Thursday, 18 April 2019

Feedbacks and what do we learn from them

Its a free world and everyone is entitled for their feedbacks and comments on the other.

But...Why only customers give feedback about service providers/services and vice versa is not a norm?

Always wondered about this....Google with search words " service providers feedback" ... It only gave results on customer feedback, how their feelings are important for our business and " our" feeling( service providers) did not appear to matter. We could reply to their feelings.
As a doctor felt that if customer is not pleased- I will flop - it did not seem to matter that the decision I made was in the best interest of the patients.
But then look at the list of 6 types of businesses :…/ (in this list:doctors do not even make it to the professional services..)

Learning very late in life but then ...Capitalism and Humanism were not in my curriculum anywhere so far...
some answers- 
Medicine taught me compassion,ethical and humane qualities and I have grown up with the fear of God.
Humanism convinces us that 'we' are the ultimate source of meaning and that our free will is therefore the highest authority of all.
Because customer is always right - Nobody has the authority to tell the customers that they are wrong, and heaven forbid if we try to even attempt to persue them..
Customer knows what's good for them, atleast what makes them " feel" good and in control...
Some of above learning is from my recent read by Yuval Noah Harari..

something needs to be done. There should be terms and conditions to be accepted before writing a feedback. Terms and conditions should include that the feedback is genuine and the patients should write the fact not their judgement ( strict action will be taken for defaulters: example you will be banned from Google medical search for 3 months or something like that) Just a suggestion 😊
On a serious note - Just in a 10-15 minute consultation: our years of hardwork and dedication is judged and written for public. I have reached a stage ( finally) to stop caring. I am writing this as a form of catharsis because when I did care- no one gave me this insight in to feedbacks. Nowadays some websites have started verifying the feedbacks. I request the patients to write the fact/incident and not their judgement. Let's say a patient writes "When I told Dr Sheelu that according to Google "A" treatment is better for me, she concluded to prescribe "B" : this is an example of fact. Same patient can write a feedback ' She is full of herself/ does not listen to me'. Now how do the reader interpret if they only read the second feedback ( judgement). They don't know the incident, they read the judgement. I will argue that in my experience and after clinical examination, I decided B in patient's interest.( I make it a point to explain to them why I decided so).
To save my image/ practice/ livelihood, Do I have time to sit and reply to these comments? I personally reply to my Centers page and not to any Practo/ JD/ FB .
Infact look at Practo- they actually put words in the mouth- they have options to grade us on " friendliness, time we spent, and best option in their list 
' satisfaction' . " No place for " Did you get cured?".
What is health?: WHO says physical , mental and social well-being. We as specialist are mainly trained for physical health and sympathy to especially cancer and disability. Empathy comes for all, only if they can come out of their preconceived notions about the doctor.
Nowadays, everyone wants to see an ENT for cold / cough as first choice. They do not go to their family doctor. Infact where is the family doctor? we drove them out. Now we go to a super specialist who is super trained and diagnosis is reached quicker but feedback says doctor did not spent time! A family doctor would have touch based with their families and then told the diagnosis and given treatment. Infact I keep refunding consultations and redirect patients to physician almost on daily basis. But doing this makes me rude: 
"we waited and then she asked some questions and finally sent us to another doctor." ( Money returned but that " me" is hurt. One person told me that I wasted his time by doing so (sending him to right doctor).
I also want to make a comment about : giving a doctor's consultation 🌟 rating. We can be anywhere from 1 star ( thanks Google and Practo) you did not give a zero 🌟 option! Are we some mobile phone bought on Amazon to be graded like this? We doctors are also humans and to earn a decent living we need to see an average 30 patients per day ( some more), busy days 60-75. Is it humanly possible to befriend everyone ( Practo listening: remove friendliness)
I may be an authoritative doctor but I stick to my Medical oath "Do no harm".
To conclude: there are 2 sides of a coin, I am sure there are patients who want to reply to me, I am sure I had a bad day and was really not friendly! But also sure that I Do no harm and I still continue to read the feedbacks in case there is some authenticity and I can make myself better.

Thursday, 24 January 2019

Pediatric ENT Program

Pediatric ENT Program: "Comprehensive and Personalised Care for Children with Ear, Nose, Throat and Airway disorders "
To provide unparalleled care for the little ones, we have a team of Pediatric trained ENT surgeon, Pediatric Intensivists, Anesthetists,Pulmonologists, Pediatricians ,Psychiatrists and various other specialities like Audiologists, Speech and Language therapists, Occupational therapists, Physiotherapists,Psychologists and Special Educators to name some.

Our program of pediatric ENT is unique as our team specialises in managing all Pediatric ENT conditions from Adenoid and tonsil surgery to Cochlear implantation to Airway surgeries.

Common Conditions we manage are
  • Tonsil and Adenoid Hypertrophy
  • Ear infections and hearing loss
  • Chronic ear infections and cholesteatoma
  • Allergies and Sinusitis in children
  • Noisy breathing and snoring in children
  • Sensorineural hearing loss and Cochlear Implantation program
  • Congenital Airway Problems and Airway surgeries
  • Hoarseness and Voice disorders
  • Head and Neck masses and Swellings
  • Foreign bodies in the aerodigestive tract
  • Swallowing Assessments in babies and swallowing therapy
I am an ENT surgeon who has established my pediatric ENT practice in Bangalore for over a decade working with pediatricians, various interdisciplinary specialists, therapists and parents. 

I am based in the private sector as Consultant ENT surgeon since 2006  and running my own ENT Center with Deafness habilitation services. Since 2006, I have also  worked with various pediatric units like Indira Gandhi Institute of Child Health, Spastics society of Karnataka and National Rural Health Mission updating and upgrading pediatric ENT services.


I am pleased to say that approach of improving opd diagnosis is very popular among the pediatricians. We regularly perform opd based airway assessments in children and have popularised flexible nasoendoscopy in children.

Our pilot of Universal pediatric hearing screening was the first universal hearing screening pilot under NRHM and was presented to secretary to health, Government of Karnataka. I introduced Swallowing assessments in children at spastics society and regularly assesses babies who had long NICU stay and are tube fed. Our team has weaned many babies off the feeding tubes.
I have worked relentlessly with NGO’s, Anganwaadi’s and Rotary for pediatric ENT assessment. I believe in providing end to end care. All children are followed up and help for treatment and habilitation.

Dr Sheelu’s ENT Center has been one of the finalists for BMJ Asia Healthcare Awards in 2015.
My mentors in India and abroad include the doyens in cochlear implantations and pediatric airway surgery. With their support and training, we want to make difference in the lives of many more children....

I also volunteer as “Shikshika” for Balbharathi of my local community and make use of  opportunity to spend time with children eg. Volunteer at Bannerghetta Biological Park. I regularly participates in charity events to raise awareness for Pediatric ENT cause.

And finally, I thank God for giving me this wonderful opportunity to work with the kids.

Tuesday, 2 October 2018

Adult Cochlear Implant Program: Boon to silent ears

Adult Cochlear Implantation: A boon to ears unable to listen with hearing aids
Cochlear implants (CI) are designed for individuals with hearing impairment to compensate for moderately-severe to profound sensorineural or mixed hearing losses, if there is limited or no benefit from hearing aids.
CIs bypass the non-functioning part of the auditory system in order to deliver electrical signals directly to the auditory nerve.

A cochlear implant consists of two parts, an external and an internal component. Internally, the implant consists of a receiver-stimulator, which contains the electronics, the receiving antenna and a magnet that holds the coil in place behind the ear, and the electrode array. Externally, the device consists of a sound processor that is generally worn behind the ear and consists of a microphone, which picks up sound, a processing unit which processes and converts sound into a radio frequency signal, and a transmitting coil through which the information is transmitted through the skin to the internal components of the implant. The sound processor also includes manual controls and batteries.
Cochlear Implantation only works well in those who have developed language before their deafness or in those who receive their implant at a very young age.

Implantation requires an operation and comes at a high cost. Also there is a requirement of post implantation auditory and language therapy for 3-4 years in children born with profound deafness. 

There are about 25000 CI done in India and this has increased exponentially in the last 5 years. About 10 state governments are sponsoring CI in children below 5 years and there are about 300 independent clinics in India running a multidisciplinary CI program. All these programs are mainly concentrating on children and the adult deaf population is not aware of CI option available to them.
However we have a large young and elderly deaf population who could benefit from this technology. 

As per Census 2011, in India, out of the 121 Cr population, about 2.68 Cr persons are ‘disabled’ which is 2.21% of the total population. The Census 2011 revealed that of this disabled population, 19 % are with disability in hearing. If we refer to the age group statistics, out of the total disabled in the age group 0-59 years, 18 % are having disability in hearing. The impact of hearing loss in the elderly effecting their quality of life and cognition is already well known.

Hearing loss in adulthood is linked to a greater likelihood of unemployment, as well as an increased risk of poor health, depression and other conditions, including dementia. Despite this, there is little recognition of the impact of hearing loss or of the latest hearing technologies which could improve hearing in the adult age group in India. This failure to address the consequences of hearing loss is exemplified, above all, by the low level of awareness and provision of cochlear implantation for adults.

Age of onset of hearing loss has a big influence on selection criteria for Cochlear implantation. People who are born with profound sensorineural hearing loss are prelingual deaf. This group should get a cochlear implant within 3-5 years of birth. The second group is the post lingual deaf population who were born with normal hearing and lost hearing later in life due to following causes
·         Ear infections and surgeries
·         Tumour and lesions of nerve of hearing
·         Meneires Disease damaging hearing
·         Trauma and ototoxic medications
·         Progressive hearing loss of any etiology

People who are born with normal or mild to moderate hearing loss and later progress to profound deafness are called progressive hearing loss group. This group should be fitted with appropriate hearing aids and regularly monitored for hearing and speech. The absolute contraindication for CI is complete absence of inner ear or absent nerve. Also as it involves general anesthesia-sometimes a high risk medical condition can become a risk for CI.
In our program we have have strict selection criteria for adult CI. The factors commonly influencing decisions are age of onset of hearing loss, use of hearing aids, duration between hearing loss and CI and also cause of hearing loss. The etiology in adult can be so varied, it needs careful planning and different surgical technique tailored to each of them.

Hearing with CI is not automatic. After the implant is switched on, the recipient is likely to hear sounds right away. But, it can take months or years of hard work to interpret these sounds and give meaning to them. Rehabilitation, regular mapping, family support and setting appropriate expectation is the key to success of a CI program.
Adult population form 50% of the CI we have performed in our program and that is due to the awareness we have created and also the rehabilitation support. Our deafness rehabilitation team patiently works with age groups of 6 months to 65 years who are using hearing aids or cochlear implants.
We recently offered CI to a 63 year old Mrs Savitri and her husband had some genuine feedbacks.

Till we start thinking of benefit beyond hearing and speech, we will not be able to convince families or governments for an adult CI program. We need to take into account the broad cognitive, social, and physical functioning outcomes that are likely detrimentally impacted by hearing loss. This can be overcome by cochlear implantation in the right patient group followed by dedicated rehabilitation.

Dr Sheelu Srinivas
Consultant ENT Surgeon and Cochlear Implant Surgeon

Saturday, 9 June 2018

Preauricular Sinus

Preauricular Sinus is a common congenital malformation characterised usually by a dimple near the external auditory canal. Most of them are asymptomatic and not treated unless they get repeated infections.

Preauricular Sinus can have some clear or whitish discharge even when it is not infected. In this case , just keep the area clean by washing with soapy warm water.
If there are signs of infection: pain, fever, pus discharge: meet a doctor and antibiotics are needed.
If abscess, then incision and drainage is required.
If a preauricular Sinus is getting infected repeatedly or abscess is drained, then a definitive decision of Sinus is planned in 8–12 weeks.

Feedbacks and what do we learn from them

Its a free world and everyone is entitled for their feedbacks and comments on the other. But... Why only customers give feedback about se...