Welcome to the third part of our interview with Dr. Aditi Sinha, where she will debunk common ear myths, discuss diseases observed in both private and government hospitals, and explain how doctors stay updated with the latest advancements and trends in the field of medicine.
Arpita Meher: Ma’am, we know that when we share knowledge, that's when we gain more knowledge. The next question I want to ask is: What are some of the common myths or misconceptions that you might have heard about ENT procedures? And how often do you encounter them, and how do you address them?
Dr. Aditi Sinha: There are indeed many myths that patients commonly believe, and addressing these misconceptions is an essential part of medical practice. For example, patients may ask questions like, "Doctor, can tonsils grow back once they are removed?" It may sound silly, but this question is surprisingly common. The answer, of course, is no; once removed, tonsils do not grow back. However, patients often hear otherwise.
Similarly, if a patient is undergoing surgery for a deviated septum, they might ask, "Doctor, can it grow back after you remove it?" Again, the answer is no, but these misconceptions persist. Patients often hear stories of conditions or body parts regenerating after surgery, which leads to such questions.
Dr. Aditi Sinha, ENT Specialist and Head and Neck Cancer Surgeon
Additionally, some patients fear that undergoing inner ear surgery, such as a stapedectomy, will result in deafness. This is another common myth. Patients need to be reassured that, with proper post-surgical care, their hearing can be maintained or even improved. Hearing aids are another area where myths persist. Many patients in India are reluctant to wear hearing aids because they believe that doing so will worsen their hearing or label them as handicapped. It's crucial to educate patients that hearing aids are simply devices to amplify sound and improve their quality of life. These devices should not be stigmatized or feared.
In summary, addressing these common myths is essential for providing patients with accurate information, alleviating their concerns, and ensuring they receive the appropriate medical care and treatments.
Arpita Meher: True, ma'am, and we have certain practices, like in villages when kids are born, some mothers believe that oiling their ears is good. Even in Ayurvedic practices, they have this practice of oiling their ears. How does that benefit us, and do you have a different opinion—that's something Ayurvedic, and we focus on allopathy? So how do you think the thoughts differ in that?
Dr. Aditi Sinha: In India, convincing patients not to put non-medicated substances in their ears can be quite challenging. Surprisingly, around 80% of patients who come in with an earache have used some unconventional home remedy for their ears. These remedies can range from using warm mustard oil or hot coconut oil to concoctions involving garlic or onion juice. While these practices may sound strange, they are deeply ingrained in traditional home remedies.
Patients often argue that they used these remedies in the past for their children, and nothing adverse happened. However, the issue is not always about immediate harm; rather, it's about the lack of a scientific basis for these practices. I emphasize to them the importance of not putting anything in the ear without knowing the underlying problem. Instead, I suggest using hot compresses externally to alleviate pain and discomfort. Medicated ear drops can be a safer and more effective solution.
One significant problem with using oils like mustard oil or coconut oil in the ear is that they create a sticky film that covers the eardrum. This film hinders the doctor's ability to examine the ear properly. Therefore, before any examination, I often have to clean the oil residue, making the process more challenging and less accurate.
Despite our efforts to educate patients about the potential risks and lack of scientific evidence behind these practices, they continue to persist. These traditional remedies have been passed down through generations, and changing these deeply rooted beliefs will likely take many more years.
Arpita Meher: That's true. They have their own ancient beliefs in that, and it continues. Now my colleague Priya will ask you some questions.
Priya Bairagi: You have worked in different hospitals, like government hospitals and private hospitals. What kind of patient load did you observe in government and private hospitals, and what kind of common diseases were seen in government hospitals rather than private hospitals?
Dr. Aditi Sinha: When it comes to government hospitals and the ENT department, the dynamics are quite different in India. In a typical three-hour ENT OPD session, which usually starts at 9 o'clock, doctors may see a staggering 200 to 300 patients. This high volume of patients is mainly due to the cost factor. In government hospitals, the fee for an ENT OPD consultation is as low as 10 rupees. Interestingly, even relatively well-off patients often choose government hospitals because they believe that the doctors there have extensive experience.
On the other hand, private practice in India can vary significantly in terms of charges. Specialist consultations in private settings may range from 500 rupees to as high as 2000–3000 rupees, depending on the doctor's experience and location. However, not everyone can afford these fees, especially since medical expenses are typically not reimbursed in India. Affordability plays a crucial role in healthcare decisions, and many people are hesitant to spend extensively on medical care. Bargaining for medical services is not uncommon.
In private practice, the patient volume is lower compared to government hospitals. An ENT doctor in a private setting may see around 20 patients in a three-hour session, largely due to the higher costs associated with private healthcare. The patient demographic also differs.
In government hospitals, common cases include ear infections, ear discharge, fungal infections (often related to poor hygiene), respiratory issues like cold, cough, and pneumonia, chronic sinusitis, and unfortunately, advanced cases of cancer that were not diagnosed early.
In private practice, the patient profile shifts. There, you are more likely to encounter senior citizens with hearing loss who are interested in hearing aids, patients with migraines, allergies, allergic rhinitis, sinusitis, and individuals seeking routine ENT checkups. Additionally, many younger patients who use earphones frequently visit private practices for earwax removal and routine ear care.
Priya Bairagi: Ma'am, various health camps are organized all over India. Is it good to attend these camps for free checkups? Everything, including all necessary checkups, is conducted and covered.
Dr. Aditi Sinha: The effectiveness of medical camps largely depends on who is organizing and running them. There are well-organized camps that I would highly recommend due to their thoroughness and quality of care. However, there are also random and haphazard camps that seem to be primarily driven by financial interests or political agendas. These can include health checkup camps, ENT checkups, or general screening camps held at fairs or other events, attracting hundreds or even thousands of patients.
In such large-scale camps, it's challenging for a doctor to provide a comprehensive examination of each patient.
Dr. Aditi Sinha, ENT Specialist and Head and Neck Cancer Surgeon
On the other hand, there are well-organized camps conducted by reputable institutions like Tata Memorial Hospital or the Cancer Patients Aid Association. In these camps, the patient load is manageable, and there is a full panel of healthcare professionals available. Doctors can devote more time to each patient, conduct thorough examinations, and even offer basic lab investigations on-site. These camps are better equipped to provide meaningful healthcare services and detect serious diseases.
The effectiveness of medical camps varies widely, and patients should exercise caution when seeking healthcare in such settings, especially in large-scale camps where thorough examinations may be challenging to conduct.
Priya Bairagi: In your opinion, what are the most positive impacts of AI and technological advancements? How does it have a positive impact on people's lives?
Dr. Aditi Sinha: Health technology, including AI, has significantly benefited patients residing in remote tier 2 and tier 3 cities, where access to various healthcare services has traditionally been limited. For instance, even radiology reporting has been revolutionized. Today, a patient can get an X-ray done locally and have it reported by a doctor located anywhere in the world, such as in Georgia, ensuring access to expert opinions.
Furthermore, AI is empowering numerous health tech apps that allow individuals to monitor their basic health parameters. During the COVID-19 pandemic, there was an app that measured SpO2 levels, providing people with a tool to track their health. There are also apps designed for diabetes care programs, enabling patients to upload their reports and receive reminders for various health-related tasks, such as checking blood sugar levels. These technologies assist individuals in practicing preventive healthcare by keeping their health in constant check.
Additionally, these apps facilitate remote consultations with doctors, including senior specialists from prominent hospitals across the country. Patients now have access to medical advice from the comfort of their homes. I've even had patients consult me from remote locations like Nagaland, Gangtok, and lesser-known villages in South India, all thanks to their internet connectivity and the convenience of these health tech apps. These advancements have not only made healthcare more accessible but also faster and more efficient.
Priya Bairagi: You might have heard about NExT 2024. What is your opinion on this?
Dr. Aditi Sinha: It is extremely senseless, and It's a money-making exercise, but then, you know, earlier, when we did it, we had bonds; we had to do a rural bond, and the government made money for that.
So people didn't want to go and serve rural. The unfortunate part was that there were no rural postings available that they could offer for all the students that would pass. So many people paid off that bond. It was a way the government took money. 5 lakhs, 1 lakh could have gone up to now 20–25 lakhs for government college students because the government said that your education is subsidized. You don't pay much. It's only 10,000 rupees a year for a government college student.
So they felt that because that is subsidized, you either serve in the rural area, serve the country because the government has subsidized your education, or you pay this amount. Now they have come up with this, but I don't think it is right to do so.
Priya Bairagi: No, ma'am. The bond system is still there. My brother is doing MBBS at a government college in West Bengal. It is still there. But it's a compulsory two-year internship. He has to do it in rural areas.
Dr. Aditi Sinha: I know, but the amount has gone up. It's 20–25 lakhs now.
Priya Bairagi: Yes, ma'am.
Dr. Aditi Sinha: But that is post-MBBS and post-PG. If you pursue PG from a government college, you have to fulfill two bonds after MBBS. If you have completed both MBBS and PG in a government college, it feels like a punishment. If you've studied in a government college, they penalize you either by placing you in a rural area where you cannot apply your skills or by requiring you to repay them.
They're claiming it's the same thing. You end up paying what you might have paid for a private medical college education. I know somebody who specialized in gynecology, recently passed the gynecology exam from a government college, and was a topper. She had to pay 25 lakhs because she didn't want to undertake a rural gynecology posting somewhere. So, regarding NExT, I don't think it will be implemented; that's my opinion. It shouldn't.
I anticipate a lot of protests and opposition, which has already hindered its progress. They claim that they don't think it is feasible. If it is, I believe medical personnel, professionals, and students should voice their concerns against it.
How do you stay updated with the recent advancements in your field?
There are both positive and negative aspects to the requirements for renewing credit hours and points in the medical field. Every five years, medical practitioners are obligated to apply for license renewal. In the past, many doctors, particularly general practitioners, did not keep up with evolving medical knowledge. Some had not attended conferences, Continuing Medical Education (CME) events, or updated their knowledge since their initial qualifications. However, in Maharashtra, there is now a CME rule in place, mandating that doctors accumulate 30 credit hours to renew their medical licenses. This rule compels even those who have been distanced from academia to attend various workshops and conferences in their field, or in general practice, to stay updated.
Interested individuals often stay updated through their interactions with students, especially those in hospitals with DNB (Diplomate of National Board) students and other trainees. These students bring in new knowledge, and doctors teach and exchange information with them, fostering a mutual learning environment.
There are numerous medical conferences and workshops being conducted, and some of them are exceptionally valuable and worth the time investment. Many international-level conferences are held in India, featuring speakers from abroad. These conferences are often conducted in person rather than virtually. Hands-on surgical workshops with cadaveric dissection are highly recommended, particularly for students. While these workshops can be expensive, they offer invaluable practical experience that complements theoretical knowledge obtained from textbooks and journals. Thus, attending live surgical workshops, especially those involving cadaveric dissection, is highly advisable for all medical professionals.
Priya Bairagi: What advice do you want to give to our readers and to society about ear health? Like when people are unaware of their ear health, you know, ear check-ups, you know, what kind of tips you have from the layman's point of view.
Dr. Aditi Sinha: I'd like to share some important advice with everyone.
Firstly, for parents with newborns, please consider the significance of newborn screening, especially for hearing loss and deafness in India. This crucial step is often overlooked. Ensure that your baby undergoes newborn screening for a comprehensive assessment, in addition to other standard tests, right after birth.
Secondly, for the younger generation, it's crucial to reduce your exposure to excessive noise. Many of you use headphones and spend significant time on your phones, but I strongly advise against using noise-canceling headphones. Additionally, try not to use in-ear headphones, which place the sound source closer to your eardrum. Increasing the distance between your eardrum and the sound source can help protect your hearing. Noise-induced hearing loss is the leading cause of hearing impairment among young people, and it's often underestimated. Prolonged exposure to loud sounds can result in irreversible nerve damage, so it's essential to be mindful of this.
Thirdly, make an effort to undergo an annual hearing and eye checkup. I recommend this to all young individuals. It's essential to monitor your hearing and vision regularly to catch any issues early.
Fourth, please avoid any blind procedures on your body, whether it's in your ear, eye, nose, or throat. These procedures can cause more harm than good, so it's best to consult with a specialist.
Fifth, if you find that you don't have access to an ENT specialist, consult your family doctor or general practitioner for basic advice. If they cannot resolve your issue, such as chronic sinusitis, allergies, or earwax problems, they may refer you to a specialist. Your health is of the utmost importance, so don't hesitate to seek specialized care.
For individuals above the age of 40, I recommend getting an annual audiometry test as part of your regular checkup. Recent studies have shown a link between hearing loss and conditions like Alzheimer's and dementia due to the lack of auditory stimulation. Ignoring hearing issues can significantly impact your quality of life, so it's crucial to address them promptly.
Additionally, don't hesitate to use hearing aids if needed. They are similar to any other electronic device and can significantly improve your quality of life.
In conclusion, please take these recommendations seriously to protect your health, well-being, and quality of life from an ENT perspective.
Stay tuned for Part 4, where we explore diseases such as GERD and its link with ENT, apnea, vertigo, and other conditions related to ENT.