Healthcare Sector in India

Healthcare sector in India

HEALTH SECTOR

Health as one of the Fundamental Human Right, has been accepted in the Indian Constitution. Although Article 21 of the Constitution requires the State to ensure the health and nutritional well being of all people, the Federal Government has a substantial technical and financial role in the sector. Due to growing importance of healthcare industry, it has been conferred with the Infrastructure status under section 10 (23G) of the Income Tax Act.

GOAL
The goals for health systems, according to the World Health Report 2000 - Health systems: improving performance (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another.

HEALTHCARE IN INIDA
Healthcare is the largest service industry in India in terms of revenue and the second largest, after education, in terms of jobs, employing more than 4 million people.
The Economist Intelligence Unit estimated the Indian healthcare sector (Including pharmaceuticals) to be around US$44.6 billion in 2006 which amounted to around 4.9 per cent of the GDP. It estimated the sector could grow to US$82.5 billion by 2011 accounting for 4.5 per cent of the GDP. The spending in healthcare is expected to rise by around 10 per cent per year during the year. Private consumption is forecast to increase in real terms by an annual average of 7.4 per cent during the period.

	2006	2007	2008	2009	2010	2011
Healthcare spending(Rs bn)	2,019	2,242	2,555	2,881	3,221	3,382
Healthcare spending(% of GDP)	4.9	4.7	4.7	4.6	4.6	4.5
Healthcare spending(US$ bn)	44.6	53.6	62.3	70.3	78.5	82.5
Healthcare spending(US$ per head)	41	48	55	62	68	71
Physicians(per 1,000 population)	0.6	0.6	0.6	0.6	0.6	0.6
Pharmaceutical sales (US$ bn)	9.4	10.1	10.8	11.6	12.4	13.3

Indicator	Value(year)
Total expenditure on health as percentage of gross domestic product	5.0 (2004)
General government expenditure on health as percentage of total expenditure on health	17.3 (2004)
Private expenditure on health as percentage of total expenditure on health	82.7 (2004)
General government expenditure on health as percentage of total government expenditure	2.9 (2004)
External resources for health as percentage of total expenditure on health	0.5 (2004)
Social security expenditure on health as percentage of general government expenditure on health	5.6 (2004)
Out-of-pocket expenditure as percentage of private expenditure on health	93.80 (2004)
Private prepaid plans as percentage of private expenditure on healt	0.8 (2004)

Source: WHO
INFRASTRUCTURE SHORTFALL
Despite the phenomenal GDP growth seen by India in the last decade and a half making it one of the fastest growing economies in the world, the healthcare infrastructure in India still lags far behind the international standards even by emerging market standards.
Against a world average of 3.96 hospital beds per 1000 population, Russia has 9.7, Brazil has 2.6, China has 2.2, and India languishes at just 0.7.
In terms of availability of trained medical personnel India has 0.6 physicians per 1000 population as against 1.8 in the developed countries and a global average of 1.5. The number of nurses available per 1000 population in India is 0.8 as opposed to 7.5 in the developed countries and a global average of 3.3.
At present India has 242 medical colleges from where around 23,000 doctors qualify each year with an MBBS degree. In addition there are 205 dental colleges from where 14,700 dentists qualify each year.

GROWING DEMAND
Population growth - India’s growing population is expected to surpass China by 2030 and be 1.6 billion by 2050. With greater life expectancy by 2025 alone an estimated 189 million Indians will be at least 60 years of age—triple the number in 2004. The growing elderly population will place an enormous burden on India’s healthcare infrastructure.
Growing middle class - India’s economic growth is driving urbanization and creating an expanding middle class. With rising incomes this has resulted in more disposable income to spend on healthcare. Today at least 50 million Indians can afford to buy Western medicines -a market almost 5/6th the size of the UK market.
Rising lifestyle diseases – Socio-economic and demographic changes within certain segments of the Indian population, particularly in urban areas, have created increased demand for advanced healthcare services. Not only is there a growing awareness and sophistication among healthcare consumers who are demanding more services, there is also an increase in the incidence of so-called “lifestyle” diseases like cancer, diabetes and cardiovascular disease, which are more expensive to treat than communicable and infectious diseases.
Healthcare insurance - Less than ten per cent of India’s population today has some sort of health insurance cover. With the emergence of private sector in the insurance industry, healthcare insurance is rising. Healthcare insurance premium collected in 2005-2006 registered a growth of 35 per cent over year 2004-2005.

MAJOR PLAYERS IN THE SECTOR
Hospital Services - An estimated that 450,000 additional hospital beds will be required by 2010 - an investment estimated at US$25.7 billion. The government is expected to contribute only 15 to 20 per cent of the total, providing an enormous opportunity for private players to fill the gap. There also is strong demand for tertiary care hospitals, which emphasize the treatment of lifestyle diseases, focusing on specialties such as neurology, cardiology, oncology and orthopaedics. Tertiary hospitals are projected to grow faster than the overall healthcare sector, in response to the growing incidence of lifestyle disease and the accelerating growth of medical tourism. The private sector accounts for 62 per cent of hospitalization treatment and 81 per cent of the non hospitalisation treatment in India in the urban areas and 58 per cent and 78 per cent of the hospitalisation and non-hospitalisation treatment in India in the rural areas. Major private sector companies in the hospital services are Apollo Hospitals - 40 hospitals with 6000 beds, Fortis Healthcare - 12 hospitals with 1900 beds, Wockhardt Hospitals – ten hospitals with 1500 beds, Max Healthcare - seven hospitals with 800 beds and Manipal Hospitals – 13 hospitals with 7000 beds. Some of the new companies with plans in this segment are Reliance Healthcare, Artemis Health Sciences and Paras Group. The international companies with plans in this segment are Parkway Group - Singapore, Pacific Healthcare Holding - Singapore, Columbia Asia – Malaysia, EMAAR Group – Dubai and Prexus Healthcare Partners – USA.
Medical Tourism - India offers highly cost-competitive and technologically advanced treatments options. India’s private hospitals excel in fields such as cardiology, joint replacement, orthopaedic surgery, gastroenterology, ophthalmology, transplants and urology. According to a joint study by CII and McKinsey, Indian medical tourism was estimated at US$350 million in 2006 and has the potential to grow into a US$2 billion industry by 2012. An estimated 180,000 medical tourists were treated at Indian facilities in 2004. Patients from approximately 55 countries were treated at Indian hospitals. However, most of the foreign patients are from nearby developing countries such as Afghanistan, Pakistan, Nepal, Bangladesh and Sri Lanka, which lack top-quality hospitals and health professionals; patients from the US and Europe are relatively few. International patients choose India primarily because of the substantial difference in the cost of high-end surgery and critical care and quicker access to medical care in India vis-à-vis some highly developed countries. The cost of such medical care also compares favourably against costs of other more established medical tourism destinations like Thailand. For example, a cardiovascular surgery, which costs approximately US$50,000 in the USA and approximately US$14,250 in Thailand, costs approximately US$6,000 in India, and orthopaedic surgery, which costs approximately US$6,900 in Thailand, costs approximately US$4,500 in India. Apollo Hospitals has successfully treated over 60,000 foreign patients from across the world in last five years.
Tele-medicine - Only 25 per cent of India’s specialist physicians reside in semi-urban areas, and a mere 3 per cent live in rural areas. As a result, rural areas, with a population approaching 700 million, continue to be deprived of proper healthcare facilities. Tele-medicine is a fast-emerging trend in India, supported by exponential growth in the country’s information and communications technology (ICT) sector, and plummeting telecom costs. Several major private hospitals have adopted tele-medicine services, and a number of hospitals have developed public-private partnerships (PPPs), among them Apollo, AIIMS, Narayana Hridayalaya, Aravind Hospitals and Sankara Nethralaya. Today there are approximately 120 tele-medicine centres throughout India. The Asian Heart Institute (AHI) is planning to establish 60 more tele-medicine satellite centres across the interiors of Maharashtra. The Indian Space Research Organization (ISRO) plans to establish 100 tele-medicine centres across the country. ISRO has already connected 25 major hospitals in the mainland and plans to link at least 650 district hospitals by 2008. The government also is reducing import tariffs on infrastructure equipment. With the shortage of radiologists the world over, tele-imaging offers good opportunities for the international market. Teleradiology Solutions is a leading company providing tele-radiology to 50 hospitals in the USA.
Pathology Services – The market for pathological services in India is estimated at US$500m and has been growing at 20 per cent annually. There are around 40,000 pathology labs in India but most of these are small companies and comprise the unorganised sector of the pathology market. The growth in the segment is expected as healthcare insurance market grows and preventive healthcare takes root in the country. Further there is a huge potential for providing outsourced pathology to major healthcare markets abroad as India offers a distinct price advantage. Some of the major players in this segment are Dr Lal’s Pathlabs and Apollo Group.
Medical Equipment - The rebuilding of India’s healthcare infrastructure, combined with the emergence of medical tourism and tele-medicine, will drive strong demand for medical equipment, such as x-ray machines, CT scanners and electrocardiograph (EKG) machines. The demand for hi-tech medical devices in India is growing by 12 -15 per cent annually and 90 per cent of demand is being met by imports from countries like USA, Japan and Germany. Leading international companies market most high value medical equipment, while only consumables and disposable equipment are made locally. Many international companies have expanded their operations in the Indian market in recent years and established manufacturing facilities to assemble equipment for the domestic market and export sales. The market is expected to be around US$1.7 billion by 2010, against US$1.2 billion in 2005. Changing disease profile and clinical needs, and growth of medical tourism are all expected to drive the potential for medical devices. Some foreign companies conduct first 500 surgeries in India after approval of a medical device or surgical treatment by US FDA.
Healthcare BPO Services – The rapid strides that India has made in the IT industry along with the availability of a large English speaking skilled manpower has opened opportunities in the healthcare outsourcing in India. Some of the services offered include managing their patient information data and back office operations like Medical Transcription, Medical Coding (ICD & CPT) and Medical Billing. Outsourcing to India results in cost savings in the range of 20-30 per cent. The opportunity in this segment is estimated to be worth around US$4.5 billion.
Healthcare Insurance - In recent years, there has been a liberalisation of the Indian healthcare sector to allow for a much needed private insurance market to emerge. Due to liberalisation and a growing middle class with increased spending power, there has been an increase in the number of insurance policies issued in the country. In 2001-2002, 7.5 million policies were sold. By 2003-2004, the number of policies issued had increased by 37 per cent, to 10.3 million. The Insurance Regulatory and Development Authority (IRDA) eliminated tariffs on general insurance on 1 January 2007, and this move is expected to drive additional growth of private insurance products. In the wake of liberalisation, health insurance is projected to grow to US$5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry. Currently there are 25 licensed third party administrators in the Indian health insurance industry. Some of the international majors that have entered the segment are Max New York Life, a joint venture between Max India and New York Life, and ICICI Prudential Life Insurance, a joint venture between the ICICI Group and UK-based Prudential plc.
HEALTH SECTOR PRIVATIZATION, A BOON OR BANE?
Privatization! Do we need it or not? Few other questions can kick start a heated debate as this. What is seen now is that India is slowly engulfed by an enthusiasm to privatize anything and everything. Even while the left parties in India staunchly oppose the “privatize all” move, the proponents present it as a panacea to problems of the poor, incompetent services and loss making performances of public sector units. So is the case in health sector. As per a recent study ("Health transition in Kerala" by P.G.K Panikar), the share of private hospitals in Kerala is about 93%. The irony here is that Kerala supported a leftist Govt for nearly 50% of its life time!

Hospitals or medical care systems run by individuals is not a new phenomenon to us. Before the British rule, all the medical centers (e.g.: vaidyasala) were run by individuals or families who had a legacy knowledge about those system of medicine. Public health care system run by the state was predominantly a western idea (I don’t think that any of the earlier kingdoms that ruled India – or parts of it--- had a public health care system run by the Kingdoms) and naturally it came to India with the British rule.

Present Situation
By any stretch of the imagination it’s hard to believe that the Govt would have been able to provide the same service, quantitatively or qualitatively, with out private sector participation. Moreover private sector has provided unwavering support to the Govt for all of its endeavors towards attaining a national health security. An example is the national immunization programs. Private hospitals have helped the Govt in setting up the infrastructure for such a huge exercise which has parallels only to the General election in India in terms of its scale. Definitely the private healthcare sector is unequivocally a stakeholder in the better healthcare system we are enjoying at present.

But even while considering all contributions of the private sector in health care system in India, it needs to be pointed out that most of the times people are subjected to a disconcerting ruthlessness of profit making. As with any other private industry, the motto of business is making profit. Agreed; a business is not run for charity and it’s the right of the owner to make a return on his investment. But surely there should be a clear difference between robbery and making a justifiable profit.

I have seen that most of the time the proponents of privatization, repudiate the allegations of private hospital exploitations by terming it as problem of paranoid vision. Let me tell you one incident where I witnessed a classic example of looting by a private hospital.

On the morning of 7th October 2006, my friend Mithun took his wife Pavithra (names have been changed as per their request), who was in the initial stages of her pregnancy, to a five star hospital in Bangalore (This hospital is having branches in most of the metros). Pavithra had a severe abdominal pain and giddiness. This was followed by a brief loss of consciousness and convulsion. She had become noticeably pale by the time they reached hospital. When I reached hospital she was inside the Emergency room and Mithun was waiting outside the room. After some time a doctor came outside the room (we later came to know that he was Neurologist) and asked about her pregnancy and told Mithun that they suspect an epileptic fits and need to do more investigations as the symptoms manifested, like convulsions, point to the possibility of seizure disorder. Mithun who was in bewilderment had no other way but to buy the claim of the doctor who (at least in theory) knows a human body more than him. To rule out (or reinforce?) the possibility of an epileptic fits; she was taken for an MRI scanning. But the results ruled out the possibility a seizure disorder.

While standing outside the emergency room I saw one of the most interesting ad, I might have ever seen. Interesting part was not its presentation but its content. The colorful notice on the wall of the Emergency room was to inform the visitors of the hospital about the great discount they can avail if they do an MRI on weekdays than on weekends. There was almost a 30% discount on the MRI done on weekdays. I started wondering whether a hospital is something like an amusement park, where you go to enjoy your vacation and is MRI some kind of high adrenaline thrill ride that makes your visit worth remembering.

As far as I know, MRI (Magnetic resonance imaging) is a noninvasive medical imaging procedure that uses powerful magnets and radio waves to construct clear, detailed pictures of the part of the body under investigation, to assist the diagnosis.

Meanwhile I talked to my father who is a Surgeon in Kannur (A town in Kerala). He immediately told me that he suspects an Ectopic pregnancy rupture as in this case she is in the initial stages of pregnancy and complaining a severe abdominal pain. (Ectopic Pregnancy is an abnormal pregnancy that occurs outside the uterus. The most common site for an Ectopic pregnancy is within a fallopian tube).

As the MRI conducted could not pinpoint the cause of her symptoms and as there were no improvements made with the initial fluid supplements given, she was taken to ICU, where an abdominal ultra sound scanning reveled that it was an Ectopic pregnancy complication with ruptured fallopian tube and massive internal bleeding (Leading to a condition called shock—Due to loss of blood volume and low blood pressure). They performed an emergency surgery to fix the problem. She was pulled back to life from the brim.

Two days she was in hospital, as it was a laparoscopic procedure the stay needed at hospital was minimal. But then it was a shock (Literary this time and not medical) at the time for us, when we saw the bill. According to hospital its “just 80,000 rupees ONLY”. In the bill the cost of MRI was given as 20,000. When inquired we came to know that MRI for inpatients was higher than outpatient MRI and the "lucrative offer" of MRI discount in the advertisement was not applicable to inpatients!.

In the above case, was the incorrect assumption made by the neurologist, that it’s a case of epileptic fits; a non culpable error in judgment happened by overlooking the primary symptoms of the patient (like acute abdominal pain and anemia in early weeks of pregnancy) or was it a clever blissful wrong diagnosis to squeeze the patient?

How could a doctor miss the possibility of an Ectopic pregnancy rupture when the patient was manifesting copy book symptoms of the same? Was it a problem of the doctor’s super specialization? Is super specialization something where you learn more and more about less and less and ultimately know everything about nothing?

When I inquired in some private hospitals in Kerala I came to know that the same treatment would have incurred only a sum of 12000-- 15000 Rupees. Then why was the treatment exorbitantly costly in this five star hospital?

Was it not a daylight robbery? I strongly feel it was. Considering the fact that the hospital was promoting their radiology department with discounts and other offers, this incident of taking a cerebral MRI for pregnancy related complication smells fishy. If the cost of treatment, for a not so uncommon condition like Ectopic pregnancy rupture, was too high even for two upper middle class IT engineers, then its unthinkable what the situation would be for the majority our compatriots.

Complete privatization is not a panacea for our problems of poor service, at least not in service sectors like health care industry. Yes we do need private sector participation to a certain extent and I am not belittling their contributions. But this does not mean that you can get rid of the Govt healthcare system and rely only on private sector for all your needs.

Having the system of public domain may not stop this exploitation, but we will have at least an alternative to depend on. The achievements that we made in public healthcare are results of the accessibility that the common man had to the hospitals. But 5 star hospitals that charge exorbitantly high rates, like the one above may hinder this progress by introducing an economic inaccessibility and will pull down our progress.

As it is very evident that we have already crossed the rubicon of privatizing the health care system, it’s time for us now to think about having a regulatory authority which has the powers to audit the actions of private hospitals. This regulatory body must be composed of medical and legal experts, along with representatives from the Govt. This will definitely bring down private hospital exploitations where the patients are subjected to unnecessary/ unwanted medical investigations in the name of diagnosis.

Ending note: - How about this for an offer you may find in the near future at a pvt hospital; “Combo Offer: - Along with mother’s Hysterectomy, you get daughter’s caesarian Free!”
FOREIGN INVESTMENT

For developing countries with failing health systems, this foreign investment may seem an attractive source of capital and medical technology at a time when other sources are thin on the ground. Yet involvement by the foreign private sector in health care has the potential to marginalise the poor even further. Companies seek markets in which they can be assured sufficient returns, and this typically concentrates investment in more affluent areas. Loans granted to private health care providers by the World Bank's International Finance Corporation, for instance, are predominantly directed towards facilities for the richer communities of the country or for expatriates, not the majority of the population. This practice of "cream skimming" by the private sector is already familiar in the field of private health insurance, where insurance companies and health maintenance organisations (HMOs) typically favour the healthy and wealthy over high-risk customers, excluding the latter by means of prohibitive premiums.

MEDICAL TOURISM
India is quickly becoming a hub for medical tourists seeking quality healthcare at an affordable cost. Nearly 4,50,000 foreigners sought medical treatment in India last year with Singapore not too far behind and Thailand in the lead with over a million medical tourists. As the Indian healthcare delivery system strives to match international standards the Indian healthcare industry will be able to tap into a substantial portion of the medical tourism market. Already 13 Indian hospitals have been accredited by the Joint Commission International (JCI). Accreditation and compliance with quality expectations are important since they provide tourists with confidence that the services are meeting international standards. Reduced costs, access to the latest medical technology, growing compliance to international quality standards and ease of communication all work towards India’s advantage.
It is not uncommon to see citizens of other nations seek high quality medical care in the US over the past several decades; however in recent times the pattern seems to be reversing. As healthcare costs in the US are rising, price sensitivity is soaring and people are looking at medical value travel as a viable alternative option. In the past the growth potential of the medical travel industry in India has been hindered by capacity and infrastructure constraints but that situation is now changing with strong economic progress in India as well as in other developing nations. With more and more hospitals receiving JCI accreditations outside the US, concerns on safety and quality of care are becoming less of an issue for those choosing to travel for medical treatment at an affordable cost. The combined cost of travel and treatment in India is still a fraction of the amount spent on just medical treatment alone in many western countries.
In order to attract foreign patients many Indian hospitals are promoting their international quality of healthcare delivery by turning to international accreditation agencies to standardize their protocols and obtain the required approvals on safety and quality of care.
Another secondary motivation besides accessibility and cost of care is the idea of having your medical treatment combined with a relaxing vacation at an exotic destination. This is an opportunity for India to embrace its Ayurveda and other alternative medicine options by adopting more of a holistic approach to healthcare delivery that includes wellness tourism for rejuvenation of the body and mind.
One of the main concerns that patients face when opting for medical value travel is whether or not they will receive proper follow-up care in their home country post treatment in a foreign country. Another concern is the issue of liability, for example if something were to go wrong during a procedure in a foreign country how easy or difficult would it be for that individual to work through the host country’s legal system.
With a growing medical tourism market the Indian healthcare system will benefit from improved quality, standards and increased investments. Private hospitals argue that medical tourism reverses the brain drain, as health workers seeking more attractive career opportunities abroad will stay in India if given the option of working in the medical tourism sector.

Health Care & Rights of Patients
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Email Etiquette

Email Etiquette


WHAT EXACTLY IS "NETIQUETTE"?
Netiquette = Network Etiquette
Email Etiquette and Proper Technology Use

"Using technology effectively to communicate with others
with knowledge, understanding and courtesy." TM
· Do you skip including a courteous greeting and closing in your emails because you believe they are not necessary?
· Do you type in caps or all small case?
· Do you send unannounced large attachments that shut down the other side’s email?
· Do you forward emails with everyone’s email address in the To: field?
· Do you forward emails without including a friendly personal comment?
· Do you email sites asking for information they do in fact have online for your convenience simply because you don’t want to take the time to read?
These are just a few of the things that can have you being perceived as an online knucklehead.



Little Common Courtesies
1. Do not type in all caps.
2. Do not leave the Subject: field blank.
3. Refrain from formatting your email with colored text and background colors or images in your day to day communications.
4. On those rare occasions where it is necessary to send a group of people the very same email, as a courtesy to those you are sending to, please list all of the recipients email addresses in the BCC field.
5. Never expose your contact’s addresses to strangers!
6. Never give out phone numbers or personal information without confirming you are communicating with a reputable party.
7. Make a reasonable effort to search a Web site for the information you are looking for.
8. Do not use Return Receipt Request (RR) for each and every email you send.
9. Understand that you will be on a continual learning curve.
10. If you receive a nasty email - do not respond immediately - if at all.
11. Keep in mind that all private email is considered to be copyrighted by the original author.
12. Always minimize, compress or “zip” large files before sending.
13. Do not forward virus warnings!

Red Means Red!
It is very common for me to get e-mails asking what a sender meant by having only certain text in their e-mail purposely changed to red.
Red is an aggressive color. The term “seeing red” means that someone is mad or so upset that they are seeing red. So it goes without saying that when it comes to communicating with the written word it is safe to assume when someone changes select text to red — that they are making a point.
If in a business letter if you changed only certain words or sentences to red, what would that mean? It would mean you are making a strong point. It would mean you are adding a robust emphasis to those particular terms or sentences. Same goes for e-mail.

And, when you use red, you leave the level of emphasis up to the person on the other side to decide the level of emphasis you may have meant. Plan on them adding more emphasis than you may have intended!
Use our wonderful vocabulary to communicate what you mean, your anger or your emphasis instead of relying on formatting to get your message across. Turning selected text into red is the easy way out and risky at best.
Is BCc: Polite?
Have you found yourself the recipient of e-mail messages where there were probably recipients listed in the BCc; field, leaving you in the dark about who was or was not included in the message?
What are the E-mail Etiquette considerations for hiding recipient’s names from others on the mailing list? Isn’t this akin to having a phone conversation on a speakerphone without telling the person you’re calling?
In this situation that would depend on the reason for using BCc:. Is the Sender trying to protect the privacy of their contact’s by not exposing their addresses to others receiving the e-mail whom they may not know? Or, is the Sender quietly letting others know of a conversation with someone else? The latter could be good or bad depending on motives; while the former is the right thing to do.

If the others that were BCc’d do not know each other, putting their e-mail addresses in the BCc: field to protect the privacy of their e-mail address is the proper thing to do. Now, if you all know each other and don’t mind having the others see your e-mail addresses, the question then becomes, what was the Sender’s motive in BCc’ing folks on a correspondence?
If you are e-tattling or copying others who are not related to the conversation to share what is being exchanged purely to gossip — shame on you. E-mails are sent to you for your eyes only. To e-tattle, CYA or included other uninvolved parties will only serve to reflect negatively on you!
Motive is key…
When to Use RR (Return Receipt)
Return receipts are a way of knowing that an e-mail has been opened on the recipient’s computer. It does not however, mean the opened e-mail has been read. Do you have someone in your life who has this feature on for every single e-mail? I’ve found those are the folks that seem to want to know when you receive their e-mail even if the content is not critical or important - sorta a control thing.

Or, it could be your friend does not even know they have this option selected. Maybe nicely e-mailing them with a “Did you know…..?” letting them know this is not a feature to be used for every single casual e-mail can help to inform them.
The recipient should have the privacy to determine when/if they want to read an e-mail and reply to it. RRs should be reserved for those instances where it is critical to knowing the e-mail was received/opened. Such instances would include legal and important business issues.
It is important to know that some e-mail programs allow the recipient to decline the sending of an RR. I know when I receive RR requests, for the majority, I immediately decline. None of anyone’s bee’s wax when I opened any particular e-mail. That said, when it is an important matter and I can understand why there is an RR requested I go ahead and give my approval.
I use RR for legal issues and important company matters where I want to have some sort of proof or trail to document that an e-mail was sent and subsequently opened. I’ve never found a reason to use RRs with personal e-mails to friends or family. To send an RR request for every day-to-day e-mail, especially personal e-mail, is simply not necessary (and to be honest a PIA).

Requesting delivery receipts

To request delivery receipts for messages you send to others, you must be using Microsoft Exchange Server as your mail service.

Note For Outlook 2000, you must have installed Outlook in the Corporate/Workgroup (CW) mode.

You can request delivery receipts on either a per message basis or for all messages you send.

To request a delivery receipt for a specific message, follow these steps:
1. On the View menu of the message, click Options.
2. Under Voting and Tracking options, click to select the Request a delivery receipt for this message check box, and then click Close.
Outlook 2002 and Outlook 2003
To request delivery receipts on all messages you send in Microsoft Outlook 2002 and in Microsoft Office Outlook 2003, follow these steps:
1. On the Tools menu, click Options.
2. On the Preferences tab, click E-mail Options, and then click Tracking Options.
3. Under For all messages I send, request, click to select the Delivery receipt check box, and then click OK.
Outlook 2000
To request delivery receipts on all messages you send in Outlook 2000, follow these steps:
1. On the Tools menu, click Options.
2. On the Preferences tab, click E-mail Options and then click Tracking Options.
3. Click to select the Request a delivery receipt for all messages I send check box, and then click OK.

Requesting read receipts
To request a read receipt for messages you send to others, you can use either Microsoft Exchange Server or Internet Mail as your mail service. For Outlook 2000, you can install Outlook in the Internet Mail Only (IMO) mode. Alternatively, you can install Outlook in the CW mode. You can request read receipts on either a per message basis or for all messages you send.

To request a read receipt for a specific message:
1. On the View menu of the message, click Options.
2. Under Voting and Tracking options, click to select the Request a read receipt for this message check box, and then click Close.
Outlook 2002 and Outlook 2003
To request read receipts on all messages you send in Outlook 2002 and in Outlook 2003, follow these steps:
1. On the Tools menu, click Options.
2. On the Preferences tab, click E-mail Options, and then click Tracking Options.
3. Under For all messages I send, request, click to select the Read receipt check box, and then click OK.
Outlook 2000
To request read receipts on all messages you send in Outlook 2000, follow these steps:
1. On the Tools menu, click Options.
2. On the Preferences tab, click E-mail Options and then click Tracking Options.
3. Click to select the Request a read receipt for all messages I send check box, and then click OK.

“That is Not what I meant” Doesn’t Cut it!
I received an e-mail the other day from a potential client that included several accusations and very demanding comments about how, if they chose to work with me, I would run my business. Clearly this person had some bad experiences in the past with others they chose to work with and got burned. That was now being passed on to me to compensate for.
What type of impression do you think the approach will have? Not a good one! Any consultant worth their salt would run in the opposite direction of any potential client that approached them in this manner.
I am in the envious position of choosing who I work with. Come at me like that and you can bet I’ll be too busy to consider your project. I do not read anything into e-mails sent to me, I take them at their face value based on the choice of words used.

There are those who try to beat me up over their bad experiences with other consultants. As in the case of this particular e-mail, even expecting me to lower my rate to compensate for money already spent (wasted) with others. I don’t take kindly to being blamed for things I’ve never done, what others have done or being told what I should charge because of others poor choices.
I answered each comment point by point — factually and unemotionally. Their response? No apology — “that’s not what I meant — I didn’t intent to hurt your feelings.” My “feelings” were not hurt nor did I say so. I simply stated I was disappointed that they felt the need to type to me, someone they did not know or had never worked with, in the manner that they did. Truth be told — I was insulted.
“It was not meant to be personal, so please do not take it that way.” When you question my ethics or integrity without any reason or past experience — it is personal — very personal!
This is typical of people who just type what they want to without taking a moment to review if their questions/challenges are apropos or even accurate. You can’t say “it was not meant” or that “didn’t mean to” if you typed it! And if you find you are misunderstood — do not hesitate to humbly apologize.
In this case, this potential client was playing “boss” with me. If they would have taken a moment to review my site(s), bio or information, they certainly would not have sent the e-mail they did. But then again, maybe this particular e-bully would have…
I was supposed to accept that they knew what they “meant” regardless of what they typed, and I should also know that by osmosis. Not me — I hold people accountable for what they type and how they type it.
The moral of the story? You are what you type; you are the words you choose to use. Know that what you type will be taken at it’s face value by the other side — that they will take you at your word(s).
If you want to form strong and trusted partnerships with friends, family or business associates, you don’t whip off accusatory e-mails because you are having a bad day or had a bad experience that had nothing to do with the person you are communicating with.
You take your time, you choose your words carefully so as to relay your concerns while you make darned sure that what you type is what you mean because that is exactly how it will be taken.
And, if you don’t want to make that effort, don’t be surprised when the response you receive is not what you desired — that is if you get one at all.
Is Cc: Enough to Forward to Others?
What is proper E-mail Etiquette when forwarding personal e-mails sent to you to a third party? By Cc:ing the Sender when you forward their e-mail make it “O.K.”? No it does not! That e-mail was sent to you for your eyes only!
Whether it be a business or personal e-mail common courtesy would dictate you don’t forward e-mails sent to you, to others, without the original sender’s knowledge. That said, we all know people who do this every day. And as I am sure you can agree, rarely is it for positive reasons. Usually its to make fun of, e-tattle or to just plain gossip. For those who do this, know this practice will come back to haunt you one day. You do so to others; they do the same to you.
All e-mails are naturally copyright protected by the author. So in order to forward an e-mail sent to you to another person, you should get the writer’s permission to do so first.

Cc’ing doesn’t negate your responsibility to ask for permission. Notifying the Sender as you forward their e-mail does not replace asking before you take action. The Sender may not want their words to you published to others. That is their choice to make — not yours.
E-mails are sent and written to the party for which they were intended, not to be sent to others without the Sender’s knowledge or permission. By Cc’ing without asking you risk the Sender getting upset due to the possibility they didn’t want the content shared. Even if you feel there is nothing personal or that the e-mail is about a “common subject” that is subjective to each person’s definition of what can be considered common.
So show you get it and are not a sneaky gossiper. Always ask first before sharing any e-mail sent to you.
Proper Use of Reply to All.
How ironic that those who complain about others use of Reply to All also seem to be those who do not respect the privacy of their contacts by using the BCc: field!
You only use Reply to All when you are confident that “all” will be interested in the content of the e-mail or need to be aware of that information. You do not use Reply to All to CYA or to e-mail those you don’t know whose e-mails were irresponsibly displayed by the Sender in the To: or Cc: fields.

If you are the Sender, if you e-mail a bunch of folks who do know each other and include their names visibly in the To: or Cc: field, do not be surprised if those who receive your message view that as an invitation to communication or have a discussion with all involved. You cannot have all those e-mails displayed and then get upset if those you send to hit Reply to All.
Reply to All abuse and misunderstandings can be avoided easily:
1. Senders: If you don’t want those you e-mail to use Reply to All, then use the BCc: field to list all your contact’s addresses so they are not seen by those who receive your message. Then, if one of those folks hits Reply to All — it only goes to you.
2. Recipients: You don’t Reply to All if you do not know “all.” Reply to the Sender only. And, please use your discretion as to what you feel everyone needs or wants to know. If you are not sure, only reply to the Sender.
Easy!

Online Copyright Myth.
One of the most misunderstood issues online has to do with copyright. Both with e-mail and Web site content copyright issues. For some reason, as with many things online, there is this incorrect perception that anything goes or that the entire online world is “public domain.” Many are finding out the hard way that when it comes to protecting creative collateral; copyright is law. And, copyright laws can and are being enforced online.
No, I am not an attorney. Nor do I play one on T.V. But I can help you avoid potential problems based on guiding clients for over a decade about the issues involved in using other’s work. Hopefully, this effort will help you from finding out the hard way that copyright is alive and well online.
1. “I can right click, save anything online and use it how I wish.”
This is a perfect example of just because you can doesn’t mean you do! Those graphics or files were created by someone out there. They legally attained the copyright upon that file’s creation. Without their specific permission to use that file or graphic, you have no right to just take it and use it as you please. There is no exception to this rule. Always ask a site owner before you illegally swipe anything off their site to display on yours.
2. “As long as I note the author’s name, I can use their site’s content on my site.”
Although you are being nice and giving credit where credit is due, you still need to ask the author’s permission to post their work on your site. The author may not want their information posted anywhere off their own site or they many not approve of your site as a venue for their information - that is their choice to make not yours. Just because you choose to give credit doesn’t give you permission. Always ask a site owner if you can use their content before you put it on your site.
3. “I can link to graphics on other sites so that they display on my site.”
O.K., maybe you didn’t actually download the graphic and put it on your server, but if you are displaying someone’s work on your site without their permission the bottom line is still the same. And, you are using their server’s resources to display their files on your site.
4. “I can display pages from other Web sites within frames on my site.”
Many site owners prohibit their site pages from being framed within another site because it gives the impression that the other site created the information. Many times folks innocently do this so they don’t have to send site visitors off their site for information they want to provide. Others do so to precisely give the impression it is content they created. A better option is to link to the information you like and create a new window to open when doing so to ensure your site is still available to your site visitors.
5. “If I only quote a portion of other site’s content and link to them I do not need their permission.”
Again, it would behoove you to have permission to do so. Using only portions allows you to possibly give the wrong impression about the author’s overall content and this can be misleading at best. If you want to quote any written work in whole or part you need to ask permission to do so.
6. “If I pay someone to create graphics for my Web site, I own the copyright to those graphics.”
Not necessarily. Unless your agreement with the graphic artist explicitly states that upon your payment all of their rights are then transferred to you in whole, you most likely only have exclusive license to use those graphics. In addition, to purchase the full copyright will cost you a much more than simple exclusivity!
The fact is that the moment anything is created whether it be written or drawn, the creator owns the copyright - that’s the law. Copyright can only be transferred in a written legally binding agreement signed by the creator of the work stating they are transferring their rights to you. Saying you own it because you paid for it doesn’t make it legal fact.
7. “E-mail is not copyright protected once it is sent.”
E-mail is a written work that once created is copyright protected by the author. This means you cannot post publicly an e-mail sent to you privately. You cannot post private e-mails to your site, to message boards or to your blog without the author’s specific permission to do so.
Just because an e-mail was sent to you as a private communication does not mean you then own it and can do with it what you like. In addition, e-mail that is posted to a group of people, on a mailing list or Newsgroup does not make the e-mail available for reposting, copying, or any other use - not without the express and written consent of the author.
What’s the bottom line with online copyright?
Courtesy! Don’t assume that you can use, repost or take anything you find online simply because you can. Be a courteous Netizen and always ask first!
Seek out the DMCA (Digital Millennium Copyright Act) page and policy statement on your ISP and hosting provider’s Web sites to handle complaints and reports in regard to copyright abuse. Take some time to read that information and make yourself aware of your rights and make sure you do not infringe on others. The main resource for all the legal mumbo jumbo on online copyright and the DMCA is on the Governments site @ http://www.copyright.gov.
Again, I am not an attorney nor am I providing legal advice. I hope I’ve informed you of some of the issues that need to be seriously considered by all who are online whether they are creating their own or using others creative or written works.

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How to play Table Tennis

Table Tennis - How to play

Here are most of the basic preparations and strokes necessary to get you started. A few of the more advanced techniques are also discussed. One may wish to move from top to bottom-from most basic to more advanced, but don't hesitate to look ahead to get a taste of what's to come.

There is no written substitute for live instruction, so if you are lucky enough to have access to a club or a skilled acquaintance, then be sure to spend as much time training with them as possible. Even if such opportunities are hard to come by, we strongly suggest that you see a skilled instructor or practice partner as soon as you can. A few meetings are better than nothing at all. This is critical when you are just beginning to develop your game, since you will be getting off on the best table-tennis foot.

Above all, practice these techniques constantly! Just like any other sport, Table Tennis demands the utmost in effort from the prospective player. Various practice techniques are discussed, whether with a partner or alone. Obtaining a regular practice partner early in the game is a very good way to get better steadily.

Basic techniques

Getting Started

In order to start playing the real sport of table tennis, one requires the proper equipment and techniques. Although experimentation forms a large portion of one's advancement later on, in the beginning most everyone needs to learn the basics. Remember, even a wanderer had to find out how to walk one time or another.

Equipment

If you are just starting out, take stock of your equipment(if any):

• Does the equipment meet legal requirements(in table tennis)?
• Is the equipment in a good enough condition as to not hamper performance(very important when starting out)?

The paddle can be of any size and weight, from a lollipop to a pizza ladle. It must have one side of red and one side of black.

The table must be 9 feet long by 5 feet wide, and the surface must be 30 inches from the floor. A white line divides the table lengthwise, and white lines form the border of the top surface. The net used must be 6 inches high, spanning the entire table at the middle. Although not required for most uses(as some nets are 5 feet long), regulations stipulate for a net to be legal, it must stretch out 6 inches beyond the table on both sides.

The ball can either be orange or white, depending on light conditions and/or personal preferences. Try to buy the best quality balls possible, even for practice. This will pay off in the long run. Three-star balls denote top quality...but even there, quality differs between manufacturers. Cost is a good barometer of quality here, about 1$US each for a respectable ball. They usually get cheaper in bulk. Good balls last longer and play more consistently for better practice results.

Try to wear nonreflective clothing, choosing relatively dark solid colors whenever possible. Wear shoes that allow quick movements of the feet and easy ankle control. Avoid running shoes or any shoes designed mainly for forward movements.

If you are buying your first equipment, follow these tips:

• Try to buy from an established table tennis dealer if possible, although this means you will likely be doing the buying over mail. The advantages include knowledgeable service(not always-check) and a wider selection of quality equipment. If you must buy from your local sporting goods store(many retailers carry table tennis equipment), then the section to look would be most likely "games(an unfortunate case in the US)" or "racquet sports(more often under games)." Although you get your equipment quicker, the selection is severely limited and often of "game quality." Make sure the above guidelines for legal equipment is followed when purchasing.
• When buying paddles, look for wooden rackets with inverted rubber-that is, rubber with a smooth flat surface, as opposed to the pimples out rubber with little "pips" jutting out of the surface. The modern game leans toward inverted surfaces.
• Assuming you will be playing with the shakehands grip, racket selection shouldn't be a problem, as 99.999999% of the retailers in US(Fred Meyer, Sportmart etc..) carry only shakehands rackets. Penholders will find their respective rackets usually only in specialized vendors.
• When selecting a table, definitely go for quality. While there is no need to spend over $500 on one, make sure the table you are buying is legal and durable. Do not store the table outdoors. Keep the table clean and away from heavy traffic(i.e. store when not in use).
• Try to only buy three star balls, both for practice and games. The color of balls is left entirely to the reader's preferences. Orange is the predominant color today, and many people find it easier to track the color in most lighting conditions, especially fluorescent.

Pre-Play Preparation

Many people have the misconception that table tennis is just a "game", and therefore is to be regarded as such, even to the point of not warming up properly before play! If the "game" in question had been light frisbee, then warming up would not be as much of a concern simply due to the fact that throwing and retrieving frisbees don't tax the body that much(usually).

Warming up helps get your body ready for the rapid coordinated moves that make table tennis such an intensive sport. There are no special or unique exercises; it's just like warming up before playing any other sport. A light jog, jumpropes, and various stretches help loosen your muscles and get you "in gear" for optimum performance. When selecting the types of stretches(proper techniques can be learned from books or knowledgeable people-don't overdo it!), try to cover all parts of the body, from your neck to the ankles. When you are done playing, perform cool-down exercises-essentially the same as warm-ups to gradually improve overall flexibility and fitness.

Also remember to before picking up the paddle:

• Pack water and towels if necessary
• Take extra balls along in case one breaks or gets lost(very easily done in garages!)
• Keep 8 feet of space all around the table clear of traffic or debris
• Make sure the lighting conditions meet practical standards(see if you can reasonably track the ball in play)-bad lighting can ruin a practice
• And finally-be anxious! Get excited about what you will accomplish, set goals and work towards them, do anything to make practicing and playing fun. After all, if you aren't interested in table tennis, you couldn't have read this far.

Guide to Grips

The way one chooses to hold his/her table tennis paddle will make a big difference in his/her play. There are currently 3 "standard" grips existing in table tennis today. Because of lack of experience/expertise, this website will cover techniques in shakehands only, but most strokes will transfer over to the other grips with only a few modifications.

The shakehands grip is the prevalent grip of table tennis today(as of 1998), used by the majority of recreational and professional players. The paddle is gripped with all fingers, with the thumb resting by itself on the opposite side as the index finger. The grip is analogous to shaking a hand at an approximately 45-degree angle. The pinky, ring, and middle finger wrap around one side of the handle, and the index finger rests on the bottom edge of the rubber. The thumb rests on the top of the handle on the other side, thumbnail perpendicular to the wood. It should point in the same direction as the index finger. When held out straight in front of you, the paddle's edge should form a line with the outstretched arm. The grip should feel natural, with no particularly uncomfortable areas. Too tight a grip can sacrifice control and power. Be sure to grab the handle loosely enough so that another person would have no trouble plucking it from your hand. But at the same time, maintain enough tightness so the paddle won't fly out of your hand during an intense loop shot.

Some of the advantages of using the shakehands grip are:

• Equally strong forehand and backhand advantage(provided you pay equal attention to both)
• Wide selection of paddles to choose from

Once a dominant grip in its heyday, the penhold grip still has its supporters, world class players included. The racket is gripped as one would grip a pen, with the thumb and index finger, with the rest of the fingers being tucked away on the other side. There are several variations to this grip, and two types of paddles to reflect this. The "chinese" paddles are basically shakehands paddles with a shortened handle. The remaining fingers rest against the other side. "Japanese" paddles have a raised handle, which is called a "hook." The index finger curls around the "hook" for extra leverage. Which one you use depends on personal preferences. Penhold paddles typically only have one side covered with a rubber sheet. This makes them lighter than most shakehands paddles. The other side must still comply with the paddles rule, so it is usually painted red or black, or covered with a sheet of colored paper.

Some of the advantages of using the penhold grip are:

• A dominant forehand game(while backhands are possible with this grip, the vast majority of penhold players rely on their forehand game)-quick feet are required to sustain this!
• Since it is not as widely used, an element of surprise against opponents unfamiliar with the grip

The Ready Position/The Importance of Footwork

The typical playing area for table tennis is about 20 feet by 40 feet(the legal dimensions). The actual table width only occupies 5 feet of the 20. This means in tough matches, the ball will come in at a variety of angles, some very sharp. Therefore, despite the seemingly diminutive area the table tennis table covers compared to most sports playing areas/fields, the ability to move the body around becomes extremely important. But table tennis footwork also requires precision. The smaller steps that get you in perfect position for that forehand loop are just as important as the veritable leaps one may make while traversing the table edge in pursuit of a corner smash. Before attempting anything at the table, however, the correct stance must be performed.

A ready stance must be kept at all available times during play to ensure maximum control, power, and consistency. The typical table tennis stance is a slight crouch forward, feet shoulder-width apart. Make sure you bend your knees and ankles. Most of the weight should be on the balls of the feet, because this makes quick sudden movements and pivots necessary for good shots much easier. The upper arm should be close, but not flush, to your body. The forearm and racket should point forward, which requires that the elbow be bent. A relaxed posture is important, adjust the stance until most of the tension is gone. Just make sure you aren't so relaxed that slouching occurs; the idea is to maintain the optimum position for well-coordinated and explosive movements.

For right-handers, the place to stand is on the backhand half of the table. The right foot should be slightly to the left of the center line. Try to have the left foot slightly forward. Stand at an enough distance away from the table so that the tip of your paddle barely touches the edge of the table. This should mean standing fairly close to the table; the arm should be close to the body, not outstretched. Also, the body should face the table at a slight angle, with the right foot and shoulder slightly farther away from the endline than the left. This allows good positioning for both forehands and backhands.

When the ready position is mastered, the necessary footwork can follow. Remember, footwork is done primarily to position the player for an optimum shot, one that doesn't have to be reached for. Therefore any unnecessary movement is a waste of time and energy, besides allowing your opponent to catch you unawares with a shot opposite your direction of movement. Most players use a side to side shuffle when moving across the table. Doing so allows one to face the table at all times, important when the ball is coming in very quickly. The same principles are used whether moving left or right. The foot in the direction of movement takes a short step in that direction, and at the same time the weight of the body shifts to that foot. At the end of the shuffle, the other foot slides to take its place alongside the foot that moved first.

The timing of the footwork is as important as the actual execution. If done too early, the opponent will notice and likely fire a shot where you weren't planning on going. Catch it too late and you will find yourself reaching for the ball, or worse. Pay close attention to the opponent when he/she is getting ready to hit; prepare yourself and don't start moving until he/she has started his/her stroke. Follow the ball with your eyes and use the feet to move to the best shotmaking area relative to where the ball lands. Don't start the stroke until you have finished moving. After hitting the ball, get back into the ready stance immediately, in anticipation for a return that could go anywhere. When the action gets fast, all of these movements and decisions must be made in split seconds. Training will help you get there.

Basic Strokes

For all of the strokes described below, the arm should be very relaxed. Power should be concentrated on the waist, forearm, and wrist (acting together) like a whip, with the upper arm moving very little. Almost every shot requires a little movement to get into correct positioning-in other words, you can't stand still and play table tennis! And always remember to return to the ready position following each shot.

The Drive

Drives, a light topspin stroke that produces a low ball trajectory, are the primary offensive strokes in table tennis. One employs drives to force errors and to set up winners. The mastery of both the forehand and backhand drives is important because it will give your opponent less options when using attacking strokes of his/her own. In executing this and all other offensive strokes, the usage of the entire body in unison is important for consistency and power. Keep in the ready position until you are ready to execute the shot and remain relaxed but responsive(this is very important).

FOREHAND DRIVE: Keep the upper arm close, but not flush, to the torso. The forearm(form a rough 90 degree bend with the upper arm) should be drawn back to the 3 o'clock position, and let the waist turn naturally along with the arm(this is where relaxing is important). Shift your weight toward the right foot at the same time. While shifting your weight back to your left foot, swing forward with a slight upward motion, with the waist providing additional force in the swing. Use the elbow as a pivot point; it should not move so much up and down, but also should be allowed to move slightly forward in the follow-through. Contact with the ball should be made slightly to the side of the body after the top of the bounce. Make sure the paddle is somewhat closed(or facing downwards at an angle), and remains that way throughout the stroke. Follow-through should finish when racket is parallel with the left shoulder. Immediately return to the ready position. The left foot should be slightly in front of the right for support.

BACKHAND DRIVE: From the ready position, the waist turns left with the racket pointing towards the 9 o'clock position. When following through, contact with the ball is made in front of the body, slightly after the top of the bounce. Let the elbow again act as the pivot point, and snap the forearm forward in a slightly upward direction. Make sure the paddle is closed. Follow-through should finish naturally(about 12~1 o'clock) after contact with ball. The left foot should be slightly ahead of the right.

Note : Be sure to contact the top half of the ball when hitting topspin drives.

The Push

Pushes are the basic backspin shots, used to change the pace of an exchange or to return certain very low and close shots such as backspin serves. A generally defensive shot, it allows placement anywhere on the table that is difficult to attack when executed properly. All pushes should be done with the right foot stepping in. The ball is contacted right after the bounce with an open racket. How open the racket is depends on the intensity of backspin on the ball. Heavier backspin requires a more open racket to return over the net. Try to keep the ball low, varying the amount of backspin and racket angle.

FOREHAND PUSH: Bring the racket slightly up and back, while keeping the elbow at your waist. Bend the wrist back. Swing forward with a downward motion, and when the racket reaches the ball snap the wrist forward for extra racket speed. With an open racket, graze the bottom half of the ball. An ideal contact point is right after the ball bounces. Never push a ball at the top of the bounce, because the resulting return will pop the ball high enough for the opponent to execute a smash. Try to hit the ball in front and slightly to the right of your body. Follow through forward and slightly down, and return to the ready position.

BACKHAND PUSH: Bring the racket slightly up and back, close into your stomach while cocking the wrist back. This time try to contact the ball directly in front of your body, and remember to keep the elbow still while the forearm and wrist move forward and down. Graze the bottom of the ball and follow through.

Note : Keep the push stroke gentle, as being too hasty often makes the ball go long, or too high. Keep in mind that unlike the drive, the push is more of a finesse and 'touch' shot. As you advance the stokes can start becoming more aggressive, with a variety of spins.

The Block

Blocking allows a player to use the opponent's force against him/her, and is done immediately after the bounce so that maximum control and speed are retained. Adjusting the racket angle depends on the severity of topspin on the ball; the more topspin there is, the more you should close the racket. Being essentially a cut-down drive, there is very little backswing and follow-through. Think of blocking as a backup shot that can be used when there isn't enough time for a full drive or loop. Depending on how much control you have over the block, it can be used offensively as well. Use your wrist to vary the direction of these block-returns, and make sure footwork takes you to the most choice areas to hit in.

The Smash

The smash, or kill, is the put-away stroke of table tennis. Any ball that is high enough and close enough to the opponent's side can be smashed, although some opportunities are better than others. Smashing combines waist, forearm, and wrist movement to the fullest extent. A good smash is very hard to return, but it can be done. Do not dawdle after you have executed a smash. The ball is contacted at the top of the bounce at its highest point.

FOREHAND SMASH: Similar to the drive, the key differences include:

• A longer backswing
• Greater weight transfer during swing
• Faster, more intense snapping of the forearm when contacting ball
• Depending on ball height and position, the racket is closed more than usual to keep the ball in the court
• Longer follow-through, but don't forget to anticipate a possible return!

BACKHAND SMASH: Again, use the guidelines above and apply them to the backhand drive. Be sure to snap the wrist more as you contact the ball and finish in a long follow-through.

Note on smashes: Don't just indiscriminately smash the ball when you find the opening; instead, try to direct the ball to a location where it is least likely to be hit back, accidentally or intentionally.

Basic Service Techniques

The following are the basic rules of service:

1. The ball must be held above the table level in order for the opponent and umpire to see it.
2. The ball must be held in the palm of the hand with fingers stretched, and tossed vertically at least six inches.
3. The ball must be struck only on the way down.
4. The ball must be struck behind the end line.

Serves are entirely up to the player; there are no specific serves that must be used by everybody. But to begin with, there are some basic serves that should be experimented with. Imparting spin on these serves should be concentrated mostly on the wrist.

Backspin- just like pushing or chopping, a backspin serve is executed with an open racket slicing the bottom of the ball.

Topspin- like driving, topspin serves can be done hitting with a flat racket, or like looping, where the player grazes the top of the ball with a closed racket for more spin.

Sidespin- simply hit the back of the ball in a left-to-right or right-to-left motion, as desired. To make the stroke easier, try holding the racket in front of you and brushing the bottom of the ball in a pendulum motion.

Notes on serves: Be sure to assume the ready position as soon as you finish your service motion. Keep the ball as low as possible to prevent an early attack by the opponent. Experiment with all the spins; mix up your serves during games. The spins are not the only thing that should be varied. Practice placing the ball in different depths and in different directions. Unlike doubles, a singles serve can go anywhere on the opponent's court. The advantage to service is the uncertainty faced by the returner. Be as inconspicuous as possible.

Advanced Strokes

The advanced strokes described within should be gradually incorporated into a beginner's training regimen. After you have solid control of the fundamentals, the experimentation of these difficult strokes can begin. Again, no amount of written instruction can show you exactly how to do these shots correctly. Even if it is your playing partner with just as much experience as yourself, have him/her critique the motions, and do the same for him/her. And watch the professionals do it, be it on television, exhibitions, or even competitions, should you be lucky enough to be able to attend(tip:watch their bodies move, not the ball). Finally, even if you don't readily have access to a table and training partner, many serious players use shadow-practicing and it should be a part of your training too. Good luck!

The Loop

The loop drive is the primary attacking stroke of serious players today. A loop is basically a spinny counterpart of a drive, emphasizing topspin over forward motion. Likewise, a stronger upward motion is required in the swing, grazing the ball instead of hitting it. Despite the nature of the loop, they can go just as fast as the drive-approaching 100mph for an over-the-table loop by a talented player. If there were any doubts about the endurance requirements of table tennis, try hitting decent loops against extreme backspin time and time again. Players not used to this stroke may find it the most tiring for the first time.

Depending on the characteristic of the incoming ball, the loop must be modified to hit the ball correctly. If a ball is coming in fast and high with heavy topspin, the paddle should be more closed and the swing should go forward more. However, if a chop came floating your way, then the correct thing to do would be to open the paddle somewhat, and perform a strong upwards swing-think of it as 'pulling the ball back up with the paddle'. This is especially what makes the loop such a tough stroke. As the ball touches the paddle for only a short time, as well as meeting on a more perpendicular path(as opposed to the highly parallel paths during a drive), good timing is critical to avoid completely missing the ball altogether. This means keeping a sharp eye on the ball throughout the stroke is important, as it is for all other strokes.

FOREHAND LOOP: From the ready position, bring the right foot slightly back(while transferring your weight to it). At the same time, rotate your body backward, and the paddle should be brought back and slightly down, depending on which spin you are hitting against. Bend your knees slightly. Start the stroke by rotating the waist and hips forward, and start straightening out the knees to add more force. The forearms should gradually accelerate from the backswing to contact, snapping for maximum speed when you meet the ball. Hit topspin balls at the top of the bounce or while it is dropping. Hit backspin balls while it is dropping. Follow-through forward more for topspins and upward more for backspins. The weight should be completely transferred back to the left foot at this point.

BACKHAND LOOP: This time, the backswing goes in front of your legs, and to do so you should drop your right shoulder somewhat. Remember to keep the eye on the ball no matter what the other parts of your body are doing. Rotate your waist to the left and transfer the weight to the left foot. Against topspin, unwind your waist and hit the ball at the top of the bounce(or during the drop) with a forward motion, but remember to just graze the ball as opposed to driving it. Snap your wrist at contact. Against backspin, remember to apply more of an upward motion, but also add a bit of forward force or you could hit your nose in the follow-through!(nothing like defaulting due to a self-inflicted nosebleed eh?:)

Notes on the loop: Since a lot of paddle speed is required in this stroke, the extra backswing, bending of the knees, and the usual waist rotation and weight transfer are all needed, not to mention the wrist snap at contact. A forward graze will produce higher speeds, but they can only be used on relatively high balls at the top of their bounce. Use something between the all-out topspin loop and extreme backspin pull-up for most rallies. Killer topspins are prone to the net or going off the endline, and excessive usage of the high arcing loop can lead to a deadly smash by your alert opponent. A relaxed posture is doubly important for loops, both your speed and consistency will improve if you can go through the swing 'naturally'. Keep your rubber in good condition; how much spin and control you put on your loop depends upon the tackiness of the rubber. Bad rubber=weak loops(if at all).

The Chop

The chop is the mainstay of advanced defensive players. Essentially an extreme backspin shot, the ball tends to travel in a very flat trajectory and bounce low. Chops are always taken when the ball is dropping, often below the table-up to 15 feet away! Anything higher and the stroke becomes a push. Defensive players who chop do so to force the other player into an error, and to do so one may vary the amount of backspin or change the direction of the shots. Matches against two equally skilled choppers used to be an affair of many hours until the introduction of the expedite rule.

FOREHAND CHOP: Back up, depending upon the speed of the incoming ball. At the same time put your weight on the back foot. Bring the arm back and paddle up, while rotating your waist. When the ball has dropped to about the table level(it has to go off the end in order to execute a successful chop! Push short balls), rotate your waist, bring the forearm down, and snap your wrist at the point of contact, which should be at the bottom-back of the ball. The paddle should be open at this point. When chopping, remember to graze the ball barely enough to return it over the net. Avoid extra impact that would take away the backspin or hit it too long. The follow-through should be long enough that the arm nearly straightens at the finish.

BACKHAND CHOP: Similar to the forehand chop, bring the paddle up and the wrist back while rotating the waist. Transfer weight to back foot. Snap the wrist and follow through all the way.

Notes on the chop: The point of contact will vary depending on the topspin present on the ball. The more topspin on a ball, the lower it should be taken during a chop. This means against a loop, one must bend his knees in order to get low enough to return the heavy topspin. Don't let this cause you to lose sight of the table. Also, the farther you are from the table, the harder you need to chop down on the ball. Be sure to relax and use a smooth stroke.

The Flip

The flip is one alternative to the push in taking short balls. By allowing one to return such balls faster, it can provide an element of surprise. The nature of the flip requires a special foot position for support. The right foot(for right-handers) goes several feet ahead of the body, which often means sliding it under the table. In case the table has a crossbar that prevents your leg from getting through, just remember to brace yourself for the sudden forward lunge and put the right foot as far ahead as possible. The flip is a wrist shot. There is no room for anything else, so make sure you strengthen the wrist as much as possible.

FOREHAND FLIP: Bend the wrist back. Slide the right foot forward, then with the racket open, move it under a dropping short ball. When the ball touches the paddle, immediately rotate your wrist and move the arm forward and up, grazing it. Follow through, then immediately return to the ready position.

BACKHAND FLIP: Bend the wrist back. With right foot forward, execute a mini-loop with extra wrist and follow through.

Notes on the flip: How open the racket is before contact depends upon the backspin content of the ball. The most backspin there is, the more open the racket should be. For faster flips, graze the ball at the top of the bounce with more forward motion. If the ball is high enough, flip-kill(flip with extreme speed) it.

The Lob

An exclusively defensive shot, the lob is almost always used to return a smash far away from the table. A good lob will land deep in the table, with plenty of topspin/sidespin. The trick to lobbing is consistency. The opponent, provided he/she is skilled enough, will relentlessly attempt to smash every lob that comes his/her way. Occasionally they will try something else, but the most common scenario is the lob/kill rally. A lob requires plenty of anticipation and footspeed on the part of the lobber. Without either of those, one could not possibly hope to play catch up with a 100mph ball(although they do slow down considerably with distance).

To execute a lob, first detect the opponent's movements: if he/she is well into a smash, move back fast! Get ready, and drop your paddle low, along with the shoulder. Move the weight to the back foot. Bend your knees a bit more. When the ball comes your way, watch it carefully and push off on your knees, while bringing the entire arm up in an upward swinging motion. Hit the ball of the drop, on the back-bottom surface. Follow through high, then get ready for the unexpected(another smash, smother kill, etc.)!

Notes on the lob: Hitting back a lob can be very difficult if one is not prepared. Make sure to modify any stroke so that it can hit an extremely high ball, not one that goes up 6 inches. Also use the entire body to introduce more force into the stroke, as you will be hitting a fast moving(and often spinning) ball in a perpendicular direction. To smother-kill a lob(for variety), the paddle should be very closed. Perform a smash right after the ball bounces. Timing is extremely important.

Advanced Service Techniques

Advanced service differ from the basic service in the following ways:

• The stroke is the same for all spins
• By controlling where you hit the ball on the paddle(tip, middle, near handle) you can control the rate of spin
• By controlling at which point in the stroke you hit the ball, the combination of spins is possible
• The toss is often higher to aid in speed, spin, and deception
• A variety of techniques, including high tosses and foot stamps, are used to prevent the opponent from anticipating the spin on the ball

There are two primary families of advanced serves: backhand sidespin, and forehand pendulum. Each uses a different side of the paddle, and both have variable points in the stroke that will produce one or more of the spins.

BACKHAND SIDESPIN SERVE: From the backhand side of the table, stand with the feet and shoulders 45 degrees to the left. This helps the body block some of the stroke from your opponent's view. Bend the wrist back. Bring the paddle, which is open, back and upward, while the ball is tossed from an open palm in front of the paddle. When the ball starts to drop, bring the paddle downward with your elbow in a semicircular motion sideways. At contact, snap the wrist. If you desire a sidespin serve with a little bit of backspin, graze the ball in the first third of your semicircular motion(downwards, right). For almost pure sidespin, contact the ball at the bottommost part of the swing. For topspin/sidespin serves, hit the ball at the last third, when the paddle is travelling upwards in the semicircle. This last spin may be the toughest to execute, but it can be done. Remember that topspin in these serves is not at all like the basic topspin serve, where the racket moved forward through the ball. The advanced topspin serve is more of a lob, or loop against backspin, where the paddle 'tugs' the ball upwards, causing spin. Thus it can still be executed with an open paddle. Follow through is the same regardless of the spin you chose, and this is important to complete the deceptive movement of the serve.

FOREHAND PENDULUM SERVE: The racket movement required in this serve cannot be achieved with the normal shakehands grip. The paddle is held almost entirely with the index finger and thumb. The other three fingers are curled against the handle. On one side, the index finger lies flat against the rubber, sticking towards the tip of the paddle. On the other, the thumb rests on the bottom part of the rubber(note: the thumbnail is not perpendicular this time to the blade. hold the rubber with the printed part of the thumb). Rotate the paddle back a bit more backwards in your new grip without bending the wrist-something that isn't possible with the shakehands grip. Now you can rotate the paddle in a semicircle with your wrist.

Stand in the forehand(or backhand) corner of the table, with your left shoulder and foot back so your body faces away from the table. This position helps hide the ball during contact. Place the ball in the flat of your hand close to your stomach, and with the new grip hold the paddle slightly behind the ball. Toss the ball about 1-2 feet into the air(more as you get better), and move the paddle back and up, with the hitting surface open. Use the elbow as a pivot point, and try to keep its movement to a minimum. the wrist back as far as possible. When the ball starts to drop, swing forward and down with the forearm, keeping the elbow in place. To hit a backspin/sidespin shot, graze the ball in the back-right region early in the swing, when the paddle is travelling down and left. For an almost pure sidespin shot, graze the ball at the bottom of the swing on the back of the ball. For topspin/sidespin, graze the back of the ball as you pull up on the racket. With this serve, the topspin portion can be especially tough when you consider the body is facing away from the table. For this reason it is vital to make sure that you perfect the grip for maximum wrist movement, and use the forearm and elbow only for the swing.

Advanced service notes: Be sure to shift your weight during the serves for maximum spin and speed. If speed is your goal, then there will be less spin. Speedy serves should hit your side of the table very close to your endline. That way the ball has the maximum distance available to travel in the air, and also land on the other side(preferable very close to his/her endline). Serving cross-court increases this distance. For increased spin or speed, make your toss higher. Incorporate exaggerated movements/follow-throughs to confuse your opponent. Everyone's serve is unique. If you have an unorthodox version and it shows promise, practice it. Practice a wide variety of angles, spins, and depths. After your service, remember to go into the ready position as fast as possible, and prepare for the return. If you use the special grip for the forehand pendulum, practice the transition from that grip to the shakehands(or insert your preferred grip here) grip. This goes double for speedy serves.

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