Reasons of having excessive thirst:

If some ones feels the need to drink lots of water, most of time reason is usually known . For example, not drinking enough of it. But some times there can be more sinister mechanisms and need evaluation. There can be number of diseases, which can present by excessive thirst. This derangement is more other than merely being dehydrated.

If drinking more fluids for several days hasn’t helped, there can be reasons other than dehydration.

Dehydration:

If some ones feels the need to drink lots of water, most of time reason is usually known . For example, not drinking enough of it. Dehydration occurs if some one does really hard work in the ground or sweating in the sun. The loss of fluids need to be replenished .

Dehydration commonly happens, in cases of food poisoning , diarrhoea, vomiting, inability to eat or drink and loose motions.

Diabetes

One of the most important symptom of diabetes is thirst. All types of diabetes will present as increased intake of water and being thirsty. Frequent urination, another common symptom of diabetes, will bring on thirst. Therefore excessive thirst and urination, along with unexplained weight loss, fatigue, or irritability, can be indications of diabetes.

Dry mouth

The abnormal dryness of the mucous membranes in the mouth, due to decreased flow or change in the composition of saliva. It is also known as xerostomia, is often mistaken for excessive thirst. Causes of dry mouth include smoking tobacco, use of marijuana, stress, anxiety, or aging. But certain drugs (antidepressants) and autoimmune diseases can also cause dry mouth.

One may think being thirsty, whereas actual reason is having a dry mouth.

Dry mouth can present as :

a burning sensation or soreness in your mouth
changes in your sense of taste
difficulty speaking, eating or swallowing.

Menstrual blood loss

Estrogen and progesterone levels can both affect fluid volume. If blood flow is more, it can also cause more blood loss. The blood loss will cause increase in thirst.

Thyroid problems

When the thyroid function is deranged , hormone production is erratic can, produce increased or less e hormone. Thyroid dysfunction can spur a variety of nonspecific symptoms, including abnormally heavy periods, anxiety, feeling hot, and dry mouth. These all can lead to increased thirst.

Stress

Stress or specially chronic stress is a cause for adrenal gland dysfunction specially if stress is severe. This can cause dizziness, depression, anxiety, and severe thirst.

Diuretic and food containing diuretics:

Drugs that produce lot of urine are diuretics. They can cause feeling of thirst.

Foods that have a diuretic effect can make you thirsty because they cause you to urinate more. Foods like melons, ginger, celery, asparagus, beets, lemons.

Low-carbohydrate diets:

One of side effect of Keto- diet is thirst. The eating plan significantly cuts down on carbohydrate intake. Carbohydrates s absorb more water than protein and fat.

Pregnancy:

excessive thirst can happen in pregnancy due to many reasons for example Increased urination, nausea and morning sickness

Excessive bleeding:

Ongoing or sudden blood loss, can cause thirst levels in order to make up for the fluid loss.

Diabetes insipidus:

Diabetes insipidus is a rare disorder that affects water absorption. It can cause loss of huge amounts of water by production of litres of urine. Cause can be brain or kidney called as central and nephrogenic respectively.

Psychogenic polydipsia: this is an urge to drink more water and patients are unable to control the urge. Patients may have intake of many litres per day.

April 11, 2019 0

“EDG scale of doctor’s comfort: guide for medical students” – How to choose medical specialty

Choosing a medical specialty is possibly one of the most important variable factor in doctor’s life. This one factor will decide the rest of the life of the doctor. General rough guide to the factors involved, which persist forever and throughout the life, after a doctor chooses a specialty is given below. There can be individual variation depending upon the individual attitudes, compromises and way to do practice. Therefore there will be some variation in all the fields for individuals, places, systems and countries.

Re-blog

There can be extremes and variations on either side of spectrum, but are exceptions. Following article does not include satisfaction and earning gained from other businesses done by doctors, running nursing home or hospitals, commercial gains from pharmaceuticals etc. this is on basis of income purely from professional work of treating patients. These factors and units can be used as a scale for guidance of medical students and hence named as EDG scale of doctor’s comfort (Extinct doctor good)

Factors—

Earning
Prolonged tough training
Satisfaction of treating patients
Satisfaction of making diagnosis
Emergency & odd hour duty
Stress of life and death
Legal complexity and stress

The Unit—-Single * or (I) is one unit. With experience and years of work , this unit (for same doctor) will also multiply with age.

UNIT

India ( * or 1) is 1 million rupees/annum

Advanced countries- (* or 1)== one lac or 100,000 dollars/ annum

General practice
1. Earning	to * 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	**
Internal medicine
1. Earning	to** 2-4
2.. Prolonged tough training	to*
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	***

cardiology
1. Earning	to***** 2-7
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	****

gastroenterology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	**

Neurology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Nephrology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Pulmonary medicine
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Emergency Medicine
1. Earning	to** 2-4
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Anaesthesia
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	**
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4
Endocrinology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2
Psychiatry
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

paediatrics
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	***
7. Legal complexity and stress	**** 4

Critical care
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Paediatric critical care
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

General Surgery
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Minimal access surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Cardiac surgery- CTVS
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Urology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Gastro-surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Neurosurgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Head and Neck surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Orthopaedics
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Ophthalmology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Radiology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	*
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2
ENT
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Dermatology
1. Earning	to*** 2-5
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	*
6. Stress of life and death	*
7. Legal complexity and stress	* 1

Gynaecology/obstetrics
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	****

Plastic Surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	*
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Oncology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2

Onco-surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2

Anatomy
1. Earning	to* 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Physiology
1. Earning	to*
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Biochemistry
1. Earning	to* 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Microbiology
1. Earning	to** 2-4
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	0 to*
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

Pathology
1. Earning	to ** 2-4
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	NIl
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

Medical administrator/Manager
1. Earning	to****** 2-8 sometimes multiple
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

. There can be extremes and variations on either side of spectrum, but are exceptions.

If the reader have some different view, or want to add something, they are welcome to write in comments. This table just highlights a trend of factors and may not be perfect. But it gives the factors which need to be taken into account, before choosing specialty.

April 10, 2019 0

How to choose medical specialty? Variation of doctor salary, earning & important factors

Factors—

Earning
Prolonged tough training
Satisfaction of treating patients
Satisfaction of making diagnosis
Emergency & odd hour duty
Stress of life and death
Legal complexity and stress

The Unit—-Single * or (I) is one unit. With experience and years of work , this unit (for same doctor) will also multiply with age.

UNIT

India ( * or 1) is 1 million rupees/annum

Advanced countries- (* or 1)== one lac or 100,000 dollars/ annum

General practice
1. Earning	to * 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	**
Internal medicine
1. Earning	to** 2-4
2.. Prolonged tough training	to*
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	***

cardiology
1. Earning	to***** 2-7
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	****

gastroenterology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	**

Neurology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Nephrology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Pulmonary medicine
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Emergency Medicine
1. Earning	to** 2-4
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Anaesthesia
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	**
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4
Endocrinology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2
Psychiatry
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

paediatrics
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	***
7. Legal complexity and stress	**** 4

Critical care
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Paediatric critical care
1. Earning	to*** 2-5
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

General Surgery
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Minimal access surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	***
7. Legal complexity and stress	*** 3

Cardiac surgery- CTVS
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Urology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Gastro-surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Neurosurgery
1. Earning	to**** 2-6
2.. Prolonged tough training	****
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	**** 4

Head and Neck surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Orthopaedics
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	***
6. Stress of life and death	**
7. Legal complexity and stress	*** 3

Ophthalmology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Radiology
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	*
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2
ENT
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Dermatology
1. Earning	to*** 2-5
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	*
6. Stress of life and death	*
7. Legal complexity and stress	* 1

Gynaecology/obstetrics
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	****
6. Stress of life and death	****
7. Legal complexity and stress	****

Plastic Surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	*
5. Emergency & odd hour duty	**
6. Stress of life and death	*
7. Legal complexity and stress	** 2

Oncology
1. Earning	to*** 2-5
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	***
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2

Onco-surgery
1. Earning	to**** 2-6
2.. Prolonged tough training	***
3.. Satisfaction of treating patients	***
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	**
6. Stress of life and death	**
7. Legal complexity and stress	** 2

Anatomy
1. Earning	to* 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Physiology
1. Earning	to*
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Biochemistry
1. Earning	to* 2-3
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	Nil
6. Stress of life and death	Nil
7. Legal complexity and stress	Nil

Microbiology
1. Earning	to** 2-4
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	0 to*
4. Satisfaction of making diagnosis	**
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

Pathology
1. Earning	to ** 2-4
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	NIl
4. Satisfaction of making diagnosis	****
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

Medical administrator/Manager
1. Earning	to****** 2-8 sometimes multiple
2.. Prolonged tough training	**
3.. Satisfaction of treating patients	Nil
4. Satisfaction of making diagnosis	Nil
5. Emergency & odd hour duty	*
6. Stress of life and death	Nil
7. Legal complexity and stress	*

. There can be extremes and variations on either side of spectrum, but are exceptions.

March 22, 2019 1

Medical device harms, hidden by regulator: policies akin to protection @USFDA

Modern medicine has been captivated by the industry. In the name of people’s health, business and industry receives a kind of protection by none other than regulator itself. The report about USFDA, hiding the adverse events or device failure and harm is just one example how powerful industry has become. It is not always possible to identify complications arising out of device failure and there can be possibility of these not being reported. The numbers that are hidden may also represent a fraction of actual number of harms related to device. A sad truth of present era, where doctors are punished and blamed for human errors or even natural poor prognosis, Medical industry remains not only hidden behind the scenes, but receives policies akin to protection by regulator.

USFDA ‘hid’ reports of medical device snags The US Food and Drug Administration (FDA), which claims to have stringent processes in place to ensure safety of medical devices, has been found to maintain a “hidden database” of reports of serious injuries and malfunction of devices. Since 2016, over a million incidents that were reported went to the hidden database rather than to the publicly available database of suspected device-associated deaths, serious injuries and malfunctions. This was revealed in an investigation carried out by Kaiser Health News, a US-based non-profit news service covering health news. The revelation has serious implications for India, which approves a lot of devices based on USFDA approval. KHN found that “about 100” devices including mechanical breathing machines and balloon pumps were granted “reporting exemptions” over the years. The investigation revealed that many doctors and engineers dedicated to improving device safety not only did not know the issues raised in these reports, they didn’t even know about the existence of the “hidden database” or the exemptions. While the agency hid such crucial information about device risks, lawsuits and FDA records show that patients have been injured, hundreds of times in some cases, noted KHN. According to KHN, FDA confirmed that the “registry exemption” was created without any public notice or regulations. “Any device manufacturer can request an exemption from its reporting requirements,” an FDA spokesperson told KHN. The USFDA’s public database that tracks medical device failures, Manufacturer and User Facility Device Experience (MAUDE), receives thousands of medical device reports that are used to detect potential device-related safety issues, and contribute to benefit-risk assessments of these products. These reports are submitted by mandatory reporters — manufacturers, importers and device user facilities — and by voluntary reporters — healthcare professionals, patients and consumers. MAUDE is used by doctors to identify problems or to check the safety record of a particular device. But they could reach the wrong conclusion as they would be unaware of and have no access to the reports on the “registry exempted” products, pointed out a former FDA official to KHN. For instance, KHN found that in 2016, while reports of only 84 stapler injuries or malfunctions were submitted to the public database, nearly 10,000 malfunction reports were included in the hidden database. Medtronic, which owns Covidien, considered to be the market leader in surgical staplers, had used reporting exemption. Surgical staplers are used to cut and seal tissues or vessels quickly, especially during minimally invasive surgeries and if the device fails the patient could bleed to death unless the doctors moved quickly to resuscitate the patient and seal the tissue/vessel. After the KHN report was published, the FDA has written to doctors expressing concern about the safety of surgical staples and staplers. The agency said it has received reports of 366 deaths, over 9,000 serious injuries and over 32,000 malfunctions. The letter also acknowledged that the FDA was aware that “many more device malfunction reports during this time frame” were submitted as “summary reports”. The agency said it was analyzing the reports and that the results would be made public. According to the KHN report, the FDA has deemed manufacturers of over 5,600 types of devices including cardiac stents, leadless pacemakers and mechanical heart valves, eligible to file “voluntary malfunction summary reports”, one of the many exemption programmes. Ironically, in India, doctors and regulators have argued that FDA has the most stringent regulation for devices compared to regulators in Europe, Canada, Australia or Japan and have even sought to make it mandatory for devices to have USFDA approval to be eligible for government procurement tenders. This was especially evident during the efforts to cap the price of stents when top cardiologists argued for higher prices or even price cap exemption for USFDA-approved stents.

March 20, 2019 0

West Nile virus : first reported death in India ( Kerala): How to prevent?

A seven-year-old in Kerala, who had tested positive for West Nile Virus (WNV), died in Kozhikode on Monday. It is first reported death in India due to the WNV. West Nile Virus is a disease which spreads from birds to humans with the bite of an infected Culex mosquito. The symptoms include cold, fever, bodyache, fatigue and nausea, with complications leading to meningitis and death. Birds are natural hosts of the virus.

West Nile virus (WNV) is the leading cause of mosquito-borne disease in the continental United States. It is most commonly spread to people by the bite of an infected mosquito. Cases of WNV occur during mosquito season, which starts in the summer and continues through fall. There are no vaccines to prevent or medications to treat WNV in people. Fortunately, most people infected with WNV do not feel sick. About 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness. You can reduce your risk of WNV by using insect repellent and wearing long-sleeved shirts and long pants to prevent mosquito bites.

The WNV can cause neurological disease and death in people and is common in Africa, Europe, the Middle East, North America and West Asia.

Here is all about the virus:

What is West Nile virus? West Nile virus (WNV) is an infectious disease spread by infected mosquitoes. It spreads from birds to humans with the bite of an infected Culex mosquito.

What are the symptoms on WNV?

People who get WNV usually have no symptoms or mild symptoms. The symptoms include a fever, headache, body aches, skin rash, and swollen lymph glands. They can last a few days to several weeks, and usually go away on their own.

When is it dangerous?

If West Nile virus enters the brain, it can be life-threatening. It may cause inflammation of the brain, called encephalitis, or inflammation of the tissue that surrounds the brain and spinal cord, called meningitis.

How is WNV diagnosed

A physical exam, medical history, and laboratory tests can diagnose it.

Who are at risk?

Older people, children and those with weakened immune systems are most at risk.

What is the cure?

There are no specific vaccines or treatments for human WNV disease. The best way to avoid WNV is to prevent mosquito bites. Treatment is supportive for patients with neuro-invasive West Nile virus, often involving hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections.

Have there been any outbreaks?

The largest outbreaks occurred in Greece, Israel, Romania, Russia and USA. Outbreak sites are on major birds migratory routes. In its original range, WNV was prevalent throughout Africa, parts of Europe,

Middle East, West Asia, and Australia. Since its introduction in 1999 into USA, the virus has spread and is now widely established from Canada to Venezuela.

In India : Since 2016, 124 cases of the disease have been reported from across the country, but no deaths.

Experts in virology say there is usually no single reason that leads to death in cases of WNV disease.

According to previous research, WNV is not a new disease to India.

In India, the existence of antibodies (protein produced by the human body to fight bacteria and viruses) against WNV in humans was recorded for the first time in 1952, according to a 2006 research paper titled “West Nile Virus isolates from India: evidence for a distinct genetic lineage”.

The research was conducted by experts at the National Institute of Virology in Pune, and published in the Journal of General Virology.

Since WNV is a vector-borne disease, the health ministry has been monitoring the situation closely. A team of experts from health ministry’s National Centre for Disease Control has been assisting state authorities

Prevention

The most effective way to prevent infection from West Nile virus is to prevent mosquito bites. Mosquitoes bite during the day and night. Use insect repellent, wear long-sleeved shirts and pants, treat clothing and gear, and take steps to control mosquitoes indoors and outdoors.

Take steps to control mosquitoes indoors and outdoors

Use screens on windows and doors. Repair holes in screens to keep mosquitoes outdoors.
Use air conditioning, if available.
Stop mosquitoes from laying eggs in or near water.
- Once a week, empty and scrub, turn over, cover, or throw out items that hold water, such as tires, buckets, planters, toys, pools, birdbaths, flowerpots, or trash containers.
- Check indoors and outdoors.

Treatment

There is no specific treatment for WNV disease; clinical management is supportive. Patients with severe meningeal symptoms often require pain control for headaches and antiemetic therapy and rehydration for associated nausea and vomiting. Patients with encephalitis require close monitoring for the development of elevated intracranial pressure and seizures. Patients with encephalitis or poliomyelitis should be monitored for inability to protect their airway. Acute neuromuscular respiratory failure may develop rapidly and prolonged ventilatory support may be required.

WNV Antibody Testing

Laboratory diagnosis is generally accomplished by testing of serum or cerebrospinal fluid (CSF) to detect WNV-specific IgM antibodies. Immunoassays for WNV-specific IgM are available commercially and through state public health laboratories.

WNV-specific IgM antibodies are usually detectable 3 to 8 days after onset of illness and persist for 30 to 90 days, but longer persistence has been documented. Therefore, positive IgM antibodies occasionally may reflect a past infection. If serum is collected within 8 days of illness onset, the absence of detectable virus-specific IgM does not rule out the diagnosis of WNV infection, and the test may need to be repeated on a later sample.

The presence of WNV-specific IgM in blood or CSF provides good evidence of recent infection but may also result from cross-reactive antibodies after infection with other flaviviruses or from non-specific reactivity. According to product inserts for commercially available WNV IgM assays, all positive results obtained with these assays should be confirmed by neutralizing antibody testing of acute- and convalescent-phase serum specimens at a state public health laboratory or CDC.

WNV IgG antibodies generally are detected shortly after IgM antibodies and persist for many years following a symptomatic or asymptomatic infection. Therefore, the presence of IgG antibodies alone is only evidence of previous infection and clinically compatible cases with the presence of IgG, but not IgM, should be evaluated for other etiologic agents.

Plaque-reduction neutralization tests (PRNTs) performed in reference laboratories, including some state public health laboratories and CDC, can help determine the specific infecting flavivirus. PRNTs can also confirm acute infection by demonstrating a fourfold or greater change in WNV-specific neutralizing antibody titer between acute- and convalescent-phase serum samples collected 2 to 3 weeks apart.

Other testing for WNV disease

Viral cultures and tests to detect viral RNA (e.g., reverse transcriptase-polymerase chain reaction [RT-PCR]) can be performed on serum, CSF, and tissue specimens that are collected early in the course of illness and, if results are positive, can confirm an infection. Immunohistochemistry (IHC) can detect WNV antigen in formalin-fixed tissue. Negative results of these tests do not rule out WNV infection. Viral culture, RT-PCR, and IHC can be requested through state public health laboratories or CDC.

March 19, 2019 0

Black coat vs white coat. What if money part is taken out of medico legal cases?

What if financial part is taken out of medico-legal issues, like compensation and lawyers fee? The cases will drop down drastically? If money part is zero, only errors will be identified and punished. Few will remain only for idea of revenge. In an era where people cheat their brothers, sisters and spouses for money, it will be naïve to think that idea of money extracting from doctors does not exist.

Financial zeroing can be done in larger public interest to keep down the cost of medical expenses. It is because of career building of few professions, that medico-legal cases are being fueled. Medical errors and complications are integral part of the treatment . Even simplest of diseases carry some amount of risk. These will still remain, even if doctors are hanged to death. Natural complications, poor prognosis can be attributed to errors by clever lawyering and because of benefit derived by other professions.

Many careers are shining in name of preventable deaths and medical errors at the cost of medical profession. The managers, right activists, media and lawyers have made their career and wealth out of it. Ask any doctor really, are these issues really preventable after a point. The line separating errors or natural complications is really blurred and arbitrary. People who work in life and death situation know it well that even natural poor prognosis can be labelled and proved as error by retrospective analysis and wisdom of hindsight and more certainly with luxury of time at disposal for lawyers and courts.

Lawyers and courts should also be given those fraction of moments to decide same as is available to doctors. Otherwise it becomes a unbalanced match specially when the amount of money which was paid to doctor to save a life was peanuts as compared to now being paid to punish him.

March 14, 2019 2

Doctor need to train themselves for “ Cool” communication with patients to save themselves.@ Supreme court on insensitive comments by Shimla Doc

Doctors are sitting ducks for revenge, which can be in many forms. It is necessary not to make unnecessary comments during discussions with patients and relatives. A sweet talk or even stoic silence is still better than making irrelevant and insensitive comments. Sometimes, in emergencies doctors are too busy, feeling harassed, and in heat of moment , they utter some words. But later, no one will take into account the amount of distress in emergency situations. Irrespective of the number of patients, try to refrain from uttering the words, which are non- professional. But few words said in disgust will be remembered by patient and interpreted by courts in retrospective analysis can be held against the doctors..

Supreme court granted an additional Rs 10 lakh in compensation to a woman from hills in medical negligence case on finding about the insensitive comment made by doctor at hospital in Shimla

Few points, which should be followed are as under to save themselves from future harassment. There can be many more.

Do not have a word match with patient or attendants.
If attendant are shouting or angry, restrain your mind and do not answer to give back in same words. Better to be silent.
Try to avoid being in that situation, specially if you are being irritated and some thing goes out of your mouth.
If the situation is arising because diagnosis is not clear or not able to treat, try to refer the patient, without making comments.
Try to have cool and calm communication and make a record of it.
Communication should be regarding only professional matters. Rest all irrelevant communication to be avoided.
Unreasonable and unrealistic demands are not uncommon . Just tell calmly about the same. Do not make angry or sarcastic comments.

But sometimes when during ongoing medico legal lawsuits, a feeling of revenge prevails or as guided by lawyers, such uttered words may cause unnecessary problems.

“Documenting the communication”

examine, investigate, diagnosis , treat correctly and communicate
Make a note of plan of treatment and prognosis, and communicate to patient or attendants.
Sign yourself and ask the patient or nearest relative to sign.
It is not uncommon that relative will refuse to sign. In that case just write a note and mention that attendant refuses to sign.
It is also a common issue that after listening to everything, relative will say that he does not understand or will ask his uncle or aunt. These are difficult moments and commonly happen. Just make a note of everything. Besides it wastes crucial time.
Can use camera for communication in difficult cases.
Never rely on verbal communication. It has little value. Commonly people refuse to admit verbal communication, and will say that they were not told anything.

As time for everything is limited in life, be it treatment, communication, consent or documentation. . “Talk less and write more”. You will be judged by documents after many years.

Doctors need to train themselves to restrain and avoid irrelevant comments, to save themselves.

March 12, 2019 0

Cure for AIDS may be possible in near future

“London patient” becomes second person to be cured of AIDS after stem cell therapy. It has helped them put their infection under remission without medication. The breakthrough offers hope for a potential cure using gene manipulation for an infection. Concept that scientists will one day be able to end AIDS, the doctors said, but does not mean a cure for HIV has been found.

An HIV-positive man in Britain has become the second known adult worldwide to be cleared of the AIDS virus after he received a bone marrow transplant from an HIV resistant donor, his doctors said.

Almost three years after receiving bone marrow stem cells from a donor with a rare genetic mutation that resists HIV infection – and more than 18 months after coming off antiretroviral drugs – highly sensitive tests still show no trace of the man’s previous HIV infection.

“There is no virus there that we can measure. We can’t detect anything,” said Ravindra Gupta, a professor and HIV biologist who co-led a team of doctors treating the man.

The case is a proof of the concept that scientists will one day be able to end AIDS, the doctors said, but does not mean a cure for HIV has been found.

Gupta described his patient as “functionally cured” and “in remission”, but cautioned: “It’s too early to say he’s cured.”

The man is being called “the London patient”, in part because his case is similar to the first known case of a functional cure of HIV – in an American man, Timothy Brown, who became known as the “ Berlin patient” when he underwent similar treatment in Germany in 2007 which also cleared his HIV.

Brown, who had been living in Berlin, has since moved to the United States and, according to HIV experts, is still HIV-free.

Some 37 million people worldwide are currently infected with HIV has killed around 35 million people worldwide since it began in the 1980s. Scientific research into the complex virus has in recent years led to the development of drug combinations that can keep it at bay in most patients.

Gupta, now at Cambridge University, treated the London patient when he was working at University College London. The man had contracted HIV in 2003, Gupta said, and in 2012 was also diagnosed with a type of blood cancer called Hodgkin’s Lymphoma.

In 2016, when he was very sick with cancer, doctors decided to seek a transplant match for him. “This was really his last chance of survival,” Gupta told Reuters in an interview.

The donor – who was unrelated – had a genetic mutation known as ‘CCR5 delta 32’, which confers resistance to HIV.

The transplant went relatively smoothly, but there were some side effects, including the patient suffering a period of “graft-versus-host” disease.

Most experts say it is inconceivable such treatments could be a way of curing all patients. The procedure is expensive, complex and risky. To do this in others, exact match donors would have to be found in the tiny proportion of people — most of them of northern European descent — who have the CCR5 mutation that makes them resistant to the virus.

Specialists said it is also not yet clear whether the CCR5 resistance is the only key – or whether the graft versus host disease may have been just as important. Both the Berlin and London patients had this complication, which may have played a role in the loss of HIV-infected cells.

Sharon Lewin, an expert at Australia’s Doherty Institute and co-chair of the International AIDS Society’s cure research advisory board, told Reuters the London case points to new avenues for study. “We haven’t cured HIV, but (this) gives us hope that it’s going to be feasible one day to eliminate the virus,” she said.

Gene manipulation, like any experimental technology, comes with several caveats, including concerns about the “off target effects” that can cause adverse mutations, including cancer.

March 7, 2019 0

History and ancient discovery of Diabetes Mellitus

Diabetes was one of the first diseases described, with an Egyptian manuscript from c. 1500 BCE mentioning “too great emptying of the urine”. The Ebers papyrus includes a recommendation for a drink to be taken in such cases The first described cases are believed to be of type 1 diabetes. Indian physicians around the same time identified the disease and classified it as madhumeha or “honey urine”, noting the urine would attract ants.

The term “diabetes” or “to pass through” was first used in 230 BCE by the Greek Apollonius of Memphis. The disease was considered rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career. This is possibly due to the diet and lifestyle of the ancients, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease “diarrhea of the urine” (diarrhea urinosa).

The earliest surviving work with a detailed reference to diabetes is that of Aretaeus of Cappadocia (2nd or early 3rd century CE). He described the symptoms and the course of the disease, which he attributed to the moisture and coldness, reflecting the beliefs of the “Pneumatic School”. He hypothesized a correlation of diabetes with other diseases, and he discussed differential diagnosis from the snakebite which also provokes excessive thirst. His work remained unknown in the West until 1552, when the first Latin edition was published in Venice.

Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 CE with type 1 associated with youth and type 2 with being overweight. The term “mellitus” or “from honey” was added by the Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination. Effective treatment was not developed until the early part of the 20th century, when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922. This was followed by the development of the long-acting insulin NPH in the 1940s.

Etymology

The word diabetes comes from Latin diabētēs, which in turn comes from Ancient Greek διαβήτης (diabētēs), which literally means “a passer through; a siphon”. Ancient Greek physician Aretaeus of Cappadocia (fl. 1st century CE) used that word, with the intended meaning “excessive discharge of urine”, as the name for the disease.

The word mellitus comes from the classical Latin word mellītus, meaning “mellite” (i.e. sweetened with honey honey-sweet. The Latin word comes from mell-, which comes from mel, meaning “honey” sweetness. This sweet taste had been noticed in urine by the ancient Greeks, Chinese, Egyptians, Indians, and Persians.

source

March 5, 2019 2

Illegal Organ (Kidney)transplant trade : Defined as crime, but saves life

A paradox, where a defined crime saves a life and following law and regulation correctly will result in end of life. If some one is asked to choose between a certain death or follow regulations, the choice will be very predictable. A patient , who has an irreversible organ failure, will try to defy death at all cost. People who can afford, can not see their children or loved ones to die, just for the sake of following law and regulations. Genuine concern here will be that If a patient can be cured of disease, why he should be left to die for just regulations. The wish to live is the basic reason, why the procedures, which are termed illegal, will flourish. They will thrive underground or in countries, where laws are lax. Touts, agents and liaison managers are people, who will be beneficiary and mint money by organization of the procedure. The people who can afford, get gift of life, in the bargain.

Organ transplant may be termed illegal, in certain circumstances as defined by Law. But legal or illegal, it gives life . It gives another chance to people to live or have their kith and kin, children , spouses and parent to live another life. Because of gap in demand and supply, when legal means do not help, adoption of illegal means becomes a compulsion. If following law and rules means death, they are unlikely to be complied with.

The gap in demand and supply of organs is the reason behind these activities. Nearly four lakh people suffering from end stage kidney failure need transplant and only 8000 get it. (Times of India). The recipient has two choices for Kidneys. It can be living donor and deceased donor or cadaveric in cases of brain death. 90% come from relatives, rest are cadaveric. The rest has to undergo repeated dialysis to survive.

After the enactment of The Human Organ Transplantation Act of 1994, transplants became less in India. But it was followed by booming market of donors In other countries like Pakistan, Philippines .

But given the circumstances of life and death, the underground market may still be existent.

The ACT also allows unrelated donors to give one of the kidneys if there is sufficient evidence to show that they know the recipient for a long time and are donating organs out of affection. The loophole has potential to be exploited. The affection or the papers for affection can be easily generated in today’s era in lieu of money or other favors in case of high profile cases. Therefore, the mediator’s work becomes easier to generate the papers projecting affection and tutoring and training of donors and recipient.

Alternatively, the procedure can be done in nearby countries. Therefore the role of doctor or surgeon doing a transplant (although the key point) is much smaller than the agent organizing the whole process. Thereby the agents , who can manage and organize the show, are thriving. The wish to defy a certain death is stronger than following the regulation. That will remain so till demand supply gap reduced , better awareness for brain death, medical infrastructure, organ retrieval and transport and supporting facilities are uplifted. Till it happens, even if it is defined as crime, the fruits will outweigh the risks, because of shear margin of money temptations and wish to live.

February 21, 2019 0

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Take steps to control mosquitoes indoors and outdoors

Treatment

WNV Antibody Testing

Other testing for WNV disease

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