Leisure, Lifestyle & Wellness
Five safe surgery tips for patients

Many patients fail to realize that there are practical steps they can take to help ensure a successful surgery. Here are five recommendations to consider before going under the knife

My late daughter, Katherine Eileen Hallisy, was 5-months-old when she was diagnosed with malignant tumors in both eyes. We knew cancer would be a formidable enemy. But we did not expect to fall victim to medical error, misdiagnosis and fragmented and chaotic care.

I learned the hard way how to protect my daughter. Once, when Kate developed worrisome signs after a biopsy, our discharge papers directed us to contact the emergency room. Staffers there did not expect to be contacted for follow-up, and advised use to stay home. We missed an opportunity to identify the early signs of life-threatening sepsis, which caused my daughter tremendous suffering.

We learned that we had to ask the right questions at the right time, to communicate effectively with providers, and to take steps to avoid errors and infection. It was Kate who suggested that we share our hard-won knowledge with others so they could avoid many of the problems she faced.

My promise to Kate eventually led to our non-profit, The Empowered Patient Coalition.


Now I speak to hundreds of patients, and on their behalf at conferences around the country. There are about 80 millionsurgical procedures a year in this country, and unfortunately, many patients do not realize that there are practical steps they can take to help ensure a successful surgery. That’s why I developed five recommendations for patients to consider when considering surgery:


  1. Deciding on Surgery. No surgery is risk free. So do you know why surgery is needed? You should be clear about how successful the surgery is in correcting your specific condition. Ask if there is medical evidence that supports surgery over other treatment options. What should you expect if you decide not to have surgery?
  2. Choosing a Surgeon. Ask if your surgeon is board-certifiedin the specialty you require. Check to see if she is a member of the American College of Surgeons and the American Board of Medical Specialties. Check to see if your surgeon has anymedical board disciplinary actions. Ask your surgeon how many times he has performed your specific surgery. What have been the outcomes? What is the complication and infection rate? Demand specific answers and not vague generalizations like “not many.”
  3. Surgical safety. Will your surgeon be performing your entire surgery? Will she be assisted by other surgeons, residents, or students? How much direct supervision will doctors-in-training receive? I learned the hard way to ask these questions after surgical residents operated on my daughter instead of the senior pediatric orthopedic surgeon. There were no complications, but I was alarmed. Patients   need to be completely clear about the identity and the experience level of their surgeons. Be sure the surgeon signs your surgical site and confirm the location by adding your initials as well. Ask your surgeon if she will take a “time-out” in the operating room to confirm the right patient, the surgical site, and the correct procedure. Ask if the team uses a surgical checklist to ensure that important safety protocols are followed.
  4. Preventing infection. Patients play an important role in preventing infection. Ask if you need antibiotics before surgery and remind the staff to administer them. Inquire about using a pre-surgical body wash in the days before surgery to lower the bacterial count on your skin. Do not shave your surgical site in the 24 hours before surgery to avoid making cuts in the skin where bacteria can enter. Try not to touch or scratch your surgical site and keep your hands clean by washing with soap and water or by using a hand sanitizing gel.
  5. Recovery and home care. Be sure that pain and nausea are controlled, because they can delay healing. If you are receiving narcotic pain medications, be sure your vital signs are closely monitored since a bad reaction may lead to hallucinations, nausea, or labored breathing. Pay close attention to your discharge instructions and be clear about your medication schedule, when to see the doctor for follow-up, and when to remove bandages or bathe. Ask if you need any medication to prevent blood clots.


For more information, see our free Hospital Guide for Patients and Families.


Courtesy: http://www.propublica.org/



Nem Chandra Singhal

5 years ago

How many points are applicable in India ?

Round 2 goes to Obama; slams Romney's outsourcing plans

Obama, who drew flak from his own party for a lacklustre performance in round one two weeks ago, this time often dictated the terms of the debate questioning Romney's approaches towards China, immigration, taxes, unemployment, gun laws and other domestic and foreign

Hempstead (New York): A combative Barack Obama has hit back at Mitt Romney, retrieving lost ground in the second of the three high-stake presidential debates, saying his Republican rival's plans on outsourcing will only result in more jobs in China and India, reports PTI.


Obama, who drew flak from his own party for a lacklustre performance in round one two weeks ago, this time often dictated the terms of the debate questioning Romney's approaches towards China, immigration, taxes, unemployment, gun laws and other domestic and foreign issues.


During the 90-minute face-off at the Hofstra University in Hempstead for a town hall style debate, Romney retorted claiming US has been losing manufacturing jobs to China as enterprises feel it is "more attractive" to go offshore than to stay here.


A snap CNN/ORC International poll showed 46% of respondents thought 51-year-old Obama won, compared to 39% for 65-year-old Romney. The result was within the survey's margin of error.


Both Obama and Romney fielded questions also on topics like gas prices and Libya from members of the audience, a group of 82 undecided voters from New York's Nassau County.


The question on outsourcing of American jobs overseas came at the fag end of the debate, which saw an aggressive and assertive Obama take on Romney as he tried to improve on his performance at the first debate in Denver where the Republican leader came out as the surprise winner.


"One of his (Romney's) big ideas when it comes to corporate tax reform would be to say, if you invest overseas, you make profits overseas, you don't have to pay US taxes.


"But, of course, if you're a small business or a mom-and- pop business or a big business starting up here, you've got to pay even the reduced rate that Governor Romney's talking about. And it's estimated that that will create 800,000 new jobs. The problem is they'll be in China. Or India. Or Germany," Obama said.


"That's not the way we're going to create jobs here. The way we're going to create jobs here is not just to change our tax code, but also to double our exports," the president said.


Responding to the question on what plans they each had to keep jobs in the US, Obama said while Romney and he agreed that the corporate tax rate should be lowered, there is a difference on the way they both would approach the issue.


"I want to close loopholes that allow companies to deduct expenses when they move to China; that allow them to profit offshore and not have to get taxed, so they have tax advantages offshore. All those changes in our tax code would make a difference," Obama said, slamming Romney for wanting to expand the tax breaks.


Romney shot back that "if you elect President Obama, you know what you're going to get -- you're going to get a repeat of the last four years."


Responding to the question, Romney blamed Obama for not labelling China as a currency manipulator, promising to put the label on Beijing on day one of his presidency.


"We are going to have to make sure that as we trade with other nations that they play by the rules. And China hasn't. One of the reasons -- or one of the ways they don't play by the rules is artificially holding down the value of their currency. Because if they put their currency down low, that means their prices on their goods are low. And that makes them advantageous in the marketplace."


"We lose sales. And manufacturers here in the US making the same products can't compete. China has been a currency manipulator for years and years and years. And the president has a regular opportunity to label them as a currency manipulator, but refuses to do so," Romney said.


Romney repeatedly took on Obama, blaming his rival's policies for rising federal deficits and debts, leaving more than 20 million people jobless.


"We don't have to settle for what we're going through," Romney said at one point. "We don't have to settle for unemployment at a chronically high level. We don't have to settle for 47 million people on food stamps. We don't have to settle for 50% of kids coming out of college not able to get work. We don't have to settle for 23 million people struggling to find a good job."


Charity must begin at home, in this case at the PIO’s table

Maharashtra Chief Information Commissioner Ratnakar Gaikwad has urged public authorities to comprehensively abide by Section 4 of the RTI Act which makes it mandatory for them to put most of the information in the public domain

Seven years down the line, one of the setbacks of the RTI (Right to Information) Act is the failure/unwillingness of public authorities to abide by Section 4 which makes it mandatory for them to upload most of their functions and activities on the website. If such information is put in public domain, a citizen will hardly be required to file a RTI application. He would get the information at the click of the mouse.


At the one-day workshop held in YASHADA in Pune last week on the occasion of the seventh anniversary of RTI Act, Maharashtra Chief Information Commissioner Ratnakar Gaikwad stated in no uncertain terms that, “charity must begin at home. The mandate has been given to us to implement pro-active disclosures under Section 4 of the RTI Act and all public authorities must be committed to it.”


He lamented that many public authorities are still not aware of the intricacies of Section 4 (a) and (b) and urged civil society groups to perform social audits regularly. Mr Gaikwad states that, “There are 81,000 Public Information Officers (PIOs) and 23,000 First Appellate Authorities in Maharashtra. How do we know whether the public authority is doing his duty or not? Civic groups should audit and report the quality of pro-active disclosures by dividing them into A/B/C and D categories and send the reports to the CIC. I assure immediate action.”


Mr Gaikwad, in his role as the SCIC, has directed heads of all public authorities to pro-actively be involved in suo motu disclosure of information on their respective websites. He stated, “I have issued directions under Section 19 (8) to collectors, commissioners, CEOs, heads of departments and director of health sciences that it is not enough for heads of public authorities to ensure that PIOs are merely functioning. They must monitor whether pro-active disclosures under Section 4 are being uploaded in the public domain on a regular basis. Some of them shrewdly appoint low-rung officers as PIOs and AAs. There are a few though who do show a lot of sense of responsibility. In Mumbai for example, ward offices do not feel that RTI is their responsibility. Hence, I have recently written to the chief secretary and municipal commissioner of Mumbai to find out where RTI is properly implemented and where it is not. I am awaiting the report.”


Mr Gaikwad urged citizens to use the RTI to improve governance and not to ask details which would waste the time of the PIOs. Giving an example he stated, “Some citizens have been asking frivolous queries like what is the menu served for lunch for officers with details like how many vegetables were used for it and so on. We must realise that PIOs have to do other works too. Hence, citizens must focus on vital information which will bring in transparency and accountability. Sincerity in seeking information is of utmost importance.”


Praising social activist Anjali Damania, Mr Gaikwad stated that, “I was impressed with the way Anjali Damania pursued seeking information regarding the irrigation scam. After she applied under RTI, she was not disclosed the information she required. When she approached me I asked the secretary, irrigation, to provide her with complete information. She has gone on record to say that CIC helped her immensely. Another RTI activist had pursued the same information and was given the needful within a week. However, he insisted that it should be given in a particular format. Now, this would have taken a lot of time. There was a stark contrast in approach of the two RTI applicants. It is not always possible for PIOs to supply information in the format that the citizens ask for hence the former should be considerate. Also, our democracy will be strengthened if citizens use the information they have sought by pursuing it and taking it to the logical end.”


Putting the onus on the PIOs and FAAs to perform their duties as mandated by the RTI Act, he stated that, “those who are providing information and taking decisions should be accountable. Everybody in the government is a public servant and RTI is a good instrument to remind those serving in the government and change their mindset. Every government servant must remember that today he is questioned by the citizen who may be a Below Poverty Line (BPL) or illiterate but has the right to know and has the right to access information.”


Lamenting that many officers are averse to disclosure of file notings, Mr Gaikwad stressed that, “officers should have the moral courage to disclose whatever they are writing on the files.  Whosoever is highly placed in the bureaucracy and is taking decisions should do so with a full sense of responsibility.”


In conclusion, Mr Gaikwad stated that, “the main challenge before Maharashtra is capacity building. For the Act to become a strong weapon in the hands of the citizens to strengthen democracy, the civil society, public authorities and Information Commissioners should work together. We are in the seventh year and we should not be discussing (Section 4). There has to be a culture of transparency.”

Department of Personnel & Training (DoPT), Centre for Good Governance (CGG), Hyderabad and YASHADA have worked together to develop an audit tool to help citizens/public authorities, Information Commissioners and NGOs to assess whether a particular public authority is comprehensively executing the pro-active disclosures under Section 4. YASHADA has conducted an audit of more than 400 offices using this tool. The assessment is measured by putting the government office (which is audited) into A, B, C or D category depending on its pro-active disclosures in the public domain. All those who are interested in the tool-kit may write to Dr Pralhad Kachare, director of the RTI Cell of YASHADA at [email protected].


What must a government office disclose under Section 4?


Under Section 4(1) (b), every public authority is mandated to publish the following categories of information within 120 days from the enactment of the Act:

1. Particulars of the public authority

2. Powers & duties of officers & employees

3. Procedure followed in decision making

4. Norms for discharge of functions

5. Rules, regulations, instructions, manuals and records under its control/used by employees while discharging functions

6. Categories of documents held by the authority or which are under its control

7. Arrangement for consultation with or representation by the members of the public in relation to the formulation of policy or implementation thereof

8. Boards, councils, committees and other bodies constituted as part of the public

9. Directory of officers and employees

10. Monthly remuneration received by officers & employees including system of compensation

11. Budget allocated to each agency including all plans, proposed expenditures and reports on disbursements made etc.

12. Manner of execution of subsidy programmes

13. Particulars of recipients of concessions, permits or authorisation granted by the public authority

14. Information available in electronic form

15. Particulars of facilities available to citizens for obtaining information

16. Names, designations and other particulars of public information officers


(Vinita Deshmukh is the consulting editor of Moneylife, an RTI activist and convener of the Pune Metro Jagruti Abhiyaan. She is the recipient of prestigious awards like the Statesman Award for Rural Reporting which she won twice in 1998 and 2005 and the Chameli Devi Jain award for outstanding media person for her investigation series on Dow Chemicals. She co-authored the book “To The Last Bullet - The Inspiring Story of A Braveheart - Ashok Kamte” with Vinita Kamte. She can be reached at [email protected].)





5 years ago

Let this spirit begin with the Govt of India first and then with the state governments under the supervision of the Supreme court. RTI is more of a farce, having finally been rendered a toothless tiger by the PM in his latest declaration of his govt.'s intention that RTI Act must be "restrained" from intruding into the "private lives" of the people (read:(influential and powerful politicians/bureaucrats and their family members)). In the insurance sector/DDA/ police/income tax/RTOs/MCD/NDMC/FCRA/CBDT (especially sec. 35CCA and sec. 35 AC and 80G relared matters, and all Banks (PSU ones not excepted) for instance, it is indeed a non-starter for almost pre-printed-computer-generated-replies-needing-no-signatures issued in almost 100% cases, without any fear or risk of any reprisals as though this is systemic. Save being chiefly a welfare measure for (pliable) retired-civil servants rehabilitation programme, RTI does not appear to have made any dent on the insensitive govt. machinery which is now a hundred percent corrupt with impunity, as is being revealed almost daily. In the "post-poribartan (total change)"state of the great prime mover, Westt Bengal, the state govt and its functionaries being ruled by the ruling party's only leader and the extra-constitutional local contract-holders (like the infamous LCs in the CPM-ruled hoodlum years), RTI and people's rights have been non-existent for the last four decades. In this overall negative scenario for a politically correct RTI Act is best called an academic adventure rich enough as a PhD subject and for getting forein tours to attend conferences for the blue-eyed-brats of the govt.! Thank you for the article though.

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