Archive for January, 2010

Why should we care about the name of the Disease?

January 29, 2010

[In my previous blog, I had mentioned that I would be talking about various aspects of Doctor – Patient Relationship over the next few months. This blog is in line with the same.]

What is in the Disease Name? (img src - please see below)

What is in the Disease Name?
(img src - please see below)

Over the last weekend, my brother – Dr. Mukesh Rathi (as mentioned in my previous blogs – Mukesh is a practicing Gynecologist) published a blog titled “What is in the Name?“. I will encourage you all to check it out. As I had mentioned in my previous blog, I had been very curious about how patients typically get treated and also about what typically goes on in Doctor’s mind while diagnosing a patient. Mukesh and I have had several conversations on the same in the last few months. He has tried to capture some portions of those conversations in this blog. He had sent me the first copy of his thoughts a week back. My contributions to his blog has been from the proof-reading side.

Mukesh’s blog talks about an interesting aspect – which IMHO – many a times sub-consciously is considered as non-important by many of us – “why is it so important to know or derive the disease name?” The reason I say it is interesting is because – how many times ‘we‘ patients have walked out of  the doctor’s room without asking him/her – what is the name of the disease/illness which I am suffering from?

Based on lots of reading and research, I have come to the realization that almost all human ailments typically tend to have a name i. e. a disease name. These names either are a derived name from a primary classification of diseases or could be combination of multiple of disease names. The second realization (and I thought an important one too) for me was that any prescribed treatment in medical books/literature are always associated with a disease name. A very simple example – there is a prescribed treatment plan set for H1N1 (Swine Flu). So a patient possibly suffering from H1N1 would undergo the treatment associated with it only after it has been validated that he/she is suffering from H1N1. In other words – the treatment is linked to the disease name. So the key (from doctor’s perspective) here is to identify the disease name (note that there are millions of diseases out there) from the set of symptoms which the patient is exhibiting. Once the disease name is correctly identified – prescribing the treatment is easy as most of the treatments are very well documented in the medical literature. This is the gist of Mukesh’s blog.

So why is disease name identification so important – you may ask? Well, if the disease name is not correctly identified – logically the treatment which a patient might be undergoing may also be incorrect. Simple as that. Incorrect identification of the disease name to start with is the major cause of medical errors/misdiagnosis.

To get an essence of Mukesh’s thoughts from a doctor-patient relationship perspective – it might be worthwhile to consider what Federation of State Medical Boards of United States has mentioned in their model guidelines on when do they think a typical relationship between a doctor and a patient starts evolving –

“A typical physician-patient relationship tends to begin when an individual seeks assistance from a physician with a health-related matter for which the physician may provide assistance. However, the relationship is clearly established when the physician agrees to undertake diagnosis and treatment of the patient and the patient agrees, whether or not there has been a personal encounter between the physician (or other supervised health care practitioner) and patient.”

As the above guideline states – the function of diagnosis and treatment are at the core of a good Doctor-Patient relationship. And as I had mentioned in my previous blog (link above) – if we all were to understand the behavioral drivers behind these functions – it can only ultimately result in better doctor-patient relationship and communication. Hence I felt that Mukesh’s blog was highly relevant.

Deriving the name of the disease correctly as part of the diagnosis process can be tough many a times and can be prone to trial and error. Contrary to common perception that it is doctor’s responsibility to derive the name – patients also have to play a big role in this investigative process. I will be talking more about this in my future blogs.

I would welcome your thoughts and comments.

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Weekly retrospectives and my two cents! [Jan 17 – Jan 23]

January 24, 2010

[As promised in my new year blog, I was keen in starting up a series which captures my thoughts/2 cents on the weekly take on the list of events/news/observations with some satire thrown in. Here is the first in that series. Look forward to hearing your feedback.]

Sunday, January 17’th –

  • Birthday – Mom’s birthday. Happy Birthday, Aai!
  • Jyoti Basu – End of an era for the Left-Communist purist! Not many left in the world (other than Fidel Castro, I think) and they don’t make any more of these (phew!). So long, Jyoti Basu! You were one of the kind!

Monday, January 18’th –

  • The Next Recession? – I thought we were still to recover from the global recession which was at its peak last year; there is already a talk about the next one. New York Times editorial today talks about more to come after the Dubai fiasco. Greece, Ireland, Mexico also seem to be suffering from a similar flu. I wonder if it has got to do something with Amar Singh. Well, he has invested in housing property in Dubai. Has he invested in the above countries too?
  • Talking while WalkingIdea Cellular‘s recent “Walk When You Talk” campaign may no longer be slotted in the “What an idea, Sirji” category. Ohio State University’s recent study has found that in 2008 more than 1000 pedestrians visited emergency room because they got distracted and tripped, fell or ran into something while using the cell phone to talk or text. This was double the number in 2007 which itself had doubled from the numbers in 2006. While this study came out – Adam Gazzaley – a neurologist at University of California, San Fransisco has also found in a study that animals never walk into a pole!
  • e-Cigarettes – Looks like I had missed out on this one. e-Cigarettes! Electronic Cigarettes. Yup, this is what the electronic gizmo freaks were missing out in their storage shelves. These e-Cigarettes are some kind of plastic tubes, shaped like cigarettes, have a heating element to vaporize a refillable liquid nicotine mixture. How cool! Wait, this gets better! They have electronics to monitor air flow so that when a user inhales, the device delivers a vapor with a taste and feel that the manufacturers say simulates cigarette smoke. Pretty cool! And it comes with free shipping too! Can someone please update me on what is the latest progress on Cancer Research?
  • Relationships and Global Warming – For those who are continuously thinking and concerned about external factors which could potentially affect their marriage and/or relationships – here is one more thing to worry about. Clean Tech! New York Times today carries an article on how Therapists have started reporting increase in Green Disputes.
  • And Sachin Tendulkar continues to keep getting younger! He scored his number 44’th in Test Cricket today.

Tuesday, January 19’th –

  • NBC, Leno, O’Brien, et. all – I am sorry but I am not able to get a grasp on the squabble at NBC between the NBC Executives, Leno, and O’Brien. Here is the way I see it – first the NBC Executives moved Leno from his ratings peak at the Late Night Tonight Show to a different time which directly was in competition with the local news hour time with regional channels. These Executives said that this was a long term view of Tonight show. Leno represented the past and O’Brien was the future. Their future view suddenly got limited to 6 months before O’Brien could realistically get a chance to prove himself. Ratings dipped and regional TV channels complained. Now suddenly Leno is back as their future, O’Brien is being shown the door, and NBC is getting poorer by few measly billion dollars. What am I missing here? Just one thing, I think – is NBC (or their new buyer Comcast) dolling out bonuses this year?
  • Up – Pleased to hear that “Up” – a stirring and heartfelt animation movie from Pixar with an old man as the main protagonist along with a 8 year old kid going on a long-held adventure trip – was awarded the Golden Globe yesterday.  I had watched the movie 10000 feet above the land in a bumpy plane ride and hence got the practical experience behind it too. Not too sure if the in-flight entertainment on that particular flight was sponsored by Pixar.

Wednesday, January 20’th –

  • Political Inclinations and Professions – “Why are Professors Liberal?” – An interesting working paper report published out on 15’th by Professor Neil Gross and Ph. D. candidate Ethan Fosse at Department of Sociology at University of British Columbia. Talks about why Professors in general tend to be more Liberal in their thinking as compared to being Conservative in their beliefs. While it has taken Professors as the case point – IMO, the same hypothesis probably also stands for many other professions out there. Ever wondered why Jerry Springer is a Democrat?
  • Senate Loss at MassachusettsOuuch! this should have hurt the Democrats and President Barack Obama. Senate loss in the bluest possible state of Massachusetts! Come on! Even the life-long but life-less Massachustetts Senator John Kerry won the state of Massachusetts when he ran for President.
  • Life can be sarcastic and charming at the same time – This is very, very interesting! There were atleast about 165 people who survived the atomic blast in Hiroshima only to land up in Nagasaki when another bomb fell three days later (srcNew York Times article). And they still survived! Sorry, I do not think I can have any sarcasm on this particular one! The real sarcasm and/or charm is from life itself.

Thursday, January 21’th –

  • ‘Sachin’ and ‘Warne’ as verbs – Yesterday only I thinking about touching base with the mechanic to see if his estimates would be in the ballpark of my budget. And no, I am not a baseball fan! Confused? Read the interesting article which appeared at Cricinfo today – “Sachin, Warne and other such verbs” written by Sue de Groot. While sports terminology being used in regular talks have been a norm for a long time – use of names seems to be the modern thing. I think next time when I have say – “Let us not screw up the project”, I might just say – “Let us not Lalit Modi the project”.
  • Environment and those pesky marketeers – You know as a person who strongly believes that our Environment/Earth is under tremendous strain, I am personally not that upset with the recent exaggeration of Al Gore at the Copehagen Environment summit (about artic being ice-free in summers in 5 – 7 years) and now his Nobel Prize colleague Rajendra Pachauri’s recent botch-up about all Himalayan glaciers disappearing by 2035. IMO they got carried away while marketing a concept or an agenda. An important element of a marketeer’s job is to exaggerate. Come on! You don’t believe this? Ever heard of Cloud Computing?

Friday, January 22’th –

  • Joy’ism Bill Joy (co-founder of Sun Microsystems) had once said “that there are always smart people outside the organization than within” and I would like to add to that “till the time you get those smart people into your organization“.

Thats a wrap for this week. I will be back next week with another one in this series. Until then, have a great week ahead.

Doctor – Patient Relationship – Peeling the Onion Layers

January 21, 2010

As I had mentioned in one of my previous blog about my interest in thinking/brainstorming on various aspects of healthcare from a consumer perspective i.e. from a Patients’s perspective. I have now started to think and understand more about ‘Doctor – Patient Relationships‘ and ‘How do patients get treated?‘. After a lot of reading/research, personal experiences, and talking/debating with many doctors including my brother – I think now I am able to come to some kind of better understanding and hypothesis in this area.

One such point of curiosity for me was to understand how do patients get treated in general. What drives a patient to a doctor? What are his/her real pain-points or drivers? I also had the curiosity from doctor’s perspective.

Doctor and Patient Relationship

Doctor and Patient Relationship (img src - National Human Genome Research Institute)

How do doctors treat a patient? What goes on in their mind from the moment they see the patient? What logic do they use to prescribe the treatment which they prescribe? Do they have a crystal ball which tells them what the patient is suffering from? Do they have cheat-sheets which they look at? Or sometimes very simply put – do they really listen to what the patients are saying? I really wanted to get into their brains! I started talking with few of my friends and soon they got curious too.

So we started reading and researching and talking with many closely associated with this profession. Very soon, we realized that this is not the area where lots have been researched about or talked about. It is just assumed that both doctors and patients act and behave in a certain way – without each party completely knowing or understanding the ‘why‘ part. For example – no two doctors have given me a coherent/similar answer on my question as to why they think many patients have difficulty in communicating or describing their health problems to them. Neither have many regular patients been logically able to tell us about why do they think doctors misdiagnose some times.  Our point was not that either party have a fault that they don’t know this. But it is that both parties (doctors and patients) have probably been operating under lots of assumptions about each other which sometimes are not the most correct ones. It just felt that there was lot of mystery in the ‘why‘ aspect of the behavior/approach of both the parties than there really should be.

The first question in our mind – should we start demystifying this? Should both the parties (again doctor and patient) make an effort to understand why the other behaves/acts in a certain manner? And our straight-forward answer for this was – absolutely! Our reasoning was that if both patients and doctors understand these aspects of behavioral drivers – it can only ultimately result in better doctor-patient communication. This would certainly result in better Doctor-Patient Relationship and hence potentially better healthcare. While all the progress and development which has been happening in the area of Healthcare-associated services and technology is a good thing – the physician-patient relationship remains (and will continue to remain) fundamental to the provision of acceptable medical care.

So over the next few weeks/months – as we are in process of exploring this aspect of doctor-patient relationship – I will be blogging about what we are learning. As has been my typical style of blogging – I am thinking about breaking these findings into several but discrete blogs. My aim is also to continue getting your thoughts and comments also on the same.

Stay tuned!

Understanding the Cloud Computing Vendor Landscape

January 18, 2010

More than six months back, I had written about the tremendous amount of hype surrounding Cloud Computing. Then few months after that I took some clues from the Gartner Hype Cycle Report and said that this hype around Cloud Computing has reached the peak and now has started declining (Ref – “Beyond the hype – can some real work using Cloud Computing start now?“). IMO, real work or usage of any technology typically starts once the products shreds some of the hype or unrealistic expectations around it. As we work with our customers at GlobalLogic in consulting/helping them on various aspects of Cloud, I am now seeing the validation of my prediction.

However, now we have started seeing new challenge facing many who are taking or planning to take their first steps towards the implementation – figuring out which solution or technology does what and which solution to select by going through the mesh of vendors out there. The reason I say this is because Cloud Computing is a paradigm which does not suit itself to home development. Any solutions built up on or using Cloud would have to be built up by using or in partnership with the vendors out there. Deciphering the confusing marketing message sent out by various vendors about their capabilities and how these capabilities fits with the requirements in hand can be an overwhelming task by itself.

Considering the above challenge – recently I came across the vendor taxonomy created by Peter Laird which I thought was an impressive start in terms of laying the lay of the land in Cloud Computing.

Cloud Vendor Taxonomy - 2009

Cloud Vendor Taxonomy - 2009 - By Peter Laird. (Click on image for bigger view)

This blog post from Peter also describes what each of the category stands for. It is worth reading. Although based on our experience here some of the specific vendor classification could be debatable either way – however I am in agreement with the overall structure of the taxonomy. In our business at GlobalLogic in the Consumer-oriented applications side, we have explored solutions provided by the Public Cloud, Business User Platforms, Development Platforms along with Storage and Integration platforms. As we are enhancing our expertise in building applications/products on the Enterprise side – next steps for us would be to explore the Private Cloud side along with Billing and Integration side. Also my feeling is that Infrastructure-related technologies (as listed in the figure) would be mostly seamlessly packaged in by the Private Cloud Vendors.

In any regards, just wanted to share this pretty useful taxonomy created by Peter Laird to the readers of my blog. Thoughts and comments are welcome.

2010 and what it could possibly hold for me…

January 15, 2010

Like few other instances before – ever since I started blogging – I am now once again back from the hiatus away from blogging. It was not a planned one. It just happened like the other previous breaks I had taken. I have now realized that these periodic breaks are now part of the blogging routine.

Lots of things happened in this break. Did some traveling around; had to execute some work-related deliverables; attended some family chores; and tackled few things on the personal front. While all these were happening, I managed to get lots of reading done on few topics which had been occupying me since the last few months. (surely I will be writing about the same over the next few months). And on top of that – we all also moved into the new decade. Being a person who has quite a bit of interest on historical aspects of things around, spent some time in doing some reflection on the decade which just passed – where it started and how it ended. My personal thoughts – both from the world affairs perspective and personal perspective – I think the past decade was quite an intense decade. It will be remembered for many different things for long time to come.

Now that we are in 2010 – belated happy New Year to all the readers of my blog. Hope the New Year brings in (or has already brought) the best in health and prosperity for you and your loved ones. As for me – I am excited about the prospects for this New Year.

The Past Decade and 2010 (src -

The Past Decade and 2010 (img src -

On the professional front – over the last 3-4 quarters it has been in some sense ‘back-to-school‘ time for me. Learning new businesses/domains/roles and conglomerating it with my past experience/expertise has been extremely enriching. There are few very interesting things which I (along with few others) have been trying to understand and work upon and hopefully should see some fruition this year.

Interestingly when I was introspecting on the past decade as I mentioned above, I also realized something. This year I am also going to leave my ‘thirties‘ behind! I have always had an opinion that leaving behind a decade in our lives is always a different feeling. Few of my friends also felt the same way. Somewhere down there everyone gets that ticklish feeling. I still remember the morning I got up and realized that I have left my ‘twenties‘ behind. Someone at that time had quipped – “from now onwards your body will have a mind of its own“. It was probably a quote and it took me some time to understand what it meant. Now that I am leaving my ‘thirties‘ behind – I am taking a lot of heart from the following quote attributed to Arthur Schopenhauer

“The first forty years of our life give the text; the next thirty furnishes the commentary upon it, which enables us rightly to understand the true meaning and connection of the text with its moral and its beauties”.

So cheers to the ‘morals‘ and ‘beauties‘ of the life – here I come!

This year I was also thinking about trying out few new things on my blog. Few readers of my blog – while they have appreciated my thoughts and arguments on topics which I have been writing till date – have also felt that is probably too intense and some lightening-up of it would be interesting. After a bit more prodding with them, I realized that they were probably referring that I should also write more about more personal and lighter/day-to-day aspects of life. So here are some of the ideas I am thinking about –

  • Write about a quick take on a weekly or fortnightly basis about my take on list of events/news/observations with a satirical angle – possibly Jerry Seinfeld style. I do have a tendency to have one-liner metaphorical quips ready for many things which I see in life. So make use that skill/habit.
  • Regularly talk about few mundane things in life – politics, sports, entertainment, etc. which I indulge in.

Let me start with these two things and see how it goes. There are always chances of making the corrections.

Once again – a very Happy New Year to you all!

[Update|Feb. 1st 2010 – At the start of this blog, I had mentioned about the past decade being an intense one. Phillip Niemeyer, Art Director at Double Triple has done a wonderful job in putting and summarizing the last decade in pictures. Check it out at the New York Times link – “Picturing the last 10 years“]