The prescription debate; The Judge know better than your doctor?

A recent urgently called meeting by the boss of my medical university , caught me off guard. The busy out patient of my department needed me more as I was the only consultant on duty. But you comply to orders from the higher up, the system minces no word . The long drawn , passionately debated meeting was regarding a recent court order by the high court of the state. The court listening to matters related to unethical and fraudulent practices of a hospital , which was owned and run by a non-allopathic practitioner , gave some blanket sweeping orders pertaining to a prescription of a doctor, allopathic ones( Irony ,never cease to amuse). It says , a doctor must write a prescription , with a legible handwriting or typed, with patient’s name , date and doctor’s name , signature , date and registration number . Also he must write generics only ,in block letters, with proper dose , frequency, route and duration.

Now , nothing seem out of place in the first look. The recent , MCI( Medical Council of India, apex body for allopathic medical practice) and Apex court directives take the same stand. And , not to get surprised , our populist prime minister outright threatens the deviant doctors.

So what is this hullabaloo? our group debated , some of the salient features , were:

  1. what about fixed dose/drug combination , where there can be as many as a dozen compounds in one combination. The commonly prescribed ones ,like multivitamins nutritional supplements and cough syrups to name a few
  2. Now , with this added burden, our already overburdened average doctor in this 3rd world country, will be drained further . How do you expect him/her to do this when he spends an average of 2 minutes , taking history, examining , making diagnosis, writing prescription and explaining , it all…oh by the way are you game for some more paradox? Recently , the Madras high court gave directives to the toll plaza managers , to make separate and special arrangement for the VIPs including the sitting judges, so that they don’t lose their precious time. Mind you, doctors and ambulances carrying critical patients were not in that coveted VIP list.

OK. so doctors wont write brands , and write only generics. what about medicines which are not available as generics , most of the recent medications and patented ones are not . Does that mean , we have to not practice , recent updates in the medicine world and keep our patients away from the cutting edge treatment modalities. Hmm.. now that’s a food for thought . The VIPs may take these treatments , as they can fly to the nearest destination out of the country to avail it. And .oh how may i miss this point? Now if doctor’s cant write these brands, then whats the point in marketing these medications, in India.

Imagine a situation where a pharmaceutical   company ,does not see any profit in developing a new drug , will that not stop their research in looking for better molecules . And research are costly affair . A brand is usually costly due to these indirect cost in manufacturing not just the direct ones . And can a socialist government really force pharmaceutical industry in making newer advances , without the incentive of profit . Another food for thought ..huh

Well if doctors are not going to write a brand , then who will decide , which product to be given to the patient , in cases of medicines , which does not have their generics. And there are a substantial portion. The pharmacist ? The patient himself ? Now when we want to buy any item , we have many choices and we are quite informed about their prices as well . They are advertised on all sorts of medias . The medicines are not . An average Joe does not know about the various products . so should medicines also be advertised just like the soaps we use for bathing . Its hard to imagine , at least my limited imagination fails me here . And if the pharmacists decide , then how would we ensure , ethical practice from them ? And on what ground they will decide ? would it not be the highest profit margin ?

Now at last , I thought I might as well dig deeper and understand what exactly is a generic. I for one was always unsure about the definition of this term . And. knock. knock.. MCI does not define it either . Thank god . I am not the only one . So I searched the literature , just like ,how I usually do when I am writing a research paper . I wonder the judges passing the blanket order , did that exercise . looks doubtful . So here it is .

Branded drug:
A drug that is marketed under a trade name by the
company that first brought the drug to the market, regardless of whether
or not the patent on the drug has expired. Branded drugs are promoted by
medical representatives to medical practitioners
Branded generic:
A drug that is marketed under a trade name by any
company other than the company that first brought the drug to the market;
this marketing usually happens only after the patent on the drug expires.
Branded generics are promoted by medical representatives to medical
practitioners. Sometimes, the same drug may be marketed by the same
company under different trade names for different indications; this happens
when the different indications are handled by different marketing divisions
of the company, and retail pricing may vary widely between the trade
names because of differences in the economics of the marketing divisions
Nominally branded generics:
Same as branded generics, except that
these drugs are supplied to distributors and retailers but are not promoted
by medical representatives to medical practitioners. Retailers use their
discretion in supplying these drugs to patients when the prescription carries
a pharmacological name
Generics:
Same as branded and nominally branded generics; this definition
ensures conformity of the suggested nomenclature with international usage
Pharmacological generic:
A drug that is marketed under its
pharmacological name. In popular parlance, such drugs are sometimes
called “generic generics
confused ?Hmm. Now my learned readers may decide for themselves .

A democratic competitive exam : solution to every ailment

With the recent cancellation of the UG neet counselling and admissions, I have an idea. In our country anyways the seats of all colleges including professional ones are reserved to the tunes of minimum 50 % and some times even more . So basically talent is not the soul decisive factor in the admission procedures . Moreover I feel talent , intelligence or marks in a competitive exam are quite overhyped . It adds so much of burden to a students as well as their parent’s life and ultimately to the society as a whole and what purpose it serves . Take for an example , our political representatives are chosen based on a highly fair democratic system of election , no where talent , or education is measured . And these fellows are doing fairly good . If our legislators and law makers can be chosen just like this then why can’t our doctors , engineers and other professionals and non professionals ? Imagine what good it will do to us

1. No more competitive exams : no more jealousy

2. No more wastage of money on the coaching institutes . So in short no more “Kota”

3. No more wastage of precious youth and their creativity

4. No more false bravado

So now the next question would be , how to choose and fill the seats of our world class colleges . I mean the education that any student will receive is irrespective of their rank , marks and intelligence etc , so i dont know whats the fuss .

Ok coming back to the selection process ..I propose 2 methods for the time being , with more brooding , I may come up with more in future .

Method 1 – Lottery system – every candidate will register online and will be given a token number and on the “d-day” some celebrity, like any of our great Bollywood stars or cricket gods can help choose the lucky ones through a draw of lots . Wow . I can already imagine all the media bites it will get . What a great day it will be .

Method 2 – Two phase process . In phase 1 there will be a lottery like the previous one . Through thjs we may select 4-5 times more candidates than the actual seats . In the next phase of our democratic election .we will use our prized and well tested method of ” first past the post” . This way we will select the candidate with the maximum vote as rank 1 and subsequently 2nd 3rd etc. This election will be done on the basis of constituencies and only candidates from that constituency will be eligible for the election from that constituency for college in that constituency . By this we the people will chise our own doctors engineers etc . Truly democratic.

Now many of you may ask me what about the reservation? I must assure you , i did not forget about it .

We will continue following our current reservation policies and reserve seats in the colleges of a particular constituency in line with reservation i.e. minimum 50 %. And I think we should follow the panchayat election model and reserve seats for women too.

To summerize , this would be the most fair way of choosing our future professionals , non professionals , civil servants etc .

Kindly comment with your suggestions .

Movies and mental illness: a welcome trend !

Now that I have your attention with this picture , I would come to the point that I intend to make ;). I have watched many “Bollywood” films where the story is either based entirely on a mental illness or one of its main characters has been depicted to have a major mental/psychiatric illness.

To my mind in last 10 years there will not be less than 10 such movies.  Some of the largely successful ones are “Tare Jameen Pe” which revolves around main protagonist having Specific learning disability, which is commonly called as dyslexia. , then there was “Kartik calling Karkit” which deals with the issue of Schizophrenia, and “You me aur Hum” and “Black “, where the story revolves around the subject of Dementia. Apart from these there are some others too.

Among the recent movies , “ Anjana Anjaani”, which probably deals with depression  according to the writer/Director , where in the 2 characters meet while attempting suicide for different reasons and then they decide to “live to die” together , like a suicide pact .This one romanticizes a very serious psychiatric issue namely” suicide” and makes itsound a fancy thing to do.  Similarly a recent movie “Hansi to fansi” also depicts mental illness in a very bad light, and where in the male protagonist tells the female protagonist, that taking medicine for depression is a sign of weakness. This one statement probably will stop many depressed people watching this bollywood picture from seeking psychiatric help for their own anxieties and or depression.

On the other hand in the movie “Tare jameen Pe” the topic learning disability has been depicted very accurately and the message has been conveyed also in a very positive manner and it appears to be well researched. Similarly in the movie “ Wo lamhe “ the symptoms and problems of Schizophrenia has been depicted quite rightly and appears to be well researched . Apart from some minor glitches “ Kartik calling Kartik” also deals with topic of Schizophrenia nicely.

These movies overall have reduced the stigma towards mental illnesses in our Indian society. Largely because of the awareness of the signs and symptoms of these illnesses through a vast media such as bollywood movies, which has a penetration so deep that no amount of healthcare promotion awareness campaign can imagince to achieve in such a short time?

Many a times I am asked about Deepika Padukone’s coming out in public forum about her Depression.  I would not comment on why Deepika chose to speak about her depression, and was there any hidden agenda or not . But I must appreciate her for being brave in publicly acknowledging and speaking about her depression. This has done wonder to the awareness of the issues of mental illnesses in general and Depression in particular.

Having said that, I must assert , depression is an illness which is still more common among the lower socio-economic societies than in the upper affluent society. Moreover suicide is the second largest killer among the 15-30 age group in India, and mostly in lower and middle class India. This I am emphasizing, because such celebrity endorsements can sometimes take our attention away from the larger community, which requires the maximum help.

 

sexual disorders- hidden under the sheet , but written on the wall

From quite some time , I have been getting queries from my clients , regarding sexual disorders and the lack of information (authentic ones). It struck me only yesterday, that one of the easiest way to reach to as many people as possible , I could just start writing about it here (where else?).

what follows below , is a summarized account of everything and anything that one wanted to know about sexual disorders and shied away. Hope you enjoy reading it

P.S: forgive me for making it a little bland , but then nothing can match the actual fun, so I did not even try 😉

Sexual Disorders are quite common.  However there is lot of ignorance surrounding it. Surprisingly there is no quality platform to share and handle the concerns of people suffering from sexual disorders. I , in my humble being strive for complete mental health well-being of the society and that can’t be achieved without addressing sexual disorders.

To begin with, I would like to reemphasize the fact that Sexual problems are quite common. We may choose to think otherwise though. Statistically, these occur more frequently in:

  • Younger women and older men
  • People with less education

And perception of sexual problems is subjective

  • Not everyone experiencing a sexual problem is necessarily distressed or sexually dissatisfied

There are various types of specific sexual difficulties, however in reality, these overlap considerably

– Problems with desire and arousal often affect orgasm;

– Problems with orgasm easily affect desire and arousal

One way to classify is based on the phase

  • Desire-phase difficulties
  • Excitement/arousal-phase difficulties
  • Orgasm-phase difficulties

Now before we go further, we need to understand these different phases.

As a function of “normal” sexual responding:

  • Desire: Defined by an interest in being sexual and in having sexual relations by oneself or with an appropriate partner
  • Arousal: Refers to the physiological, cognitive & affective changes that serve to prepare an individual for sexual activity (e.g., penile tumescence(tightness) and erection, vaginal lubrication, expansion & swelling of vulva(female external genitalia)
  • Orgasm: Refers to climatic phase with release of sexual tension and rhythmic contraction of the perineal muscles and reproductive organs:
    • Sense of ejaculatory inevitability in males followed by ejaculation
    • Contractions in the outer third of the vagina
  • Resolution: Refers to sense of muscular relaxation and general well-being; men are physiologically refractory(temporarily have no desire and arousal) while women may respond to further stimulation

Now let’s try to understand these sexual disorders with our basic understanding of the various phases of normal sexual response

  • Sexual desire disorders
    • Hypoactive Sexual Desire Disorder (HSDD); Male/Female
    • Sexual Aversion Disorder (SAD)
  • Sexual arousal disorders
    • Female Sexual Arousal Disorder (FSAD)
    • Male Erectile Disorder(E.D)
  • Orgasmic disorders
    • Female Orgasmic Disorder (Inhibited Female Orgasm)
    • Male Orgasmic Disorder (Inhibited Male Orgasm)
    • Premature Ejaculation
  • Sexual pain disorders
    • Dyspareunia (not due to General Medical condition)
    • Vaginismus- inability to relax female genitalia, leading to difficulty in penetration (not due to General Medical condition)
  • Sexual Dysfunction Due to General Medical Condition
  • Substance-Induced Sexual Dysfunction
    • With impaired desire
    • With impaired arousal
    • With impaired orgasm
    • With sexual pain
    • With onset during intoxication
  • Sexual Dysfunction Not Otherwise Specified (NOS)- broad category which leads to dysfunction and distress but does not fit into any of the specific categories.

Hypoactive Sexual Desire Disorder (HSDD)

  • Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity
  • Not better accounted for by any other psychological disorders (e.g., depression, anxiety) and not due to physiological effects of a substance (e.g., alcohol, prescription medications)

Sexual Aversion Disorder (SAD)

  • Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.

Clinical Presentation:

  • Negative/ indifferent affect (Mood and attitude)
    • Disparity in relationship member desire
    • Possess social expectations of “normal” sexual behavior
  • “Take it or leave it” attitude
  • Lack of attraction to partner
  • May be associated with trauma
  • Avoidance of sexual activity
    • When avoidance is accompanied by extreme aversion of genitals, SAD diagnoses may be more accurate

Arousal Disorders

Male Erectile Disorder

  • Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection

Female Sexual Arousal Disorder (FSAD)

  • Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate lubrication-swelling response of sexual excitement

 

Clinical Presentation:

  • Factors influencing Male Erectile Disorder
  • Physiological: partial or complete inability to attain, or maintain an erection sufficient for intromission and sexual activity
    • Some men report full erection potential during non-coital stimulation (e.g., masturbation, nocturnally during REM sleep)
  • Psychosocial:
    • Performance anxiety
    • Embarrassment
    • Depression
    • Negative affect in presence of erotic stimulation
    • Sensitive to feelings of demand
    • Underestimate erectile response
    • Result of chronic & acute stress

Clinical Presentation:

  • Factors influencing Female Sexual Arousal Disorder (FSAD)
  • Physiological:
    • lack of responsiveness to sexual stimulation (e.g., vaginal lubrication, swelling of vulva)
  • Psychosocial:
    • Anxiety, worry, fear
    • Depression
    • Low self esteem
    • Performance anxiety
    • Shame
    • Sexual abuse
    • Marital difficulties
    • Poor communication with partner
  • Negative affect toward sex during adolescence

Orgasmic Disorders in Men

Orgasmic Disorder (Inhibited Male Orgasm)

  • Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person’s age, judges to be adequate in focus, intensity, and duration

Premature Ejaculation

  • Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors affecting duration of excitement phase, such as age, novelty of new partner and sexual situation and recent frequency of sexual activity
  • There is no minimum time limit varies from definition to definition with 1- 3 minutes of intra-vaginal ejaculatory latency time
  • Three core components:
    1. Short ejaculatory latency
    2. Lack of control over ejaculation
    3. Lack of sexual satisfaction
  • Perception of how long it takes for the “average” man to ejaculate varies between 7-14 minutes
    • Vary across countries, Germans, 7 mins; Americans, 14 mins

 

 

Female Orgasmic Disorder

  • Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in type of stimulation that triggers orgasm.
  • Diagnosis based on clinician judgment that orgasmic capacity is less than reasonable given age, sexual experience, adequacy of sexual stimulation
  • Clients tend to compare themselves to unrealistic ideals, creating anxiety and perpetuating dysfunction
    • “Maybe I’m just dead down there”
  • Media influence of patient perceptions emphasizing importance of psychoeducation (e.g., myths of sexual encounter, male & female sexuality)

*Absence of orgasm during intercourse without direct clitoral stimulation is not uncommon in women

Clinical Presentation:

  • Factors Influencing Female Orgasmic Disorder
  • Physiological:
    • Inability to achieve orgasm
  • Psychosocial:
    • Sexual knowledge
    • Levels of sexual desire
    • Sexual fantasizing
    • Sexual attitude; confidence
    • Religious/cultural beliefs
    • Body image
    • Self-esteem

Prevalence:

Arousal Disorders

  • Overall, prevalence range of ED is 10-20%
  • Presence of ED increases with age and poor medical status

Orgasmic Disorders

  • Prevalence of PE is approximately 30% across age groups (GSSAB)
    • Highest rates reported in Southeast Asia (30.5%) & lowest in Middle East (12.4%)
    • Found to be significantly correlated with Social Phobia

 

Other disorders

  • Prevalence of pain disorders 1%-21% in women
  • High rates of comorbidity with anxiety & depression
    • Loss of libido or decreased sexual desire has been reported in up to 72% of patients with unipolar depression; 77% with bipolar
  • General medical conditions associated with SD
    • Men: diabetes, cardiovascular disorder, hypertension, dyslipidemia, obesity, smoking, prostate disorders
    • Women: chronic illness, poor general health status, such as diabetes, breast cancer, lower urinary tract infection, surgical removal of ovaries, multiple sclerosis
  • Risk of SD is increased by smoking and excessive alcohol use
  • SD consistently reported in patients taking SSRIs
    • Estimates range from 10%-65%
  • Common factors of low sexual desire in men & women:
    • Boredom
    • Lack of physical attraction to partner
    • Negative or faulty attitudes
    • Dissatisfaction with partner sexual activity
    • History of sexual abuse
  • Common factors of arousal disorders in men & women:
    • Health status
    • Performance anxiety
    • Negative affect:
      • Suppression and expression of anger correlated with higher rates of ED
    • Organic theories of PE
      • Penile hypersensitivity – lower ejaculatory threshold, reached more rapidly
      • Hyperexcitability ejaculatory reflex – faster emission phase
      • Genetic predisposition
      • Risk factors
      • Age
        • Overall, SDs increase with age
        • PE decreases with age
        • Inverse relationship between age & distress brought on by SD
      • Health status
        • Genetic inheritance (Type 1 diabetes)
        • Hormone deficiency
        • Lifestyle (poor diet, low activity level)
      • Excessive substance use
      • Dyadic adjustment
      • Decreased sexual knowledge
      • CSA(Childhood sexual Abuse)

Predisposing factors (genetics) X Precipitating factors (coping with stressful life events) X Maintaining Factors (poor dyadic adjustment) = Diathesis Stress

                Myths of Sexuality

  • Myths of male sexuality
  1. A real man is not into sissy stuff like feelings and communicating.
  2. A real man performs in sex.
  3. Sex is centered on a hard penis and what is done with it.
  4. Real men do not have sexual problems
  5. Focusing more intensely on one’s erection is the best way to get an erection
  • Myths of female sexuality
  1. Sex is only for women under 30.
  2. All women have multiple orgasms.
  3. Pregnancy and delivery reduces women’s responsiveness.
  4. If a woman cannot have an orgasm quickly and easily, there is something wrong with her
  5. Feminine women do not initiate sex or become wild and unrestrained during sex.
  • Myths of Male & Female Sexuality(Common)
  1. We are liberated and comfortable with sex.
  2. All touching is sexual or should lead to sex.
  3. Sex is intercourse.
  4. Good sex requires orgasm.
  5. People in love should automatically know what their partners desire.
  6. Fantasizing about someone else means a person is not happy with what he/she has.

We are all susceptible to these false assumptions and seemingly silly generalizations about human sexuality. 

How to Enjoy and get the spark back (Take Home Tips)

  • Accepting this is as a problem and to seek help for is the first step.
  • You have to come over the shyness and stigmas associated with psycho-sexual issues and consider it just like any other medical or psychological problems you may be having.
  • Then plan to visit a professional (marriage therapist, sex therapist, behavior therapist or gynecologist) for proper guidance that would help you enjoy your sexual life.
  • Be aware and be wary of your own traits or external situations that may cause excessive stress and work on addressing it and also work on your coping skills if you anticipate a stressful situation to arise in the future.
  • Spend quality time with your partner which should be nonsexual intimate time to get to know your partner well and to develop a comfort level and confidence in each other which will help maintain the relationship. This will mostly lead to increase sexual interest in each other.
  • Talking about your sexual fantasies and where you would like to be touched would enhance your partners understanding about you and ask your partner about their preferences to make it a memorable experience. Talking sex is a part of foreplay so once you develop this comfort level it would lead to both adequate sexual arousal and increased sexual desires for each other
  • Have a lot of touch time with each other say holding hands or kissing or just giving each other massages to get comfortable with each other. This is very important for mutually satisfying sexual relationship.
  • Include a lot of humor around sexual acts and just have fun touching each other without having an intercourse till both of you become comfortable with each other.

Most importantly have a lot of respect and give each other time to open up and share any concerns regarding sex so as to work on them together rather than using these signs and symptoms against each other in an argument or to make fun of each other.

The party drink- a battle sans gender

Not everyone who drinks is an alcoholic, but anyone whose life is negatively affected by alcohol on a consistent basis is considered to have an alcohol use disorder. Any addiction has two basic qualities. 1) You often use it more than you would like to use. 2) You continue to use despite negative consequences.

People use drugs or alcohol to escape, relax, or to reward themselves. But over time, drugs and alcohol make you believe that you can’t cope without them, or that you can’t enjoy life without using. People usually think of the physical and economic consequences of addiction. “I don’t have a serious addiction because my health is fine, and I haven’t lost my job.” But those are very late stage consequences. The greatest damage is to your self-esteem.

Women are more vulnerable than men to alcohol’s effects, even after drinking smaller amounts. Women are as likely as men to recover from alcohol dependence, but women may have more difficulty gaining access to treatment

Historically, women have tended to feel a greater sense of shame about drinking and getting drunk than men, but it appears that among younger women, this stigma may be fading. While men are still more likely to drink—and to binge—women are drinking more, and more often, than they did in the past

There is a specific class of alcoholism known as high-functioning alcoholism. People who are high-functioning alcoholics are capable of keeping their alcoholism from interfering in their professional and personal lives. A New York Times article estimated that as many as half of all alcoholics are high-functioning alcoholics. Professional like lawyers, doctors, high performing corporate managers etc make up a large portion of these individuals. High-functioning alcoholics rarely recognize they have a problem until they face severe alcohol-related consequences. The danger of high-functioning alcoholism is that it can continue for years without a person ever recognizing they have a problem.

Taking into consideration above mentioned facts and special factors associated with alcohol addiction, I would like to share one case vignette.

Aradhana Negi , comes from a very affluent class , with schooling from India’s best boarding schools and college education from ivy league colleges . Her father was a very successful civil servant and lived in Europe and the Americas for the most of his career. Aradhana was a very sensitive girl, from her very young days- says her father. Whenever they used to move from one city to another, she was the first one to make new friends. However she used to always complain her father about the instability in their life. She used to miss her friends and family from the previous cities, and used to try hard to be in touch with them.

As she grew into a fine young lady, she was the social butterfly in all the social gatherings, with her beauty and wit by her side. She trained to become a fashion designer and started her fashion lines and boutique soon. She was quite an independent woman. Soon she was becoming the talk of the town among the fashionesta circle.

She used to be invited to parties like on a daily basis. Initially she did not drink at all, but started drinking her occasional beer and wine once in a while just to not sound very prude . However she never used to enjoy late night parties and would excuse her from the hosts and move back home to her solitude, her books and the ghazals. Those days she met a musician, in one of the parties. She could sense, that he was the one for her. She will feel extra coy around him and would start blushing for no reason. She fell in love with him in no time. When her father asked her, how sure she was about him, she told “I know he is my soul mate and nothing else matters”.

They got married in the most extravagant and grandeur marriage of their city. Life was like a cake walk; everything seemed to be just perfect. She will be still called to those parties and she will have a drink or two, never more, but it was just that, she used to be invited to one party or another on most days of the week. After marriage, the real struggle began, her husband’s quirky artistic ways and temperament pissed her to no end. She loved him, a lot but his distant ways broke her heart completely. She would often come back home to an empty house. She never used to get drunk in any of the parties, but now she will occasionally open her own bottle of beer, when loneliness hit hard. Soon it became a pattern. Often she will pick fight with her husband and would say things to him, when drinking, which she would never say otherwise. Quarrels became regular, she forgot when was the last time they spent one evening without arguing with each other. Romance dwindled, sex became ceremonial and everything else followed later. He cheated her first, with a young student of him, she cheated him soon after with a dashing divorcee businessman, who would visit her boutique often. Marriage was symbolic only. Her drinking became an issue, however she still never got really drunk, but there was always a bottle of a pint with her in the evening, when she was lost in her creative perusal or just being with herself. They filed for a divorce and it came without much fuss. She found what real loneliness felt like after that. Days would turn into night and night would give way to days and there would be no one, just no one to talk to. She poured all her energy into work and on such a work related tour, she met a middle aged man, who was living a bachelor life and maturity seemed to have missed him by yards. She liked his manly looks but boyish charm. She fell in love again. This man adored her and admired her for her professional success. She wanted to get married, but he chose to remain single. At last they decided to live together. She sold her business, he sold his business and with all the money, they bought a big farm in the mountains. They built a house together, a beautiful one and started doing organic farming. Life was quiet, life was smooth. Everything seemed to be going just perfect once again except her drinking, which will never leave her, wherever she went. Her partner will often ask her to just leave the bottle aside , but she would often find it as intrusive , as she was never drunk and was absolutely sober .She had hardly any social life , but she would never mind . Rather she would wait for the days when her partner would leave the house to go to the town for some work or another. As on those days, she could drink in peace. She would absolutely love those nights, alone, with a bottle in her hand and book to give her company. Later she would feel guilty and would throwaway the bottles before her partner comes. Drinking seemed to be the only thing that would give her any happiness she used to hate being called to any social event, as that would make her uncomfortable, and she would rush home, so that she could drink in solitude. She had started writing a memoir and would find it difficult to put words on paper without her favorite brew. If her partner would speak about her drinking, she would become defensive and often irritable. So many times she would drive her car herself to the nearby market after drinking a bottle or two , to bring her supplies, lest it gets over.

However in spite of all this nobody could guess there is anything wrong .she was a perfect cook, managed the house like a pro, was respected socially,  did all that is required for the organic farm and her memoir was about to finish , with a publisher waiting by her door.

Last year, her father retired from his job, and shifted to their parental house, which was not far from her settlement either. She was invited by them to come and spend some days. She did not want her father to know about her drinking habits and decided not to drink at all, when she is with him. After a day going without alcohol, next day she felt, so edgy, she could hardly sleep and was shaking with anxiety. Next day she could not control herself and sneaked from the house to bring her favorite beer, she felt so embarrassed doing it , as it was a small town and everybody knew her family very well. However, she felt helpless and helped herself to one carton of beer in just a few hours. Next day by afternoon , she started having shakiness all over her body, she was feeling very anxious, she tried to control her symptoms and locked herself in her room without any dinner , after some time she felt sleepy but the moment she closed her eyes, she started having the most weird dreams, she woke up in panic, and was sweating profusely , she felt someone is calling her name from outside, she was so scared, but she did not want to disturb anyone in the house , this continued almost the whole night, in the wee hours she felt sleepy , and does not remember anything till 2 days later when she gained her senses in a hospital bed. Her father told the treating doctor, that they heard loud bang and woke up startled, later they realized some screeching sound coming from her room, luckily the door was open and they rushed inside, to find her convulsing. They immediately called an ambulance; on the way to the hospital she had many such episodes of fits. In the hospital her convulsions stopped after the initial treatment, but she behaved in a confused manner, would not recognize any one, would try to remove her cloths, shout, and cry and bang her head. This continued for 2 days , before finally after the treatment she came into her complete senses. For her it was like a long nightmare. The doctor briefed her and told her, it’s her favorite friend (beer) that has to be blamed for this and diagnosed her with Alcohol Dependence Syndrome. She was put on medications and extensive sessions of psychotherapies. It has been 6 month since then now. she has lapsed a few times and drank , but with the support of her father , partner and the treating team , now she is way better and realizes , how happy and contented she feels now , often repenting the years she lost to this so called “party drink”

(Disclaimer: To hide the identity, the names have been changed)

R you also procrastinating your health goals.. read on if you do

As a medical doctor , I happen to end up giving many advice, most of which are unpaid and uncalled for. But one advice , which I give only when asked is ” follow healthy lifestyles, a.k.a Exercise”. often my patients later complain” Doc, I wish I could follow your advice, but I just cant make myself do that”. And procrastination is the guilty culprit almost all the time.

Read on to know , how one can shake that off and get on with their healthy lifestyle goals. This is an excerpt from my interview that I gave to a healthcare magazine, sometimes back.

  1. What is your idea of procrastinating health?

Research shows that about 20 percent of adults are chronic procrastinators, but many more of us occasionally put off until tomorrow what we need to do today. Yet for the most part, we don’t realize that it’s happening or that, in the process, we’re undermining our own happiness. When it comes to living healthy, change can be hard. It’s not that we’re not capable of exercising or eating healthier. It’s just that it’s too easy to procrastinate. Procrastination can range from delaying a healthy lifestyle, for e.g exercise or dieting, to something a lot more urgent and serious like getting that blood test to be done for that nagging fever, or seeking treatment for the intermittent chest pain. In my practice, as a psychiatrist, I have found that people procrastinate the most when it comes to mental health. Mental health problems are not considered serious or significant enough by most in India, that’s why they seek treatment only when the problem have already become big.

  1. What is the psychology of people behind it ? (For example why do people keep delaying their workout routines or miss out on a health treatment when required etc.)

The basic psychology behind the people who tend to procrastinate a lot is, their immature defense mechanisms. For example someone who does not seek treatment for his alcoholism or his drug dependence has denial as a prominent defense mechanism. They keep fooling themselves along with others that it’s not a problem yet and everything is under control, which is not. The same applies to many other health conditions like obesity and other lifestyle diseases. Another defense mechanism is the rationalization, where people tend to rationalize or justify their delay, by coming with excuses like “oh, I am drinking often, only because I have some stress” or “I can’t go to the gym, as it cost a lot of money” etc. Sometimes people delay in their health goals for the simple reason that they don’t know how they will cope up with all the stress of having been diagnosed with a disease and the need to seek treatment for it. This happens in the case of serious and life threatening diseases. Procrastinators are also disorganized in their thinking, making them forgetful and unable to plan adequately.

  1. Why do treatments fail or major factors behind failed treatments and low results in patients?

One of the most important reasons for the failed treatment in the field of medical science is late diagnosis and treatment. And the reason behind that apart from the many other reasons, which are not in our hands, is plain and simple procrastination on the part of the patient. Another major factor behind failed treatment or less than adequate response to treatment is poor compliance or adherence to treatment. Most of the non-pharmacological advises given to a patient are not complied with diligently and that too can be explained by the procrastinating nature of the patient.

  1. Why do people do not follow fitness regimes?

We all put off working on unpleasant or tedious tasks from time to time. And it’s a fact that most of the fitness regimes are unpleasant to begin with. It forces us to go out of our comfort zone. I have seen that even the so called workaholics who like working more than they need and finish every work way before the deadline also procrastinate. Another reason is the lack of motivation , which stops us from having the drive and the consistency that is required to follow any kind of fitness regime. Another reason why its not followed is that, when people start following any fitness regime, for example a diet or an exercise regime, they tend to overdo it, or do it in the extreme in the beginning, hoping to achieve the results fast. But this is often counterproductive and makes them disillusioned and they stop following the regime.

  1. What are the ways one can improve it OR how to bring about a change in it (Solutions to it)?

One of the best ways to deal with your procrastinating habit is to follow the two-minute rule .The idea for the two-minute rule originally comes from David Allen’s best-selling book, “Getting Things Done.” The rule is simple: If it takes less than two minutes, do it now. You will be surprised how many things you can do if you follow this simple rule. From cleaning the clutter sitting on your desk , to calling back on your parents, to putting the cloths away for washing. Most of our daily chores do not take much time if we divide them into small tasks. One of the hardest parts of living healthy is getting started. If you actually get your workout clothes on and get to the gym, you’ll usually end up finishing the workout. It’s getting off the couch in the first place that’s the hard part. The same is true of eating healthy, making time for fun and relaxation, and dozens of other healthy habits. You’re perfectly capable of doing these things, but finding a way to start doing them during your busy day is hard. This is where the two-minute rule comes in.

Some simple day to day tips to help you deal with your procrastination.

Nag yourself: It’s hard to ignore in-your-face reminders. Put Post-its on the fridge at night with a list of errands for the next day.

Think of an ominous task: Maybe cleaning out the attic. Soon you’ll find yourself doing what you really need to do because it’s better than the dreaded chore. It’s all relative: Some activities may be mundane, but they’re not nearly as bad as cleaning out the attic.

Just start: say to yourself, “I will just start . Don’t think through to the end. Once you have started your half the task is done, because hurdle for any procrastinator is the start.

I will just do it today: Use the AA(Alcoholic Anonymous) principle of deciding for just a day and committing yourself completely for that day. For most of the procrastinators, the enormity of doing it again and again is the biggest spoiler.

The Journey Begins

Thanks for joining me! A blog, a website of my own.I wondered how it will feel. it feels “fantastic”. I am a trained Psychiatrist by profession , but a writer and a traveler by passion. I believe ” settling down” is such a cliche. I equate it to becoming a tree. Follow me to read about my travel experiences, or to update yourself to the latest in the field of mental health and public health , acts , policies everything. In short follow me for random psycho-babbles ,to keep you sane and give you company, when you crave for some “cognitive masturbation”;)

Travel makes one modest, you see what a tiny place you occupy in the world.-Gustave Flaubert

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