opinions matter. BTW you yourself have a author name in Tamizh which most of the commentors here dont understand, and you yourself could be as good as Anony M. I would also have been an Anony M, but coz I know you, just thought would let you know.
And since you are a doc and have access to textbook, you are asking for a text book reference. But we have access to Medical sites and hence we are pointing to a few respected ones. Now you being a doctor, we would appreciate if you can clarify what is wrong with the site and why by referencing to textbooks. And this you have been doing well, but dont belittle the effort the commentators here are making.
And Bruno, since I know you I am taking the liberty to advice you and this is not because I am on the other side of the argument here. Bruno, honestly speaking you are being very rude here and your choice of words lets you down most of the time in the argument. You need to check on these both, particularly since you are a doctor. You can be angry with comments made here, but those need to be channelized to arguments sans abuses to people.
June 19, 2009 at 2:12 PM
//Well yes you have been saying what you are saying for quite sometime, but there are questions been asked by Suman and Rashmi, what about answering them. They arent getting answers from Wockhardt as well, other than just brushing it aside.//
Dear Mr.James,
I cannot answer questions on behalf of any hospital
But I can point out foolish and blatantly unscientific statements being made in the public domain
I have already pointed out those
Instead of having conclusively proven that many statements made by the smear campaigners are wrong, it is very astonishing to find that the rumour mongers, without acknowledging their falsehoods just disappear and then another anony appears to continue the cyber hooliganism
//There are some repeated questions on why the OT was not ready and why it took 40 odd minutes for the c section to happen? Any comments on this specifically, without drifting to any other topic/analogy?//
As far as I see the Caesarean section has been done
//So you say medical negligence is only when some gauge is left inside or wrong blood is transfused etc. //
It is also when something that needs to be done is not done
For example if A C Section had not been done after VBAC, it is medical negligence
Or if it had been done after 5 hours, it is negligence
But here it has been done immediately
//What about hospitals basic equipments for labour not working, a nurse not knowing what medication for a patient and needs to be reminded to give medication, a doctor not keeping ready a OT at stand by when VBAC is being done. Which category do they fall under?//
No proof for this except the statements of few anony’s
If this had been indeed true, then this is wrong
You have only Rashmi’s and few anony’s words for these
And based on the reliability (or rather lack of) their other statements, I am not ready to believe their allegations
//So we are here asking on why such lapses happened in a complication and is there a way to avoid them in future when a similar complication arises.//
This is the right way to discuss
But why insert falsehoods like “Oxytocin is contraindicated in VBAC” and mislead the readers under anony IDs
June 19, 2009 at 2:16 PM
//And we believe it is a lapse because from Suman’s and Rashmi’s account they have stated their opinion after checking with multiple doctors. And yes in the process of asking questions, there are fingers being pointed at Wockhardt, because we are directing the questions to them and this is not slandering. It is just a bunch of questions pointed at the hospital.//
I am sorry
The following facts are not bunch of questions
They are plain lies and need to be condemned vehemently. It is surprising that you are not condemning such false hoods
FALSE STATEMENT 1 : the professional here is the doctor and if things do not go as planned, it is only professional for the doctor to accept part of the blame.
Wrong Statement 2 : Oxytocin is not recommended especially since her labor had already started naturally.
Wrong Statement 3 : so why was Oxytocin prescribed since it is clearly contraindicated in a VBAC?
Dear Mr. James. Why don’t you first give your remarks about writing twisting facts in this argument
You seem to only criticise me, someone arguing from the other side, while you are not telling anything about those liars from your side of the argument
June 19, 2009 at 2:17 PM
//Lets get to basic, when a question is asked to you, please dont respond back with another question. You respond back with an answer (be it your response or asking for clarification or saying you cannot answer etc.) and then augement that point with argument or asking a question back. So now please answer my question first in this regard.//
If you answer my question, you will get the answer for your question
It is so simple
By asking another question, I am trying to not only answer your question, but also substantiate the answer.
June 19, 2009 at 2:18 PM
//Just to be clear again, your analogy is irrelevant because we are here not to beat up 4 wheeler (Wockhardt) but asking them questions on things that we seem to have lapsed and could be done to avoid it.//
You have already beaten the four wheeler. !!!
And now only asking the questions
That is why I asked that question
You may not accept the analogy immediately because, it shows that you guys (with the exception of few like you) behaved like street rowdies and hooligans
Truth is of course bitter sir
June 19, 2009 at 2:20 PM
//. BTW you yourself have a author name in Tamizh which most of the commentors here dont understand, and you yourself could be as good as Anony M.//
Not at all. False comparision
If you click the link, it takes you to my site where my full contact details are given
I strongly oppose comparing someone who has given full contact details with some one who has not given anything other than the name
Wrong Comparison
YOU ARE WRONG. Correct yourself
June 19, 2009 at 2:23 PM
//And since you are a doc and have access to textbook, you are asking for a text book reference. But we have access to Medical sites and hence we are pointing to a few respected ones//
Yes…
You can point to a medical site. But a scientific data is different from Patient Pamphlet
I understand that you do not have medical books. So I accepted that site Please read my points clearly
–
But In that case, even that pamphlet was irrelevant. I have explained in detail how that anony cyber hooligan tried to take everyone for a ride with that twisted data
–
// Now you being a doctor, we would appreciate if you can clarify what is wrong with the site and why by referencing to textbooks. And this you have been doing well, but dont belittle the effort the commentators here are making.//
Nothing is wrong with that except for the fact that that pamphlet was irrelevant. I have explained in detail how that anony cyber hooligan tried to take everyone for a ride with that twisted data
June 19, 2009 at 2:25 PM
// Bruno, honestly speaking you are being very rude here and your choice of words lets you down most of the time in the argument. //
Good
Can you find as to who first used these words
mercenary service providers.
shitless
reprehensible
And may I know why you find my words are rude while you don’t care to advise the anony cyberhooligan
Strange !!!
June 19, 2009 at 2:26 PM
//It would be good if you can keep the discussions cordial and not be rude.//
Why are you telling this only to me and not the the rowdy who used words like mercenary service providers, shitless
Strange !!!!
Biased !!!
June 19, 2009 at 2:32 PM
//Infact I am amazed at your choice of words//
What words I use are determined by the choice of words of the person who talks to me
So simple
For a child, I talk in his language
For a cybersavvy mentally deranged person, I talk in her language
//Assuming you are a doctor and you interact daily with patients //
You are right
//how many people come back to you if you are so rude//
Who told you that I am rude with my patients.
// – as to question their intelligence when they ask you questions on topics that are supposed to be better knowledgeable than them.//
If they ask me questions, I patiently explain to them as it is their right to know about their disease and it is my duty to explain to them
But here questions were not at all asked
FALSEHOODS were spread by an anony person with an aim of misleading persons
I tried to explain politely at first, But have to meet words like mercenary service providers, shitless, reprehensible
That showed me that I am dealing with a third grade person. I have to reply in their language only
–
I have responded to your query at June 18, 2009 at 10:07 PM
Please read and if you feel that there are any rude words in my reply to you
June 19, 2009 at 2:36 PM
//All I am saying is if the probability of risk involved while performing a c-section is lesser than that of a VBAC – they why not always do that instead of VBAC.//
It is because of the fact that Caesarean is associated to many other maternal complications
VBAC – More Risk for the baby, less risk for the mother
Caesarean – More Risk for the mother, less risk for the baby
And this is just a generalisation
The decision decides on the patient and the doctor
//All I am saying is if the probability of risk involved while performing a c-section is lesser than that of a VBAC – they why not always do that instead of VBAC.//
Few doctors always do Repeat Caesarean instead of even trying VBAC – and end up getting a name that “this doctor does Caesar for making more money”
Now tell me honestly : – Have not you heard at least one obstetrician being criticized for not letting normal deliveries, but “cutting up every mother” for “sake of quick money”
I hope that now you understand the issue in totality
–
June 19, 2009 at 2:44 PM
// Biased !!!//
Wrong.
I had asked you to be polite in the conversation when you got rude with “me”. I had asked you a question politely and I expected a similar answer.
I cannot police everyone here (esp since this is not my blog). You could have been rude to someone else for all I care. But if you use such language with me, I will object to it.
June 19, 2009 at 2:44 PM
Ok Mr.James
Let me ask you straight questions
Please answer
1. Do you accept the fact that a patient may still die in spite of best medical treatment
2. Do you accept that just because a patient is dead it does not automatically mean Medical negligence
3. Do you accept the fact that Rashmi’s labour was not induced, but occured spontaneously
4. Do you accept that Oxytocin in Not Contraindicated in VBAC
5. Do you accept the fact that a C Section was done within 30 minutes of fetal bradycardia (1:50 PM 2:20 PM)
Can you please reply to this specific queries
June 19, 2009 at 2:46 PM
//I had asked you to be polite in the conversation when you got rude with “me”.//
Which comment at you by me do you think is rude
Can you specify it
I have made only one comment with you and that was at June 18, 2009 at 10:07 PM
What word or sentence in that comment do you find as rude
June 19, 2009 at 2:53 PM
// I am amazed at the intelligent level of those commenting in this post against medical field //
I found this line offensive. You probably could be an expert in your field, but statements such as these where you just ridicule the other person are uncalled for.
June 19, 2009 at 2:55 PM
//
// I am amazed at the intelligent level of those commenting in this post against medical field //
I found this line offensive. You probably could be an expert in your field, but statements such as these where you just ridicule the other person are uncalled for.
//
OK
You have a point. Point Taken
Sorry for that statement
June 19, 2009 at 2:56 PM
OK Aruna ji
Let me ask you straight questions
Please answer
1. Do you accept the fact that a patient may still die in spite of best medical treatment
2. Do you accept that just because a patient is dead it does not automatically mean Medical negligence
3. Do you accept the fact that Rashmi’s labour was not induced, but occured spontaneously
4. Do you accept that Oxytocin in Not Contraindicated in VBAC
5. Do you accept the fact that a C Section was done within 30 minutes of fetal bradycardia (1:50 PM 2:20 PM)
Can you please reply to this specific queries
Reply
–
June 19, 2009 at 3:11 PM
#1. Yes
#2. Yes.
#3. It was not induced but as per her statements she was given “Syntocinon” to enhance labour.
// At 10am, I was given Syntocinon, a drug used to enhance labor; the dosage was increased at 10.45am. //
Now, as a non-medical professional I am not sure if and how this can cause complications in a VBAC.
#4. I will refrain from commenting on this since I am not qualified to do so.
#5. I cannot comment on the exact time duration.
But the following statements made by Rashmi – gives the picture that the baby was deprived of oxygen for over 40 min.
// Dr. Latha finally visited me at 7.30 pm. She confessed that she was unaware that there had been a 43 minute delay in performing my C-section. //
// At 9.30 pm the neo-natologist told Vivek that the baby had been deprived of oxygen for over 40 minutes, possibly resulting in “some extent” of brain damage. //
Now you can contest that Rashmi’s statements alone cannot be considered as the truth. In which case, I cannot argue back.
Finally, I am not blindly mud-slinging the hospital or the doctor. All I would hope to see happen in this case is a review/investigation by a neutral third party doctors/medical professionals (that both parties agree upon).
Not only will that be a closure for Rashmi, but it would also either clear the hospital (if they have indeed done all that was to be done in this case) or be a learning for so many others.
June 19, 2009 at 3:54 PM
i cannot but amaze why so many of our concerned citizens conscience have been stirred up by a case of medical complication and not a necessary medical negligence
I wonder how many of them really have the balls to complain and blog about instances of women from slums have not been even treated by the so called private hospitals or hundreds of pregnancy cases botched up by interns in the name of experimentation. I know of a case when my friend lost his life becoz he was denied admission until he paid the amount.
Instead of fighting for the actual issues . Our facebook and b
bloggers find it oh so much uplifting for an issue which is has a medical history to it which 95% of the people dont have a clue on and yet feels they are doing something uplifting..
Oh my liberated souls .. if you only had a fraction of energy for genuine medical negligence cases ,or denial of medical facilties or a crumbling medical infrastructure ..
But no our liberated bloggers of India prefers to raise issues which ought to be fought in court.. rather than commenting pasionately over something which they have no clue on
June 19, 2009 at 5:46 PM
//. I could also go on to ask a question as a answer to your question which might be irrelevant to this discussion, or which might seem irrelevant to you.//
Try it !!
Let us see
June 19, 2009 at 9:49 PM
Well, I too would love to play such games, but this is not the forum. You know my email, let us play questions-questions over there. Mail me. This forum has a purpose for discussion, lets not undermine it.
June 19, 2009 at 5:47 PM
//it is a phrase of talk and not a abuse. //
Wow Thanks I understand
June 20, 2009 at 12:34 PM
I have been closely following the entire episode of Rashmi and people speaking for and against the doctors.
I would like to add on that i have undergone 3 deliveries under the care of Dr.Latha Venkatram, i find her highly professional and very much for following the protocols of international standard and also a wonderful person who works for the welfare of the patients.
I would also like to add that i do sympathize with Rashmi, as i have also gone through what she is going through.
I lost my first child inspite of having a C-section and a timely one too and that too with Dr.Latha.
The only difference is that i trusted her judgement and i have had two other normal deliveries later and both my children are normal with no problems.
She is not the one who takes a decision without explaining to the patient, and when i choose to opt for a normal delivery after the first mishap with the C-section I was explained all the pros and cons that follow the normal delivery after a C-section, including the statistical quotes from international protocols, The choice was finally left to me to and there was no pressure of any sort from the doctors side.
After i lost my first child i went through the same phase of depression which i think Rashmi is also going through, but i had Dr.Lathas full support which helped me to overcome the grief and also gave me the courage to go through another pregnancy and also have a normal delivery.
Dr.Latha is a person who has the courage to accept her faults if there were any and also to stand by her patients in case of any calamity.
I have seen her send her relatives to donate blood when there was a PPH following a delivery for her patient who was not even related.
Infact I also know that she was with Mrs.Rashmi, counselling her time and again and even when the baby was taken out of ventilator, she was by her side to support her morally when it was not required of her to be present.
I also read that Mrs.Rashmi’s statement that Dr.Latha will do the same thing with the next patient.It is just misinterpretation, I presume that she would have told that she would quote the same protocol to the next patient too when she comes.
I think that if Mrs.Rashmi was so sure that the entire thing is due to negligence and she had ample proof of the negligence she would be in the lawyers office instead of trying to create a sympathy wave by writing all these in the blog.
My sympathies are also with her, i only hope she would go back to Dr.Latha sit and discuss what went wrong and what should be done to prevent it in future instead of mud slinging and also hope that her friends and family will stop talking about the same thing time and again and push her to depression. It would do her a lot of good if she can leave this episode behind her and carry on with her life so that her first son gets her attention and she can always embark on a pregnancy again.
Nobody is god here to always give 100% positive result and it will help if we can surrender to destiny, and accept that just as there is life there is death too. I know that this attitude will help as i have experienced it personally that too with my first pregnancy loss when i was not even sure that i will be able to concieve again.
So Mrs. Rashmi buck up and stop this mud slinging and get along with life.
June 26, 2009 at 1:10 PM
I feel this is some form of a corporate warfare. Afterall, this sort of mudslinging is well known among marketing people. Sadly, patients who depend on blogs to chose hospitals and doctors are taken for a ride. It is probably better to trust mummy and go to our ‘family Gynecologist’ like good old days.
July 10, 2009 at 3:53 PM
I actually stumbled on this blog when trying to research on the hospital offering the best Obs and Gyn services in Bangalore. I couldn’t help but comment on the comments that have been made in this blog. And it looks as if the comments have been made in a state of heightened emotions. The commentators have taken side either with the affected party on one extreme or with the accused party on the other extreme. We have put ourselves in the shoes of the concerned parties and tried to argue from their position and have refused to listen or possibly understand what the other person is trying to say. First as a member of general public I would like to appeal everyone else to stop considering doctors as gods as neither have they asked us to do nor it is prudent on our part to treat them as one. It is when we start treating them as gods that our expectations rise to a level where even a minor deviation from that point leads to intolerable emotional outbreak.
This whole episode of heightened awareness and informed consent on the part of the people seeking hospital services is good for the society but we should be careful in that we don’t push it to a point where doctors become over cautious in their approach to a case. When they become over cautious and get ready to counter all our questions with proof, we have to be ready to pay for the extra and unnecessary tests they order which might have required only in an exceptional situation. Well coming to the questions that can be posed to the doctor; there could be no limit to the number of the questions that we can pose to them on the condition that we are suffering. Literally we could dig up hundreds of websites and bring print outs and put it in on his desk and ask him to explain each one of it. Somewhere there has to be an optimum point at which we are convinced that the doctor can handle our case on one side and another where the doctor feels that the patient is asking questions out of ignorance and not using this as a platform to test his competency.
I would like to refer to one of the comments where someone had wondered as to whether there would be any repeat patients entering Dr. Bruno’s clinic. Cheer up guys… if he is not a person concerned about his patients not returning back to him…he must be someone who cares little about profitability. One thing that we all must agree to is that any field has its own set of rules, complexities and intricacies that as an outsider would not be possible for us know. And just by visiting a couple of websites and quoting a couple of references don’t make us fit to judge on this issue. If learning something was just that easy, then one could refer to the whole lot medicine websites and treat themselves or their families.
Every issue in any field for that matter has to be looked from a holistic view. Unless you are an expert know all the details, you cannot judge on a complex issue. For that matter even the experts have known to differ and that is the reason why panels exist instead of individual experts. And given the unpredictable nature of medicine, there could be more ‘ifs’ and ‘buts’ when compared to a technological or mechanical issue.
And reputation of the institution does matter. It has taken them years to be build on it and they have all the rights to protect it too. Another issue that has bothered me is the comparison of Indian hospitals with their counterparts in the west. This comparison lacks a holistic view and is one-sided.
At this point I would like to draw attention to the fact that Indian doctors are not formally trained in communication skills. This is a drawback and is the root cause of all misinterpretations and miscommunications. And a doctor has to be taught to don two caps at the same time; one emotional and another logical.
Last but not the least the hospitals shouldn’t be projecting themselves of achieving unrealistic results which raises the patient’s expectations to very high levels. Unless we are an expert on the subject matter, we should at least stop maligning someone’s reputation.
Leave a Reply
Recent Comments
 | vijayashankar on Sani Dasa and it effects for 1… |
 | alok shrivastava on Sani Dasa and it effects for 1… |
 | TamilSelvan on BEWARE OF LIFELINE HOSPITAL… |
 | Gitanjali on All about Wockhardt, Bannergha… |
 | unikkat sasi kumar on Sani Dasa and it effects for 1… |
June 15, 2009 at 12:22 AM
oh i KNEW this comment could only come from a doctor. I have already responded to the comment on Mad momma’s blog, but here is a post i was planning to do. My favorite part of this response is:
“Is medicine now going to be judged through the lens of only opinions running across chain mails or through the untiring efforts of institutions and doctors which toil endlessly to save lives but remain spectators to their actions being judged by emotive outbursts?”
My dears.. the sooner you get off that high horse, the better it will be. No one sees doctors as Gods any more. They are just mercenary service providers. Their current fees and attitude towards patients who cannot pay, makes their approach to “toil” rather obvious.
We stick to Rashmi’s version. We believe her. The response has more holes than one. Try and plug those holes when you come back again, IF you come back again.
What has made Wockhardt respond even now, is not any attempt to apologise to Rashmi, but an attempt to save their own “reputation”.