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I would like to begin with a little disclaimer. This is a detailed post about the process that I went through for making it to the hot seat. The idea is to cover as many details as possible to clear most of the genuine queries I have received about the process.This answer is going to cover the broad steps I went through till I reached the hot seat, as objectively as possible. Also, please keep in mind that in 2020 the show was shot under extraordinary conditions, so a lot must be different from their usual process.Is KBC scripted?As I mentioned in more details in a previous answer, the only scripted bits I directly observed during the show were the handing over of the 3,20,000 cheque, the full amount online transfer right after a contestant finishes the game, and the choice of Flip The Question Category.Unlike the popular conspiracy theory, KBC candidate selection isn't fixed/scripted. The contestants at any stage are not aware of the GK questions that will be asked to them. I was never asked to fake a story about myself. Additionally, while I was encouraged to be candid, the team respected my privacy.The First Step: RegistrationThe registrations for KBC 2020 began on 9 May 2020 and went on till 22 May. A Simple GK question was asked each day which could be answered via SMS or Sony LIV App. I used the app to register myself.I vaguely remember sharing a few personal details including my name, age, gender, my State, phone number and e mail while registering on Day 1 before submitting the answer to the question of the day.That's all. You register with your details, answer the question of the day till the registration is open and keep your fingers crossed for the randomiser to select you for the next step. This is probably the easiest step in the whole process in terms of merit, however, the hardest in terms of sheer luck.Step Two: Electronic telephonic assessmentAfter the registration process closed on 22 May, the selected candidates start getting calls for telephonic assessment. It is an electronic message that congratulates you for being selected to the next round and quickly throws three questions at you which have to be answered within a few seconds. Basically, no time to plan a peek-a-boo! You know it or you don't.I received the magical call on 27 May 2020. I was asked a question each about art and culture, economy and KBC's favourite topic- Nobel Prizes. Options were not given for the third question. I personally felt that the level increased with each successive question. I wasn't sure whether I had answered the last question accurately. It was a calculated guess made under 10 seconds! So didn't expect it to go any further. However, soon I was about to be proven wrong.Step Three: The App Based Online AuditionOn 1 June 2020, I received a call from KBC team. The person congratulated me for making it to the next round and asked me to be ready to give an App based audition on 6 June 2020. I was also asked to mail certain proof documents.The audition consisted of two parts. First, a quiz comprising of 20 GK questions took place for all the selected contestants simultaneously. The quiz was in a MCQ format and the questions were extremely general- current affairs, history, geography, science, bollywood, etc. Basically everything under the sun.Each question had to be answered within 20 seconds, once again, extremely tightly timed.Once the GK test was over, 6 pre-recorded video messages by Amitabh Sir were shared through the app. Each video had a personal interview/slam book type question and had to be answered by making a video. It is requested that dark coloured clothes are worn and video is shot in a well lit room with no background noise (including the fan's noise).I was given about a day to record and upload the videos. Believe me when I say this, it isn't easy. This was hands down the toughest step for me. The questions, were while simple and straightforward, they made me think a lot. I must thank the KBC team for this self awareness exercise they made me go through, especially during the lockdown.Step Four: Personal Interview via Virtual MeetingAfter about a month, in the second week of July, I received a call from the KBC team that congratulated me for making it to the next round. I was then asked to be ready for a virtual meeting scheduled to take place after 4 days.The same instructions about clothing and room being well lit and sound proof were repeated. I was also asked to fill (handwritten), scan and submit a 14 paged questionnaire within a day.The interview took place on the designated day, a little earlier than the designated time via a virtual meeting app. The interviewer was quite humble and tried making me comfortable about the process. The interview went on for about 50 minutes during which we mostly chatted about the videos and questionnaire submitted earlier. Towards the end, the interviewer took a surprise GK test of 20 questions, once again in MCQ format to be answered under 20 seconds each.And that was all!Step Five: The Long WaitAfter the personal interview, I received no further intimation from the KBC team till late October. In fact, the show had started airing and I was convinced that I hadn't made it. Thus, I completely forgot about it.Step Six: The Sudden GK TestIt was in the last week of October 2020 that i received a call from KBC team to be ready for a GK test scheduled the next day. Next evening, at around 9 30 pm, I faced another senior member from the production team on a virtual meeting. Once again, I faced 20 GK questions in MCQ format, to be answered within a few seconds each.This was by far my most average performance in their GK tests. However, I personally felt that the question set was the toughest till that point. So, I started considering a possibility of making through it.Step Seven: The Final CallTwo days later, I received a call from the KBC team to congratulate me for making it to the Fastest Finger First (FFF) round. I was invited to Mumbai along with a companion.Details about the basic logistics (stay, travel, quarantine, etc) were exchanged. As told by many participants in the past, the stay and flight expenses of the contestant and one companion are borne by the production. All arrangements, even the web check in, etc are managed by them. So it is quite seamless in that sense.Over the next week, till the time my father and I flew to Mumbai, we went through multiple calls with various KBC production teams. This also included shooting lots and lots of bits using my phone for the short video that they show during the show. The reality shoot team guided us quite patiently through this process.As mentioned earlier, since the show is being shot during these extraordinary times, I doubt this is their usual modus operandi.We also got a call regarding the clothing requirements. Each contestant and their companion is asked to arrange about 10-15 pairs of clothes. Certain colours, textures, stripes, etc are not allowed as they can cause jittering issue with the camera. Clothes with brand logos are also not allowed.Step Eight: MumbaiOn reaching Mumbai, we were checked into a comfortable hotel stay. All individuals were isolated till the COVID-19 RT-PCR tests were conducted.Obviously, since my father tested positive, he was immediately isolated into the quarantine facility where he was duly taken care of under a doctor's supervision till he tested negative.Despite testing negative, the rest of us contestants and companions were strictly asked to not leave our hotel rooms to avoid exposure. Thus, unlike what I had read online from previous contestants, the contestants did not get to interact a lot this season.The only time we left our room was a day before shooting began, for a final GK test that took place in the hotel common area. Proper physical distancing measures were maintained during the 20 minutes test. Once again, the MCQ test comprised of about 20 questions.Step Nine: D-DayEarly morning we were taken to the shooting location with all our luggage. Extremely high standards of hygiene and sanitization are maintained in the building. Masks are mandatory. After sanitization spray, body temperature and oxygen level are checked. Then, one is asked to sanitize their hands. Only after that, one can enter the building.Then we were taken to the dressing area. All our clothes are collected for steam ironing and selection. The team decides what will be worn by each contestant. The hair and makeup is also decided by the KBC team. The production team is extremely experienced, on a countdown timer mode and yet, each person is extremely polite and helpful.Food, tea and even kaadha is provided to all the team members as well as contestants.Once ready, all the contestants are taken to the set for practice. No electronic gadgets and watches are allowed into the set. We had to keep wearing our masks till the shoot began. So when the shoot would start, we were asked to keep the masks behind us on the seat or in the pockets, if the attire had any.To make everyone comfortable with the FFF touchscreen, 4-5 mocks are done. Even a mock for sitting on the hotseat is done to make everyone comfortable with the set.And that is all, after that the game begins. It is shot in a flow, cuts only when Amitabh sir announces a break and that cut too is for a very short period.The only big cut happens after each FFF round once the contestant for the hotseat is selected.When I cleared the FFF, upon reaching the hot seat, we got a 10-15 minutes break during which they did my touch-up, wished me luck and asked me to stay calm.Post that, I played the most grand quiz of my life, quit at the 13th question, got clicked the quintessential photo with Amitabh sir around the hotseat, and left the stage for the next round of FFF to begin!I hope this answer was helpful to those who have been curious about the show's process. One of the most valuable things that I learnt after participating in KBC this year was that most of the contestants that make it till the FFF stage are talented. Some might appear below average because of the few questions they faced in front of the camera, but believe me, they handled and cleared a rigorous process before reaching the KBC set!Big salute to all KBC FFF Contestants! 🙏

taken from Taking a Second LookSome opinions on the second opinionTwenty-eight physicians, ethicists and sociologists responded to a questionnaire on the role of the second opinion in medicine today. Their comments provide the basis for further discussion on this practice, the issues involved, and the ethical complexities in a changing health-care scenario.When a physician agrees to attend to a patient, there is an unwritten contract between the two. The patient entrusts himself to the physician and the physician agrees to do his best, at all times, for the patient. This contract disallows the patient from seeing another medical expert for opinion or advice without a referral note from his physician. It also enjoins the physician to respect the autonomy of the patient so that if the patient so desires, he will refer the patient to another physician for a second opinion.Traditionally, the concept of a second opinion is based on certain assumptions. First, that the physician has studied the patient's medical history and clinical findings; if he is the patient's family doctor, he has also over time acquired a fund of medical and socio-economic information on the patient and his family. Second, that the physician is knowledgeable about the various specialists in the town or city and their respective strengths and capabilities, and is thus qualified to advise on whom to consult for a second opinion, and provide that consultant relevant and often crucial medical infomation on the patient. Were the patient to consult another physician on his own, these benefits would be lost.However, second opinions are often not sought on these principles. Some patients move from doctor to doctor without the primary physician's knowledge. They obtain a variety of opinions, often conflicting. Without any one doctor in overall charge of their therapy, they may follow whatever advice they choose to accept. If a complication ensues, no particular doctor can be held responsible.Patients who do ask their primary physicians for a note of referral to another doctor are no better off. Such requests are often taken as a personal insult and evidence of lack of faith or trust in the doctor. Some doctors react by withholding key information, such as detailed notes on surgical operations. The result is often a general breakdown in the harmonious relationship necessary for good patient care.The problem is compounded by the absence of clear-cut guidelines on the use of the second opinion. In India, our medical councils have failed to contribute to the discussion, or to regulate the use of the second opinion in any way.It is in this context that colleagues were asked their opinions on the need for, and use of, the second opinion. By recording the views of respected academicians and medical professionals, one hopes to lay the ground for further discussion on the question. The following essay is an attempt to extract, from the responses received, considered thoughts on some aspects of this issue. Excerpts from the responses have been included to illustrate various perspectives.Is the doctor-patient relationship a contract or fiduciary relation?While several medical colleagues agree that the doctor-patient relation ship today is some sort of unwritten contract, there were many qualifying notes. Ruth Macklin raises a fundamental question: what kind of contract is it, anyway, if it is both unwritten and unstated? "A contract in which the provisions are not clearly spelled out is not really a contract at all. In a legal sense, it would be considered invalid. From an ethical point of view, how can all partiesphysicians or patients be fully aware of their obligations or, for that matter, their rights? Contracts in the strict sense of the term are (usually) written documents that spell out the provisions clearly, say what all parties are obligated to do, and also specify penalties or remedies for breach of contract. That sounds very different from the physician-patient relationship, which is perhaps better described as a fiduciary relationship".Clearly, this question needs further discussion for any systematic understanding of the issue.And in fact Thomas George holds that it makes little sense to talk of contracts and obligations in our health care system. He would support enforcing the doctor-patient contract, and expecting referral notes from every patient, if we had a structured health care system, "as, for example, in the National Health Service (NHS) in the UK. Borrowing only one part of the system leads to a lot of problems for the patient. At present there is no system at all in India and the patients are completely at sea as to whom they should consult".Homi Dastur argues that patients would not accept the enforcement of such regulations. "Very few patients would be willing to observe, accept or even understand (the concept of an unwritten contract), as is evident from the frequency with which those who can afford (to pay the different consultants) will seek multiple opinions. Many patients will reveal that they are under the care of another doctor only after the consultation is over. Sometimes one becomes aware (of the earlier consultant) only after reviewing reports which mention the name of the referring doctor".Likewise, Bela Blasszauer suggests that such a contract would work only in theory, for doctor-patient relationships rarely develop in the prescribed manner. "Physician-patient encounters may take many forms. I may bump into the physician. I may have no other choice. I may be shopping for a suitable one. And so on." 'Many doctors oppose enforcing contracts because they perceive the doctor-patient relationship as unequal, and liable to be misused by unethical doctors. "I would like to spare the patient the trauma (of having to face a doctor unwilling to refer his patient for a second opinion)," writes George. Blasszauer suggests that such contracts can generally not be made binding on the patient, since the conditions under which he sought advice or treatment were heavily weighted against him.Others perceive the relationship differently. Eugene Robin and Robert McCauley suggest that the physician-patient relationship is a partnership and not a contract. "Either (patient or doctor) is free to 'terminate the relationship without cause', with the doctor having the additional burden of informing the patient when this occurs, and remaining available for such time as is reasonable for the patient to find another doctor who will assume responsibility for delivering medical care". This is generally true in the urban US, they state.Sociologist Rohit Barot suggests that the Indian situation resembles private sector health services in Britain. He has been a patient in the UK National Health Service, as also with private practitioners there, and comments that the doctor-patient contract and the rules of referral seem to apply only in the NHS.The American Medical AssociationAccording to the American Medical Association's code of medical ethics, physicians should recommend a second opinion whenever they believe it would be helpful in the patient's care. When doing so, they should explain the reasons for their recommendation and inform their patients that they are free to choose a physician on their own or with their assistance. Patients are also free to seek second opinions on their own with or without their physician's knowledge.With the patient's consent, the referring physician should provide any information that the second-opinion physician may need. The second-opinion physician should maintain the confidentiality of the evaluation and report to the first physician, if the patient has given consent. Second-opinion physicians should provide their patients with a clear understanding of the opinion, whether or not it agrees with the recommendations of the first physician.Where a patient initiates a second opinion, it is inappropriate for the primary physician to terminate the patient-physician relationship solely because of the patient's decision to obtain a second opinion.In general, second-opinion physicians are free to assume responsibility for the care of the patient. . . . By accepting second-opinion patients for treatment, physicians affirm the right of patients to free choice in the selection of their physicians.There are situations in which physicians may choose not to treat patients for whom they provide second opinions. Physicians may decide not to treat the patient in order to avoid any perceived conflict of interest or loss of objectivity in rendering the requested second opinion.Physicians must decide independently of their colleagues whether to treat second-opinion patients. Physicians may not establish an agreement or understanding among themselves that they will refuse to treat each other's patients when asked to provide a second.opinion. Such agreements compromise the ability of patients to receive care from the physicians of their choice and are therefore not only unethical but also unlawful.Council on Ethical and Judicial Affairs: Code of medical ethics. _ Chicago: American Meditial Association 1997. 191 pages.A one-way obligation?Does the patient have responsibilities as well as rights in this relationship? "The doctor's duties, ethics, standards are well-known in theory and lapses from accepted norms are recognised in practice", writes Farokh Udwadia. "It is equally important (to emphasise) the patient's duties, responsibilities and obligations... It is time for this aspect to be discussed and the discussion circulated, for it must never be forgotten that the doctor-patient relationship is not a one-way street".Again, this view is a matter of debate. Jagdish Chinappa and Lawrence White argue that the two groups are very different. "The patient is the consumer who has needs based on certain beliefs and attitudes. The doctor is a service provider. Patients, under the stress of their illnesses, should be expected to behave irrationally and inconsistently". Therefore, Chinappa goes so far as to say, "honest and ethical action is therefore dependent only on the doctor and has to be decided upon the merits of every case. Certainly, the emphasis on autonomy guarantees a patient the right to ignore a doctor's advice, and to seek whatever opinions are wished. (I believe that this, even though considered a nuisance and counter-productive regarding patient care, is nonetheless a good thing.)"Likewise, White notes, "Just as it is not an equal relationship in terms of power distribution, vulnerability, etc, so it is unequal with respect to promises on either side... it is generally accepted that patients have the right to do whatever they wish, including shopping for alternative opinions, etc". This does not mean that many physicians like or accept (the practice). "However, to demand otherwise will reinforce the physician's position of power and elitist attitude, which I believe would be a regressive step".Why doctors should want a second opinionThere are a number of reasons why a second opinion may be sought. Traditionally, general physicians and patients seek specialist opinion and advice with benefit, especially when the disease is uncommon or the patient's condition serious. The patient with a hole in the heart, a brain tumour or failing kidneys will do better in the hands of specialists.In certain situations a second opinion is almost a 'must'. "Take for example a 'shadow' in the lung of undetermined aetiology", writes Farokh Udwadia. "Is it tubercle, pneumonia, cancer or a rare disease, for example, Wegener's granulomatosis? What is the patient to do about it? In fact, it would be advisable to take more than one opinion..".Christopher de Souza adds that young consultants would welcome second opinions from respected seniors — provided they were sure the patient would return to them for definitive therapy — in order to validate the line of treatment they propose. The senior consultant's concurrence would protect the younger colleague against unjust accusations and boost the patient's confidence in him.B N Colabawalla feels that a second opinion may benefit the primary physician in yet another way. "Patients are now increasingly conscious of their rights and it would be improper for any physician to deny the patient his autonomy and right to seek a second opinion. It would be in the interest of the primary physician to make the necessary reference for a second opinion."Unfortunately, requests for a second opinion from other consultants are uncommon. "The practice of referral from primary to secondary to tertiary, or from general physician to specialist remains an ideal not realised," according to M S Valiathan, who has rarely had a primary consultant seeking a second opinion from a senior consultant, or referring a patient to him. In cardio-thoracic surgery, at any rate... a senior consultant usually enters the picture only when the primary consultant fears medico-legal trouble in a given situation.That is not to say that patients aren't asking for them. One reason why seond opinons are relatively uncommon is the absence of any publicly available medical audit. "Patients approach several consultants simply because, at present, they have no way to get authentic information on the quality of services provided by a given consultant or institution", says Valiathan.Outpatients come to Anil Desai because they are dissatisfied with the information their primary physician gave them, or with the treatment's progress. "I always request a referral from the family physician, but (find that) many families do not not have a family physician".However, the hospitalised patient is unable to obtain a second opinion without permission from the admitting physician — and even discussing such permission can be a source of stress for the patient and his relatives.Is the second opinion a right?All doctors surveyed felt so, though they did not agree on whether there were any limiting condiions. Some, like BIasszauer held that patient autonomy required that it be unlimited: "The patient has a freedom of choice, and even the responsibility... to go to as many doctors as he wishes. It is his life or that of his loved one that is at stake!" This right becomes particularly important with the deteriorating physicianpatient relations."Since trust in the medical profession has been greatly eroded, it is small wonder that patients (and I, myself, too) try to find the person who is up to date in his profession and displays humane features as well. In an open market system, this is no real problem. Even where there is a national health care system it may be cheaper for the system as well, if I can find the solution".Others would limit that right, mostly to when the physician ignores the patient's wishes. Udwadia feels that the patient's right to consult another doctor (independently) is absolute when the treating physician refuses to allow another opinion in spite of the patient's request; is clearly disinclined or procrastinates unduly in granting permission to seek a second or third opinion, more so when the patient's condition is not improving or is, in fact, deteriorating; when he reacts with anger or displeasure to a request for another opinion, and the patient feels that he now no longer receives the care he expects and needs."Also, when the problem ... is of serious, unsolved diagnostic import (the patient) has an absolute right to seek as many opinions as he wishes. However, the physician should caution the patient that... too many opinions would only confuse and harm the patient".But there are limits to this right, according to Udwadia. "It would be unjustified, in bad taste and bad manners if he seeks fresh medical advice of his own accord when already under treatment for an ailment for a considerable length of time by his primary physician. He should not seek a consultation with a new practitioner without permission and a referring letter from the primary physician. If the patient is dissatisfied, for whatever reason, with the primary physician, he should have the gumption to tell him so and inform him that henceforth he proposes to get treated elsewhere. This... absolves the primary physician from further care of the patient. It is not uncommon for many patients to surreptitiously see many doctors (as if to test the primary physician's management), and then quietly go back to the primary physician without the latter even being aware of this duplicity."The General Medical Council, UKThe General Medical Council (GMC) recommends that patients should continue to see specialists only on referral from a general practitioner. The GMC has strongly defended the referral system as a proven feature of medicine in the UK. Specialists should not usually accept a patient without referral from a general practitioner. The referral system is seen as the best way of ensuring that patients see the right specialist.General Medical Council News, Spring 1997, pages 1-2.Why don't patients tell doctors that they're 'double checking'?Why do patients behave 'duplicitously'? P. K. Sethi and Colabawalla see the reason in the behaviour of most doctors. "In practice this (request by a patient for a second opinion) seldom happens because the public has an apprehension that I may be annoyed. It is we, as a profession, who should work towards dispelling this impression. We have not done so," writes Sethi. He holds that patients are justified in breaking their contracts if physicians are rude at the mention of a second opinion. And it is "morally, ethically and possibly even legally unjustifiable" for medical professionals to withhold information and case history details, either from the patient or the second opinion physician.How should it be done?Under the UK's National Health Service, only the primary physician can refer a patient for a second opinion, writes Blasszauer. The physician must make the request in writing and provide all relevant medical details. In return, he obtains in writing the diagnosis made by the consultant and his advice on treatment.But this is rarely done in India, writes Thomas George, pointing out that patients rarely go up the primary, seondary and tertiary levels of care. Samiran Nundy notes thatmost patients in India do not have a doctor they can call their primary physician.V. R. Joshi points out that even the most punctilious of consultants would find it hard to enforce such a protocol. "Patients often travel long distances from other cities or states to reach you. It is only when they reach your office that they are made aware that a referral note is required.""Having come after seeking an appointment, I cannot refuse to see them just because they have no referral note," writes P. K. Sethi. "If, however, I discover that the patient is admitted to a local hospital and has come to me without informing the treating doctor, I ask him to go back and bring a referral note I feel this is in the interest of the patient and also conforms to the code of medical ethics... The advice is often no implemented."But it is not always possible to get a letter from the first doctor, feels Arunachalam, giving the patient's side of the story. He may be unavailable, or the patient hesitates to inform him, afraid the request would spoil relations. In fact the second opinion is often most needed when the patient is in the hospital — and least able to take an opinion without the admitting doctor's co-operation. Desai has always helped patients under his care obtain a second opinion without his physical presence, giving them full access to his case notes and the help of his house physician. On the other hand, if they seek a joint consultation — something Desai may also sometimes find necessary — he reserves the option on which consultant should be called in. There are also times when he recommends a joint consultation with the patient and relatives.This is not always the practice. "We do not permit second opinions from outsiders under any condition", writes Prakash N. Tandon, arguing that the second opinion can only be used ethically within a structured format. Patients wanting such opinions must first get themselves discharged from the hospital. "Every patient discharged from our ward, either by us or at his request, is given a discharge summary with full information on the various investigations carried out, a copy of the operation note, our final diagnosis and condition on discharge. The patient is at liberty to use this information for whatever purpose he wishes." Tandon's hospital does not provide the patient copies of X-ray films and other imaging tests, but sends them directly to the consultant if asked.Tandon argues that the patient's interests are met through multiple internal opinions. "Every patient admitted to our wards has the benefit of the collective opinion of the whole team which includes several senior consultants. By tradition, every patient is jointly discussed on more than one occasion."Permitting a second opinion from outside would create administrative problems on the one hand and a difficult clinical situation." For example, he asks, what if the second opinion was at variance from the first opinion? Who would implement it?"As a corollary, we refuse to provide a second opinion on patients admitted to other hospitals unless it is formally sought by the person treating the patient and with the permission of his administration. For purely administrative reasons, this is limited to public hospitals. The opinion is given to the treating surgeon and not to the patient or the family. At times, a joint meeting held with the family is addressed by the treating surgeon and ourselves."White disagrees with such a practice. "If a doctor does this, it strikes me that there is a component of spite and petulance arising out of the doctor's own needs. Patients, particularly if seriously ill, often feel the need to validate their doctors' opinion; after all, it is their life in the balance. Further, there are often enormous pressures from friends and relatives to get 'another opinion'." In other words, the second opinion can be taken for many 'ethical' reasons.Robin and McCauley add, "If the primary physician learns that the patient is following advice not consistent with his principles of treatment, the doctor should advise the patient of the difficulty/danger as best the doctor sees it... It is the patient's choice how to proceed. The doctor can be held responsible only for his own errors, not those of others.""If the patient is already admitted to hospital under another consultant, I would under no condition see the patient unless specifically asked to do so by the treating consultant," writes Udwadia. "This would apply even if the patient concerned has been previously under my care for several years. ""In the initial stages, before starting on a course of treatment, a patient may seek multiple advice," says Mr Harsh Sethi. "But once treatment has started, then a new doctor should not accept a patient without a note of referral from the first doctor (provided he knows that the patient has been under treatment). At the last, he should speak to the first doctor, and seek concurrence."The unreferred approachWhat does one do when a patient seeks a second opinion without obtaining a note of referral from his primary physician? Macklin does not see this as a dilemma. "If a patient approaches you, seeking a medical opinion (whether it is a first or a second opin-ion), the patient is in need of diagnostic or therapeutic attention. You can decline to form a relationship ... or accept the patient in your care and thereby establish a new doctor-patient relationship."Most respondents feel that it is the duty of the second physician to see the patient even without a note of referral from the primary physician, though such a note is desirable.S. H. Advani adopts a firm stand. "I am absolutely clear in my mind regarding the patient and doctor relationship. In this relationship, the patient has the major say. It is the patient who is going to receive the treatment and he has to make sure that he receives the best treatment. I give my frank opinion to the patient (whether or not he comes with a letter from the primary physician) because I strongly believe that the patient has the right to take a second opinion..! don't want the letter from the primary physician to participate in the second opinion."Ashok Bhanage emphasises that the doctor must work at all times with the patient's interests at heart. "If I realise that I am the second consultant, I write my notes in more detail and elaborate the reasons for my decision. The patient is at liberty to show this note to the first or a third consultant."Aniruddha Malpani emphasises that the autonomy of the patient demands that a second opinion, should be provided. A letter from his primary physician is not necessary. "My relationship is with the patient and I am answerable to him, not to his primary doctor."Taking over the patientWould you take over treatment of a patient already under the care of another consultant? This is one fear physicians have when referring their patients to their colleagues.Some might argue that this is the patient's prerogative. Arunachalam notes, "If I have changed doctors, I will certainly expect the second doctor to take full responsibility in treating me. If I consult more than one doctor (for getting opinions), I will retain the right to decide by whom I should ultimately be treated."Others are unequivocal: "If I find out that the patient is under the care of another consultant, I advise him to go back to that consultant," writes Gajendra Sinh. "I do not take over treatment of these patients."On the principle that a patient has a right to autonomy over his decisions, most respondents see no difficulty in taking over the patient's management at his express request — provided such a step is in his interests.However, Homi Dastur adds, "The suggestion to take over medical care would, at no time, come from me. It would have to be broached by the patient's general practitioner, if present, and the patient himself. Acceptance would follow only when persuasion to return to the primary physician fails."Advani differs. "The patient has the absolute right to be treated by the physician of his choice. If the patient decides to be treated by me, I would not normally hesitate to accept. I may inform the primary physician, though I don't consider this obligatory".Blasszauer argues that the doctor must was incompetent, mistaken, negligent, or in some other way not acting in the best interest of the patient. Patients need physicians who seek to act in their best interest. Physicians owe more to the patient before them than they owe to other members of their profession. Even if 'physician etiquette' dictates that one doctor should not treat another doctor's patient, medical ethics demands that patients receive the best medical care. Notes of referral and reluctance to treat patients under the care of another doctor are elements of physician etiquette, not medical ethics as understood today."Barot feels that the second consultant is duty-bound to approach the primary physician for all relevant medical information on the patient.Colabawalla outlines his approach: "If I am aware that the patient has been under the care of another colleague, I will offer my opinion and leave the choice to the patient. I would not 'take over' the case by ascribing to myself the arrogance that I know better! I would then try and persuade the patient to allow me to discuss the case with the primary physician.""The difficulty arises when the patient unequivocally informs you that he does not wish to be treated by the primary physician, and requests you to take over the management. I would try to resolve that dilemma — not that any dilemma can ever be resolved — by accepting that the patient's autonomy and right to choose must be respected"."If the patient is being looked after correctly I would persuade the patient to return to his consultant". writes Udwadia. "If the patient's problem has been wrongly diagnosed and if it is critical or life-threatening (e.g. a dissecting aneurysm of the aorta or an impending myocardial infarction), I would admit him to hospital under my care, inform the primary consultant and request him to see the patient in hospital as and when he wishes, so that we can jointly look after him".The dangers of mixed therapySome patients will see several physicians to obtain a clutch of prescriptions, selectively following that advice which suits them. How can we help such patients avoid the complications that may follow?Udwadia has seen patients who have gone through half a dozen or more physicians. "This is not uncommonly revealed to me at the end of the consultation! I ask that the treatment advised be carried out under the supervision of any one doctor of the patient's choice, as I would be unable to follow-up on his problem as often as I would like to. I then write a letter to that doctor , outlining what I feel about the patient's problem and how, in my opinion, it should best be tackled. (Finally,) I tell the patient that if he wishes to see me again he will now have to get a letter from this doctor".White agrees that selectively following advice offered by several physicians is courting trouble. "These are difficult situations, and in my opinion there is no one right answer. If I have a patient who is 'mixing and matching', I gently tell him he is receiving fragmented care, and that this is dangerous. Usually I tell the patient that I wouldn't continue management without a clear mandate. I feel strongly that patients have the right to several opinions, but that one doctor must quarterback the actual care. If he should suffer a complication, which of his medical attendants would be held responsible?"And the state of the bypassed..Many feel that the primary physician is justified in terminating his relationship with the patient. Valiathan sums up this sentiment: "The primary physician is not obliged to treat a patient who consults another physician or follows another line of treatment without his knowledge. When a doctor undertakes to take care of a patient he accepts a sacred contract with obligations on both sides. I do not agree that the doctor must take care of a patient 'under any circumstance'. Even Charaka, who imposed many strict conditions on the physician, recognised situations when a physician can terminate his sacred contract."At times, the bypassed physician feels rejected and acts accordingly. Sometimes a seriously ill patient is told, "You have decided to consult X without informing me. I do not wish to have anything further to do with your medical care. Please go back to X".All our experts frowned upon such behaviour. White writes: "Under these circumstances, the doctor's behaviour would be considered patient-abandonment. I would consider it a breach of ethical standards on grounds of beneficence, non-maleficence, fidelity to patient, and respect for patient's autonomy. What would be the physician's reasons for wanting to do this? The relationship starts out unequally, with the doctor having more power. This is counterbalanced, in my opinion, by the greater responsibility of the doctor, who needs to put his needs and wants aside and honour what is both a contract and a covenant. This is a critical issue - the physician's failure to put the patient's needs ahead of his own".Colabawalla writes that the physician should "gracefully end the 'contract... in his own interest" if he feels that he has lost the patient's confidence"for whatever reason".Barot strongly feels that the primary physician must pass information about the patient to the consultant or whoever else the patient may have chosen to deal with on health matters. The underlying ethic is that the primary physician should provide all necessary information as it concerns the patient's health (potentially a question of life and death).Blasszauer agrees. "The primary physician should not shed his responsibility to the patient without clarifying his patient's motives", he writes."The physician should ... understand: he may have failed the patient; the patient may be out looking for hope, or proof that his doctor's diagnosis is right or that the recommended therapy is the only solution. If he cannot find the answer for his patient's motives, than he should sit down with the patient and have a frank discussion. If he sees that the patient had no ground whatsoever to abandon him, he may advise the patient to look for another physician, since without trust no such relationship could be beneficial. But until that moment, I believe, he does have some responsibility. The patient should not fall between two stools. The primary physician should be available till he — on acceptable grounds — terminates the relationship 'officially' . An insult to my vanity is not an acceptable ground."Gajendra Sinh concurs with the need for reform within the profession. "Unless we put our own house in order it is difficult to see how we can restore the doctor-patient relationship".Will a second opinion clinic work in India?In Australia, a group of consultants from different disciplines offer counsel on the clear understanding that they will not take over the patient's medical management. Would such a clinic work in India?"It is fairly common in the U.S., in this connection, for a patient to be referred to a second physician for a decision about, say, the desirability of hysterectomy", write Robin and McCauley." The ground rules here are that the consultant will not be involved in the surgery; is not affiliated with (preferably doesn't even know) the treating doctor; and is paid the same, whatever his opinion. As you may imagine, this system has its own flaws and a long essay could be written about the good and bad aspects of this practice".Several respondents fell that such a clinic has little chance of success. Chinappa holds that it could not work in "an unorganised health care facility like that in India. You need a high level of education in the patient and a high level of ethical and moral integrity in the medical profession for this system to work".Colabawalla adds that the idea is good, but "I doubt if it will ever be welcomed by most professional colleagues. There will always be the doubt that patients would be misappropriated". Also, most medical professionals in India think they are too good to be challenged thus.Udwadia agrees. "You require a general improvement in ethical standards for this to come about. When this does happen, specialist clinics for second opinions would be redundant."Bhanage expresses some hesitation: "It is virtually impossible to get a genuine second opinion in private practice where even the most senior doctors are very insecure and distrustful of their colleagues. A second opinion clinic will have to be manned by a senior doctor with a reputation for integrity."White sees a similar problem in the US. "Medicine here has rapidly become a market commodity (unfornately, in my opinion). A physicial income often depends on 'capturing market share' from other physicians. Thus physicians and hospitals engage in extensive marketing and advertising to 'steal' patients from others.""Can a member of the clinic reject the patient's request for treatment after he has attended the clinic?"Hemraj Chandalia feels that if a patient insists he be followed up by the new consultant, "I will not deny the patient such an option

In short clinical trials are still being undertaken in parts of the USA.Recap of the 2019 Training YearThe MDMA Therapy Training Program launched a series of trainings to prepare therapy providers to become eligible to work on a MAPS PBC MDMA PTSD protocol.On October 1 – 8, 2019 Michael Mithoefer, MD, and Annie Mithoefer, BSN, led a six-and-a-half-day training retreat in Asheville, North Carolina focused on MDMA-assisted psychotherapy for PTSD. This retreat was the last MDMA Therapy Training retreat for 2019. 49 practitioners traveled from across the US and internationally to receive training. Trainees hailed from 14 states in the US and 11 doctors and therapists traveled from China to receive training in MDMA-assisted psychotherapy for PTSD. The China contingent was able to receive training thanks to the generous sponsorship from the Evolve Foundation.The MDMA Therapy Training Program organized five training retreats in 2019 and provided training to over 250 practitioners in MDMA-assisted psychotherapy for PTSD. These trainees completed the Part A online course and Part B training retreat. The training retreats took place in Israel, North Carolina, Colorado, and Kentucky. In addition to these five retreats, the MDMA Therapy Training Program offered one training for the CIIS Certificate in Psychedelic-Assisted Therapies and Research 2019 cohort in Northern California and provided training to an additional 95 practitioners.What's Next?The MDMA Therapy Trainers are gathering together in November for a Trainers Retreat to reflect on the 2019 year and strategize about the year ahead and the future of the MDMA Therapy Training Program. There are no dates scheduled for 2020 trainings yet. The training team will be planning dates and tuition fees for the 2020 training year and announcing that information through the MDMA Therapy Training Newsletter in the months to come. The Expanded Access protocol and the MDMA-assisted Psychotherapy for Healthy Volunteers Therapist Training protocol for the Part C experiential component of the MDMA Therapy Training Program are still under FDA review. The training team is using this time to strategize and integrate feedback from the 2019 year as we wait to learn about the timing, size, and scope of our protocols from the FDA. We are excited to continually improve and evolve the training program to offer comprehensive training to practitioners interested in MDMA-assisted psychotherapy for PTSD.Update from the Expanded Access TeamThe MAPS Public Benefit Corporation (MAPS PBC) Expanded Access Team is currently working through questions from the U.S. Food and Drug Administration (FDA) regarding the proposed Expanded Access protocol for MDMA-assisted psychotherapy for treatment-resistant posttraumatic stress disorder (PTSD). The Expanded Access protocol is still under FDA review and pending approval.The Expanded Access Team is grateful for the overwhelming interest in Expanded Access and future opportunities to deliver MDMA-assisted psychotherapy. Due to the level of interest and limited capacity dictated by FDA, not all interested sites will be able to participate. Growing this modality and making effective treatment options available is an ongoing process, and there are still significant uncertainties about timing and regulatory approvals. We are hopeful about making MDMA-assisted psychotherapy into a legal prescription treatment. Submitted applications will continue to be reviewed for site feasibility as we are able to add additional sites for Expanded Access or post-approval. All interested sites must undergo eligibility review and complete the pre-requisite MDMA Therapy Training Program in order to work on an MDMA PTSD protocol, Expanded Access or post-approval.How to ApplyThere are two layers of application: 1) Site Questionnaire, and 2) MDMA Therapy Practitioner Training Application. Each site must submit one Site Questionnaire. Additionally, each therapy practitioner must submit an MDMA Therapy Practitioner Training Application. Only applicants affiliated with a qualifying site can be considered for training at this time.Each application takes approximately 30 minutes to complete. You can save and return to work on your application at your convenience by creating a free Formsite account (highly recommended- instructions on first page of each application). Once you have completed the application, the final page will prompt you to confirm and submit. MAPS PBC will review applications on an ongoing basis, as they are received.Site Questionnaire Link:https://site.mdmatherapytraining.comMDMA Therapy Practitioner Training Application Link: https://apply.mdmatherapytraining.comSites and therapy providers inquiring to work on an MDMA PTSD protocol should be familiar and comfortable with the Treatment Manual before submitting an application. A full course of treatment involves three 90-minute Preparatory therapy sessions, three total 8-hour MDMA therapy sessions, and nine total 90-minute Integrative therapy sessions, summing about 42 hours of therapy. All sessions are administered by a Therapy Pair, two providers for every one participant/patient, utilizing a non-directive approach and an ability to work with extreme states. More information about the therapeutic approach can be found in the MDMA-Assisted Psychotherapy Treatment Manual and in in Cultivating Inner Growth: The Inner Healing Intelligence in MDMA-Assisted Psychotherapy.We encourage each site, in choosing location and therapy teams, to consider diversity, inclusivity, and cultural and racial competence. One of the most robust ways to provide accessible care is to train therapists and practitioners from diverse backgrounds, including people of color and the LGBTQIA+ community. If you are a therapist from a marginalized community, we encourage you to reach out to us at [email protected] site and practitioner application procedures are posted athttps://mapspublicbenefit.com/. If you have already submitted an application for your site and therapy teams, thank you! The training team will be in touch with you. The MPBC clinical operations team is currently reviewing site questionnaires to screen for initial eligibility and the training team is reviewing therapy provider applications.MDMA-Assisted Psychotherapy Code of EthicsThe MDMA Therapy Training Program has established the MDMA-Assisted Psychotherapy Code of Ethics. The Code of Ethics is available online for your reference and review.Therapy providers completing the MDMA Therapy Training Program will agree to practice MDMA-Assisted Psychotherapy within their scope of competence and in accordance with the MDMA-Assisted Psychotherapy Code of Ethics, and will agree to directly address concerns regarding ethical issues and use clinical judgment, supervision, and consultation when ethical dilemmas arise.Phase 3 Trials of MDMA-Assisted Psychotherapy for PTSD now enrolling!FDA-regulated Phase 3 clinical trials of MDMA-assisted psychotherapy for PTSD are currently recruiting participants who live within an hour’s drive of 15 clinic sites across the United States, Canada, and Israel.The Phase 3 clinical trials are assessing the efficacy and safety of MDMA-assisted psychotherapy in adult participants with severe PTSD. Over a 12-week treatment period, participants will be randomized to receive either MDMA with psychotherapy or psychotherapy only. Assignment to the group will be blinded throughout the study, and all participants will have twelve preparatory and integration sessions lasting 90 minutes each along with three day-long sessions about a month apart.The Phase 3 clinics are located:Los Angeles, CA | private practiceSan Francisco, CA | research institutionSan Francisco, CA | private practiceBoulder, CO | private practiceFort Collins, CO | private practiceNew Orleans, LA | private practiceNew York, NY | research institutionNew York, NY | private practiceCharleston, SC | private practiceMadison, WI | research institutionBoston, MA | private practiceMontreal, Canada | private practiceVancouver, Canada | research institutionBe’er Ya’akov, Israel | research institutionTel HaShomer, Israel | research institutionIf you know someone with PTSD interested in participating in a clinical trial or want to refer others, please share our new recruitment website https://mdmaptsd.org/for more information and our Phase 3 trial application.Open Call for Mental Health Providers:Join the Psychedelic Support Network!Psychedelic Support brings together a Network of clinics, therapists, counselors, doctors, and other specialists to offer services (online and in-person) for psychedelic/plant medicine integration, transformational preparation, psychological and physical health, and personal growth. Providers are required to be licensed in a health profession or be experienced as a therapist/guide in psychedelic-assisted research trials. Visit the website psychedelic.support to search provider profiles, find integration events and professional trainings, and access free resources from the collective knowledge of the Psychedelic Support Network. For more information or to apply, email [email protected] PBC Therapy Provider Connect Portalhttps://connect.mdmatherapytraining.comThe MAPS PBC Therapy Provider Connect Portal is a community discussion forum for therapy providers, physicians and facilities to connect with one another to develop a site or treatment staff, in order to become eligible to participate in an MDMA PTSD Expanded Access protocol, pending FDA approval. If you are looking for treatment staff, a physician, or a treatment facility, or for general information and Frequently Asked Questions, we hope that this platform will support you.Instructions: Upon viewing the website, register with your name, email and professional information, and read and agree to the Terms of Use. Please follow the guidelines outlined in the Connect Portal for appropriate posting and language.We're Hiring!Adherence & Supervision CoordinatorMAPS PBC is seeking an enthusiastic, focused, and organized person to join our Training & Supervision Department. Reporting to the Director of Training and Supervision, the Adherence and Supervision Coordinator supports programs and staff who monitor the delivery of MDMA-assisted psychotherapy for PTSD in MAPS protocols. This position requires competence in program coordination, project management, remote work environments, communication, meeting facilitation, team building, scheduling, contracts, creation and management of spreadsheets. Due to the sensitive and protected nature of psychotherapy clinical trials and clinical supervision, this position requires an individual who respects and is able to uphold confidentiality. Training in HIPAA and Good Clinical Practice will be provided on the job. Preferably the person filling this position will have worked in clinical research and/or mental health settings. The ideal candidate is engaged in therapeutic and self-care practices, is familiar with the process of clinical supervision and the conduct of psychotherapy. Suitable candidates are able to work well in a fast-paced environment and excel at organizing and managing lots of information virtually.You can find out more about the position by visiting the full job posting on our website.Interested and qualified candidates are encouraged to apply online at: tinyurl.com/applyMPBC.Thank you!We will continue to provide updates on the MDMA Therapy Training Program and MAPS PBC protocols when they available. In the meantime, you may find some of the resources and trainings listed below helpful. Please also visit our new website https://mapspublicbenefit.com/ and the Connect Portal for additional information. If you have any questions, please considering checking the FAQ in the Connect Portal or [email protected] appreciate your patience and continued support as we work to bring the healing potential of MDMA-Assisted Psychotherapy for PTSD to those in need.From the MDMA Therapy Training Program"The way I must enterLeads through darkness to darkness -O moon above the mountain's rim,Please shine a little furtherOn my path"– Izumi ShikibuBooksThe Way of the PsychonautThe Way of the Psychonaut: Encyclopedia for Inner Journeys by Stanislav Grof, M.D., Ph.D. (Two-Volume Book Set and eBook)Consciousness MedicineConsciousness Medicine: Indigenous Wisdom, Entheogens, and Expanded States of Consciousness for Healing and Growth by Françoise Bourzat and Kristina HunterThe Ethics of CaringThe Ethics of Caring: Finding Right Relationship with Clients by Kylea TaylorGroups for StudentsMAPS grad student listservThis moderated Google Group is for graduate students and prospective graduate students who are conducting or interested in conducting psychedelic research to share resources and ideas.Medical Psychedelic Interest GroupInspired by the MAPS Grad Student Listserv,the Medical Psychedelic Interest Group is a googlegroup specifically for medical students and residents who share an interest in psychedelic research and psychedelic-assisted treatments.SSDP Psychedelic PipelineStudents for Sensible Drug Policy is embarking on a new project to connect members and alumni interested in a career in psychedelic-assisted therapy and research to quality mentorship, training, and career development opportunities. The pipeline will provide resources through a mentorship program for members interested in all aspects of the field, to include professional skillsets beyond therapy and research that are necessary for the field to develop and thrive. To learn more visit the SSDP blog at https://ssdp.org/blog/ssdp-receives-grant-from-threshold-foundation-for-the-just-say-know-psychedelic-pipeline/.Training Resources and Events:Master Series on the Clinical Application of CompassionOctober 23 - November 14Free 4-module series, OnlinePsychedelic Science SummitNovember 1-3, 2019Austin, TXPsychedelics for Clinicians 101 & 102November 2 - 3, 2019Montreal, Quebec, CanadaKRIYA Conference 2019November 9 - 10, 2019Hillsborough, CAEntheogenic Indigenous Traditions in Times of MedicalizationNovember 14, 2019Berkeley, 2019Building Community Through Restorative JusticeNovember 15 - 16, 2019San Francisco, CAEncountering the Numinous: Expanded States of Consciousness, Depth Psychotherapy, Analysis and PsychedelicsNovember 16 - 17, 2019San Francisco, CAOn Somatics and Social JusticeNovember 19, 2019San Francisco, CACollective Trauma SummitGrof Transpersonal Training EventsSomatic Experiencing Trauma Institute TrainingsHakomi Institute TrainingsGenerative Somatics CoursesInternal Family Systems TrainingsBenefit Corporation (MAPS PBC)!Please see the message below from one of our Phase 3 Principle Investigators, Scott Shannon, MD.Business of Psychedelic Medicine SurveyDear Colleague:The rescheduling of MDMA and psilocybin has the potential to change the face of mental health care around the world. We are witnessing a massive surge in the interest and support for psychedelic medicine. This includes interest in training for mental health practitioners to provide this care. A number of psychedelic medicine supporters have concerns that the strong interest in psychedelic medicine training by psychotherapists and psychiatrists will not translate well into the business of setting up and running clinics for this type of care. We are concerned that the lack of business expertise will create a roadblock for this paradigm shift in mental health that may become a significant business opportunity as well.As a result, we are considering whether to provide concise and practical trainings about how to set up and run a psychedelic medicine clinic. This training would help individuals without business or start up experience feel more comfortable about starting a new clinic with this specific focus. In collaboration with MAPS, we have attached a link to a brief (less than 5 minutes) survey to explore your views and interest in this topic. This training would be supported by philanthropy and run by our non-profit organization PRATI. This project is not being run by MAPS, so please do not reach out to them. If we decide to move forward I will be the point person.If you complete the survey we will send you a copy of our summary of the data we collected.Survey link: Business of Psychedelic Medicine SurveyI appreciate your participation.Scott Shannon, MD FAACAPPsychiatristClinical Investigator (site Principal Investigator), Study Physician and Therapist:MAPS MDMA-Assisted Psychotherapy ResearchWholeness Center Research- Fort Collins, COThank you!MAPS Public Benefit Corp is still in the review process with the FDA for the Expanded Access protocol and the protocol is still pending approval. We will continue to provide updates on the MDMA Therapy Training Program and MAPS PBC protocols when they available. We appreciate your patience and continued support as we work to bring the healing potential of MDMA-Assisted Psychotherapy for PTSD to those in need.Kind regards,MDMA Therapy Training Program