First Imagine Yourself as a Great Performer. Then Take Steps to Become One !
Sudha Chandran classical dancer was cut off in the prime of her life - quite literally; when her right leg was amputated after a car accident.
Though it brought her bright career to a halt, but she didn’t give up.
In the painful months that followed, she met a doctor who developed an artificial limb.
Sudha knew that she believed in herself and could fulfill her dream, she began her courageous journey back to the world of dancing - learning to balance, bend, stretch, walk, turn, twist, twirl and finally dance.
After every public recital, she would ask her Dad about her performance. ‘You still have a long way to go’ was the answer she used to get in return.
In January 1984, Sudha made a historic comeback by giving a public recital in Bombay. She performed in such a marvelous manner that it moved everyone to tears while catapulting her to the number one position again.
That evening when she asked the usual question her dad, he didn’t say anything. He just touched her feet as a tribute to a great artiste.
Sudha’s comeback was such heart-warming that it inspired box office hit, `Mayuri.’
When someone asked Sudha how she had managed to dance again, she said quite simply, ‘You don’t need feet to dance.’
Nothing is impossible in this world. If you have the will to win, you can achieve anything.
MedicinMan July 2013, Now Online, Easy Download -http://medicinman.net/2013/07/july-2013-issue/
First Imagine Yourself as a Great Performer. Then Take Steps to Become One !
Anup Soans, a management consultant and executive coach, provides insights into the Pharma sales scenario through his new book “Hardknocks for the GreenHorn”. The book provides practical tips, techniques, and tricks to succeed in the highly competitive Pharma market place. In my opinion this book should be a ‘must read’ for lifescience and pharma professionals with 0 to 5years experience. I would even say that, all the final year students of lifesciences stream, who aspire to enter pharma industry should read this book to understand how the domestic formulation industry works.
What’s “Hardknocks for the GreenHorn”
The “Hardknocks for the GreenHorn” is a book authored by a seasoned Pharma Marketing and sales training expert. This book is a very useful and a practical guide for young Pharma sales professionals and aspiring lifescience or pharma grad who would want to start their career in sales.
Who is it aimed at?
This book begins with the most fundamental background information of Pharma sales scenario in India and gets comprehensive as you read on. In my opinion this book would be;
- a required reading for the beginner,
- a handy refresher for somebody who has just made a beginning,
- and could be a welcome return to the basics for the seasoned pharma sales professional.
What sort of tips are in the book?
What particularly impressed me when I opened the book for the first time was the positive note with which he has explained the ‘species’ called Pharma Sales Professional and Front Line Manager. Why does he called them species? He goes on to outline certain traits like “Indispensable to Doctors, Knowledgeable, Constantly learning, confident of selling, emotionally intelligent, team builders, problem solver” Thats a precise observation. An observation from an author who had himself risen from the ranks in pharma industry backed by 20years experience playing various senior management roles.
As the book aims to add value to readers from a range of levels of experience, there is something for everyone to read. Most of the inhouse training program for a trainee PSR focuses largely on cliched but essential stuff like anatomy, physiology, product knowledge, therapy knowledge, roleplays, objection handling, detailing etc. Less then 10% of the time is devoted to train the freshers on industry knowledge, commercial aspects, etc. And for a trainee PSR a lot is left for himself to learn from the field. Depending on the mentoring a trainee gets from his field manager, what they learn about the industry takes varying times.
So, the learning curve for a fresh PSR is pretty long to gain an overall knowledge about the whole industry.
In this backdrop, this book is a very comprehensive one. The flow of contents are structured such that more than 50% of the book is dedicated in giving detailed perspective to PSRs on the how the industry works. Anup does a lot of handholding in minute aspects like importance of chemist surveys, selling skills, distribution management, product knowledge, territory knowledge etc. He also details about the typical hierarchy in pharma sales organisations. And there is a section is dedicated to discuss the success factors for becoming an outstanding and high achieving PSR.
A good part of the book is dedicated to discuss Anatomy, Physiology and Pharmacology. He goes a great deal to explain in a very simple manner about the various class of drugs used in different specialty and therapy areas. I am particularly impressed by this section because, for a PSR, gaining all round knowledge apart from the few therapeutic segment they sell will anyday be useful and help in of having more indepth discussions with their customers. Which otherwise would take a longer time to learn provided the PSR is blessed with a good mentor.
So, I would suggest you to lay your hands on this book before reading further reviews. You can get in touch with Anup through his email id.
But do not forget to share your thoughts here. Your comment will add lot of value to the discussion.
Disclaimer: I do not have any commercial interest in promoting this book. But I wish I had….
I am an independent consultant and run a healthcare business based in Chennai, India. Pharmacareers.in is an industry blog and a job-board. Apart from providing interesting content which you might find useful in your career and daily life, this site will serve as a platform for sharing, exchanging views/ideas, and also help Employers and Job Seekers to fulfill their people/career needs. Its my pleasure to have you as a guest.
Andrew J. Vickers, PhD, DPhil
Dr. Philip Bird, a family practitioner in Oxford, Mississippi, has been sentenced to death by lethal injection for ordering an MRI on a patient with uncomplicated low back pain. Bird’s sentence is believed to be the first under the state’s new “get tough” 3-strikes law. The presiding judge, the Honorable Marsha Williams, told the court that although she sympathized with the defendant, the law left her no discretion. Bird twice previously had been found guilty of ordering unnecessary scans: a CT for a woman reporting pregnancy-related tension headache and a bone scan for a patient with localized prostate cancer.
Prosecuting attorney Luke O’Neill said that justice had been served. “It gives me no pleasure to send a man to death row,” said O’Neill, “but Dr. Bird had a choice and knew the consequences of that choice.” State senator Grant Douglas, Jr., a former hospital administrator who introduced the “3 strikes” law, said that he hoped the case would “serve as warning to the medical community. We’ve tried everything to bring down the rate of unnecessary scans. We’ve done studies, presented evidence, written guidelines — hell, I’ve even gone down on my hands and knees and begged — but nothing doing. Scratch your ear in front of a doctor and next thing you know you’ll be shoved into a CT machine. Really, they left us no choice but to threaten them with death.”
Dr. Josephine Watkins, a medical economist, said that she doubted the ruling would affect medical practice. “The economic and malpractice incentives to scan are so extreme that even the possibility of years in a windowless cell followed by a botched execution is unlikely to be a deterrent.” Bird himself was unrepentant. In a statement released by his attorney, he said that Douglas “needed his head examined” and that either CT or functional MRI should be considered.
With apologies to The Onion
Pharma brands: Old is gold
At a time when pharmaceutical companies are investing billions of dollars to develop new and path-breaking medicines, it is the old and heritage brands that continue to dominate the market. Sales in 2011 show that the average age of the top 10 pharma brands is 19.3 years, and some of them are as old as 25 years.
For instance, Novartis’ painkiller Voveran, which was launched in 1986, ranks third, whereas Ranbaxy’s much popular health supplement Revital and Himalaya’s Liv-52, both 22-years old, rank sixth and 10th respectively.
According to a study conducted by IDFC Securities on pharmaceutical brands, out of the top-100 brands, 93 are pre-2005 vintage. Among the top 300 brands, it’s as many as 260.
While most of these brands are painkillers, vitamins and cough syrups, even drugs to treat diabetes and those treating gynaecology problems figure among the vintage brands.
Matter of Trust
"Brand building is a matter of trust, high degree of recall and consistency," says Sujay Shetty, Partner, PricewaterhouseCoopers. "A brand is built with a lot of investment and it has to be reinforced every year. So ultimately, it is several crore over several decades".
Novartis India Vice Chairman and Managing Director Ranjit Shahani agrees. “Brand is a promise and reputation is the delivery of that promise over and over again. Successful brands are built on innovation while block buster brands are built on game-changing innovation,” Shahani said.
Analyst say mature brands not only dominate rankings but sales are also growing at a strong double-digit clip year-on-year. Despite ageing, top-100 brands, with an average age of 15.8 years, have shown nearly 16 per cent growth over 2007-2011. Similarly, the top-50 brands, with an average age of 17.3 years, have recorded more than 16 per cent growth.
"Importantly, despite their vintage, the top 10 brands continue to grow steadily with a revenue CAGR of 14.2 per cent over 2007-2011 – signifying high brand stickiness," the study said.
"Rising on a strong brand recall and increasing sales from rural and untapped markets, these brands are huge money spinners. Some of them clocked annual sales of over Rs 200 crore last year," said the brand manager of a leading pharmaceutical company.
According to a study conducted by IDFC Securities, Abbott’s anti-diabetic drug Human Mixtard, which was launched in 1992 and currently occupies the top-slot of best-selling brands, garnered revenue of around Rs 219 crore last year. Similarly, Pfizer’s cough medication Corex, launched a year later in 1993, clocked annual sales of Rs 215 crore in 2011. Even older brands like Voveran and Revital clocked significant sales. While Voveran earned Rs 194 crore for Novartis, Revital contributed Rs 182 crore towards Ranbaxy’s sales last year.
Other heritage brands enriching the cash registers of various pharmaceutical companies include popular medicines like Combiflam (anti-inflammatory and painkiller), Benadryl (cough syrup), Calpol (paracetamol), Mox (antibiotic), Liv-52 (for liver ailments) and Shelcal (calcium and Vitamin D3).
Most of these best-selling brands in India are off-patent, unlike in the developed countries where the average age of top brands is typically 12-15 years, depending on the length of patent protection.
"One of the reasons could be because in India, painkillers, cough and cold medication and antibiotics are initially prescribed by general practitioners and over the years they adopt characteristics of over-the-counter products. How many of us really go to a doctor for a Combiflam, a Benadryl or a Calpol? We go straight to the chemist," Shetty said.
But analysts suggest that brand building skills are critical and there is clearly a challenge in creating newer brands. Experts say, though a successful brand building is a continuous process and takes decades, a new product needs minimum of six months to develop a market.
"India is mainly a branded generics market and life cycle management can carry brands through their leadership cycle for more than 25 years. Classic examples are Voveran, a nonsteroidal anti-inflammatory drug (NSAID) for osteoarthritic conditions and Calcium Sandoz for strong bones and Otrivin a nasal decongestant," says Shahani.
Novartis had launched Voveran as a tablet, which was followed by a gel formulation and later a thermagel. The idea was to capture an additional market segment at each stage.
MNCs Vs domestic firms
Multinational companies (MNCs) have excelled in the act with better brand building capabilities, notwithstanding their relatively limited market share. Foreign players such as Abbott, GlaxoSmithKline, Novartis and Pfizer account for five of the top-10 brands.
"Given their historic strategic constraint in terms of fewer product launches compared to local players, MNCs have focused on building these limited launches into big brands. This bodes well for future as MNCs seek to broaden their portfolio through branded generics and patented products," the study said.
Abbott, which leads the top-300 list, now has 28 brands in that bracket aided by its acquisition of Piramal Healthcare.
However, some of the Indian companies are also gearing up to create a meaningful place for themselves.
According to analysts, Mankind has emerged as the biggest brand creator in the pharma space in the last few years.
Says R C Juneja, Chairman and Chief Executive Officer of Mankind Pharma, “brand is like a lifeline for pharma companies. More brands not only mean more profit, it also means that your company is becoming more popular and this is very important for drug makers.”
Since 2000, the company has built 12 brands in the top-300 list – highest in the domestic market and surpassing even the largest players. Of Mankind’s 12 brands, 11 are in the acute segment including five anti-infectives brands.
According to Juneja, brand building is a challenge and companies have to formulate product specific strategies to position their brands well in the market. “The field force also plays an important role here,” he points out.
Other domestic players like Cipla, Cadila and Elder Pharma also have successful brands in the pharma market.
Posted Date : 2012-07-02
Source : Business Standard, June 27, 2012
The book begins with two of the chief characters, Celia Jordan and her husband, on a flight home to the US anticipating trouble that the reader is not yet fully in on, involving a certain Senator Donahue. The action then goes back some 40 years to when Celia, unmarried, was a drug sales rep for a Pharmaceutical company and her husband to be, an intern beginning his career at a New Jersey hospital. Andrew Jordan is perplexed with the case of a young woman dying from hepatitis A, not a usually fatal infection, that she acquired on a cheap holiday in Mexico. Celia happens to know that her company is researching a drug that would combat the womans symptoms, and manages to get through the protocols to find some, and as a last desperate measure, the drug is administered and the woman’s life is saved. Next morning, She and Andrew Jordan become engaged, largely it appears, on a whim of Celia’s.
Celia quickly turns out to be someone who knows what she wants and gets it, and we soon learn the story of how she came to be in her present selling position, where she has made a name for herself already by going out of the way to become more knowledgeable about her job, and after one particularly bruising encounter, earn the respect rather than the ridicule of practising doctors. On their honeymoon the two share their various family histories, Andrew’s mother and father having separated and left him to the care of an aunt who has sacrificed all she has to get him to where he is, Celia’s father having died in the attack on Pearl Harbor.
On return from work, Celia is engaged to speak at the annual company conference, and is planning a major assault on what she sees as the lack of training and sharp practice that is rife even among her own company. Her manager Sam Hawthorne strongly advises against any such thing, but when Celia goes ahead anyway and delivers her speech, to not great enthusiasm from her company bosses, she is within a whisker of being fired when Sam intervenes to save her. Shortly afterward she is promoted to a new position and then begins a gradual rise through the company, interspersed with bringing up family and generally turning out to be a woman who is determined to have the best of both worlds at work and at home, and manages to somehow fit it all in. By this time she has two children, Lisa, who appears to inherit much of her organisational sense, and Bruce, a history fanatic. Strains in the Jordan’s marriage however, surface on a posting to Ecuador where both acknowledge they have let their standards slip, Andrew having spent many years covering for his Chief at the hospital, who is a closet drug addict, and due to which at least one patient has died in preventable circumstances.
Sam Hawthorne is promoted in the course of time to company president, and Celia is promoted behind him. Other characters to become important later include Bill Ingram, a Harvard Business School graduate with a similar no nonsense approach to Celia’s. There is a deathbed encounter between Celia and the president who almost fired her, Eli Camperdown, at his home, at which he urges her to always follow her conscience. Years before, Celia had deflected the company away from marketing Thalidomide, and possibly saved them great trouble. Sam meanwhile quickly makes two far reaching decisions, one ultimately to be of great benefit, and the other a total disaster. He has a whim to set up a British based research unit to tap into what he sees as the great pool of British talent for new ideas, and at the same time buys up an abandoned French project for an antiemetic for use in pregnancy. Celia and Sam visit England to look at prospective sites for the unit, and at the same time meet a young Cambridge researcher, Martin Peat Smith, who is researching memory loss and dementia, spurred on by the case of his mother, who no longer knows him. Sam offers Martin the job of head of the British unit, which Martin at first refuses but then Celia is able to persuade him with a bare faced head on assault on his vulnerabilities.
Meanwhile back in the US, Celia has serious misgivings about the Montayne project and ends up resigning from the company, recalling Eli Camperdown as she does, whereupon she and Andrew embark on a round the world tour, ending up in Hawaii where Andrew has secretly arranged a visit to her father’s ship, with the children, recalling a wish that Celia revealed on her honeymoon many years before.
She is recalled to the company amidst the news that Montayne is indeed the danger that she feared, Sam shortly afterward commits suicide, for reasons that Celia only partly understands, that he gave some to his then-pregnant daughter about two years prior; her child, now one, has been destroyed. A deeper secret concerning the licensing of the drug and blackmail of the FDA official responsible, a Dr Mace, remains hidden.
Celia takes over as vice president but is effectively running the company. After the suicide of Sam, the board typically refuse to appoint her to the top job. They appoint a pro tem president, who is in post for 6 months before he dies. Celia then becomes president. She now has to get the company back on track, and quickly. Unfortunately, Senator Donaghue, a well known two-faced politician, has ordered a Senate enquiry into Montayne, amidst all the other legal actions that inevitably result. In a heated debate at the Senate, Celia discredits Donaghue publicly against the urging of her legal team(as he had originally been against delaying the release of Montayne, and he is very much in the control of the big-tobacco lobby), earning a brief reprieve but possibly stirring trouble for later on.
Back in England, Martin’s research project is bearing little fruit, and has already survived one attempt to close it down by the Felding Roth board who are concerned at the expense and lack of progress in a time of severe financial pressure. (Before his death, Celia was sent by Sam to investigate and make a recommendation on the activities of the British Institute, and after a short visit during which she visits the institute and talks to various people, (and she and Martin inevitably make love), she recommends that the project continue). His home life is enriched by a relationship with one of the technicians at the institute, Yvonne, and (in circumstances that she doubtless has great amusement in recounting to Celia when they eventually meet), Yvonne one morning makes a chance remark that triggers a new line of enquiry in Martin and the eventual development of a memory enhancing peptide, that is eventually developed and becomes a great success for Felding Roth, much to the disdain of the head of research Dr Lord. Vincent Lord is an ambitious scientist who rather feels that his talents are always overlooked, and took a very cold attitude to Celia on her rise through the company.
The financial rescue of the company, Martin Peat Smith’s knighthood and eventual marriage to Yvonne after a separation, Vincent Lord’s eventual breakthrough discovery of a free radical quenching drug of unquestionably great promise, follow on, and the company appears to be heading for calmer waters. Trouble strikes though when it turns out that at least some of the research into Lord’s discovery, is falsified, and that Lord, rather than expose the fraud, has attempted to cover it up. Ultimately this creates trouble, and inevitably the matter comes to the attention of Dr Mace at the FDA and Senator Donaghue, who sense a chance to exact revenge on Celia and Felding Roth. At this point we are in the know about the opening conversation of the book and the story closes there.
Hospital for Bhopal Victims Turns Cash Cow for Doctors
Nitin Sethi; TNN - New Delhi
Doctors are earning crores out of treating private patients at the Bhopal Memorial and Research Centre a hospital set up on orders of the Supreme Court to serve the gas tragedy victims free of cost.
In 1991,the SC ordered that a 500-bed speciality hospital be set up at the cost of Union Carbide for free lifetime treatment of more than 5 lakh gas tragedy victims.Two decades later,it remains a 350-bed hospital with doctors milking it for crores every year from non victims and all quite brazenly with the approval of the central government which now runs the hospital.
Documents with TOI show that doctors in various speciality departments of the hospital earned Rs 2.81 crore in just the one-and-ahalf-year period since the government took over the hospital which was earlier run as a trust.The practice of making money off private patients and giving a substantial cut of that to the doctors has been going on for years now.
The doctors in the cardiology department made the most of it,earning Rs 81 lakh while the cardiothoracic and vascular surgery department made Rs 58.22 lakh and anaesthetics Rs 28.87 lakh in the one-and-a-half year period.
Under government regulations,no doctor serving in a public hospital is allowed to earn from private practice and this hospital was specially mandated to not only treat the victims but also research on their specific ailments.Instead,the entire process has been institutionalised to make doctors earn at the cost of the victims.Forty per cent of what the hospital earned from private patients was paid to the doctors as their consultation fee.
While this has been going on for years,even when the Centre took over the hospital in July 2010 (it is now run by the Indian Council of Medical Research),it flouted its own regulations to offer the doctors the option to choose between the lucrative private earnings or the sixth pay commission salaries.
This is not the first time,though,that the hospital has been mired in controversy.Between 2004 and 2008,doctors at the hospital carried out drug trials on hapless victims in violation of several norms and regulations.Several of those treated died during the period of the trial but delays and lack of interest by the authorities ensured the cases were never fully ascertained and no one ever got punished.
The hospitals public relations officer,Mazarullah Khan,said,I dont know anything about this.Talk to the director.He will know. The director of the hospital Dr K K Maudar passed the buck on to ICMR,saying,We are doing so under instructions of ICMR.
Director general of ICMR and secretary of the department of health research Dr V M Katoch told TOI,The institute came under government control in 2010. We will soon roll out sixth pay commission regulations which has not been done till now.Thats why the doctors have been allowed to carry out private practice just like they did when the hospital was run by a trust.
In a village hospital, doctors separate twins to script medical history
Pritha Chatterjee: Betul, Sun Jun 24 2012, 01:36 hrs: Indian Express: On June 20, six friends from the 1982 batch of Christian Medical College (CMC) in Vellore and their former professor operated in the same theatre, after nearly 30 years. In a small missionary hospital tucked away in a village in Betul district, 200 km from Bhopal, near the southern border of Madhya Pradesh, the doctors performed the first successful separation of conjoined twins in a rural setting in the country.
The twins Stuti and Aradhana—christened by the hospital staff—were delivered in Padhar Hospital in May 2011. The “shocked” parents, a couple from Chicholi block, 40 km from Betul, told hospital authorities they would not be able to take them home. Formal adoption procedures were initiated at the district collector’s office, and the babies were “donated” to the hospital.
Barely a month after their birth, Dr Rajiv Choudhrie, medical superintendent of the hospital and a general surgeon, contacted his friends, over the phone—Dr Sanjeeth Peter, cardiothoracic surgeon based in Nadiad in Gujarat, Dr Gordon Thomas, paediatric liver transplant surgeon in Sydney and Dr Anil Kuruvilla, head of the department of neonatology in CMC, Vellore.
“Back then, I did not know if separation was even possible, let alone in this remote hospital of ours. I simply sought their medical opinion on the state of the fusion, and asked them if any intervention was possible,” Choudhrie recalls.
Over the next few weeks, Dr Deepa Choudhrie, Rajeev’s wife, and a radiologist at the hospital, prepared extensive reports—CT scans, MRIs and ECGs that were emailed to Peters and Thomas. Their examination brought good news. “It was a form of conjoinment known as thoraco–omphalophagus, i.e. the twins had two separate hearts in a common sack, that is called the pericardium sack, and is crucial for supplying blood to the heart. Secondly, their livers had separate blood supplies, but were joined by a bridge of the liver tissue—so it was a big joint mass of liver between them,” Brown explained. The condition merited surgical intervention. “Luckily, the case was not very complicated, because both the organs, the hearts and the liver, were separate it was just that they were joined. We had to separate the hearts and make two sacks out of the existing one, and decided the proportions in which we would distribute the liver. We felt sure it could be done,” Peter added. Dr Rebecca Jacob, a former professor of anaesthesia at CMC, was the first to come for a recce in the hospital, in November last year. “My students often contact me for advise if there are complications. My first reaction when I saw the hospital was to move the babies to another setting for surgery. They had one anaesthesia workstation to give the drugs, that too for adults, and one ventilator that was also for adults. It seemed impossible to me at first,” Jacob recalls.
Choudhrie says he was bombarded with similar reactions—ranging from voices of concern to outright laughter—at his idea. Today, as people laud him for his resolute, almost obstinate, decision to do whatever it took to perform the surgery in the village, he says there was no bravado involved. “I did not decide right in the beginning that we would to do it here. But after I approached so many specialists and took in their opinions, somewhere along the way I decided I wanted to do this. It was a tempting idea to send the babies away—everything would be so much easier in a setting that had all the facilities, but I kept myself from falling for it,” he explains.
There were offers—from reputed centres and specialists—including Dr. Devi Shetty, to move the kids, and take over the procedure. Instead of accepting the offers, the team worked towards overhauling the existing set–up—preparing the infrastructure and putting together a team to perform the surgery. Over the next eight months, more doctors were contacted. Thomas approached a paediatric surgeon in Sydney, Dr Albert Shun, who has operated on thee conjoined twins so far. “Clinically I have dealt with more complicated surgeries. But this one had so many more challenges, it was a team put together from across the world in a rural setting and we had to literally build the operation theatre and the ICU for post–surgical care. This was my first time in India, and I have never seen so much intricate planning anywhere else in the world,” says Shun.
Jacob contacted a paediatric anaesthesiologist in Sydney, Dr David Baines, who also had experience in operating on conjoined twins. “It’s amazing how much fun we have had, though there were no commercial gains—even our travel here was not funded for. It was a huge challenge and we took it. Now it’s a statement to India and the world: such a procedure can be performed in this setting provided doctors care enough,” Baines says.
Specialists in paediatric surgery were also roped in, from the country’s other CMC in Ludhiana. The doctors, after their individual visits to Betul spread over November–February, sent their requirements to Choudhrie. “I got these huge lists, and despite some donations, we had no money. It was like having Rs 10 in your pocket and going to buy stuff worth thousands of dollars,” Choudhrie laughs. There were requests for two of everything—high–end paediatric ventilators, monitors, heart and lung machines, suction tubes, internal defibrillators, cardiac monitors, pericardial patches, syringe drivers, vacuum machines and infusion pumps. “These were impossible lists. We at Padhar Hospital use innovative desi methods. We make dressing materials out of kitchen elastic wraps that achieve the same results as the kinds produced by vacuum machines–except the latter machine will cost Rs 10 lakh. Each ventilator was worth Rs 15 lakh,” Choudhrie adds. However, none of the doctors wanted to compromise on the requirements. “This was a huge risk we were all taking— we wanted the surgery to be a success so that it would be a milestone for other rural hospitals to follow. We did not want to leave any stone unturned,” Dr. Anil Kuruvilla, in–charge of the post–surgical critical care management team said.
When buying equipment did not work out with the existing donations, doctors approached companies to “loan” the equipment. “It’s not a practice that companies follow routinely. But after a lot of cajoling, they agreed to transport their equipment here for some time, with their service engineers, just for the duration of the surgery, and in return we buy some cheaper equipment from them later,” Choudhrie says. For example, the hospital has to return both the paediatric ventilators once the children are better. Meanwhile, the babies were growing up in a dedicated centre in the hospital’s neonatal ICU. Two ayahs were appointed to look after them. Their mother, Maya Yadav was visiting them, though she had forfeited her rights to them. It was at this stage that another CMC classmate, Dr. Prabhakar Thyagarajan, a psychiatrist now working at Apollo Chennai, was also called in to Betul, to counsel the parents on the public outcry, on ways to bring leaders of their Yadav community–the decision–makers for the couple—on board, and prepare for a possible reconciliation of the family, post–surgery.
The first deadline for the surgery, fixed in March, had to be postponed. “We wanted to wait for the babies to grow up a bit, so they were healthy enough to sustain the procedure. We were also delayed because of the refusal from many companies to provide us the necessary equipment,” Peters says. Doctors themselves brought a lot of disposables, many of which they did not end up using at all in the surgery. “We wanted to be over–cautious. The nearest tertiary hospital is 200 km away, so we knew the buck stopped with us. There are lots of wirings, tubes and drugs that are still lying in boxes,” Jacob says.
From the second week of June, a team of 23 doctors from India and Australia arrived at Padhar Hospital. The children were examined and re–examined, their reports checked. A day before the procedure, a three–hour dummy surgery was fixed. “We got two dolls and stuck a plaster between them and took them to the operation theatre with the entire team. We colour–coded the tubings and separated ourselves into teams—the red team and the green team—encoding the wirings of each twin. Everything was fixed—the positioning of the various equipments, where the doctors, technicians and nursing staff would stand, everything,” Peters recalls.
Anaesthetists joked about that dummy rehearsal being their first “bloodless surgery.” Now, after achieving what many termed as unrealistic—with Stuti already off the ventilator and Aradhana looking well on the way to recovery—the doctors say the marathon 12–hour procedure seems like a dream.
In the four–part surgery, doctors first separated the hearts from the single sack, and stitched two patches on the existing pericardium– to make two sacks, and inserted the separate hearts inside each twin.
Then the liver was separated—after the proportion for each liver was fixed, and finally the sternum was cut into two. “In the last stage, I was so focused on cutting the sternum bone, I did not notice the anticipation that had come towards the end of the surgery. But just as I finished, the entire theatre erupted in cheers. Everybody was clapping. I know, for as long as I live and as many procedures I perform, I will never forget that sight,” says Peter.
A week after the surgery, against the backdrop of the greenery along the Nagpur Hyderabad highway, it’s reunion time for the former classmates—playful jokes, recollections of an old college play, and memories of their “wild gang” days. “We are a close–knit batch. Six out of 60 of us are here—that’s 10 per cent of the batch—and our professor in anaesthesia. Barring old friends, who else would agree to such an adventure, in this setting, where the nearest tertiary hospital is in Nagpur or Bhopal, both at least 200 km away?” jokes Peter.
Twins on road to recovery Betul: At 5 am on June 23, nearly 55 hours after the surgery was completed, one of the twins, Stuti, has been taken off the ventilator. Stuti is crying, moving and is likely to be started on food soon. Aradhana is still on the ventilator but has started moving her hands and feet. Doctors changed her pericardial patch on Friday evening, and estimate another 24 hours of assisted breathing before she can be taken off the ventilator. Aradhana will also need some reconstructive surgery to cover the wound in her chest, in another two weeks. “The twins are lying on their back for the first time. Since they were conjoined, they would always lie facing each other, sideways. This is bringing a postural change in their haemodyanamic system, and we are waiting for them to adjust to it,” Dr Sanjeeth Peter, cardiothoracic surgeon who is part of monitoring team, says.
FFE 2012 Program Highlights: The Future of Field Force – Emerging Trends. What Should Be The HR Approach to Foster FEE? The Role of the Second Line Manager - Can the Second Line Manager Become the Change Agent for FFE? Aligning SFE with Commercial Excellence. The Half-Time Coach - A Program to Enable FLMs to Unleash the FORCE in their Field Force. 50 Top Notch Pharma Leaders Meet to Discuss the Future of Field Force medicinman.net Contact Anup Soans, Editor - MedicinMan for Registration. 09342232949 or firstname.lastname@example.org
U.S. Chief Technology Officer Todd Park speaks about how doctors, employers and hospitals in Cincinnati formed a collective to improve citizen health and the economic success of the healthcare industry.
Will the Future Need Doctors?
The following is an Ignite talk delivered at Tim O’Reilly’s 2012 Health Foo – Microsoft Research Center, Cambridge, Massachusetts.
As I see technology advancing around me, I think about what’s going to become of the physician. Where are we going to fit in? Will we become obsolete? Are we headed for a medical singularity?
The good news for me is that despite the health 2.0 movement I’m still more trusted than a social media consultant.
But this question of the doctor’s future is a serious question. Because what we once did with our eyes, hands and ears is being replaced by diagnostic widgets. Social and technological forces are conspiring to make the traditional role of the doctor irrelevant.
Every medical generation has been shaped by its technology. These are the tools that are disrupting everything we understand about a doctor’s role and defining the next generation of provider: genomics, personalized medicine/self quant, nanotechnology, robotics
Notice that we’re no longer defined by the stethoscope. And probably for good reason: the stethoscope lost its status as a critical diagnostic instrument at some point in the 20th century. This study demonstrated that some trainees aren’t exactly sure what they’re listening to. Why should they be? We’re less dependent on manual tools of physical diagnosis than in the past.
The importance of the physical exam is changing. A child presenting to an ER with abdominal pain, for example, may be imaged by CT before ever being touched by a doctor. The physical exam was critical when it was all we had. We’re becoming dependent upon accessible technology and precise forms of diagnosis.
Clay Christensen and Jason Hwang in The Innovator’s Prescription describe the landscape of medical care as evolving on a spectrum ranging from intuitive to precise. Intuitive medicine is care for conditions loosely diagnosed by symptoms and pattern recognition and treated with therapies of unclear efficacy. As the ‘art of medicine,’ intuitive medicine is dependent upon clinical judgment. Precision medicine is the delivery of care for diseases that can be precisely diagnosed and treated with predictable, evidence-based treatments.
Looking at medicine’s progression another way….In the 19th century we treated symptoms; in the 20th century we treated diseases; In the 21st century technology we will predict and prevent disease.
There’s an endemic insecurity among the 21st century doctors: we want the precision that technology brings while at once proving that we can still do it all with our hands. We want to see ourselves just as indispensable as we were 100 years ago. Intuition is a human element that keeps us most relevant.
As we extend our human abilities with new tools and creeping artificial intelligence makes its way into our workflows we’re entering a new period of posthuman medicine. This, of course, has huge implications for doctors.
It’s not just technology, but the patient that’s reshaping the physician. For a couple of hundred years you came to the doctor and they’d tell you what to do. But then came the internet, and ultimately social networks and the ability to connect. Patients can now adjust what they’re doing based on the input of others. Now information finds patients.
Information is the new 3rd party in the exam room.
The social web has created a type of disintermediation. And the physician encounter is evolving as a more narrowly defined element in an individual’s quest to understand their condition and get better.
In the end I suspect that doctors won’t be replaced but will be radically redefined. The physician of 2050 will have workflows and ways of thinking that are critical but unrecognizable to today’s physician.
But we’re not prepared. The next generation is not ready for the changes that are coming. We’re seeing digital natives appearing in medical school to be trained with analog tools and a curriculum structured for the early 20th century. We need medical education reform consistent with what is perhaps the physician’s most dramatic transformation in recent history.
Despite my technodeterministic predictions, the physician will always have a role. But I suspect that over the coming generations technology will take us further from patients. But this will create a new opportunity and a new uniquely human role for the physician of 2070. Machines may help us understand what constitutes a real human connection.
“Maybe it’s not until we experience machines that we appreciate the human…The inhuman has not only given us an appetite for the human; it’s teaching us what it is.” - Brian Christian, The Most Human Human.