Dr Piyush Agrawal

MD Medicine | DM ENDOCRINOLOGY

[Sanat Dixit MD FACS @sdixitmd]

As a neurosurgeon, let me tell you how frightening this injury actually is - an occipital compound depressed skull fracture treated with a WIDE craniotomy (outer staple line).

What's scary isn't the fracture; it's what's adjacent to the damaged skull. The axe blows (that tree-branch scar at the center) hit right over the posterior superior sagittal sinus, a large vein that runs lengthwise between the 2 cerebral hemispheres and carries blood from the brain to the heart.

Penetrating injuries to the sinus can carry upwards of a 40% morbidity/mortality - partially because a transection of the sinus can be difficult to repair and can result in extreme blood loss, venous air embolism, or thrombosis - all of which can be fatal.

There's scary, and then there's the "you go to elevate the fracture and risk unroofing the sinus, losing 2 liters of blood in a minute" scary.

The surgeons likely had their hands full and did an amazing job. Divine providence called many heroes into service that day. Damn fine work.

धन्यवाद

[Dr Piyush Agrawal @docpiyush1995]

💯 take.

[Amit Thadhani @amitsurg]

1. There is really no justification for it. The huge margins offered by drug manufacturers are due to market distortion. Manufacturers view the purchasers and prescribers, ie hospital and doctor, as their clients, not the patient on whom the medicine is used.

2. Controlling the margins on these drugs won’t affect research as claimed by manufacturers, since they are still free to fix their sale price to distributors. Only the subsequent exorbitant margin gets capped. However, corporate hospitals will certainly take a big hit and by and large their overall profit margins are not good enough to fully absorb this impact.

3. Bed charges, even in highest category of rooms, are well below the infra and running cost per bed of the hospital. It is a fact that hospitals cover the cost of stay and treatment primarily from high margins on pharmacy.

4. If margins from pharmacy and consumables too are cut off, you may find that hospitals substantially increase other charges to offset this substantial loss of income. We have seen this happen in coronary angioplasty - when margins on stents was capped, the procedure charges were increased to keep package cost the same.

5. Unfortunately in India, as of now services are not valued as much as products. Most patients are willing to pay 1 lakh for an implant, stent or medicine a lot more readily than giving the treating doctor 50k for his expertise. Additionally in oncology, the fear of cancer is a big incentive for people to spend any amount for medicines in the hope of cure. It is a sad reality that manufacturers, hospitals and doctors do exploit this situation. It is not a grand conspiracy, each of them is in it for their own reasons.

6. Even though I’m not a fan of overarching govt controls, in some situations such as this, the govt does need to step in and correct market distortions. I reiterate that for antibiotics too, rampant misuse due to high margins is causing scarily high rates of antibiotic resistance. The margins on all antibiotics must be made so low that there should be no incentive at all for misuse.

7. My opinion is that it is better for medical professionals to charge directly for services rendered, than rely on such indirect and somewhat unsavoury sources of income. People too should also get used to paying their treating doctors well for good, clean and timely services and treatment.

[The mood doctor @Chulbulpanda420]

Someone who took ₹10 crore for one movie is calling doctors “looters” for charging ₹500
while the audience lounges on ₹500 recliner seats, munches ₹1000 popcorn, and cheers.
How much more development do we need?

[Sabeer Bhatia @sabeer]

India doesn’t just need a regime change. It needs a system change. The current system is designed to reward corruption, protect the powerful, and punish honesty. Changing the faces at the top without changing the system will only change who benefits from it.

[Dr Piyush Agrawal @docpiyush1995]

@darkandcrude 💯

[Dr Piyush Agrawal @docpiyush1995]

@Adityakrsaha 16.2 k

[ஆத்தும நிருபர்💯🤔 @josephselvraj]

The rich have always been able to afford every level of private healthcare and understand the reality of their lives.

The poor have always been dependent on govt healthcare and understand the reality of their lives.

It's the partially educated people who are in the middle who don't understand the reality of their lives. They're too proud to go to GH and too poor to afford private healthcare. These are the ones who go to GH and cry incompetence/negligence, and go to private and cry loot.

[Arun Bothra 🇮🇳 @arunbothra]

doctor’s duty is to treat patients, not to tolerate abuse and intimidation. When attendants aggressively confront a doctor and start filming her, walking away from an escalating situation is not ego. It is self-defence.

You cannot expect doctors to work under fear of assault and then lecture them about their duty when they try to protect themselves.

Patient safety matters. But doctor’s safety is a prerequisite for that.

[eternal newbie @samanya_kumar]

They are all enjoying their retirement. Created generational wealth, settled kids abroad, experimenting with whatever policies they want on a live lab called India. What else to do?

[Dark Pill @darkandcrude]

By that logic, serving food to hungry was considered punya & profiteering from hunger was paap

I remember an interview with a man who would give free langar and Bhandara

So we should close Hotels ?

Khud tweet bhi free mein nahi karte & audacity to expect free from others

[Aditya Gupta @DrAditya2935]

I 100% agree.
Healthcare 100% should be socialist!

It’s 100% the fault of Govt- that Govt. hospitals are in shambles.
They get the blame!

Till the time - that doesn’t exist - the blame still is of Govt - not the private hospital.

Private hospital is not charity and it’s entitlement on your end to want socialistic prices at private capitalistic establishments Just becuase govt is shitty.

Demand better from your elected leaders and GOVT!
Not private individuals and doctors!

[Dr Piyush Agrawal @docpiyush1995]

@tanitiwari16 Someone tell this lady affordable healthcare is duty of the govt and not Pvt hospitals who have put in 100s of crores to build state of the art five star hospitals. It ain’t for everyone.
I agree it’s expensive but ask govt to build more affordable quality hosp and not freebies.

[Dr Gunjan Deshpande MRCSEd, FICO (UK), FAICO, DNB @drgunjand]

Affordable and efficient healthcare is the duty of the state, not the doctor.

[Dr Piyush Agrawal @docpiyush1995]

@rohit_thanage @khabrimishra No not at all. I mean 80-90 % would be peace loving but there are groups who thrive on creating ruckus and not paying bill. It takes only 1-2 bad experience a month to know that it ain’t worth it. Law and order is shit anyways. In the end it’s d people who wd suffer as no option.

[Dr Piyush Agrawal @docpiyush1995]

@rohit_thanage @khabrimishra It’s easier said than done. Everyone doesn’t have spare 10-20 crores to open up hospitals.
If people think it’s easy then they should do it as they think it’s a loot machine. Build hospital and employ doctors and earn bonkers!
It’s not that easy. Grass is always greener on….

[Dr Piyush Agrawal @docpiyush1995]

@rohit_thanage @khabrimishra Even basics cost a lot nowadays.
Land prices have increased a lot, there are lots of rules and regulations for opening a hospital and very difficult to get those unless you bribe.
Cost of medical equipments and machine is more than USA as they are taxed as we import.

[Dr Piyush Agrawal @docpiyush1995]

@khabrimishra Also ask better civic sense from people and laws for doctors, few doctors now want the trouble of opening own hosp as well as risks involved if patient dies. What do you think is going to happen if Pvt healthcare becomes completely corporatised. Dr earn only a fraction out of it.

[Dr Piyush Agrawal @docpiyush1995]

@khabrimishra Although I do agree that corporate hospitals charge a lot but how can you expect a very capital intensive business(1crore/bed) not charge enough so that they can turn profitable especially when they are stock listed and answerable to investors. Govt should not allow it then. (1)

[Dr Piyush Agrawal @docpiyush1995]

@khabrimishra As going to 5 star is personal choice then so is corporate hospitals. You have govt hospitals and medical colleges working on ayushman where it’s free. If you feel they aren’t good enough ask govt to upgrade it rather than pumping money in useless bribe based Yojana for votes.

[Dr Piyush Agrawal @docpiyush1995]

@WhateverVishal C