## Doctors, Ethics, Surgeons, Expert problems:
* NNTaleb has been writing about [expert problems](http://www.zerohedge.com/news/2017-02-07/not-fascism-nassim-taleb-warns-theres-global-riot-against-psuedo-experts) for a while.
* He has also mentioned about [doctors](https://medium.com/incerto/surgeons-should-notlook-like-surgeons-23b0e2cf6d52) belonging to experts class for a while
* I’ve had experience with doctors, that suggest a similar problems(non-clarity/transparency
about conflicting interests), and I wrote some general set of advice [here](https://softwaremechanic.wordpress.com/2016/08/07/advice-to-doctors/) and a short related announcement [here](https://softwaremechanic.wordpress.com/2016/08/03/notesthoughts-from-waiting-at-the-labour-ward/).
* However, NNT also has this [quote](https://en.wikiquote.org/wiki/Nassim_Nicholas_Taleb)
about fraud and ethics.
* So I’m calling out the [specific people, hospital and incident](http://www.lakshmimadhavan.com/dr_madhubala_manickavasagam.php) that triggered me to write that article above.
* This happened last year 1st of August and since there was a whole lot of emotions involved
from my side on the incident, I’ve waited to let them all get out of my system, and almost
a year later, I’m still convinced, this needs to be a specific pointing post at specific
people , hospital and incident.
* In the time since then, I’ve spent a lot of time soul-searching, trying to read Doctors
answering on quora^1 etc.
* I really liked the answers by [Dr.Vinay
Kumaran](https://in.linkedin.com/in/vinay-kumaran-7a50951a) to that question I linked
above, but quora is messed up^2 and banned him based on BNBR policy reporting by a horde
of nationalist trolls(Stay tuned for politics/policy related post for that one).
I wrote a set of disclaimers for the advice for docs post, add these too.
* I am not a doctor, or for that matter in any ways working in the medical field
professionally, now or in the past.(doesn’t look likely in future either, but that’s
* I am not hiding behind anonymity, this blog is at best pseudonymous, but for this post, I
am using my real name, which can be googled and found.
* I am aware of the complexities of biology and medicine, and how much surprises it has
thrown up, just when science thought it knew humans.
* I have two Doctors in the family(a aunt and an uncle) and have some idea of the pressures
they face, and habits they pick up.
* I did no research or enquiry on the hospital or Doctor before choosing them. The
patient(my wife) was insisting on them, and I had no way of gathering reviews/evidence.
* I won’t even bother claiming, I was being rational at the moment.
* I do claim, I could have and did guess the potential side-effect (of using a sublingually
administered, hormone pill to induce labour) simply by my basic understanding of biology,
but did not raise the question or confront the doctor(deferring to their judgement),
till the nurses started saying the blood pressure is not stable^6, we might have to operate.
## Now Here’s a list of Cons of [Lakshmi Madhavan hospital](https://www.google.co.in/maps/place/Lakshmi+Madhavan+Hospitalemail@example.com,77.7189863,17z/data=!3m1!4b1!4m5!3m4!1s0x3b04118b20988cb5:0xe602ee84ba35d923!8m2!3d8.7262335!4d77.721175):
* Chief Doctor Madhubala^3 may be a good surgeon and probably has a primary focus on surgeries.
* However, she’s shuffling between atleast 2-3 roles(a physician, surgeon, reputation
manager, PR representative, hospital administrator, etc.)
* She’s clearly insecure about her knowledge of the drugs administered, and their
side-effects, risks vs benefits tradeoffs, and her judgement.(aka physician role, See my
previous post linked above)
* She really needs to get hold of her emotions, and not drop back to the
[intimidation/dominance game](https://en.wikipedia.org/wiki/Dominance_hierarchy). Aka
switching to English (to distract) works only on some types, not on others. (as evidenced,
by taking, do you know you’re in my property and asking me questions)
* Taking a hi-fi (“Who-are-you-to-question-my-treatment^4”) only works with people who’ve had
a history of being intimidated by “Experts”
* She showed no sign of awareness about the conflict of interest involved in the roles, she
seems to be playing.
* She’s fairly hard to catch/meet (as the patient’s husband) as they have ladies only
inspection sections, and use internal paths to navigate.(in effect avoiding the relatives)
* There’s signs of un-awareness of responsibilities of roles(in terms of treatment), as
evidenced by her question, “Do-you-know-how-much-time-I-spent-with-her?”(She’s expected to
make judgement on best treatment, and explain to the patient her top few choices of
treatment. Being nice is good, but secondary responsibility. I understand some
sections/types of patients, don’t want to know the details of treatment, but that doesn’t mean you fail
to explain the risk-benefit tradeoff)
* She clearly, is too afraid of risks and of losing her image/status/assets over the
patient’s welfare. (as evidenced, by a threat/blackmail to expel the patient).
* There’s not enough transparency^5 of treatment given. As I mentioned during treatment, the
patient should know, and after discharge, there should be medical history sheet of sort
given to the patients.
* After you’ve made the threat of expelling a patient, and the patient’s mom, has fallen to
your feet etc.. All actions, like for example assigning a separate room, and letting the
husband, be with the wife etc.. simply seems like a PR stunt, rather than genuine,
concern. (Especially, after all those moves, you pulled, when confronted in private.)
* Eventually, She did do a C-section and delivered my daughter safely without any
complications. Thanks to that.
* I do conclude that she’s not caught up or upto date in her treatment research .
* Ironically enough, writing this blog post is more likely to bias the set of patients the
hospital receives towards the bunch of people who’re vulnerable to all that intimidation.
* That is, if this has any effect at all, it will be on the people who read and are
reasonably regular readers and then it will convince them to choose a different hospital.
* So this blog post might actually become a positive-feedback loop for the very same
behaviours and incidents that caused it to write in the first place.
* I struggled with an effort at guessing, the impact of writing this in public vs sending a
private e-mail, but without any real numbers or demographics of the patients the hospital
it caters to, I could only make guesses. and none after that(i.e: future changes/processes
at the hospital, introspection/self-awareness on the Doctor etc..). So I won’t claim i
wrote it as a PSA(public service announcement), but I’ll observe that it is a relief to
have written this out.(Make what you will of it).
* I’ll finish with my [favourite humourous quote from Douglas Adams](https://softwaremechanic.files.wordpress.com/2017/06/da.jpg).
2. SideRant: Dear [quora founder](https://www.quora.com/profile/Adam-DAngelo), while I understand the reason for your BNBR policy, and how algorithmically it works in the first world, you really, really, have to find a way to handle the crazy, hordes of masses from the non-first world. it doesn’t necessarily have to be manual, but get some better training data atleast. (For ex: mechanical turk, but they don’t do Indian audience, may be try [Squadrun](https://squadrun.co/). Really try to get people to review someone’s profile history and rate his trustworthiness, may be that help build a NN model to predict a person’s rateworthiness(segregate/segment by country/location if needed). Don’t just ban good writers, who are actually helping.
3. Or as I nicknamed her Dr. Tasmac Bala
4. Ironically enough, I was questioning whether she explained the risk-benefit tradeoff to her
patient and not her judgement or choice of treatment.
5. I am a little bit conflicted by the necessity of this point, as I haven’t done any hospital
administration. My reading on quora and interactions with some of the Doctors suggests that
requiring it by law, only makes the “Doctors too cautious and biased towards inaction till
emergency.” So as a policy, better to study different countries and implementations and results
before concluding anything.
6. Which is a side-effect of sub-lingual hormonal administration
UPDATE: Apr.17-2018: Here’s an additional link suggesting as to what could be happening. (It originally has the US industry in mind, but probably transfers well to India)