Saurabh Singhal

Robotic Surgeon 🦾 | Complex Hepat-o-Pancreatic-o-Biliary and Liver Transplant Specialist 👨🏽‍⚕️| AI Enthusiast 🤖 | Rock and Metal Drummer 🤟🏻

[Saurabh Singhal @One_Surgeon]

@airastana manager at the check in counter at Delhi IGI airport denies to give boarding pass unless I showed him my hotel reservation at Almaty.. I don’t know if they have the right to ask that.. as per my understanding, their work is to check valid ticket and visa! @AAI_Official

[TheLiverDoc™ @theliverdoc]

STAY WITH ME.

A few years ago, a patient was referred to me because he was diagnosed with complicated cirrhosis. He had an infection which led to a condition called hepatic encephalopathy (brain failure due to high ammonia levels). The treatment largely involved ammonia reducing therapies. One drug was central to this - Rifaximin - a non-absorbable antibiotic that reduced ammonia in the body. I prescribed him Rifaximin for 6 weeks and advised him follow-up.

He came back to me, not after six weeks, but in 4 weeks, this time, in liver coma (worst stage of brain failure - due to very high ammonia). He spent two days in the ICU and six days in total in the hospital. His hospital bill was close to INR 80,000. He had no insurance and his wife borrowed the money from neighbors and friends to clear hospital dues.

Upon questioning, I found that he was not taking the Rifaximin drug I had prescribed. He was only on the other two drugs (one, a syrup called lactulose for improving ammonia clearance in gut). I was furious, because the patient spent a whole week unecessarily in the ICU and wasted so much money that he never had - just because he was "not compliant" to my orders. I decided it was time for me to school him a bit.

But I was wrong. He was compliant. He had purchased Rifaximin and was on it. For 15 days. Thereafter, he could not afford it. He was an autorickshaw driver who shuttled school children every morning and evening. He could hardly make ends meet. He had two children of his own. The Rifaximin brand I prescribed him was 42 rupees per tablet. He had to consume two a day - which would mean 2520 rupees a month. He just did not have that money - so he skipped it - to not compromise on other important matters - childrens education and food.

He was confused and scared about opting for a cheaper version of Rifaximin because one, he was unsure about the quality of Rifaximin that was not prescribed by me and two, he was "scared" that I would scold him for buying a cheaper Rifaximin and if that got him into trouble.

I was confused and scared about prescribing a cheaper version of Rifaximin because one, I was unsure about the quality of Rifaximin that was not "a good promoted brand" and two, I was "scared" that his family would scold me for prescribing a cheaper Rifaximin and if that got him into trouble.

It is heartbreaking that many doctors still simply don’t trust generic medicines. Too often, they worry that these cheaper options are lower quality or might cause more problems than the big, famous brands. This fear leads them to prescribe expensive drugs instead, and the real tragedy is that it pushes vital healthcare out of reach for the ordinary people who need it most - like my patient.

This narrative, that generic drugs 'are never good' and that only big pharmaceutical marketed drugs are what works has been deeply ingrained into doctors and patients alike - I do not know by whom and since when. Looking back, these strong emotions were based on either opinions, testimonials or second- and third-hand information. Not evidence.

Like I said. Stay with me. This is life changing and will disrupt the drug market in India. Here are the results of The Citizens Generic vs. Brand Drugs Quality Project.
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[Saurabh Singhal @One_Surgeon]

@alexfinn That’s why you shouldn’t for a few bucks from Tesla, man! :)

[Saurabh Singhal @One_Surgeon]

@alexfinn There is a problem here in your judgement.. pixel is seen filming in one car while the reflection you quote is from other car.. most likely, one car had pixel and other one had an iPhone.

[Saurabh Singhal @One_Surgeon]

Something interesting! @IndiGo6E claims to have their food from their ‘chef’ (from Varanasi) on the same day… however, their manufacturing unit is closed as per Google!!! Where are our rolls and sandwiches coming from? @MoCA_GoI @MOFPI_GOI

[Saurabh Singhal @One_Surgeon]

Interestingly, just now, in my American Airlines flight to delhi, they made people on wheelchairs and with small kids wait to board before the grp 5 while all the ‘priority’ and ‘premium’ groups (1-4) were boarded first.. trump effect?! @AmericanAir @FAANews

[Saurabh Singhal @One_Surgeon]

@_LTSI_ The ongoing violence against doctors, especially the threats to the safety and dignity of our female colleagues, is not just an attack on individuals but on the very foundation of healthcare. Let us unite to ensure that their safety, dignity, and respect are upheld.

[LTSI @_LTSI_]

Women’s safety at work is non-negotiable. The incident at RG Kar Medical College highlights the vulnerability of any working woman, not just doctors. We must come together to ensure every woman is protected and respected.

#JusticeForDoctor #WomenSafetyIndia #IMASolidarity

[Restoring their Dignity @RestoringDign]

This is one of the hardest photos we’ve restored and colored, and perhaps one of the most necessary.

These two men are showing their liberators what their work was like as part of the Sonderkommando at Dachau camp. But what was the Sonderkommando?

Thread:

[Saurabh Singhal @One_Surgeon]

@Karthik74406704 @Dr_AkshayBaheti Many airlines around the world offer paid seats but the situation is the worst in India currently. Sometimes while checking in, there are no free seats to choose from at all and the auto allotted seat is a middle seat in the last row.

[Saurabh Singhal @One_Surgeon]

@Karthik74406704 @Dr_AkshayBaheti Imagine if you bought tickets on IRCTC only to be placed in different rail cars and separated seats and then they would have asked you to pay extra for choosing seats if you wanted to be seated next to each other. And what about people who were barely able to afford the ticket!

[Saurabh Singhal @One_Surgeon]

@Karthik74406704 @Dr_AkshayBaheti @Dr_AkshayBaheti is correct that it should be the airlines responsibility to put the minors next to the adult on the same PNR. Buying seats is optional and airlines are using these tactics to make it compulsory. Why pay again once you have paid thousands to buy tickets already.

[Saurabh Singhal @One_Surgeon]

@Olacabs was offering a ride ₹300 cheaper, yet I fell for the apparent ‘premium’ ride that I’ll get with Uber Premium!!!

[Saurabh Singhal @One_Surgeon]

@Uber_India how is this an ‘Uber Premium’ ride for which you have charged me a premium fee? An old shabby smelly noisy Hyundai xcent passing off as a premium ride?

[Saurabh Singhal @One_Surgeon]

@ApolloPharmacy @Apollo_Pharmacy is this you guys deliver insulin these days? No cover around the insulin cartridges. ORS tetra packs as ice packs? Is this the way you guys maintain cold chain? Who is responsible if the insulin goes bad? Any actions will be taken? @President_PCI

[Saurabh Singhal @One_Surgeon]

Do you remember when you joined Twitter? I do! #MyTwitterAnniversary

[Saurabh Singhal @One_Surgeon]

@RailMinIndia @AshwiniVaishnaw Train 22985 from udaipur to delhi - 15 minutes before departure, the previously used blankets and sheets are still lying on seats, fresh haven't been kept and AC is still off with damp smell in the coach. Coach B13.
Expect better services!

[LTSI @_LTSI_]

A Novel Salvage Technique for Portal Vein Thrombosis in #pediatric #livertransplant.

@pedtransjrnl @_ILTS_ @IndiaSoTx @TransplantJrnl @LTxJournal @SPLIT_TTS @StarzlT @AmerAcadPeds #MedTwitter
#livertwitter

https://t.co/sbhAUUvdhD

[LTSI @_LTSI_]

"Clinics in #Liver #Disease and #Transplant" @medanta @ArvinderSoin is ongoing.
Check it out at this YouTube live link: https://t.co/o0b5e3DGSY
Program in linked tweets.

@_ILTS_ @EASLnews @APASLnews @AASLDtweets @CUH_CambsLiver @SAASL_Liver @LTxJournal @MedTwitter @LiverTwitter

[TheLiverDoc™ @theliverdoc]

1st, Ayurveds attacked my publications. Legal notices, harrassments -they failed

Then they came after my career. Misconduct, defamation -they failed

Then they went to Supreme Court to prove Ayurveda is science -they failed

Science wins bcoz
its for the people, not for a person