Bharat Inder Singh

Dr Bharat Inder Singh, who passed away yesterday night was one of the most warm and jovial person I ever met. He was always laughing, mostly at himself or while cracking hilarious sardarji jokes. I had met Bharat for the first time a little over 17 years ago at our office (Max Healthcare, Okhla). He had recently joined the Max Medcentre Panchsheel Park as the centre head and he was going through his induction. I was the young and somewhat brash brand manager of the company.

In our very first meeting Bharat told me that he never understood why the organisation needed a brand manager. He explained that he had been practicing medicine for the last two decades and in his experience the only marketing he had ever needed was a board bearing his name outside his clinic. Lest, I become uncomfortable, he quickly added that things are changing now and maybe he needs to learn a few things from me.

Bharat had a unique way with his patients. He would connect with them in an instant, make them comfortable with humorous asides or simply laugh away their concerns about their illnesses, reassuring them that all will be well soon. He had a particular charm, which worked so well with the ladies, particularly elderly ladies, who were mostly his patients. He would always listen to them with great attention (or at least pretend to be listening), talk about their grand-children or dogs or husbands and be ready with his prescriptions. Bharat, always had time for his patients and he was never in a hurry for anything.

While, Bharat was a very good physician, he made no bones about the fact that he knew nothing of managing a facility. Thus, while Max Medcentre in Panchsheel Park was his responsibility, he had happily delegated the running of the centre to Dr Dilpreet Brar. He would often laugh at himself at his lack of ability as well as interest in anything, which required meetings, excel sheets or power-point presentations. He would show up at the last minute for reviews, quickly understand the drift of what was being presented and wink his way through it all. He made hilarious gaffes and we would all be hard pressed to keep straight faces, it really didn’t matter much to him.

Bharat was passionate about Squash. He was supremely fit and even coached youngsters in the game. I recall that once we had participated in a corporate Squash tournament. Our team comprised of Bharat and Dr Nitiraj Oberoi, an Orthopaedic surgeon who also worked at Max Medcentre in Panchsheel Park. Bharat and Nitiraj made their way to the finals without difficulty and invited Pallavi Das (who headed Corporate Sales at Max Healthcare) and me to watch them win the tournament. Pallavi and I drove across Delhi to Gurgaon to watch the match. The other finalists were two youngsters representing Amex. They were on the court, warming up, shadow practicing their shots and had quite a lot of supporters who had come to watch the match. They looked young, confident and were a bit cocky, prancing around the court. Bharat and Nitiraj were no where to be seen and I told Pallavi that these youngsters will probably whip Bharat and Nitiraj.

Our team showed up at the last minute, Bharat in his graying beard and Nitiraj too looking much older than the competition. I went and wished our team luck and also mentioned that these youngsters appear to be quite a handful. Bharat, looked at me scornfully and said ”watch the fun begin”.

Bharat and Nitiraj made the Amex team run around the court with such great ease that by the end of the first set itself the youngsters were sprawled flat on the court and Bharat had hardly broken into a sweat!!! That day, I learnt never ever to look at men with gray beards as old.

I last met Bharat two months ago. My mother had an appointment with her cardiologist at Max Medcentre, and while I waited with her for him to arrive, I noticed Bharat’s familiar name-plate outside his clinic at the centre. I learnt that he was in and relatively free. We chatted about old times for close to half an hour. He did appear a little frail and I did know about his illness, yet he looked in good spirits and was doing what he loved most, seeing patients. He joked with me about my paunch and advised me a diet and walking regimen that should help me reduce weight. We never spoke about his own health.

Rest in peace, Dr Bharat.

NHS and the dilemma of Outsourcing

A few months ago, a friend who lives in London visited his GP with a complaint of persistent headache. The GP advised him some medicines and asked him to follow-up in a week’s time. The head-aches continued and appeared to be getting worse, my friend visited the GP again, who referred him to a Neurologist. My friend managed to get an appointment with the Neurologist after 3 weeks. The neurologist examined him and suggested that he needed a MRI of the brain. A routine appointment for a MRI was given after another 3 weeks.

While waiting for his appointment, my friend had a seizure in his office. He was rushed to the A&E of a tertiary care hospital, an MRI was immediately conducted and a large vascular tumor was visualized. He was hospitalized and his family was informed that the he needed immediate surgery in a delicate part of his brain. The risks of the surgery included death because of uncontrolled bleeding or paralysis. Not operating meant certain death. They had little choice.

If, this would have been in India, my friend would have undergone an MRI the day after he had been advised by his neurologist. The tumor would have been diagnosed right-away and not after he had a seizure. His family would have been given some time to seek another opinion before deciding on surgery. They would also have had the time to visit a hospital of their choice and decide on a surgeon that they would have been most comfortable with. Essentially, this would have been an elective surgery rather than an emergency.

In England, the service was of course cashless at the point of delivery, in India, it would have been cashless as he would have been covered by an insurance policy.

With private healthcare extremely expensive and insurance premiums being very high my friend had no choice but to rely on National Health Service (NHS). This is just one case out of probably thousands who have no choice but to access tertiary healthcare in England through the A&E. The thought itself is scary.

With the issues facing NHS being well-known (and we are again in the middle of a winter when horror stories mount) it is quite a shame that the NHS mandarins haven’t considered outsourcing some of the work to hospitals abroad. The least they can do is offer patients a choice. Something like, ”you can get your bypass surgery done in the local NHS Hospital in 6 weeks or you can travel to a hospital abroad and get the same surgery done the next week. Waiting entails some risks, traveling abroad entails some risks as well and the you can decide what you want.”

The reason that NHS is chary of outsourcing is largely because of the fear regarding the local backlash, which will follow if something ”goes wrong”. And than there is of course false pride that comes in the way as well.

In matters related to healthcare sometimes things will certainly go wrong, the outcomes will not always be the desired ones. This happens in every healthcare organisation including NHS. The key is of course working towards minimizing medical errors. Good hospitals everywhere in the world pay great attention to patient safety and reducing mishaps. They have stringent processes, multiple checks and now great technology that helps bring down medical errors. At Max Healthcare in New Delhi, India, where I work we have an ambitious program called ”Chasing Zero”, which aims at reducing medical errors to zero (or as close to zero as possible!!!). I am sure other hospitals elsewhere too have such process controls, which eliminate errors systematically. NHS can pretty safely outsource some of their work to hospitals, which report clinical outcomes similar to NHS. Additionally, they can set up an oversight mechanism for this outsourced network of hospitals pretty much like what Care Quality Commission (CQC) does to supervise and regulate healthcare services in England.

The NHS will also find that the cost of sending patients abroad for treatment is far less than providing similar services in England. This will be an add-on benefit in times where most Clinical Commissioning Groups (CCG’s) are running deficits and the government has limited funds to pour into NHS.

While, this is a sensible solution the biggest problem in implementing something like this is the lack of courage on the part of both NHS as well as the Clinical Commissioning Groups (CCG’s) and ultimately the political leadership in England. The fear of the unknown and the belief that hospitals outside of Britain/Europe do not offer high quality care (mis)informs such thinking.

In a connected world where patients can be monitored and even operated remotely, this is bizarre. The NHS needs to create an expert group that should evaluate hospitals across the world for their clinical quality, cultural affinity to England, languages spoken, easy connectivity to England and the regulatory environment prevalent in the remote country. It should reach out to these hospitals for collaboration in treating NHS patients, who may opt to travel outside of England for their treatment.

Once the hospitals are identified, NHS should set a tight regulatory frame-work, which allows them complete visibility regarding the care protocols for their patients in these hospitals. If need be they can even post ”care officers” in these hospitals to monitor the care being provided. The MIS related to clinical outcomes should be transparently shared with the CCG’s/NHS. A quarterly review involving NHS/CCG officials and the hospitals should help in smooth operations of the program.

This is quite doable. All it needs is courage, will power and some leadership to effect a change.

PS: My friend had his surgery and a reasonably good outcome. The surgery was quite challenging, took more than 8 hours and was fairly eventful. He had to spend many days in the ICU and a long stay in the hospital. He has no complaints regarding the quality of care he received. His only regret being that this need not have been an emergency.

The views expressed are personal

The Aftermath

While the slug-fest between the government of Delhi and private healthcare providers, the Indian Medical Association/Delhi Medical Association and a completely partisan media continues, one is left wondering about the possible aftermath of this ugly episode. The media will soon move on to other stories and the government having scored some brownie points and having successfully demonstrated its ‘might’ will look at another vote-catching device, only the citizens of Delhi will be stuck with a much worse healthcare system.

Let us look at some of the reasons for this.

With the kind of sheer hostility that is being shown by the consumers towards private healthcare and individual doctors, many are already talking about not accepting seriously sick patients. Their fear is that if the patient dies in the hospital, they will be blamed for the death and they run the very real risk of being publicly abused by vicious and ignorant television anchors, beaten up by patient attendants and may be sacked from their jobs. In an environment where the media and the patients believe that it is the doctor’s job to get them well and that he is fair game if the outcome is not the desired one, we are clearly telling our doctors not to treat patients where there is a risk of failure. This will indeed be very sad because as patients we must give our doctors the confidence and the strength to fight the good fight to the best of their skills and ability. That trust is the very basis of the practice of medicine.

The advent of private healthcare had also seen some of the best and the brightest Indian doctors returning to India to work in these corporate hospitals. The world over, Indian doctors and nurses are recognized for their skills and diligence. There is much demand for them all over the world. The prevailing atmosphere of distrust and antipathy is already making many of them uneasy. Many have started regretting their decision to return and work in India. Many who were contemplating to return would now prefer to stay put. Many who had plans to go abroad for training, would now look at ways to bring their plans forward and try to stay abroad longer. One can hardly blame them.

Private hospitals are beginning to realize that it is far more important to have paperwork and video recordings of their patient interactions rather than a caring system, where people are encouraged to go the extra mile to help a patient. Since, the hospitals are not sure when they may be facing a media or a court trial, they will ensure that they are well protected at all times. This will further push up the cost of private healthcare. The undue activism visible today will end up defeating its own purpose.

Setting up and running hospitals is an expensive proposition. Only investors with very deep pockets can build the required infrastructure and sustain operations till they see profits, which happen years later and are meager in any case. If the local governments pandering to their vote-bases arbitrarily decide to shut down hospitals, why would investors put in money to build healthcare infrastructure in the country? The government spends on healthcare are in any case minuscule and compare poorly even with sub-Saharan Africa. The government hospitals are already over-crowded, mismanaged, filthy and without much accountability. If the private investors decide that investing in healthcare is not well worth the risk, where will the people like you and me go for our healthcare needs? If I was planning to set up a hospital in Delhi today, I would certainly think twice.

Working for some of the leading ”corporate” hospitals in India in the last 15 years, I have had the opportunity to travel the world. Everywhere that I have traveled, I have been uniformly asked one question, which is, how has Indian private healthcare system evolved so well. Considering the country’s other developmental parameters, private healthcare, which attracts patients from all over the world (Max Healthcare received patients from 80 countries across the world this year) stands out. Not only is the quality of health care compares well with the world’s best, the costs are the lowest. Ironically, instead of taking pride in our achievements, we are trying our best to run down our hospitals and the people who work in them.

Private healthcare players in Delhi are quite dumb-founded by the political grandstanding, the unwarranted hostility of an ignorant media and worse of all the support of ordinary citizens to this madness. Are we, the citizens of Delhi willing to pay this kind of steep price just because we believe the half-truths being peddled by self-serving politicians and a biased, unprincipled media?

PS: Might be a good idea to find out where these same politicians and media warriors and their families go to when they need serious healthcare. No prizes for guessing though.

The views expressed are personal.

The Story of John and Omar – How Customer Advocacy Builds Brands

200308966-001I was in Nairobi earlier this month. The occasion was to inaugurate Max Healthcare’s information Center in the city. I was accompanied by our partner based in Dubai and the program consisted of the usual run of the mill stuff. We had a couple of doctors accompanying us for the almost obligatory OPD’s, which were being hosted by a local medical center in the Upper Hill area of Nairobi. In the evening was a small press interaction, where all of us were to make some noises about how we expected to partner with the local medical fraternity in improving healthcare services in Nairobi and other parts of Kenya.

I was quite apprehensive about this. It is a known fact that the local medical community does not much appreciate foreign doctors landing up on their shores under the guise of OPD’s and taking away ‘their’ patients to sundry hospitals abroad. Though, I have never really understood the cause of this antipathy, (after-all only those patients will choose to travel abroad whose medical condition is such that can not be treated locally) I have been told by our Kenyan hosts that this is for real. Thus, I was a little concerned about a media interaction, where I may have to respond to some sensitive questions.

Also, I was worried that we really didn’t have much to share. After all an information centre of an Indian hospital chain is not really the most interesting piece of news even from the point of view of the news starved media of the city. When we reached the venue in the late afternoon, I was relieved to see our guests trickling in, the PR guys were busy settling the media folks down, the atmosphere was convivial and relaxed.

We had lined up the doctors to talk about their specialities (cancer and neuro-surgery), I was to speak briefly about Max Healthcare and our reasons for landing in Nairobi and our partner from Dubai was to talk about their reasons for joining hands with Max in this venture. We also had two patients, who had been treated at our hospitals and had returned home safely with wonderful experiences in Delhi.

We were soon done with our respective spiels and I could feel a sense of disappointment in the room. The journalists had come with hopes of an interesting evening and our stories had hardly set the room on fire. The presentations from the doctors were also a little technical, which too added to the gloom. They had tried hard, however for doctors to speak in front of an audience and not to lapse into medical jargon is an herculean task. The only saving grace seemed to be the booze and the plentiful food.

As the evening wore on, we had John come up to address the media. John is a cancer survivor, full of life and vitality. Earlier in the day, when I had met him he had told me about his struggle with the big C and how he had fought desperately to beat it. He had been treated by Dr. Rudra Acharya, the cancer surgeon who had spoken a while earlier. “I am here to tell you all, that cancer can be beaten, I am a living proof of this” began John. He narrated his ordeal with a great deal of emotions, the hopelessness of a patient diagnosed with cancer, how it hits you and what extra-ordinary courage it takes to fight this uphill battle. John appeared to be a man with a great deal of conviction and perhaps driven by a mission to share his story widely. He spoke eloquently about how he was taken care of by a team of doctors drawn from various cancer sub-specialities, how did they collaborate to ensure he received the most effective treatment and how everything came together in the end to pull him out from a very difficult situation. He was effusive in thanking Dr. Acharya and the team of doctors, who saw him through this very difficult phase of his life and spoke very highly of his experiences in an Indian hospital so far away from Nairobi. Soon he had his wife join him on the podium, and the two held the audience completely enthralled while sharing even small incidents that touched their hearts. ” I am planning to be in Delhi once again in February for my check-ups and this time round my doctors have invited me to stay at their homes. We missed the Taj Mahal the last time round, I sure hope to see it now” said John. He than invited Dr. Acharya to join him and his wife and both of them warmly hugged Dr. Acharya, who seemed a little overwhelmed with all the attention.

The media loved John. They were now firing questions at him and were literally eating out of his hands.

Soon we had our other guest, Omar, on the podium. He wanted to talk about the treatment of his son at Max Hospital in Saket, New Delhi. His 12 year old son had met with a freak accident in school. The child had tried jumping across a barrier, had landed on the edge and ruptured his urinary pipe. Omar had taken his son to at-least half a dozen centres in various parts of Eastern Africa. Nothing had worked till he landed with Prof. Anant Kumar  in Delhi. Dr. Kumar took up the challenge and re-constructed the ruptured pipe. Omar had been delighted to see his son recover and for him his Indian sojourn had truly been one of the most rewarding experiences ever. I had met Omar for the first time in the office of Dr. Anant Kumar in Delhi, about two weeks before this press interaction.I had told him of my plans to travel to Kenya and he had volunteered to come and speak about his experiences with the local media. Omar is of Somali descent, not only did he come over to see us and share his story, he helped arrange many Somali TV stations based in Kenya to come for the press conference. He first narrated his story in English for the benefit of the Kenyan media and than for good measure he repeated everything in the local Somali dialect for the Somali audience both in Kenya and back home in Somalia.

John and Omar both did us a great turn, though all they wanted was to help others overcome similar obstacles in their lives. They volunteered to share their stories of difficult times and their struggles and how they found comfort and happiness with a couple of highly skilled doctors and their dedicated teams in a faraway, strange land.

Thank you John and Omar.

A Letter to my Readers

Dear Readers,

Many of you would have noticed that I have hardly been writing this year.

Almost a year has gone by, without a single new post on this blog. Some of you might have wondered, where have I been hiding. Well, to tell you the truth, for most of the year I have been incredibly busy, mostly chasing business for Fortis Healthcare. Till recently, I was heading Sales and Marketing there and this involved a lot of travel, a daily commute from my home to work and, which would easily top 80 kms a day and would gobble up at least 3 hours on the roads in Delhi. Now, anyone who lives in Delhi, knows what this means both on a good and God forbid on a bad day. All this added up to a 12 plus hours a day of work and travel, which left me no time to do anything else.

And than, there was travel in India and abroad. This in a given month would easily consume a minimum of 10 days. While, I love traveling and usually find it uplifting, it would still leave me with even lesser time home, where I mostly write. While on long plane journeys pretty much around the world, I learnt I could easily read, but unfortunately, I also learnt on these journeys that writing inside an aircraft  is not my cup of tea. For me it is a solitary vocation, to be pursued in the privacy of my home.

Thus, over the year, as I read and traveled and toiled at Fortis, I kept accumulating new experiences, great insights and thoughts, that I knew would one day be shared with many of you on this blog.

Last month, I left Fortis, and returned to work at Max Healthcare, which has been a happy hunting ground for me in the past too. Returning to Max Healthcare, also meant less hours commuting to work (the office is 15 minutes away from home), less travel (at least in India, all of our hospitals are in North India, most of them in the National Capital Region) and hence, I am now hopeful of putting together more posts and the output here should go up.

Well, from the point of view of the journey of this blog, this year has just run away too quickly. As I recommence this journey, I shall look forward to your usual comments, feedback and encouragement.

Sincerely,

Anas

 

The New Role of Marketing in Healthcare Organisations

Healthcare organisations, hospitals and the like have long believed that the role of the Marketing function in their organisation is limited to organising health camps, CME’s and marketing communication, mostly of the ‘below the line’ variety. Thus the patient information literature that you see in your hospital is largely the doing of the marketing folks, who usually download the basic material from the net, rewrite some of it to make it suitable for their hospital, get the advertising agency to do a layout as per the hospital brand guidelines, get the doctors to approve the medical content and send it for printing. Marketing folks also organise a couple of advertisements usually when the hospital wishes to announce a new celebrity doctor or a new ‘state of the art equipment’, ‘which the hospital acquires. Now lest you misunderstand, this piece is not meant to disparage the role of the marketing folks in a hospital, on the contrary, I believe they have a much greater role to play than customarily assigned to them.

The Marketing function in a hospital has surely to be much more than this. I believe the Marketing team in the hospital must play a critical role in customer engagement. Now you may wonder, if the marketers were to do this, than what would medical folks do? Aren’t they the ones tasked with the responsibility of patient care? Thus, here we must make the distinction between patient care and customer care, which is critical for a hospital. Patient care is the medical care provided to patients in a hospital, which of course is the domain of the doctors, nurses and other medical staff in the hospital. Customer care on the other hand is the sum total of care that hospitals need to deliver to the patient and his attendants, at all the points, where the hospital engages with the customer. In a hospital, the elements of customer care include customer interactions over the phone, on the website, through an advertisement,  at the front office, at the billing counters, at the nursing counters, in patient rooms, in doctor’s consult rooms, in the waiting areas, in the cafeterias… really anywhere that the patient or their attendants interact with the hospital.

Most hospitals realise that their biggest asset is a satisfied customer. However, many still believe that a good medical outcome is perhaps the surest way of ensuring a patient’s loyalty. Unfortunately, the modern day patients are far more demanding to be satisfied with just a good medical outcome. In fact, many believe that a positive medical outcome for most procedures and surgeries is a given. What they are really looking for is a great hospital experience, which includes an a lot more than an expected medical outcome. Since, a lot of people still choose a hospital or a doctor based on advise from friends and family, a great customer experience becomes an essential marketing tool.  

Let me illustrate the point with a few recent experiences that I have had at Max Healthcare in New Delhi. My father has been battling an oral cancer, and was undergoing radiation therapy at the hospital. Much of the last month I took him to the hospital in the morning everyday. I had requested the hospital to give me a slot early in the morning so that I could go to work later in the day. The hospital obliged without a fuss. Now the General Duty Assistants (GDA’s), who usually wheel patients to the radiation areas report to work at around 8 in the morning and thus I would happily wheel my father over. Imagine, my utter surprise, when the security personnel at the hospital’s gate refused to allow me to do this chore and insisted that he would gladly do it. This was not a one-off, this happened everyday that we went there. A small incident in a hospital’s busy day, but it made all the difference to us, we felt welcomed and cared for. Similarly, many a times in the morning as I waited for my father to finish radiation, I was offered a cup of tea by the staff on duty in the radiation area. Again a small matter, but done instinctively and always with a smile. The fact that I remember these small incidents and write about them here, is excellent marketing for the hospital.

A busy hospital delivers thousands of these experiences every day. Each of them is delivered by individuals, who come from different backgrounds, socio-economic strata, having very differing educational backgrounds, yet they are united at work in aiming to deliver a great customer experience at the hospital. Each of these experiences must exceed customer expectations for them to talk about the hospital and its services.

Many a times a customer experience is delivered even when the customer has not walked into the hospital. These are just as important and include, the effectiveness and ease of handling of the hospital website when the log on to it, the efficiency and knowledge of the telephone operator when they call the hospital and the response of the hospital when in an emergency.

I believe in a new age hospital, the Marketing team must be the custodian of all customer experiences. It should work closely with the hospital operations team in defining the customer engagement paradigm and help them in delivering great customer experiences. The marketing team should have a single goal, to excel in delivering a great customer experience at all customer touch points, whether in the hospital, in the virtual world or outside of the hospital.

Panel Discussions on the occasion of The World No Tobacco Day

Today is the World No Tobacco Day (WNTD). It is observed every year on May 31st. World Health Organisation started observing WNTD from 1987 and it is promoted globally to create awareness about the perils of tobacco abuse and to encourage people to give up using tobacco.

To commomorate the day, I moderated two panel discussions in New Delhi on the harmful effects of tobacco and how can one kick the habit for good. The panelists were all eminent doctors from Max Healthcare. These included Dr. Sandeep Buddhiraja, who is the Director of Internal Medicine practice at Max Hospitals, Dr. Samir Parikh, who is a well-known psychiatrist and also heads the Mental Health institute at Max Healthcare, Dr. IS Virdi, who is the director of Cardiothoracic Surgery at Max Hospitals, Dr. Harit Chaturvedi, who is a Onco Surgeon and the Director of Onco Surgery at Max and Dr. Anupama Hooda, who heads the medical oncology practice at Max. We had a packed house, a very interactive audience and some very interesting discussion.

I have known Dr. Buddhiraja for many years. He is a founding member at Max Healthcare, we worked together for almost 5 years, when I handled the Marketing function at Max. He continues to be my physician and has on numerous occasions treated many members of my family. In all these years I have known him to be a quiet, sincere and thorough professional, somebody whom you can implicitly trust. Today, I discovered another facet of Dr. Buddhiraja, that of a fiery crusader against tobacco abuse. Sandeep, had come prepared with all the facts, which pointed to a huge burden of disease, that is caused by tobacco abuse. He spoke with great passion, while talking about the harmful effects of tobacco. He is clearly much distressed about the increased use of tobacco in its myriad forms, cigarettes, gutkhas, chewing tobacco, pan masala, snuff etc., which is being impudently hawked on our streets. ”On one end of a cigarette is fire and ash and on the other a moron”, is how Sandeep succinctly put it.

Dr. Virdi, made a simple point saying that you can trace almost any lifestyle disease today to tobacco. Be it heart disease, peripheral vascular disease, a stroke and oral and lung cancers, tuberculosis of the chest, all of them are linked to tobacco. This hit home much closer, and I wondered aloud about my father’s illnesses in his almost 60 years as a smoker. He has had tuberculosis twice, a stroke last year and is currently battling with an oral cancer. So much for a puff!!!

Dr. Chaturvedi and Dr. Hooda had a field day, with oral, lung and other cancers having a clear association with tobacco. They too are passionate doctors and see enough and more cancer victims every day, who would be  healthy, if only they had stayed away from tobacco. One can feel their pain and if I may say anger at young people not realizing the grave danger of abusing tobacco, till they reach the office of an oncologist. Dr. Chaturvedi, wondered how is it that once someone is diagnosed with oral cancer, he gives up smoking without missing a beat. My father kicked a 60-year-old habit, the day we told him about his cancer, incidentally diagnosed by Dr. Chaturvedi himself. He wondered that giving up tobacco can not be all that hard.

Dr. Samir Parikh is one of those irrepressible live wires, who have a view on almost everything. Being a psychiatrist and that too one of the most well-known in Delhi, Dr. Parikh counsels and works with lots of people struggling with substance abuse including tobacco abuse. Dr. Parikh and Dr. Buddhiraja talked about how and why one starts with tobacco. Peer pressure, cultural shibboleths including smoking being ”cool”, and myths like ”I can quit anytime”, came up as the most prominent reasons for most people lighting up. Samir and Sandeep, both were emphatic in their pronouncement that tobacco abuse is not merely a habit but a disease. They cited ICD classifications on nicotine abuse and gave medical reasons for nicotine addiction and elaborated on the treatment that can help one kick the disease. They run a tobacco cessation clinic at Max Healthcare and work with smokers, who are keen to quit, but find it hard to get rid of the problem.

My colleague Saurabh Avasthi, who smoked 30 cigarettes a day and then gave up one fine day in October last year also spoke about how he started and how steadily tobacco caught him in its vise like grip and how one day, he just decided that enough was enough. He said that he symbolically buried cigarette sticks and then just never lit up again. The first ten days were hard, when the pull of nicotine, was at its worst and he would count his smoke free days. Over a period of time, he realized that the urge no longer existed and now he says that the stench of tobacco nauseate him.

In the final analysis we concluded that there is no running away from the fact that even one cigarette per day is really one too many. In over 150 people, who attended today’s panel discussion, even if one decides to give up tobacco as a result of today’s session, I would reckon, we would have achieved a lot.