EDITORIAL BOARD ASSOCIATION OF MEDICAL · PDF fileDr. Pai Hrishikesh Dr. Parikh Hitesh Dr. Patel Manoj Dr. Pattiwar Sanjay Dr. Ruke Milind Dr. Shah Jayesh Dr. Sharma Smita Dr. Shenoy

Vol.39 Issue No.3, Nov 2010

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EDITORIAL BOARD EDITOR

Dr. Mukesh Gupta

CO-EDITORSDr. Pradeep BaligaDr. Manoj Gandhi

Advisory BoardDr. Lalit M. Kapoor

Dr. Arshad Gulam Moh’d.Dr. Sujata Rao

BOARD OF TRUSTEESManaging TrusteeDr. Lalit M. Kapoor

TrusteesDr. S. S. Rao

Dr. S. N. AgarwalDr. Anil SuchakDr. Dilip S. NaikDr. Bipin V. ShahDr. Bipin Pandit

WEBSITEwww.amcmumbai.com

WEB EDITORSDr. Arshad Gulam Moh’d.

Dr. Sujata RaoDr. Veena Pandit

DISCLAIMERUnless otherwise stated, the opinions expressed by the writers are their personal opinions. The AMC reserves the right to use material published in ‘The Grasp’ for its Website or for any other purpose deemed necessary.

The appearance of advertisement in ‘The Grasp’ is not guarantee or endorsement of the product or the claims made by the manufacturer / advertiser.

ASSOCIATION OF MEDICAL CONSULTANTS, MUMBAI4, Ganpati Niwas, Old Police Lines, Opp. Andheri Station,

Andheri (East), Mumbai - 400 069.Tel.: 2684 4639 / 2683 6019 (10 a.m. to 6 p.m.)

Telefax : 2682 1109E-mail : [email protected]

MANAGING COMMITTEE (2010 - 2011)President Dr. Walavalkar RajeevPresident Elect Dr. Agarwal NiranjanImm. Past President Dr. Kate SuhasVice President Dr. Rao SujataVice President Dr. Hariani Ajay R.Hon.Secretary Dr. Naik SudhirHon.Treasurer Dr. Kulkarni Gurudas B.Hon. Jt. Treasurer Dr. Das DebashishHon. Jt. Secretary Dr. Pandit VeenaHon. Jt. Secretary Dr. Pikale Sangeeta Prog. Committee Chairperson Dr. Adyanthaya Kishore Office Secretary Dr. Rao Nitin Editor Grasp Dr. Gupta Mukesh

ZONAL DIRECTORSDr. Badwe Shrikant Dr. Dave RajeshDr. Khambay S.S. Dr. Nayak Achyut Dr. Oza Umesh Dr. Parikh Ketan

COMMITTEE MEMBERSDr. Bahekar Pramod Dr. Balasubramaniam Ramnarayan. Dr. Bal Inamdar Dr. Baliga PradeepDr. Borges Eric Dr. Chawan RajendraDr. Checker Vipin Dr. Desai AjitDr. Gandhi Manoj Dr. Hegde DineshDr. Pai Hrishikesh Dr. Parikh HiteshDr. Patel Manoj Dr. Pattiwar SanjayDr. Ruke Milind Dr. Shah Jayesh Dr. Sharma Smita Dr. Shenoy GopinathDr. Sheth Rajen Dr. Shukla AshokkumarDr. Vazzifdar Khurshed Dr. Wankhade RajendraDr. Worlikar Umesh

CHAIRPERSON OF CELLSEnvironmental Protection Cell Dr. Rao P. N.Consultants Benevolent Scheme Dr. Shah Bipin V.EMS Cell Dr. Pandit BipinH & A Dr. Rao Suresh S.Hon. Doctors Welfare Cell Dr. Desai AjitInfrastructure Cell Dr. Parihar AnandMedical Council Reforms Cell Dr. Arshad Gulam Moh’dMedicolegal Cell Dr. Datar NikhilNursing Home Cell Dr. Sheth SudhaTPA Cell Dr. Badwe Shrikant

Edited by : Dr. MUKESH GUPTACo-ordinated at JAI GRAPHICS, Kandivali (East), Mumbai - 400 101

Telefax : 2885 1832 • E-mail : [email protected] Association of Medical Consultants, Mumbai. (For Private Circulation Only)

Vol.39 Issue No.3, Nov 2010Vol.39 Issue No.2, Aug 2010

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A General Physician was busy attending a case of acute MI in an ICCU in the suburbs. In the middle of this, he

received a call on his mobile phone from a Gynec nursing home in which he was one of the visiting Physicians. The nurse on the other end of the line was frantic and reported that there was a case of a 30-year old male who had come with acute chest pain and could he please come immediately to see the patient. Of course, the Physician expressed his inability to see the patient since he was busy with an emergency. The nurse, however, persisted and requested him to come as soon as possible as the gynecologist owner of the nursing home was not contactable though she was expected shortly. The other Physicians were either not reachable or busy elsewhere. The Physician explained that it would be quite a while before he could reach the nursing home and asked the nurse to contact again some other Physician. The nurse agreed to this but asked what she could give the patient meanwhile. The Physician advised her to give the patient Inj. Fortwyn 1 ml. by the intramuscular route. He then continued attending the emergency on hand.

An hour or so later, the Gynecologist called him up to inform that the patient had expired a little while after the suggested injection had been administered. It transpired that thereafter a large mob of

relatives and friends of the deceased patient had gathered and become unruly. They made several allegations including doctor not being available and wrong injection having been given. The Gynecologist called the Police who controlled the mob and, of course, the body was sent for PM.

The following day, the Physician was horrified to receive a call from the PM Doctor ostensibly to get information about the case but at the same time to enquire as to how the physician had advised on phone some injection to be given to a patient whom he had not even examined. He said this was a serious matter that amounted to medical negligence and further enquiry in the matter was necessary.

Following this , the police called the Physician for recording his statement in which he said he had advised the injection to be given for symptomatic relief since no other doctor was available. Several questions were posed to him and he had to give a number of explanations. It was quite a harrowing experience. Other issues subsequently diverted the focus of attention, and with appropriate advice, the physician managed to disengage himself from the case.

The physician had not imagined in a long shot that an innocuous advice on phone could lead to so much harassment. He

DO’S AND DON’Ts TELEPHONE CONSULTATIONS – BEWARE!Dr. Lalit Kapoor


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knows better now and is a wiser man.

A lot many consultants will identify themselves with this physician and find the situation where advice is asked on the phone familiar. Most of them would have acted similarly.

What then is the right thing to do? Should one refuse all advice on phone? Should one give advice in selected cases or situations? What are the various implications of telephone advice?

The fact of the matter is that we do not have definite answers to any of these questions for the simple reason that these have, to the best of my knowledge, hardly ever been put to a judicial test in our country. The above case should provide us food for thought and stimulate us to seek guidelines, perhaps from MCI.

Undoubtedly, in the times ahead, with the increasing litigation-mania and the Americanisation of our medico-legal system, such issues are more likely to surface and we need to crystallize our concepts. This gains more importance in light of emergence of telemedicine / teleconsultations / distance treatment and so on.

Going back to the above case, hindsight (which is always 6 / 6) would have dictated that the physician should have insisted on some doctor seeing the patient and report to him before he could give any advice. In other words, it is my opinion that had a doctor, say an RMO or the Gynecologist-owner of the nursing home, asked for advice after examining the patient; the situation might have been more comfortable.

What about a patient trying to consult a doctor on phone? Most of you might

have noticed that there is an increasing tendency on the part of patients to consult doctors on phone, especially so after the era of mobile phones. This leads us to other questions: Should you give your cell number to all your patients, some of your patients or none of your patients. I have noticed that some consultants are more than willing to give their cell numbers to all patients whereas there are many who do so reluctantly.

My personal take in the matter of telephone consultations would be somewhat like this: (a) don’t give advice to a new patient whom you have never examined before. Ask him or her to take an appointment to see you in person. Refuse to give medical advice. In an emergency situation, there is all the more reason to insist that the patient be brought to you or taken to a Casualty room or ER as the Americans would say.

(b) In the case of a patient currently under your care, the situation is different and telephonic advice may be easier to justify. However, it should be made a practice to document the tele-conversation in the appropriate record of the patient, not of course forgetting to date and time the call and recording the name of the person on the other end of the line. Needless to add, even your old patients need not be given advice in situations where you think he / she needs to be examined before giving advice.

The next question that will crop up is: Should you charge for telephone consultations? In the USA telephone consultations are accepted in a big way. It is estimated that 25 % of interactions between patients in the USA take place on the telephone. Proper charges are taken for the same and regular bills are sent.

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I recall a joke I read sometime back wherein an American patient who was solving a crossword, called up his doctor and asked him the medical word for “windpipe” since this was one of the clues. The doctor informed him that it was “trachea”. The patient thanked the doctor and hung up. The doctor promptly sent a bill for $ 10 under the heading “Telephone Consultation”!! In our country, of course, patients don’t even pay the regular bills, so recovering bills for telephone consultations might be a pipe dream.

To the question, which patient should be given your cell number, personally I give my number to selected patients depending on the condition for which I am treating the patient.

I know a consultant who refuses to give his cell number to any patient. In fact, there must be many such consultants. But I have also heard patients holding it against the doctor for not giving his cell number and labeling such doctors as uncaring. “I feel secure if I know I can contact my doctor instantly in case of an emergency situation “say many patients.

I suppose there can be no thumb rule in this matter and each one of us must customize our practice on this issue.

In the USA, the branch of medicine called “Telephone Medicine” is growing rapidly and several advantages have been claimed for the same. However, the downside of this is also stressed by them. It is interesting to note some of them:

Adverse outcomes resulting from communication errors in telephone medicine may range from inconvenience to anxiety to serious risks to patient safety. History taking may be inadequate in more

than half of phone calls and management decisions may be inappropriate in more than one-third.

Problems of confidentiality whilst giving test reports on telephone if these are given to family members.

Lack of visual cues prevents the physician from gauging the patient’s emotional response.

Patients calling at inappropriate times for perceived emergencies.

Another big question that is waiting to emerge from the shadows is medical consultations on-line or e-consultations . Communication by patients with their doctors, I understand, even in our country, is gaining currency. The same issues pertaining to telephone consultations will apply to these viz. malpractice liabilities, provision for reimbursement, establishment of doctor-patient relationship, and so on. We need to understand these issues at length.

I also know a number of our Consultants communicating with their patients by SMS. Methods and need for recording these may be required to be thought of.

Be that as it may,, it is better to be Safe than Sorry as far as telephone consultations or e-communications incl. SMSes are concerned. You may even land yourself in a soup as the physician in the above story realized. Hence do not give telephone or e-advice indiscriminately.

Also the fact that you will not be paid for it is an additional reason to avoid it!!

email: [email protected]


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The total number of doctors in the country is estimated to be 6,70,000 to 7,00,000, the doctor : population

ratio being 6.7 per 10,000 population, against a desirable 10. But the distribution is skewed and the rural population has only 2 doctors per 10,000. The government, therefore, wants to increase the number of doctors by increasing the number of students in existing medical colleges, by a whopping 50% without increasing the bed strength. There will be 250 students where earlier there were 150, and 3 post graduate students per unit instead of 2 as at present. Quality will be sacrificed for quantity in the hope that flooding will send doctors to rural areas. More likely, they will flood urban areas even more. Mumbai is already having 22 doctors per 10,000 population, equal to the ratio in U.K. It has 20 beds against the national average of 9, and has most number of specialists, super-specialists and the most advanced technology. Yet a Mumbaikar lives an average life of 56.8 years 11 years less than a Maharashtrian, who lives 68 years. Too much commercialization or too much incompetence? Obviously doctors sell health-products, not health-services. The same picture is seen internationally. Despite poor infrastructure a Sri-Lankan

has a much better average life span than a Russian who has one of the highest medical manpower in the world.

And who are the buyers? 40% people below poverty line or poor have to depend on public sector and 30% upper class plus those who are well covered for their health needs prefer high-tech major hospitals. So, we sell our product mainly to the middle 30% people only. But the income of 50% people is shrinking while the number of specialists is increasing.

WHAT IS THE STRUGGLE AHEAD?

1) Increasing over crowding of specialists in cities has to be reduced.

2) The expenses are becoming unmanageable even to upper middle class, while the quality is declining. This results in shrinkage of the medical field.

3) There is no referral system, no functional demarcation-compartmentalization, if I may call it. The resulting insecurity and confusion explains the morbidly increasing heart attacks among young doctors.

4) We are totally neglecting primary health care and the public sector at our own peril. It is in our own interest that

STRUGGLE AHEAD Dr. S.V. Nadkarni


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primary care improves and public sector expands. That will absorb more G.P.s and specialists, that will help expand the medical field, and that will reduce assaults on doctors, if public unrest is subdued.

5) The concept of free treatment for the poor is creating havoc not only for doctors but also for the very poor who are supposed to benefit by free treatment.

The most important challenge ahead is to offer improved services at reduced cost. A report by D.H.S. in 2005 indicates inadequacies. Inadequate space, untrained staff and gross under utilization of space, O.T.s, I.C.U.s equipments and personnel along with increasing regulations and rising public expectations are making most nursing homes non-viable. But what we refuse to even mention is the conflict of interest between the owner and the freelance consultants who have no stakes in the place and who can and do shift their allegiance elsewhere, easily, for personal gains. The only remedy is Group Practice. A small hospital of 50 beds by 10 or more specialists will bind them together. The hospital will afford to employ good staff and up-date equipments. Specialists will be interested in training the staff & R.M.Os,

so infra-structure will improve. The flow of patients from all partners will guaranty full utilization of space, equipment & staff and the freelance consultants will lose their importance. Group practice is the answer for the future.

A linkage with major tertiary hospitals on well-defined terms can become mutually beneficial. The offer of fortis recently, is a step in the right direction. It has offered to take up difficult cases, treat and re-transfer

the patients from Nursing Homes and help with Para-medical assistance. In turn, Nursing Homes ought to demand that Fortis reduces its economy and general ward beds and admit only major cases therein.

Simultaneously, the general specialists will have to assert their separate importance in treating the middle class. The biggest task is to fight the high-tech market and maintain our biggest asset namely stress on appropriate, cost-effective technology, early decisions, short-stay and thereby reduced costs. We need to denounce loudly the misuse or overuse of costly technology and costly therapies. It will be necessary to flood the press and medical journals with articles to show where and when patients can be treated successfully without them. I believe patients can be persuaded to accept such protocols. However, maintaining meticulous records is a must, for this. It is possible that insurance companies and foreign funds from U.K. & U.S.A. would strongly support such an approach.

The central government has passed the

NURSING HOME INADEqUACIES JOTKAR D. H S. 2005Physical Standards - not met 6% Have adequate space

Un skilled Human Power 38% maintain records

Poor Sanitation & Waste Mgmt. 36% in residential building

Irrational/Unethical Practicers 64% having less than 15 beds

Poor Record keeping Only 12% have more than 25 beds.

No monitoring & Accountability

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clinical establishment Bill-2010 and accreditation is on the card soon. The association along with F.E.q.H of Mr. Gadgil is already on the job. Accrediation will be good for us, but it can spell disaster if we remain careless and ignore the aggressive high-tech high-cost market. The insistence of costly equipments with unproven merits can result in many nursing-homes being d e c l a r e d “inadequate” for major cases. Planum ven t i l a t i on , HEPA; 6 channel monitor etc. are but a few examples. We will have to insist that well m a i n t a i n e d r e c o r d s s h o w i n g a d e q u a t e results for the patients treated at the centre should be an equally important criterion of adequacy.

Compartmentalization and frontal attack on the concept of free Treatment are the other important struggles ahead. Strict compartmentalization between private and public sector is as much our need as that of the government.

Senior service doctors are quite well off-could be much better off than many of us. We must not only strongly advocate a total ban on private practice by all full-time doctors/specialists but also actively assist the authorities to implement the ban.

Similarly, we must continuously attack the concept of Free Treatment. The first step would be to denounce Free Medical Camps as an unethical practice and an insult to our brethren in service, except in disasters. Also, working as an Honarary, without per case minimum payment or free health check-ups ought to be condemned outright.

Even in public sector p r o f e s s i o n a l services must be charged. Even for the common man, these work out to be only 5% to 12% of the charges in private. But evaders must be fully charged. That will widen the net, and

expand the public sector and offer work-based incentive payment to service doctors. For example, government and municipal servants treated in public sector do not pay at all, if they are treated in their respective hospitals. If they were to be treated in approved hospitals, the govt. pays even if the patient does not. But here nobody pays. Collectively, the medical fraternity is the looser. Please realize, these families make upto 15% of the total population. Other evaders are

1) Accident victims-despite third party insurance. The public hospital fails to collect the money; the insurance company

INCOME

Private Sector Public Sector

1,00,000 Income / Salary 1,00,000

-10,000Perks - CL/PL/SL/

TA/Edu/H.R.A.25,000

-25,000PF/ Gratuity/Pension Fund

25,000

-5,000 Posturing -1,000

-5,000 C.A./Law/Media -1,000

55,000 TOTAL 1,48,000

>2,00,000 Purchasing Power Parity 1,00,000


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gains and both the hospital and the doctors lose.

2) Foreigners- sometimes they do get admitted to public hospital; yet they are treated free of charge. An Australian lady was charged Rs. 300/- for fracture radius, ulna treated with Elizarov method.

3) My study in Goa indicated that atleast 40% of the patients who attend public hospitals for emergencies belong to be affording class. Infact, they don’t mind paying but there is no provision to collect the charges.

4) Politicians, MLA’s, Corporators etc.-less said about them the better.

Despite poverty, 80% of the people are reported to utilize private services for their primary health needs. It is a pity, we have donated this field to AYUSH doctors. This is mainly because everyone who wants to specialize gets training and experience in the teaching hospitals. But there is not a single day’s training for someone who wishes to become a general practitioner. We must demand that there should be a two year diploma course in general practice in every medical college and atleast 20% of the M.B.B.S graduates be absorbed therein. Similarly there is need to define the roles of G.P.s and consultants. In my opinion, G.P.s should be prohibited from prescribing very costly antibiotics and other drugs or advise very costly investigations. Such cases must be referred to the specialists. F.D.A. can easily prepare a schedule of such drugs and investigations. Specialists, in turn, must not see any patient unless he is referred by or was atleast treated first by a general

practitioner. Compartmentalization will make clinical practice more peaceful.

I believe we have a strong case to make C.P.A. non applicable to health services, because it is contract based on faith-and not just a contract. (Visit my website for the full high-court judgement) Suffice it to say we should anticipate problems and advise the policy makers or the authorities to correct their policies before rules are framed. If we do not do it-others do-mostly the envious elements or the market. We ought to talk both to masses as well as authorities a lot more.

On my part, I have written a book, in which I have analyzed the present scenario and given my blue-print for action. It is priced Rs.100/-.

I have also created a website and a forum within it. We need to discuss a lot on these issues, I request you to buy my book and discuss or add your comments on the website and forum.

MANAGEMENT OF THE SICK HELTH-CARE SYSTEM

(What is Wrong - What Can the Done) By Dr. S.V.Nadkarni,

Former Dean, L.T. Med.College, Sion. Tel :- 9320044525

Available with: Vora Medical Publication Near J.J.Hospital, Signal Trafic

Byculla, Tel. 23754161, Telfax-23704073. e-mail : [email protected] website : www.healthandsociety.in

FORUM: Social Need for

Cost Effective CLinical PracticeSONCELP -

email : [email protected]


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As I Started my practice in 1982. I was clueless about various rules and regulations regarding private practice in Mumbai. I promptly joined AMC to get keyed in. As I interacted with fallow consultants at various events arranged by AMC. I gained knowledge and medical expertise. I also got practical tips. Be it consumer Acts, State and BMC rules and regulations like pollution control Act or fighting for doctors rights. Recently when certain rules threatened to lose down over 1200 Nursing homes in MUMBAI AMC was at the forefront to get rules amended so that we continued earning our daily bread. AMC has also

AMC is a luminous associate but can exude much more luminosity. We must improve/train consultants to introduce Guest Speaker. Also, thorough scrutiny of lectures to be delivered by Guest Speaker.

Introducing new faces will bring in novelty and break monotony.

AMC is not just Nursing homes and their owners Grievances of all consultants

WHAT I LIKE ABOUT AMCDr. Umesh Worlikar

WHAT YOU EXPECT FROM AMCDr. Lara B. Daue

arranged family get togethers at Essel world etc. as well as international tours. AMC has started its own benevolence scheme, group insurance, doctors indemnity scheme.

As I think about my journey and AMC over last thirty years – All I can say is you’re come a long way AMC you have become an internal part of every consultant life. What started as an association has ended up as one BIGFAMILY.

Recently introduced ‘Dream car project’ by AMC may make my dream (of owning a BMW) come true!

should be attended.

All this can be achieved by De-Centralising AMC activities. LONG LIVE AMC.

AMC is not just Nursing homes and their owners Grievances of all consultants should be attended.

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About 200 years ago one Hungerian doctor was born. His sir name was Simmelweis. (I guess weis means

“WISE”) His name was Ignaz. He studied medicine & worked at Vienna General Hospital. He made Following observations.

1. Most newborns born on streets of Vienna survived.

2.Many newborns born inVienna General Hospital died of illness called peurperal sepsis. Some mothers too had the same fever after delivery and many died .

They was maternity fever of women.

They could do nothing about it.

He wondered what killed them.

His male room partner doctor also died of the same illness.

HE CONCLUDED THAT IT HAD NOTHING TO DO WITH DELIVERY.

He kept thinking about it.

AND ONE DAY IT DAWNED ON HIM.

He noted following.

“They would do dissections of dead people to learn Anatomy.

Some of these were mothers who had died of puerperal sepsis.

After that they would go to delivery rooms and do PV ( per vaginum ) examination of women in the delivery room.

These there after got the same illness.

Their babies too got it. Many died.

He thought, “They did dissection, & then they did p.v.

They carried the illness of the dead to the new mothers.

Then mothers and babies got it.”

He thought that, their hands transferred the illness of the dead, to the women and babies.

He wondered if washing hands would break this transmission.

He suggested hand washing.

No one cared.

He was not head, so he could not implement it.

But once when his boss went on leave, he became the unit in charge.

He introduced hand washing.

He made it compulsory before & after seeing every patient.

They would carry a water tub on ward rounds.

This reduced the mortality in his unit to a great extend.

There after he became head of one unit.

He introduced scrupulous hand washing in his unit.

The death rate of mothers and babies went down in his unit. It became significantly less than the unit of the department head.

STORY OF OUR GURU “MAd dOCtOR” SiMMELwEiS Dr. Rajan B. Bhonsle


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This could not be tolerated.And no body wanted to carry water tub.No body wanted to wash hands.He published his work.

However all ridiculed him.

He could not see women and babies dying every where just because people were not washing hands.

On road, He would tell all pregnant mothers, not to go to Vienna general hospital, to save their lives and lives of their babies.

He became mad.

He cut his hand by a blade, then he did a PV. of a sick woman, got infected and died of the same illness.

He was soon forgotten. Many years later when asepsis was learned people re-looked into history and found him out.

He is father of ASEPSIS.

Let us salute to him.Let us become like him.Let us think of problems of our people.Let us find solution to them.Let us not ridicule new ideas.zz.

Lessons for us.

LET US practice good practices as follows.

1.Wash hands. Before and after seeing every patient.

2.Our fore fathers were correct. They bathed 5 times. Very good custom. Keeps you clean. In hot places, it keeps you cool.

3.The women bathed then they wore freshly washed clothes.

Only then they cooked food.No one was allowed in the cooking area. not even the head of the family.

THIS IS CALLED AS “SOWALE”

We ridicule it. BUT IT IS THE CORRECT WAY OF LIVING.

4.Our fore fathers observed SOYAR and avoided SUTAK.

Soyare means relatives. Sutak is the suffering due to death of a near one.

When a new baby arrives, All relatives (Soyare) come to see the newborn. All pick up the baby.Some kiss the baby. Some of them un knowingly give infection to the baby. Then baby becomes ill. Many such babies die daily in India. Sutak, the pain of losing baby follows.

Soyar means not allowing any one to come to see the baby and the mother till the bay is 40 days old.

This is following asepsis. A good custom. Let us encourage it.

5. Recent study published in Times of India Nov. 2010 show following.

“ Swabs are taken form many spots in houses and to see presence of e coli found in human faeces. They found that even the “Clean & elite” Indian houses had high e coli count and were dirty by world standards.

q: How to eliminate e coli from our houses?

1. 1.1 One toilet per house.

1.2 One toilet for visitors in each shop/ public place/commercial place.

2. Improve toilets.

2.1 Introduce showers in all toilets to wash perenium

2.2 Keep tissue papers. Use new paper

3 3.1 Keep soaps in all toilets.

3.2 Liquid soap better than soap care every where.

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4. Wash hands with soap after visiting toilet every time.

5. Learn & teach hyeginic use of toilet.

6. Tell every one

all good you know, especially media, the journalists make every one wiser.

This is the best service to the nation.

Dr.Hemant Joshi Dr. Archan Joshi Virar.

POEM

My school is good except bad toilets!

I will request my school to change

My office is good except bad toilets!

I will request my office to change

My public place is good

except bad toilets!

I will request my public with help of media

My trains are good except bad open toilets

I will write/sms/email to railway minister to improve toilets.

My country is good except bad toilets!

I will request my people

with help of media to change

My home,clinic & Hospital is good

except bad toilets. I will change them.

It is not too late

to improve the toilet. Unless toilets improve

Nosocomial infections will keep killing our patients and us.

We alone can change the scene.

We will change the scene.

Jai Hind

Email: [email protected]

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email: [email protected]



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MAll medical professionals know that practicing medicine is both art and science. It needs scientific knowledge

apart from deep understanding of human behavior. Talking about investments one is reminded about the great profession that we practice i.e. medicine. Investing is like medicine which is both art and science. The world is full of various investment theories which are both complex and difficult to understand. As potential investor you will be perpetually bombarded by various investment strategies based on charts volume and price movements.

You will be deluged with opportunities to create instant wealth. Turn your TV on 10 am to hear some of them. Twenty-twenty, khataro ke khiladi, sixer, jambazz, etc. For example, consider these enticing offers “discover a stock trading system that produces double digit profits on almost every trade! Trade right off stock market charts” Revolutionary new system …. Pays off from 50-100 percent returns in just one week” and so on and so on.

The prospectus of most mutual funds says, in small print, that past performance is no guarantee of future success. Recently, ULIPs were promised by insurance people to earn fat commissions. SEBI’s delayed intervention saved some gullible investors from falling in the hands of such agents. Medical professionals are falling prey to

mutual fund, insurance and commission agents.

Here, I want to discuss some simple and time tested methods of investing. Remember the key to investing is patience and discipline. Here we will be discussing simple investment principles especially advocated by giants Benjamin Graham, Warren Buffet, Peter Lynch and likes.

Benefit from the power of compounding

Albert Einstein actually called “compounding” as the eighth wonder of the world!

And here’s why:

vzOnce there was a king who lost a game of chess to an ordinary farmer. The king asked the farmer to choose his reward and all that the farmer asked for was 1 grain of wheat for the first square of the chess board, 2 grains for the second square, 4 grains for the third, 8 for the fourth and so on and so forth for the 64 squares. The king was very happy to be let off rather lightly and readily granted the wish. The real snag came when he tried to settle the claim.

In all required 18,446,744,073,709,551,615 grains of wheat!

All medical professionals know that practicing medicine is both art and science. It needs scientific knowledge

INVESTING - ART OR SCIENCE?Dr. N. A. Sharma

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apart from deep understanding of human behavior. Talking about investments one is reminded about the great profession that we practice i.e. medicine. Investing is like medicine which is both art and science. The world is full of various investment theories which are both complex and difficult to understand. As potential investor you will be perpetually bombarded by various investment strategies based on charts volume and price movements.

Now, isn’t that mind boggling? What happened there was that the smart farmer used the power of compounding to his advantage. And such is the power that the king just didn’t know what had hit him. Now, would you care too whether your rate of return is 12% or 14%? The fact that if you did, it would really make a big difference to your wealth over a length of time. The benefit from compounding arises from the fact that the income keeps growing the principal gradually which result in generating higher absolute returns each year. Higher rates of return or longer investment time periods increase the principal amount in geometric proportions. And this can only be advantage to you!

Choose Simplicity over Complexity

Many people believe that investing in the stock market is complex, mysterious and risky and therefore is best left to professionals. This common mindset holds that the average person can’t be a successful investor because success in the stock market requires an advanced degree, a mastery of complicated mathematical formulas, access to sophisticated market-timing computer programs and a great deal of time to constantly monitor the market,charts,volume,economic trends, and so on. Warren Buffet has shown this

to be a myth. Remember that degree of difficulty does not count in investing. Look for long lasting companies with predictable business models. Keep it simple. Here is your goal; buy stock in a great company, run by honest and capable people. Pay less for your share of that business than that share is actually worth in terms of its future earning potential. Then hold on to the stock and wait for the market to confirm your assessment.

Make your own investment decisions

Be your own investment advisor. Beware of brokers and other sales persons who aggressively push an individual stock or mutual fund to fatten their commissions and brokerages. Obviously these people do not have your best interests at heart. Beware of people finding a new growth star, a la Infosys.

Approach financial advisors, brokers and talking heads prophets with a healthy dose of skepticism. Once you acquire the fundamental of investing, make sure that you are not taken in by financial ‘experts”. Remember that most have vested interest or agendas that don’t necessarily put your financial well being first.

To succeed in the market, says Buffet, you need only ordinary intelligence. But, in addition, you need the kind of temperament that can help you ride out of storms; and stick to your long term plans. If you can stay cool while others around you are panicking, you can prevail.

Be fearful when others are greedy and greedy when others are fearful. You can safely predict that people will be greedy, fearful or foolish. You just cannot predict when or in which order. The stock market will always be influenced by periodic


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LETTERS

epidemics of the powerful emotions of greed and fear. Seasoned investors exploit outbreaks of these highly contagious emotions by behaving in a way opposite the prevailing sentiment!

Email: [email protected]

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