New Year Resolutions: fate and implications

New year is a time when one in every two persons get motivated and incited to make a resolution. The reasons and issues behind these resolutions, their fate and implications are interesting.

A recent survey found that the top four of them are around HEALTH issues, and include:

1. Getting into better shape by losing weight
2. Eating healthy, or cutting down on diet, or starting a new diet regime
3. Being regular with exercise such as going to the gym, starting regular walks or a game
4. Stopping or reducing smoking or alcohol

The next few spots are occupied by issues related to work such as “I will work less hours”, or “return home early” or “spend more time with children”. Fairly lower down is the resolution of making more money!

It is equally interesting to note the fate of these resolutions. Around 80% are dropped or forgotten within a month by the time February comes in. Only 5% survive a year!

Despite the very short lives, and the promptness with which they find themselves dropped over the days and weeks, their apparent pointlessness however underscores an important point. We are indeed aware that we have been ignoring our health, quite cognizant of what we ought to have been doing all these days of the last year. There is also a desire to make amends and switch to a new healthy mode.

Psychologists studying the phenomenon of resolutions point out that they are usually “fragile” and made somewhat impulsively. Once broken, even by force of unavoidable circumstances, they are difficult to repair or restore, till perhaps the next new year!

Strategy, on the other hand, is less dramatic, and have a longer range. They are contemplated and set short and long-term results, such as losing 2 kilos of weight every month for 6 months. They involve goal-setting and not just focused on a particular behavior.

If you were one of those who had made a resolution 10 days ago, and feel it is cracking up, do not lose heart. Your goals remain important. Just spend a bit of time going cerebral and strategizing how to get there!

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Oral Rehydration Therapy and Dr Dilip Mahalanobis

It would be difficult to find an adult today who has not heard of Oral Rehydration Solution (ORS), or does not know that Oral Rehydration Therapy (ORT) is what we should rush to provide to save the life of someone who has started passing watery stools.

It was not so simple prior to the 1970s! Cholera epidemics came as waves and spread across the world, ravaging populations. Survival then hinged on whether one could get quick access to a hospital for intravenous saline drips. 

One of the flash points of the cholera story was when an outbreak occurred in a refugee camp near the India-Bangladesh border during the 1971 war. A young pediatrician called Dr Dilip Mahalanobis, was tasked to treat thousands of children with diarrhea in a make-shift hospital that had just 16 bed, and a very limited supply of intravenous fluid bottles!

Necessity became the mother of invention, when Dr Mahalanobis started feeding dehydrated children with an oral solution made from water, sugar and salt. He noticed that the death rate dropped from a whopping 30% to 3%!

The idea of trying oral rehydration solution in children who were pouring watery stools from the other end had seemed ridiculous then and had defied conventional logic. His   approach had its basis on laboratory experiments that had shown glucose and sodium, if given together, to help each other get absorbed via a glucose-sodium co-transporter at the intestinal cell’s brush border. It could then drag water into the body partly reversing the fatal effects of dehydration.

ORS is now a household name, and is made up of a mixture of glucose, salt (sodium chloride), and Potassium chloride in exact proportions that can be made into a solution with water. It now comes in few new avatars as well: mixed with lycine, rice powder, zinc, selenium, or in a hypo-osmolar (diluted) form.

Scientists unanimously agree that ORS has been the crowning discovery of the medical profession of the last century and has saved more lives than any other. It continues to save a million lives annually. 

Paradoxically, the scientific paper written by Dr Mahalanobis was rejected by a scientific journal when first submitted. And more disturbing is that he died last month at 87 in Kolkata unsung, without getting a Nobel or any national (Padma) award!

Two-Way Patient Doctor Relationship

Doctors are sometimes accused by disgruntled patients as being unsympathetic, brisk, rude, unprofessional, unscrupulous, money-minded and many more.

The range of behavior and attitudes of the patient sitting across the table can be equally varied in spectrum, complexity and taxing!

Indian cities offer the well-to-do patient a wide range of doctors to consult. Hence if the barriers of fees and waiting time can be overcome, most patients go on to collect a few or at times, several opinions.

An anxious young mother had brought her smiling 12-year old son for abdominal pain and had proudly said that she had consulted 18 doctors, all the very best in town, in the last fortnight alone. Not knowing how best to react I had asked in a bemused tone which of the 18 prescriptions she had tried, to which she had said that she had not followed any one!

A “second opinion” is a good thing. The situation however gets tricky when having collected several prescriptions of several doctors without telling one what the previous had advised, the patient decides by himself which of the medicines he takes from one prescription, and which from another, which medications he takes from the cardiologist’s prescription and so on, often not able to trust or put his faith on a single doctor for comprehensive continued guidance. 

Many medications can have interactions, and the patient not disclosing the true picture can sometimes land him and the doctor in trouble. 

Some patients obviously seem to suffer from an innate ability to trust, but expect the doctor to go out of his way and take deep interest in his welfare. If professional equation is sought, why then the disappointment or annoyance if the doctor refuses to share his personal number or refuses to take a call in an emergency in off-duty hours?

With the rapidly evolving transactional nature of the doctor -patient relationship, old-world values such as trust, faith and empathy are beginning to fall by the side. 

Politeness, courtesy, professionalism, and appropriate medical care are to be expected from a doctor. No excuses.  The problem arises however when one starts expecting the additional factors of “empathy”, “kindness” and “personal attention” to come on as a free add-on even if they misbehave with the care-givers, just because they have paid a bill. Patients as well as doctors belong to the human race and have their varying shares of imperfections, and any interaction will unfortunately always remain a 2-way process.

Independent India’s Healthcare @ 75 years

Three quarters of a century is a good time to pause, look back at the path we have covered so far, and look at the road ahead in this long and endless journey.

I am sure no one would argue that the nation’s health is better off now than when we gained independence. A baby born in India in 1947 could have expected on average to live for 37 years. This life expectancy figure has gone up now to 69 years, indicating that most Indians being born now are living much longer. 

While on the subject of health statistics, there are two other important indicators of progress; 146 of every 1000 infants born then used to die; that has come down to 28 now. Infant mortality rate as it is called, is an important health parameter and has shown an impressive decline. So has Maternal Mortality Rate, another important health index.

It is difficult to believe that there were just 19 medical colleges in India when we became independent. That meant very few doctors indeed. One cannot imagine how difficult access to modern health must have been at the time of independence.

India now has around 400 medical colleges, producing the much- needed medical manpower. Still short, one may argue, but a 20 times jump is laudable.

Looking beyond numbers, let us see what else have changed in the health care sector. India managed to eradicate two diseases, small pox and polio.

The profile of illnesses that claimed lives in 1947 and the ones that do now are quite different too. Most deaths then were due to infections and malnutrition. Thanks to an effective immunization program and vaccine manufacturing facilities across the country, one hardly hears of deaths due to diphtheria, whooping cough, tetanus or measles these days. 

The disease profile has changed to metabolic disorders now: diabetes, blood pressure, heart disease and cancers, largely due to consuming excess calories, exercising less and gaining weight.

Access to health care and affordability remain big challenges now. Undoubtedly, there are many miles to walk, but the glass can be seen as half empty or half full.

Happy 75^th Anniversary!

Scared of Rejection? Build your Resilience to take a NO

Are you the “sensitive” type who fear NO for an answer and shy away from approaching people or taking risks out of fear of feeling hurt? 

Do you feel too inhibited to go up and say “hello” to a person you find very attractive, fearing that you may be rudely rejected? Or fear much about asking your boss for a raise that you have been waiting quite a long time for, fearing that a negative response may deeply hurt you?

Many of us suffer from a condition called “social insecurity”. It can sometimes be so deterring and disabling as to inhibit us from approaching anyone for any favor or help.

To help such people build resilience, a Canadian entrepreneur Jason Comely has devised a technique called REJECTION THERAPY. 

It requires you to go and politely approach a person with an unusual weird, at times an outlandish request which is expected to be turned down. Examples are: asking a salesman for an unthinkable discount, thumbing a lift from a passing car, asking the bank manager for a grossly enhanced interest rate, or asking a senior doctor for his personal cell number.

The expected outcome is to hear a NO for an answer; not to get into an argument or fight, and have your way, but to merely hear a “NO” or “SORRY”. And the more you hear these it helps train yourself to accept rejection without anger or sadness or embarrassment. 

For most people who suffer from this disorder, the fear can be traced down to an early initial experience of rejection that has left a deep scar in our psyche. It might have been a feeling of isolation by classmates  or a teacher that one experienced in school, or by members in a family get-together or by a perhaps by a member of the opposite sex at a social gathering.

“Rejection therapy challenge” as it is called, encourages you to seek and receive a “NO” every day, and train yourself to accept it without hurt or emotions.

A website http://www.rejectiontherapy.com could help you to understand and overcome anxiety of rejection, make your sensitive skin a bit thicker, and develop a balanced personality to get along more easily in the world.

How long do you wish to live?

The average life expectancy of Indians has climbed steadily over the decades to 69 years, as announced last week. To put it in plain terms, a baby born in India today may expect to live for around 70 years of age.

This figure is impressive in several ways: for one, it has doubled from what it was at the time of our independence. We need to keep in mind that the major contributor has been the reduced number of deaths in infancy and childhood, thanks to the effective infant-childhood national immunization programs, and the control of infections such as cholera and diarrheal diseases.

If we look around, we realize that there is much ground still to cover. Most developed industrial nations have their life expectancy figures upward of eighties. In France, for example, the average life expectancy is 85 for women and 79 for men. And the figures are steadily rising.

The longest living person in the world today is 118-year-old French nun Sister Andre. She recently beat the 119-year-old record of the Japanese woman Kane Tanaka, who died in April 2022.

The French and the Japanese attribute their high life expectancies to healthy eating, regular exercise and avoidance of bad habits such as smoking. The French, in addition, feel a daily glass of red wine contributes to their health and wellbeing.

Ironically, Sister Andre who recently lost her sight but is mentally alert, when asked what she wanted most at this stage of her life, said without any hesitation that she just wanted to die!

That brings us to the question: what do we value more: length of life or good QOL (quality of life) as long as we live?

There is no doubt that as people live longer, they try to keep themselves more fit too. For instance, sixty years, long considered the age at which one not just retired but receded into old age in a bed or an arm chair, is now considered the time when one begins the next phase of life, occupation or activity.

While extension of life expectancy is worth the medical efforts, attention also need to focus on how best to add purpose, enjoyment and productivity to the last phase. Mere prolongation of life in a bedridden demented state to achieve high numbers may not always be an attractive option as Sister Andre just mentioned.

Bullying: Could Bystanders Help

It is difficult to believe that bullying has ceased to exist at workplace or educational institutions.

Recent studies from across the globe have revealed that 60 to 80% of interviewed people admitted witnessing bullying in their organizations. When administrators or teachers vehemently deny the existence of this menace in their institutions, it is often the “Ostrich phenomenon” wherein it does not seem to happen because we choose to keep our eyes shut and not see it.

Bullying occurs when a student or employee is subjected to repeated negative behaviors that harass, exclude, humiliate or frighten him, and may range from physical violence to the subtle mocking, ridiculing, excluding or ostracizing conducts. It can seriously impact the victim’s health – physical or mental, and can sometimes lead to harm or suicide.

Up until now, the conventional approach to tackling bullying has been to formulate strict rules, try and catch the bully, and punish him. This requires someone to stick his neck out and report, risking retaliation and vengeance. Further, what this approach does is merely push bullying underground and changing the format to psycho-social than physical forms.

Recent research is shifting the focus to the role of bystanders in controlling the practice. There are 2 broad types, each with 2 subtypes:

1. Constructive:
   1.  The Active Constructive bystanders actively discourage or confront the bully or report him or her to the authorities. If they are in significant numbers, bullies tend to become the minorities, and often change their behavior.
   2. The Passive Constructive ones may not directly take on the bully, but empathize and support the victim, mitigating some of the trauma caused.
2. Destructive:
   1. The Active Destructive type encourages the bully, often joining him in the act. This is how “bully groups” are formed and expand in size, each one member venting his bullying instinct on the victim.
   2. The Passive Destructive ones, who often watch but do nothing, often finding the whole episode amusing, thus encouraging the bully.

Bullying is a psycho-social disease, and its control requires much more than strict rules and action. Sensitizing and converting workers or students to play constructive anti-bullying roles could be the workplace environment changer.

Are you a Devoted People-Pleaser?

It is nice to please people.  It brings in quick benefits such as earning you friends, making you popular in your office, locality or class, and being called helpful and dependable.

But what if you your people-pleasing behavior comes at a cost of your personal wellbeing?  If neighbors or colleagues start depending on the “ever helpful” you to help with their chores and tasks, take them out for shopping, bring their kids home from school or fix their vehicles…..and you find you are hardly able to live your own life?

Psychologists call this excessive indulgence in “People Pleasing” as SOCIOTROPY, and flag it as one of the personality traits that can have harmful consequences. Sociotropes suffer from a desperate need for social acceptance, and they do that by going out of their way to be nice and pleasing to others.

People-pleasers are often so worried about hurting others, that they are unable to take a clear hard stand at variance from what others around are saying; be it personal values or politics, they come across as “too flexible” to the extent they would say what they feel others want to hear.

The long-term consequences of People Pleasing Behavior are concerning. He suffers from social anxiety (did I hurt anyone?) and is more prone to depression. On the personal front, members of the family are often disappointed and hurt that he would attend an inconsequential party of a colleague even on his wife’s birthday (personal priorities go tops turvy).

Women are more often affected by this disorder. In several cultures, girls are raised to be accommodative and pleasing, especially towards her in-laws after marriage. They are sometimes exploited, while being praised, to shoulder all the household work and chores, setting aside any personal goals they might have nurtured.

Steps to reset priorities need to start with introspection, followed by defining one’s own personal space, boundaries and goals. And most importantly, to learn how not to say “yes” every time one desperately wanted to say NO.

It is not always selfish to put your priorities first. Safety instructions in the aircraft before every flight reminds us “Put on your own oxygen mask first, before helping others!”

Humanising Medicine

Despite significant recent advances in medical science and technology that have spiked human life-expectancy and provided a handle to control several diseases, Modern Medicine has paradoxically come under much pelting from several quarters for becoming impersonal, cold, commercial and “dehumanized”.

Most doctors agree that this charge has come to stick. And while they remain the interface with ailing and dying patients and their relatives, they have become the target of unspoken suspicion or voiced accusation for partnering with profit-makers such as the health care, pharmaceutical or device making industries.

Not unexpectedly, perspectives differ widely. For instance, “Profit” is the wonder word that forms the core value of corporates and industries. But when it comes to medical care, the word “profit” makes relatives of a patient of terminal cancer cringe!

Realizing that “trust” underpins the core foundation of any successful patient-doctor relationship, a group of doctors, psychologists and sociologists led by a diabetologist Dr Beena Bansal, are attempting to reset the balance.

“Humanising Medicine” is the name they have given to their movement. As an initial step to inject and restore “human” values back to the medical profession, they are organizing their first meeting on March 5 and 6, 2022. Visit https://HumanisingMedicine.com for details.

The topics slated for discussion includes a wide range from “How to Break Bad News”, enhancing “empathy” in our interactions, new techniques to help patients and relatives navigate difficult decisions like choosing one treatment over another, restoring focus on “quality of life” rather than using the latest technology just because it is the new fanciful chip on the therapeutic shelf, and so on.

Another crucial aspect is to listen to the voice of patients and relatives those who have found themselves on the receiving end. This platform is encouraging them to join in. In fact, it is for them to share their experience and perspectives, and shed light on which way modern medicine ought to travel.

The aim and perspective of this forthcoming event is different from the usual “jargonized” medical conferences that doctors love to attend. It could well hold a mirror and make many doctors re-orient their future paths and destinations, as they remind themselves to re-invest human values in the most challenging human profession that they have committed themselves to!

Time makes all the Difference in an Emergency

The relatively high proportion of people who suffer and emergency and do not make it alive is well related to the significant delay in appropriate treatment reaching them. Some of the common situations are:

1. Chest pain, heart attacks, cardiac arrhythmias
2. Stroke
3. Accidents, especially involving the head or neck, or when there is associated bleeding.
4. Severe Allergies; especially with breathlessness, often called anaphylaxis
5. Seizures, fits, coma
6. Difficulty in breathing
7. Bleeding from intestines or a perforation.

Others such as appendicitis, gallbladder pain, pneumonia, sepsis or cancers are of course important, but a few extra minutes may not make so much difference in the immediate outcome unlike the seven listed above.

During an unexpected emergency last week when I had a close brush with death, one of the main reasons behind my survival was TIME. Paying attention and doing things ON Time may make a lot of difference should you have an emergency.

1. Save the EMERGENCY numbers on your cell phone: Hospital emergency ( at least 2), Ambulance services, Doctor (your personal one), a critical care expert, apart of course that of the police and fire services.
2. Share these numbers with each member of the household as well as neighbors…don’t keep them to yourselves alone.

When I suddenly lost consciousness due to a cardiac arrest, each second could matter. As I was not in a position to call anyone (was unconscious), my wife had the presence of mind to call 3 numbers…that ensured.

It might well be possible or necessary for others to call on your behalf.

• Keep the home address save on your smart phone, preferably with a location indicator on Google map. It makes it much easier for the ambulance to reach home than trying to give verbal instructions all the way.
• Keep money at home, in case you do not use credit cards
• Informing relatives and explaining things to them should wait till the above emergency issues have been lined up.
• Try not to bargain with doctors when they are trying to save your life. I have seen some people wanting to have a detailed discussion and seek endorsement of distant relatives, when each second could matter
• Make sure that you have an ADEQUATE Health Insurance policy, preferably a cashless one. Make sure you declare all your health issues when you take your policy…don’t hide facts like diabetes, hypertension so that they do not become reasons for rejection.

Do these today please, and do not postpone till tomorrow, as you never quite know when it could become necessary.