SAVE OUR SAVIOURS (Session 5) - How to Prevent Attacks on Hospitals, Doctors, and Staff

It's live, sir. Got it. Okay. Welcome everyone. People in India this evening we are honored to have great personalities from Indian healthcare system. Especially in the Telugu states. Dr. Gurwari Digaru from Sunshine Hospitals. Dr. Hariprasad Garu from Apollo Hospitals. Dr. Ramesh Babu Garu from Ayush Hospitals. And also shortly Dr. Satyaprasad Garu from Bhimavaram who is a pulmonologist and Nagastar Charanjivikar is very close friend. He's going to join and also as a special guest as a person with Social Awareness Dr. Mr. R.P. bhatnai Garu, our famous music director. He's also going to join because he's very much interested in social topics and how to help people without wasting time. Let's jump into the topic. Our topic is Save the saviors. How to prevent violence against doctors, the medical community, the hospitals who have been helping. Especially Covid time though doctors. Three and a four months back San Diego, California I practice internal medicine and I'm also a stress management consultant. So three to four months back Nakoka phone call. Then I started zoom calls. I started doing zoom calls every day morning like 6am for me, 6:30pm for Indian time. So that people can learn about COVID Of course Indian doctors are helping but we needed all help. So I want to do something too. So e process. I encountered. Attacks community 57 questions. So. So let me answer them. Actually I did interview with him and answered all those questions and try to calm the situation. Now then I realized it is not just one isolated incident the whole India There are so many things that are happening again against doctors, against medical communities. And I know personally many of the doctors, my classmates how much dedication that they work with. For the mistake of the few. We should not judge the whole point. So Danti save the CVS program. And I'm very thrilled to be able to speak with various personalities over the past two to three months. And today now I'm going to hand over the mic to our eminent personalities and Doctors here. Welcome Dr. Sathipra Sadiari. Thank you for joining us.

Thank you. Thank you.

And the main question is. Sir, I will ask the first question to Dr. Haripra Sadhguru. But anyone can interrupt and join and is the conversation. You know. So sir, maybe me experience. You have so much experience. You know, you have taken the emergency department in Apollo and as an administrator of Apollo you have taken to the great heights and you every day you see so many things as a physician, as an administrator. So give me your perspective. Sir, what do you think about this whole situation about violence against doctors and medical communities?

I'll start with the story which would probably set the perspective. Right. I used to play cricket and was a Ranji trophy player and was an opening batsman. So thank you for giving me an opportunity because often the openers set the tone for the rest of the innings for the team. So probably I'll set the tone for the rest of the innings for this discussion. I'll tell you the story of an 80 year old gentleman who came to the emergency in a collapsed state. And very soon they diagnosed that he had a dissection of the iota and was sinking rapidly. So the family was counseled, the costs were explained, everything was done and informed consent was taken. And within hours he was in the operating theater. Some 15, 16 bottles of blood were administered, everything was done, he was operated. But on the fourth day he died of acute renal failure. Now each day the patient was being family was being counseled and was being told about the patient's condition, was being told about the cost, was being told about everything. But once the patient was expired and the family was told about it, some outsiders gathered in and said the bill was about 2 and a half, 3 lakhs. I guess they killed the patient, they operated and killed the patient and stuff like that and started creating a big hue and cry. And the funny thing was within seconds the entire media was there and it became a big huge pressure thing. And ultimately when the family was asked, they said, yes sir, you did everything, you informed everything to us. These people have come in and they said this. So the ultimate goal was just to not pay the bill. That was the ultimate goal of doing the whole tamasha. And I think there is a lot.

Of.

Contribution of multiple stakeholders in the current situation. They're not really the old respect and trust that they had on the medical professionals has disappeared. And I think it's because of multiple factors. One is, I think just what the media is carrying around now. Just you talked about the pandemic and you know, the services that were rendered by the medical professionals during the pandemic. They risked their own lives. More than 2,000 doctors lost their lives during the pandemic. But I know of at least a couple of channels who ran continuous stories on the negative side about the medical professionals in the pandemic and created mistrust amongst the medical, amongst the public. And then we have the famous movies which are even quoted now about how doctors can behave and how hospitals can behave. And then this whole environment of mistrust which has been created, has actually been responsible for many of these attacks. And second thing is there is a interest, some sort of a malified interest which is there in which you can actually, when you do a root cause for any of these incidents happening anywhere in the country, there will be a root cause. It could be either a commercial root cause, it could be a political root cause, it could be a, you know, just a gimmick root cause, whatever. There is a root cause for it. And ultimately when you do the complete analysis, you would understand that it is an environment that's been created around the medical professionals and the medical profession which is responsible for the current status. Some of the most experienced doctors on the panel and I think they would be able to elaborate more on this.

Okay, that's amazing. So one thing here because you mentioned about looks like you're suggesting that there is some amount of some kind of organized crime that is part of this, at least in certain situations. I mean we can't say like every situation is like that. Some situations where, you know, like the old guy with the aortic dissection, 100%, 100 people, 100 attacks he organized mob attack type V ANTA percent 10%, 20%, 30%. What is. Anyone can answer this but you know.

What'S your take on now Opinion? See, there's a. Sometimes an emotional outburst which can result in an incident like this. And that emotional outburst is genuine and probably would account for about 10 to 15% of the entire attacks. But the remaining 85% are with modified intentions. And I have no doubt in my mind about that.

Thank you, sir. Gurvalgaru, would you be able to say anything about it? About the mob attacks?

Your experience?

Can you hear me?

Yeah, yeah, I can hear, sir.

Yeah, of course. I worked in Apollo. Now I got their own hospital. More or the less the situation is same and what happened is over the last 20 years the trust between the doctor and the patients eroded. What are the. What are the reasons? We don't know. In fact, when I was coming back from England, that is 20 years back, I met one cardiologist friend and he said, don't come back. Because the beauty of Indian practice so far is the blind trust of the patient on the doctor. Because of the technical inadequacies or whatever is that patient. They never even ask the cause of the death. But those are gone now, the mistakes. Half of the blame should go on to the doctors for being not transparent. Whatever is it now the patients abated by the media and became a deadly combination. WhatsApp media. But media before going live they won't ask the doctor or the hospital what exactly is the reason. That is unfortunately a bad story sells 100 times better than a good story. So that's what and Hari J. 70% of the incidents are slowly boiled up. They start doing that and troublemaker he will say that no, I'll take care of these people and precedents are there. I don't need to know the names. Organized people to create havoc. No doubt about that. Real relatives, real patient, same problem. Politicians, local mla, local gondasu. These people become arbitrates. That is a sad story of evidence. Harija, been absolutely correct. 70% now this are very much organized. Organized crime, but organized. Yeah.

Wow.

Wow. I mean, you know, the most important thing is today to have you people who are the top administrators, you know, for some of the biggest hospitals and with so much experience to talk about it. Because you know, someone who is just working as a doctor may not be able to see, you know, the entire spectrum and your experience and as not only as a physician, as the administrator is going to be very helpful. Five, six sessions, four or five sessions. Different people made different points. But this is definitely mob attack. 70 to 80% outstanding point and tape.

Ramesh will answer this. The peripheral the hospital is the smaller the hospital is the more vulnerable for the attacks. In fact, Apollo should be the most secure hospital from that point of view. Because if it's a massive size Ramesh, I'm sure you would agree Vijayawadala much more.

Good evening all the panel members for answering Dr. Guravaradi's question. The smaller the hospital, the risk is more. I do accept it. But at the same time it is a multifactorial to say it is purely due to organized or planned attacks may or may not be correct. In my view there are different aspects of why this is attacks are being happening. And for majority of the problems in the society, if you look at it, the economics makes a very big difference. Especially in small and mid sized towns. And as I heard to people who spoke in the same save the savior's program. I do accept one aspect of it. The system of family physician where they have a trust. Once the patient is very serious, only then only they go to a tertiary care hospital where the expectation is there even the doctor will be intermediary between us and the patient family. So the risk is less in that system. Apart from that certain things are very critical intriguing for us to explain the mortality. Let us say when you take a very serious case and if you Explain them. There will be risk of 5% death for this patient. The patient can be 95% or 5% that risk explanation. Majority of the ordinary people they are not able to perceive. Even if a coronary bypass in the best centers it gives a mortality of almost 1 or 2%. But for that one person, this is that family, it is 100%. So when you are explaining this, let us say one family. If you say one person mortality and if you are telling 2%, we should explain them, it is almost double the mortality. That explanation may be every hospital to make it much more clearer. And another funny thing is for any sort of problem in the community, we have a civil problem. Let us say a dispute in this land or something. We go to judges. But unfortunately, in our country the people are becoming judges. If a doctor or hospital is not good, they can as well represent the judiciary. They can take the help of judiciary. That's not happening. That is another thing. Everybody becomes a judge. And for judging us, Internet is it gives a partial information. I am a cardiac anesthesiologist. I do not know almost anything in ophthalmology. So when I am not knowing the things as a doctor for about the other branches. How a common man can perceive how the treatment is given what is happening, he cannot judge properly. Because of misjudgment. Based on their inadequate Internet experience, they are attacking doctors. Then another thing is there is a misconception in the people. If you spend more, he has to survive. Suppose I spend 5 lakhs, he has to survive. If I spend 10 lakhs, he has to survive. Medicine is not a concrete science. There can be events where you cannot save the patient. And we all know once the patient comes into inspection infection then you give a empirical treatment of an antibiotic. If it strikes, the patient will be cured. If it won't strike before we get the culture reports and all patient may patient may die. These intricacies the patient side are not understanding. That is one major problem. Another problem is this country out of pocket money. What they are spending is the root cause of all these problems. That's what I personally see at it. Because we never even governments never teach them. For marriage, we save money. For education, we save money. For health, we never save money. The culture of insuring ourselves, saving some money for saving us in case of disease, that habit is not there in the people. That is, these are the factors which are there, which are troubling us in medical practice. From the patient point of view, coming to government point of view. What I feel is what we are spending on health is minuscule. Less than 1 GDP. Spending for this type of country is ghastly inadequate. There are countries where we are spending 7% or maybe 13%. Also there are some countries that spending of government has not increased over the years. That is another very big problem we are all facing. Then we should make. We should be as a country of this where we are trying to put some something on the planet Mars. We are not able to make our own equipment. When you are not creating our own equipment where there is no import substitute, naturally cost is more. So when the cost is more, it has to be transferred to the patients. Definitely these are the factors which government has to look into it and government from their side, it is better they incentivize somebody who ensures themselves that incentive should be very good. So that people ensure in case of crisis, in case of disease, they can protect themselves. If the economic burden is not there. Emotional burden of the family, the loss of the family member can be handled better if there is no economic problem with that. And another thing is when we were younger, in my childhood days, the MBBS doctor used to sit with one microscope, one stethoscope. What was he spending? He's not spending anything. There is possibility of him to be immensely good to the community around. But once this has become corporatized and this has become a place where you need to invest huge money. We have to do it in a proper way in that we are helpless. Unless you do some give good equipment, do good things. We are not getting any relief. And the people expectations are very high nowadays in Vijayawada now we are giving monoclonal antibodies like cocktail. What the past president, Mr. Trump got few months back in America. Can all of us afford all these things in this country? So that means the best of the possible medicine is available at least in big cities in India. But the economy has not grown up so much to accommodate these type of advances. That is creating loss of lot of restlessness. People, they know what is the best, but they cannot afford it. That inefficiency or deficiencies of them is manifesting. On the hospitals coming to hospitals are we, are we practicing very well? In any profession there may be five, 10 people who are, who are making money out of it, who are doing in a commercial way that that should be accepted by everybody. If you are running the hospital properly, if you have a proper counseling mechanism where you definitely record everything, your documents are good, it's a national accredited hospital, your proper systems in place, you'll be in a place to explain Them properly. What is happening? You have evidence there to show them what exactly you did so. Larger establishments having accreditation and all are not facing these type of problems. Smaller establishments wherein they are not having good equipment. All these things they are facing problems. And from our side from doctors. If your setup is not adequate to take up tertiary care and serious cases we should be honest to tell them we cannot take this case. That honesty was not there. That is also another problem from our side. Whenever I meet lot of bureaucrats, they question me. Only one thing. We never like to punish any doctor sir. But show me few incidents where you doctors yourself punished some of your doctors for not treating well. That type of introspection or a mechanism wherein you correct your doctors is not existing. That is why people are not feeling that there is no correcting system. That is another thing from our side. We may have to correct from our side. Then another thing. This question I am asking Dr. Kiran. Kiran. To my knowledge a lot of my friends are there practicing us. Except very few. There are very few hospital run by individuals. They are run by non not for profit organizations. By charitable trust societies. Unlike what we do in India where the possibility of people blaming us because we own the medical shop. We sell so many things. So is it creating some mistrust in the people that also we have to have introspection? For that I need a specific concept from Dr. Kiran. Is it? Is it the problem you are not having very huge hospitals run by people for profit in America. Is it another thing which we need to look at it in Indian perspective. These are my views. It is a multifactorial. It is not a single thing which is causing all these problems. It should be look from Indian Medical Association. It should be seen how we can do better from hospital side. Government also should think how best we can handle this. These are the things which are there in my mind for other opinion. Others are invited for this. Thank you.

Sure sir. Thank you. You have very nicely outlined many things. From government side, from doctor side and from patient side. What are different things? But before we proceed further, I want to say that Mr. R.P. patnai Garu, our famous music director has joined us also. Not as a music director today but as a person with social awareness wants to say a few words about this situation. So thank you sir for joining. I know you said you had a movie shooting and all that. So thank you for joining us. And of course everyone here is very busy with their schedules. Thanks everyone for joining us. I will answer sir. But I want to give everyone an opportunity. And then I'm going to speak about some other things from America also. Ramesh Bab Guru Chepindi yes. He organized attacks Jarut Nai Khani Chala Varku the economic disparity, same medication capacity. There are things here, you know like a mob attacks and heavy hospital suit at the hospital. We'll dive deeper into those problems because I really want to get to the root cause and there are no better people in this room than you guys actually to help understand everyone because there are lacks of people watching this probably and lacks of people will be watching also because we'll put it on YouTube and promote also.

Doctor. Emergency cases iccu. Emergency medicine PC level.

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Until.

Patient.

655K pregnant lady.

Rally. Within 15 minutes. Saramana na shala institute.

Peli golden.

Yeah. Money extraction.

Family physician. Family physicians. Patient serious condition. Me.

Medical staff.

40 liters per minute. Occupation what is serious counter. My hospital Gatala is a insurance. Insurance claim.

Insurance, the like but it is. Emergency department. They have to be treated, They just have to bear it. That is how it is. Homeless taxpayers essentially so someone is paying for it ultimately. But the good thing is they have to be taken care of. There is no doubt about it, you know that that thing. And then I'm going to go to RP Patnai garu Dr. Hariprasadgaru root cause analysis initial so we have gone a full circle and listened to everyone. Mob attacks yes Organized crime Laga Kanta Percentage majority percentage percentage different people on Kunai but Adokot individual Dr. Sachiprasad. Economic, you know strain so even root cause analysis of course you are like experienced emergency medicine and area Salman India and you see so much in Polo. So what is your root cause like? Give me few factors that you think yes, for 30 years back.

It is multifactorial and reason it is multifactorial and a factor they enumerated. They have a commercial and economic Ghanaian organized Ghanaian like trust Lake Potangani Indie like with expectations. It is multifactorial, right? More important, the end of the whole thing is trust in the healthcare professionals and the healthcare profession. That is the most important thing.

Yeah.

Hospitals, doctors. It has to be again a multifactorial approach. Government, media, all communication modes. Hospitals, doctors who communities who people who create. I mean who create a sort of an impression on the community. We will not get back the trust in the medical profession. Who is the loser? And I can very surely say that the loser is ultimately the patient and the community. The defensive medicine approach Start nd Yeah, Investigations equini More number of people are being employed to manage this problem. More number of people, more techniques, technology is being taken up by the hospitals. So ultimately the patient who is suffering the most in the community, who is suffering the most. So in interest of the community, in the interest of the patient and obviously in the interest of the healthcare profession as a whole, I think everybody needs to put their hand together. There can't be. And there are black sheep in every profession.

Yeah.

There is an inner face. There is a criminal case which you can file. There is a civil case you can file. There is a consumer case you can file. But today it has become a trial by the media and trial by the people themselves. So environment. It is not possible for one individual or a group of individuals to do it. It has to be everybody involved in it. And unless it is done, the community will suffer. Individuals will suffer.

Absolutely.

Well said. You know, I want to say something remarkable in what you said and what everyone has said. Five sessions and different people across the country have participated. From Ames in Indigeni, Mumbai Leilabaith in Indigeni different people. The common points that everyone coming down to after discussion is the same thing in a day. Building trust. Important next value for money. Communication, managing expectations.

Right.

And accreditation overburdened doctors, other barriers. But the point is it is the same factors. Everyone knows it. Everyone knows it. Then why are we not able to fix it? Or what needs to be done to get to the point. And of course you all have to forgive me. I am not practicing in India, I'm practicing here. But I grew up in India, you know, at least under affinity my medical college. I know, but. I know things have changed since I left. But my friends.

So.

Loss of trust is the biggest problem. But why is it? Why is this loss of trust? Corporate hospitals. Doctor x rays labs chase cd scan jc.

So.

Doctors explain. Next.

So.

Especially investigations defensive medicine. So anyone Dr. Gurva, Redigaru or.

Yeah, trust. Let me take the blame the doctors. Number one, the lack of communication. Number two, lack of transparency. Number three, with all the apologies to the younger generation. The haste to become something. They want to earn the pig money. Then they start doing these things. They think that patient. Still good doctors. Are there still good systems Are there still good doctors are respected. I'm telling you with hand on my heart in Apollo 5 years, never one day either Sangeeta or Hari came to be and asked me to write an unnecessary investigation. Yeah, the same thing with my hospital. No doubt there is one black sheep in 100 Atlan I'm sure Ramesh also will agree.

Will agree.

There are good doctors even now. But trust to put on a carnival the black sheep. I heard some of the ghastly stories. But there must be otherwise why would it come? Investigations chart low right side. Normal value no doubt. Number two, social media. Number three media. We know Chesry so there is no way we can not we can escape from the blame. Doctors are the root cause for losing the trust. Number one. Number two, media. Media is the worst culprit. Culprit.

Yeah, yeah, yeah, yeah. I have seen sir, I have seen some of things in different interviews.

The doctor's life or hospital life in India is the loneliest life. People number media number Government number easiest scapegoat out of the hospital.

Yeah.

Government matter tweet Just so everybody has got access to the politicians and politicians. So same thing. Absolutely same thing. Defensive practice. For example take Vijay because Ramesh is here practice Hyderabad complex intervention. Beyond our capacity go to the higher hospital. So they move to Hyderabad. Patient they have to travel all over. And again the same result. So same thing. Other type 2 cities. Everything is extended to the higher centers. So people are the losers. People are the losers and that's it. And media. Gamma Balaji is the ipa. That's all. Patient do not have the wherewithal either intellectual or emotional. To separate boys from men or to separate a bad doctor from a good doctor very difficult. Even me. So that's what it is. Patient.

Sir. Next Meer Chappal sir. So what you have been now listening to everyone what is saying. So please share your perspective.

Yeah. I would like to thank Gura, Ridgar first and Gandhi for treating me from a severe Covid. I was in the first wave victim Armata and he. He took personal care for me and he got me back to my life. And this is the platform. I would like to thank him and I know how much how much care he has taken to get me back to life.

It feels really good.

We, I mean look forward for compliments and compliments are becoming fewer.

It feels really good to hear that sir. Somehow Guru Redyaru has been a family to me. And also frankly speaking for many cases I referred, he took personally and he wanted to care of the developments and all out of the way. But one thing I'd like to say because I am my family is sunshine family. That's why I'd like to start with him first. And I like to be a listener than telling something. But as a other side of the coin I'd like to get to your notice. So that it will be of help for you to understand the perspective of the patients. Not feeling an end, sir. Whatever the anger or force. Apart from Rameshwar some gangs are working. There could be but a momentary patients. A momentary reaction. The lack of finances, lack of knowledge. Complete knowledge. But first problem second opinion medicine platforms. Let's try for a second opinion. Second opinion and a point. Second opinion and a point to start. A second opinion and a point. There are so many things we can start from there. Second opinion. Even corporate side Doctor side Corporate side.

It's a seed, sir.

First of all. It's social media and the Google which is misguiding people like anything. Google has ruined our lives.

Testimony also.

Doctors. They need to understand these things. Patients. I found many of the hospitals. Please excuse me sir. Patient's perspective. Families are suffering a lot, sir. While they are paying the bills. Insurance, Mandatory insurance. They'll be insured Insurance unexpected thing time low hospitals. Insurance no cash. Is admission insurance Hospital patients. Complaint Laga Kadgani. Vishal tele. In fact Nasinger Okayana Chalakalon treatment. They tried their best to save him but he could not survive. But Guru Reddy Garu he made it a point. He's getting all the discounts possible from his side in lakhs. Because he knows the other side of the coin. Gavati patience side. I know how it happens there in sunshine. But there are few hospitals where I found all these complaints. And also. And yeah main. Main end. More than the patient. The family suffered a lot because of unexpected burden financially on the families. They are in depths now because of the hospital bills. Alani hospital bills exorbitant. It was an unexpected thing that came into everyone's life and which was never planned by any of the families. What subsequently ended up as a pandemic in the family itself. I requested many of the hospitals to consider the families than the patient to partu families are considered jnd they are getting onto roads because of the bills that that they are paying any. And I'm not trying to blame any hospitals or I'm not trying to blame any doctors. Because doctors have really worked very hard risking their life to save as many people as possible. At the same time the families also have suffered a lot because of the unplanned financial burden. I wanted to give a light. I just told. Pardon me if I am any wrong.

You don't need to be apologetic. Okay? Patient's perspective. There are a lot of things which we have to do that and there is no need for you to be Apologetic.

Thank you sir. Thank you sir. I think you brought a very important point. I want to say something quickly. Dr. Hariprasad, some other appointment on this. So you may have to leave. But sir, before you leave I want to thank you very much for joining this and any last words that you have to say or response to Dr. Mr. Patnai Garu or anything else that you want to say on your mind. Because this, this problem is not going to solve in one session. We all know that. But we are starting, we are doing something, you know, we'll have future sessions also. But any last words you have before you go.

In. Patnaigar doesn't have to be apologetic. Because as doctors, as medical professionals we should be receptive to feedback. We learn, we understand and we correct ourselves if there are some mistakes. And definitely the pandemic has started. A lot of things, it's not just about the medicine and this thing. A lot of social things also. Pandemic. There was a huge, especially second wave law, huge burden on the healthcare infrastructure. I lost my father despite being at the best hospitals. I lost my own father despite getting everything. And I remember Guru Aridiger also called me for a patient somewhere in Calcutta for a bed and stuff like that. So there's a huge, huge burden on the infrastructure. And the entire medical profession worked under that stress. Lot of patients got stuck with the long term pandemic ventilator, non invasive ventilation, regular ventilator. So they were there for months together and bills went into lakhs. And it was definite burden even for a rich person. The bills were huge.

But what to do?

The patients want us to continue the treatment. Patient want us to want the patient. I mean the agendas want their patient to get the best treatment. And we cannot discontinue treatment. And I can vouch that almost 40 to 30% of our patients we actually discounted before discharging. Because the burden was just too much on the patients during the COVID So Patnaikar Jaipind, absolutely right. And we do understand the social responsibility. And I think we also have that responsibility to respond to the community when it requires us the most. Thank you so much. I have another session so I request all the elders to please excuse me and pardon me for leaving early.

Thank you. Hari, it's great to see you.

Thank you.

Thank you for every minute.

So.

So the point, we all know the problem. Actually all are very good doctors. Every single person that I have spoken so far, whether it is a friend of mine or someone on this platform. They all agree to what Patnai Garu said and what we have discussed so far and all that yet how come there is no unified platform to make all this thing happen?

Unified platform. Okay. Professional law doctor okay. So first doctors law are professional ethics who are criticizing or commenting somebody as a tagal first doctor himself insights. Oh boy. So first actor. I agree trust is the root cause for the lack of trust. But there is another thing which you have to understand. Complex standing only bypass surgery only emergency bypass Multiple modalities of treatment Multiple modalities of treatment Multiple thoughts, multiple perspectives Triple vessel disease, cardiology it is tentable. Cardiac surgery is so patient is confused so copy multiple ways to treat. Now that's what it is. Property second opinion is not exclusively because of lack of trust because of the multiple high tech alternative treatments available. So that's why second open even. But you are right. Even 80 year old repeated myocardial infection. So that's why the second opinion should not be blamed as such.

Dr. Kiran, I have a little partial solutions for the problem. Let us start from how we we are going to correct this. In my opinion there are two things from our doctor community we have to address. One is I am the vice president of the hospital association of ap. Now when a particular disease is being treated when government of AP asked me how much you are spending on a Covid case or some other cases. Now government of AP is trying to enhance the prices of below party line white card people's prices, major hospital cost accounting. This is what I am spending on every case this has to be spent. If you want a good treatment, this is a need you have to do this much energy. That is the weakness. First we should start working on it. Treatment with efficiency, with scientific proof. That is one point. Second one is hospitals are not transparent no how much they are spending. If the balance sheet can be given to somebody, this is what I am spending. When we are spending that much, how can anybody ask you to do it? Free. Cost accounting proper. Definitely government will respond. Second point in it is there is no categorization of hospital. Sunday poor man cannot go to five star hotel. There are national accredited hospital, there is non accredited hospital. There are small hospitals, one family run hospitals. This is in the top 10 of the hospitals. All the accreditations are there Giant commission accreditation on the hospital. Facilities. There are people. Because the investments are different. The type 1, type 2, type 3 cities, the way we procure properties, the way we structure. Nobody is realizing in the public every mission including guravaridi or somebody's machines including my hospital. Almost all the equipment is imported and $1 40 rupees 75 rupees. Every. Every equipment has to be imported. Every equipment has to be imported. 75 rupees. Why are not we not able to get a import Substitutes from the government of India. Catheters Manantu Jayla, Patno Manchi Giants Manantujas Kolapatno Mana treatment. Is it not shame for all of us. We are trying to put it on Mars. Almost placed. Unfortunately when you can reach Mars with your technology common man. You search across the country all major corporate hospitals. 80% of the equipment is imported. That is forcing us to charge more. That is the culprit. And everybody should know be prepared. The hospital has categorized like this. If you want the best treatment with all the accreditations you need to spend that should be driven to people. All hospitals are not same. All cities are not same. Our type of categorization by quality or the place where you practice owner marketing. If you can clearly demonstrate this is what we are incurring Our hospital we have given four shifts. Usually you know every hospital has only three shifts. Me doctors. We have made four shifts. Four shifts and 25% expenditure. Very queen.

Yeah.

Who will get it? Throughout the Narsiki we paid three times what we are paying. Because their life is at risk. That how people realize that we are spending more. Why we are charging more than evidence. There is a possibility that community can misunderstand it. Transparency lab. These are the mandatory expenditure we are incurring on treating patient properly. Definitely doctor Community responsibility only Government Nichigani associations accreditation of hospitals Categorization like type A, type B type CD hospital Sonayante complex people. Maybe these are my views. Maybe Prasad Gargani they can open on this.

I fully agree Ramesh. There is a no doubt cost accounting specialty hospitals association. Because the infrastructure. 150 crores in the hospital. 100 bed hospital real estate. Now rentals of monthly 2.5 crores. Electricity itself costs around 70 to 80 lakhs per month. Electricity. So even overhead. So actually if you take a cause a patient morning admitter 24 hours. The total infrastructure cost estimate 1 lakh 50,000.

Wow.

1 lakh 50,000. Because rentals, nurses, human resources, electricity Everything without consumables. But who will understand this by a patient day? I don't care. The second issue is Ramesh Chapra to the government. With all due respect we all want to treat poor. But we are not running a charity hospital. I have a banker who will sit there and every month okay. Crores of rupees credit Organizations in the government sectors in Jarag. So we are acknowledging some cash flow. So I think government has to take a law like Ramesh said. Any below poverty lane or any patients who expect subsidies from the hospitals they should go to type B or type C hospitals. They should not be given admission to the type A hospitals. No Type B, K. Type C. K. Government will try to support you on a type of matter. Government cannot and should not allow the people. Because government facilities are as good as private hospitals in so many places. But private hospital government. So these are all. Government should educate how good the government hospitals are. And government should regulate the people not to go to private hospitals. Number three most important is insurance. Insurance. You cannot put the car on the road. Why don't you do it for the human being?

Well said.

No, that's what I'm saying. And the moment a child goes to school, elementary school, he should be insured full stop. Number two. At a different gateway of every gateway. Government. Okay. Health is a national wing. Government has to take care. But. So there the root central government. I'm hoping thanks to the pandemic next decade low there will be dramatic improvement in the health care and this insurance policies. End of the day Kiran, all the maladies of healthcare inadequacies. One single solution is the insurance. You take any country in the world. Hardly 40% of people are insured. If I'm right, okay. The rest of the 30 to 40% are not insured. Right? Yeah.

Yeah.

So.

We have a different kind of problem here. Insurance. So insurance. $1200 to $1300. Not the best insurance. 70% insurance. 80% insurance type. So individual 500 $600. So in the Kaddindarwada. I had to work so hard. Six months. Six months Indian struggle. Now if you'll see doctors Dr. Jasthan, I'm going to do the actually facet arthropathy. So you know they said they are going to do injections, you know.

But.

Insurance. Patient, doctor they don't care. Sheep and wolf. That is what has insurance has become in this country. Yes, you are saving your life at that moment. Emergency cost of the burden. Healthcare costs is like terrible here. That's all there. But you are saving the life. I still prefer this one. They will do it for me. Two minutes. We have options. So there are problems everywhere in different forms. So Canada low UK law actual guy national health care system. You don't have to do. Actually I am seeing like lot of people. Sometimes I see people from Canada UK come here also and they say we like it very Much except for certain things we have to come here, you know so. Insurance. So with very much reserved perspective what I am seeing is infrastructure government taking a bigger role in healthcare system I think that is the only thing that is going to solve our problems Observation based on lot of different things and the government playing a major role Corporate hospitals medical school.

Elementary school elementary school.

And marry he put a parent too what he's going to think? Of course he's going to think I want to go in a Ben's car as soon as I become a doctor whatever it is. Yeah sir.

There'S a quick fixed method complex problem latest 2021 law thanks to so many corporate hospitals expertise wise now India can do any operation as good or better than any country value for money for example I do the robotic knee replacements thousand surgeries more than anybody in the world so expertise but what I'm saying is but government alone cannot do it Government to work a private remote corner law village law primary health center doctor elementary doctor. Utopia answer practical solution with so many corporate hospitals are there why what you got government has to do is it has to incentivize the corporate hospital for example electricity. Rental property housing tax 14 and asked me to spend two days a week my daughters will go to Perry Health center adopts health centers and work throughout.

It yeah.

Upper quality of the doctor center the same infrastructure can be used Atlanta anybody who will say private corporate hospital has to allot at least 50 beds on a separate wing Modular diagnostic center to the right side private hospital to the left side subsidized hospital E private hospital work just a consultant to however big he is one day of the week he has to work in this hospital about quality of the services very separate infrastructure same diagnostics can be used for example same Mr. Scan can be used for the subsidized hospital in the office on office hours. So many things are there There are some countries which have done that very successfully so in other words both PPP public private partnership in the health care is the future for India but government has to subsidize the hospital I'm sure Ramesh will agree for that infrastructure 50% to 40% government subsidiary. And there will be check and balances thanks to the technology every day every Saturday for example I adopted a health center the collector IAS officer can sit in his room and see my team whether going physically or not to that remote place and treating or not by evening he can have a complete roadmap and what we have done there thanks to technology you don't need to move anywhere. So checks and balances. Good only that is the way to do.

I love the idea, sir. I love the idea. Dr. Sache Prasad Garu, you haven't spoken.

For a long time.

Sorry I haven't given you a chance. Because you want to hear corporate hospitals, major cities, learning Matlar. But I also want to hear from you. You know, what do you see every day. But you know, when you're back, we'll hear that.

Sir.

Actually that is a very powerful point. Me perspective topics. Vijayawada, Hyderabad, big hospitals. So you know, what do you see there? And how do you respond to all these things? You know what kind of things are there? Can we match the big corporate hospitals from Behmavaram in what you do?

Municipal property tax, Commercial slab loan hospital Luxury tax hospital. What is the luxury? I don't understand.

Yeah.

Second opinion.

Sad feeling.

Anybody. Ego problems. A common kid. Medical fraternity Tiki Merajas. Okay.

Nakan. Yeah.

Generation.

Mukinga patient to communication. Easy conference Create language. Based on Dali. Man. Effortless. There are two things and I always tell my youngsters and the younger generation. There are two things every doctor should have. One is to do good to the patient. Second one is being seen as doing good to the patient. Yeah. Majority of the doctors, right. Every doctor wants to do good to the patient.

Yeah.

Every doctor wants to do to the patient. But being seen as doing good to the patient. That is the thing where cookie crumbles. For example ICU this one day ICU patient every day the ICU doctor Ghani ICU charge Ghani half an hour Kurt patient relative 30 graphic Chubichi explanation Whatever the good things really grateful to them. But. But where I am different or I manage my things are communication. The moment people come to me with serious injuries or things are children NRI distant I create a WhatsApp group technology WhatsApp group primary concern patient son in B and Madant patient care manager Real time low discussions anytime message within 2 seconds I will raise the alarm. So real time on a Covid law I will ask so many patients but patients within 2 minutes you WhatsApp group low relatives the way they responded. Thanks. We are unfortunate and the pity WhatsApp group so that is the power of communication technology. I work in two different hospitals one day so was signature three days. So Monday night operations Tuesday video call session My registers around scaly video call is WhatsApp so technology. But. That is how the youngster should be taught the communication. Communication Communication Communication. What happens is 70% of the time you are a winner. Even if you lose the patient. But of course, 30% of the patients are canton carrots. Different story but no communicate. Check on multifactor number one factor. New transparency Lakunda New patient relative Patichkogunda patient relatives concerns Patichkokunda. But the majority of our doctors are failing in this second phase. Being seen as doing good. It doesn't happen like that. Even OPD non union. You have to sit with them, talk to them. Talk to the consultants. Talk to the specialist. You have to create an atmosphere to the patient that this doctor is caring for us. That's what it is. Expertise. There is a hardly few things that will separate a top class surgeon from an average surgeon. 90% of people are well equipped. Only that communication is the one which separates boys from men.

I love what exactly you said, sir? Especially the way that you have put it. Doing good to the patient is essential. There is no not even debate about it. And I can tell and everyone here will tell that 90%, probably 95 to 99% of doctors come into the profession with that intention only. I rarely met a doctor who is like. So there will be people. Yes, there will be bad people in every profession. It doesn't matter. We actually self select is self selection. You cannot become a doctor even because that amount of hard work dedication that is needed. It will change you. That I am guaranteeing. Almost so Adibania only being seen as good. Maximum failure. Medical College almost 902004 IPN Medical College then United came here. Did residency Internal medicine. Initial residency.

Is good.

But I did not understand the power of communication. I was thinking that I was telling them the right thing, you know. But it's not just telling them the right thing. But the right way of telling the right thing is the key. Then I realized then what happens is now I assess the situation. I keep an eye. Maybe the daughter of the first Matladi. Whatever it is that situation demands. Important point. I don't think that is also a point. There is a point, but also there is no point. Because communication no one teaches us. Yes, good. We'll be continuing like that for the rest of the life. Most people. So fortunately I learned certain things about communication back in medical college itself there is a different thing but Patient room. Two minutes. You know, we can tell them.

But.

In two minutes I'll sit with you. I will hold your hand. I'll put my hand on you. And I very quickly tell you about whatever that is happening. We will discuss more after the emergency is over. This kind of presence of mind and communication Is what is needed. I think both in America, you know, everywhere, wherever it is essentially universal.

Let me tell one relevant thing. Rameshnak Senior college Ramesh College. A senior who is accessible used to be very friendly. The day he took the management of Aish Hospital. I know that hospital is going to be hit and that is proved. That is because Ramesh at the helm of affairs has got that communication skill, that accessibility and that it makes all the difference. Hospital is one of the well reputed hospitals. No doubt because of the expertise. But that's not alone for people like Ramesh. So Ramesh hats up and three cheers to you.

Thank you. Thank you Gurudi for the appreciation.

Because I know you sir from the knowledge how accessible you are. So that's what it is.

Thank you.

Nursing station Beautiful poster. Star naked. It is a animated poster. There are no clothes at all. They said we have to strip and be on the top of each other and it feels good but nothing is happening. The communication is vital. Beautiful links that much. Real poster. Okay.

Yeah, yeah. Powerful way to send the message about the communication. I love it. I am hundred percent, you know.

Session.

It all comes down to communication. There are two or three things only. Communication, trust building, economics.

These three.

Human behavior, change of human behavior. A physician burnout, nursing burnout. The amount of stress levels that we go through, you know, prevents us from communicating, prevents us from having the presence of mind. Physician burnout. California Medical association survey law 40% of doctors in ICU are burnt out. So the point is yes. Physicians what they know they won't be able to implement. Chaotic conditions created, You know, So King lion.

All of a sudd.

Indian logs. Jc pada santa santo and jp malikoti ankal kelly Tuesday ayanugu moham indian. Kundutu. Fast they finish the ball. Employee, doctor, nurse, whoever it is a talented person. Talent on the Balamundi skill on the Anya Kani. If they are in pain, okay. If they are in some kind of emotional stress, whatever kind of it is, you know then their performance is going to be severely be affected will be affected in multiple ways. Main point scenario hospital performance patient to doctor relationship. Is stress management. Lifelong. Some people do actually very well because you know, they somehow get it but many people don't. That's the reason there is a large amount of workforce. They have a lackadaisical attitude towards various things. I'm not talking about India only, I'm talking about America. I'm talking about lot of places. I think that is one of the root problems nowadays in law and when a Person is a calm state of mind automatically they will perform better. Automatically their presence of mind will let them communicate better. Automatically they'll be more compassionate. Automatically they will, you know, treat other people around them better. So main point in Guda along with economics, along with communication and many other things that we discussed and I want.

Your opinion on that here. I want to add one more thing Dr. Kiran regarding the culture. Suppose Guruvaridi owns a hospital or I am with Ayush. Everyone in the community should understand hospitals are. Even though the owners are there. They are the public properties.

Yeah.

Anybody can walk in if they have a problem, they can walk in. Don't you think they can come in anytime? Nobody says no if they have a pain. A public property attack punishment should be very serious. Because it is the property of the people. It is built with hard work. It is useful to the community. Even from the childhood you should inculcate. We are not supposed to damage our own properties which were built with lot of pain. From government side for some reason a hospital is attacked a punishment. 2007 AP State Command State assembly directly made an ordinance pass it to the government. 2008 Implement anybody attacking the hospital or doctor will be imprisoned for minimum of three years. Energy first of its kind. That type of protection is it given to people. When somebody wants to damage a property which is helpful to the people which is a public property then damage government punishments implement the attitude of damage will continue to like to be like this ordinance even Covid. But how many cases they have punished so far? Very few. There is a lack of this type of attempt from the from the government to implement the law so that the hospitals are safe, doctors are safe. That is another angle.

That is a very powerful point. At the end of the day there will be bad things that will be happening.

Not.

I'm just not talking about medical society in any kind of inner society. Because there will be bad people, there'll be good people and there'll be people who thinks that we don't want law enforcement important law making and law enforcement that is going to be one of the most important things to prevent violent attacks. Trust and JP communication, JP dividend even. But without proper enforcement of law we won't be able to change human behavior. That is my take on it and I want to. I want people to comment on it and why it is not being done.

The problem with this that type of file in the case doctor case Kiran it is taking enormous number of years of time. By the time everybody is disinterested law is delayed in this country so long. You suppose this type of doctor can fight Chastnadu? It went on for four years, five years. Do you think the doctor can pursue that type of thing? If the justice is given in a given framework of time you are interested to do it. If it is not fruitful and if it is taking a lot of your time. Apart from the measure you already suffered. Suffered. How can we go for it? That type of law. I am not surprised.

Got it. Got it.

That.

That's a major problem.

Yep.

Sir. Go ahead sir.

How many more minutes? I got some of the commitment.

No, we will be ending this in the next 10 minutes or so. Yeah. Yeah.

That doctor deserves it. Unfortunately senior Dr. Row.

Yeah.

Monday.

I call that as a Tagore syndrome. Or ventilator. Ventilator. With Betty double this control. There should be some mechanism. Ventilator patient relatives to name ventilator. He's dead.

Malo. Center law elad.

Bearer. Transparency.

Transparency.

Transparency. We are all self selected. But because we are living in glass houses they will spoil the flavor of the whole broth. That is what the problem is. We cannot blame it.

That is true. That is true. Absolutely. And you know, I know we almost spent close to two hours. So I want to wrap up this session. And every person has has said such amazing points. Like Anatan Achta and his sessions. These are Nachara just personal perspective over you so helpful. I hope lot of people watch these and they understand. You know the Chedaniki Karnu awareness. Once awareness solutions implement our own Jarada Ultimate. We'll all have our final say in a couple of lines. Whatever you want to say. And you know, before that. Actually after that I want to show you something. But. Then I let everyone say whatever they want to say. Is first of all. Challenge cinema. So I have great respect for him. And he's. So next 2002, 2003 somewhere around that time the medical college finish. Of course. I love that movie. Definitely.

So.

Doctor problem. With Vandigabatti attacks against doctors communities Mila and Duvaldu. It would awareness create especially movie format. I think people will understand. You know, it will reach them. And then I think that is going to lead to something. Anti corruption and JP General law. You know, so R type law. Hopefully something is going to happen. And that is my request to him.

But.

But sir. RB Patnai Garu. I will go with you first. Any last words? I know we have. You have remained Prakshika Pathravanjarpapam. Thanks for your time. Really. Any words from you about this session?

Better I stay as a. As an audience. The amount of expertise, what people are here and doctors. I don't think I should talk anything technically in this issue. My just in the cadet expression. That's what I wanted to tell and I told that's it. And I'm really loving to listen from all the experts here. And definitely this session will make some difference in thinking process of the people.

Thank you sir. Thank you very much. Dr. Ramesh Babu. If you want to say something.

Kiran. We are gifted and it's a privilege to be able to handle life and life and handle. We have an obligation. We should behave with empathy. That type of culture. It's a God given gift to be able to mitigate the suffering of fellow human being. Yeah. It is a totally different branch. And it's a very noble branch. There are so many new noble people even now. That's my impression.

I love it sir. I love it.

Roll discharge. Country. March 27.

Our friends.

Society. Patients. Patients.

Yes sir.

Thank you.

Thanks. Thank you sir. No, thanks for your time. That will be very, very helpful.

And yes great physician. Whether you are a doctor of naturopathy, allopathy, homeopathy, it doesn't matter. You should have sympathy. A great quotation. I always keep on remembering that. That sympathy important. Of course. Sympathy, empathy same. And this is the book I am now reading. The empathy affected Neurophysician Empathy Patient communicate patient family member. 70 to 80% of the problems. Number one. That's all simple. Number two. The money should not be the primary factor or driving factor for any doctor.

Right.

I've never seen a poor doctor, a poor successful doctor. Never seen in my life. So every successful doctor will be having enough riches subject to. But the moment you put the money as a primary then all the indications are blurred. England. The best practice in the world is England practice. Not American art.

India.

Why? Because there is no indication of doctor nailing. So he goes exactly by textbook indications. That is a wonderful way of study. But only thing is concept any doctor. Number one is accessibility. Yeah. Number two is affordability. Number three is amicability. And number four is ability. I'll put the ability as the last. If the first three are there, you'll be a successful doctor.

Love it.

Love it.

Last, I want to show you something very quickly. And I want to take your help on this one. Not just for myself but for all the medical community. With your help I want to launch this website Save our saviors. We just. You know. You know I think this is going very well. People are really liking what we are doing. I think we should have some kind of website where people can just simply go there and access the information. You know, all the videos that we have done or future projects, whatever you want to do. So I request. Your blessings and your support is what I request. And this is not for me. It is not for Naga Prophet, Dhani, Gami Khadu. I just want to do something that is good and that will promote.

Great initiative, Kiran. Great initiative. And it's a session organization. We have this wonderful chair. Three chairs to you. It's very thoughtful of you to create this session and as I said overnight. But it's a good platform. Let us all exchange the views and opinions and there will be some light at the end of the tunnel.

Thank you, sir. Thank you very much. And I once again want to thank every single panel member including Dr. Haripra Sadhgaru. I had to leave early but thanks so much for your patience for sitting for almost two hours, more than two hours and make this happen. And thanks to Srinija for the technological and marketing expertise and helping us from behind the scenes. And thanks very much to Nagar Sarao from Ayush Hospitals for helping, you know, with this initiative. Thank you, sir. Thank you very much.

Thank you, sir. Both of you. Thank you, sir.

Thank you very much.

Thank you, sir. RP Patnaik, we are there. Thank you so much for your gracious compliments. And I wish you will never need us. You will never need us. You're a social activist. Keep it going.

So I'm very eager to listen to the new tunes.

Yeah, definitely coming up with some good music work, sir. Again. Yeah, sir. Thank you, sir. Thank you. Thank you very much, sir. Thank you.

Thank you.

Thank you. Bye. Thank you.

Bye.

Bye.

Bye. Bye. Bye, sir.