#Doctor-wife-killed-by patient #Warning to Doctor/medical profession- becoming a victim of easy revenge


Any patient who visits hospital carries a static or progressive risk of death, howsoever little his illness looks to be . A genuinely poor prognosis or progression of disease or routine complication can cause or result in death. But by application of average wisdom of the people who do not have an idea about complexity of medical field, can easily blame doctors. So doctor even when doing his best is at risk of revenge or harm from public as well as authorities. A fundamental question about such situations will come to doctor’s mind naturally. What happens when doing some good work by our self causes harm to ourselves? Here you are trying to save some one. It is a happy situation for him if you are successful. But due to some reason patient dies or there is poor outcome. He has all the rights to harm you in more than one way. What if he happens to be a powerful person, a VIP, criminal or a goon. What if he becomes revengeful towards you. Doctor will turn into an object of revenge. Money a doctor receives in “what so ever risky situations” or even for saving a life is peanut. But if patient decides to sue him, court may ask to pay something , doctor may not earn in his life time. Or in extreme cases physical violence and even killing the doctors is also some thing which is not unheard off and is on the rise. And this process can happen any minute, any day and continues for years till he continues to work the whole life. Even single mistake in entire career, that too unintentional is enough to cost name, fame or even life. Even it may not be a mistake, or just be a naturally poor prognostic disease, which can be interpreted as an error easily. For people who do not treat patients, how so ever learned they may be, are unable to recognize the difference between the negligence or genuinely poor prognosis. Thanks to media and our celebrities, who have created a doctor- patient mistrust for their own populist gains. An impression is being created, as the poor outcome is because of doctor’s mistake by selective projection in a certain manner.

not-satisfied-with-treatment-man-kills-doctor-s-wife Irritated that a doctor, who wasn’t able to cure his itch for six months, was away in Delhi, an Indore man stabbed to death the doctor’s wife and injured her son. According to the police, the incident happened at the clinic of Dr Ramakrishna Verma in the Malwa Mills area of Indore, on Thursday morning. The doctor ran his practice from home. Tukoganj city superintendent of police (CSP), BPS Parihar said, “The accused Rafiq Rasheed (45) was suffering from an itchy skin disease for which he was getting treatment from Dr Ramkrishna . Verma for the past six months, but without any results. When he went to the clinic at about 11 a.m, Verma’s wife Lata informed him that her husband was in Delhi. This apparently angered Rafiq who got into an altercation with Lata (50) and stabbed her repeatedly with a knife he was carrying. As Lata screamed for help, her son Abhishekh (19) came out and Rafiq stabbed him too and ran away. However, some people who came hearing the screams managed to nab Rafiq and handed him over to the police.” The locals took both mother and son to a nearby private hospital where Lata was declared brought dead. Abhishekh’s condition is said to be critical, police said.

Being revengeful against doctor is very easy. They have become sitting ducks for revenge. Verbal abuse, physical harm, legal remedies, disciplinary actions, punishments, social mudslinging, court cases and legal harassment are common remedies easily available. In absence of support, lack of law and order enforcement, physical assaults and even murder is also not a distant possibility. Here it was just a treatment failure or may be a poor response to treatment, which resulted in killing of doctor’s family. If trying to treat some one can result in harm to one self, why should the doctors will choose to treat. More over why should one become a doctor at all. Such incidents of extreme violence are not merely disaster for a family, but they are warning signs to whole of profession.

Many in such unfortunate situations must have a thought in mind “ why should one become a doctor and treat patients?”

Women doctor and nurses more prone to work–life imbalance


 

Being a health provider  is a tough and stressful job. In any hospital, work goes on during  day and night. Rather many times nights are more heavy and challenging. The systems at odd hours are run by doctors and nurses. Continuous requirement to do odd time shifts, hard training and work demands tend to affect the overall work-life balance of doctors and nurses.

For women, it is particularly more stressful. As at some stage of life, both professional and personal roles become too demanding.  Expectation at both fronts is guided by the idea of perfection. Perception of deviation from the ideal or little imperfection   can lead to sense of aversion, linked to  average performance for them.  If they try to match the ambitions, want more in career, from the partner, children, or themselves, face the real risk of burn out. The cognizance  that perfection cannot be matched or arduous to achieve, in their circumstances, is hard to be realized  at both places.   The quest and  passion of  the women doctors or nurses, to seek perfection at both places, makes them  more prone for  burnout. This  is  a consequence to  a grave exhaustion, in their bid  to balance everything.  Woman doctors and nurses, are specially  more susceptible to stress of a kind,  as most of them face the same ordeal.

Family priority:

Perception of role identity at home  is little different on  being a woman doctor/nurse.  Male doctors are in a better position to  prioritize their work duties over their family duties  in order to  provide financial support for their families. For female doctors , there is a natural tendency to  prioritize their family life.

  Inflexibility or shift working a routine:    

         The  issues will always remain, like spending long hours at work due to inflexibility, or requirement to do shift  duties , need to stay more with patient and training requirements. For females it is very common and  frequently  lead to an imbalance between work and family duties.   More  time spent at work has an direct impact    on family requirements. Sometimes  there are financial requirements of the family, for which they are forced to  negate the effect on family duties.  In such situations they are unable to successfully complete these family duties.

High career ambitions:

Higher  education leads  to ambitions for higher social recognition and better career orientation. These goals are another  reason for taking this dual stress.  In order to correct this  imbalance, many  women doctors  expose themselves to unsolicited job stress. This reflect  in lives as chronic lack of time and  leads to pressure and stress.  The mentioned stresses and strains could lead in the long term to irreversible, physical signs of wear and tear, as well as to negative effects on the human cardiovascular and immune systems.

   Prolonged and odd working hours:

In medical profession,  simply working hard is not enough anymore. To get ahead, a rigorous training, prolonged working hours are  new standards. There is very  little time left to be divided   among relationships, kids, and sleep.

 

Conflict by Perception:

The conflict of work and family is further exacerbated  by perceived deviation from being a  good worker  at  work place and  ideal mother at  home. At work  place, they are looked as less dedicated and similarly at home as well.  Lack of organizational support  for doctors/nurses is main reason for these kind of imbalance.  They are squeezed in between  pressures at work and demands at home.

Extending families:

These day, pressures are so high that  many young women doctors,  want to just stay at home and do housework without having careers. May  give up careers to have children. It strikes to young doctors as a surprise, simply how difficult it is to build a family. The learning curve of taking care of family along with professional  responsibilities is too steep. In such situations, when everything is compounded, with  workload, it becomes utterly exhaustive.

Motherhood:

Breaks taken for family requirements may be taken as red flags, by employers. Delivery and feeding child become  difficult tasks specially in clinical branches, where long duties are routine.

Motherhood needs to be squeezed in between the requirement of profession. Changes in schedule or adjustments made are perceived as “being different”.

While women are increasingly represented in the medical field, they still face challenges balancing work and home life. The frustrations manifest in  burnout and dissatisfaction within a field they once enjoyed.

also read: work-life imbalance for doctors/nurse & consequences

 

Work-life imbalance for doctors/nurses & consequences


 

For doctor and nurses, time of work and action is determined by need of the patient. Whereas in most of other professions, time of  work  can be carried out at any convenient time. As a routine, most of the  human being  work  during day time, by  convention that is 9 AM to 5 PM . whereas, It is not uncommon for medical and nursing professionals to have more heavier  and challenging night shifts.  Most of clinical branches, doctor and nurses  remain busy through out night.

Across the globe, in the  medical systems, specially  not so well organized, it is  a common routine  for the  doctor to get night calls  everyday and  lots of them  rarely gets undisturbed normal sleep.

Needless to say that doctors and nurses do a herculean task to stream line their family and professional life. Kudos to those, who can nurture their hobbies, along with difficult clinical branches. Maintaining a work-life balance remains a distant dream for most of successful clinicians. This balance can be defined as a satisfaction gained by spending time on activities according to one’s wishes, which are besides their clinical work.

Areas of life other than work–life may  include  personal interests, family, social or leisure activities or hobbies.

Work–life  imbalance is the lack of  proper alignment  between work and other important life roles. It is a kind of balanced  state of time, achieved by spending time  on  demands of personal life, professional life and family life, that  is satisfying.  Work-life balance  is not limited to flexible work arrangements  to carry out other life programs and practices.  Work-life balance is a term commonly used to describe the balance that a working individual needs between time allocated for work and other aspects of satisfying life.

The thing that strikes as a  surprise  to most of doctors  of  starting a family  is simply how difficult it is. The learning curve of taking care of family  along with professional responsibilities is  so steep,   While working as doctor  in learning or training  phase, parenting requires  an abundance of energy, time, and grit

And when the responsibilities of being a parent are compounded with the realities of being a trainee doctor, it starts to be too much. It never feels like enough time for anything and  it really becomes utterly exhausting. There is always a struggle constantly with the balance of spending quality time with  family,  trying to study and perform well.  There is little time for hobbies or doing things  to  maintain  sanity of mind.

The environment of work today for doctors has become  more intense with legal issues,  burdening much more   than it was few  decades ago. Burdens beyond clinical work and associated stress  have   created  the need for a better  balance between work and life. Doctors have started thinking to devise or alter  the working in an effort to have a better balance. Experience of  being over-worked, long working hours and an extreme work environment has proven to affect the overall physical and psychological health of  doctors  and deteriorate family-life.

Although there are no structured studies on the issue, but doctors have started feeling difficulty balancing work and family. But the effects are already evident like alcohol and drug abuse, increased rates of divorce and suicides. Increased feeling of stress and  early burnout is an  natural outcome. Doctors,  who have attained  stage of financial security tend to have an early retirement, or reduce working hours.

Consequences of work–life imbalance

Problems caused by imbalance and consequent stress  has become a source of major concern for doctors and nurses.  Symptoms of stress can  result in  both physiologically and psychologically changes. Profession suffers as the workplace becomes the  greatest source of stress.

Persistent stress can result in cardiovascular disease, sexual health problems, a weaker immune system and frequent headaches. It can also result in poor coping skills, irritability, jumpiness, insecurity, exhaustion, and difficulty concentrating. Stress may also perpetuate or lead to binge eating, smoking, and alcohol consumption.

In medical profession,  simply working hard is not enough anymore. To get ahead, a rigorous trainings, prolonged working hours are  new standards. There is very  little time left to be divided   among relationships, kids, and sleep.

This ordeal is prolonged over years  results in  less time spent with family, friends, and community as well as pursuing activities that one enjoys and taking the time to grow personally. Even close friends and  relatives slowly start  becoming distant.

Extending family and becoming new parents  causes  extreme stress  in doctor’s life.  It can have  negative effects.  Between trying to balance a new schedule, managing additional responsibilities, and lacking flexibility and support, they can only increase stress.

Consequently, the evolving system of  health care have made doctors more prone to burnouts. Their  quest to be the  ideal, hard-working, perfectionist ultimately  turns them loner, the grim and stressed individuals.

related article: women doctors  and nurses prone to work- life imbalance

“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

  1.      Earning
  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

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.

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


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.

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.

Factors

  1.      Earning
  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

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.

Administrative and infrastructure deficiencies in health care: fail and blame for doctors


Adverse outcome in patients  can be  because of  many factors. Most of the time it is  serious illness, natural poor prognosis of disease, genuine complications or infections. Sometimes, It can be deficiency of equipment, malfunction, lack of infrastructure or facilities. There can be poor training or lack of  proper human resource and many others. There may be unintentional or human errors  by doctors or staff.  Root cause for most of the problems  can be traced to  administrative and system deficiencies rather than mistake of doctor. But since doctor is universal final link, when a patient dies, who  is visible on the bedside. So by application of an average wisdom, it is the doctor who will be held responsible for any problem or adverse outcome. Administration and people who are responsible for building infrastructure, procurement of  equipment and allocating finances or manpower  are not visible in forefront. It is very common for the doctors  to find themselves in a helpless situation, specially  in presence of  deluge of patients, difficult circumstances, scarce resources  and other  administrative issues.  In cases of adverse outcomes,  administration can   pretend to hide behind the common escape route by punishing doctors and hold them  guilty for the adverse events, as no other cause or person   is visible. By retrospective analysis  and  wisdom of hindsight along with luxury of time , it is a cake walk to give  verdict of one’s choice later, by fault finding analysis.

Non availability of ventilators or  malfunctioning  is not an issue, for which doctors are responsible. Procurement and allocation of funds is an  administrator’s domain.  But it is common that  doctors can be accused for not saving a life. They can be punished, dragged to court and even assaulted physically by crowds.  Dismal percentage of availability  of ventilators in Delhi Hospitals is a tip of the iceberg. This can be even  worse in other parts of the country. Ironically crowds visiting the hospitals only see and blame  the doctor, who is present on bedside and trying to save the patient. Patients hold them responsible for  malaise of the system  and fail to see the presence of  large  administration and industry,   that is behind  the scene. An unfortunate era,  when  the  doctors are blamed on  individual basis for system failure. In present circumstances, Lack of medical wisdom among masses is a cause of  huge discouragement for doctors.

With  High court being proactive in asking about the number of ventilators, the administration can not pretend to hide behind any more, but masses need to know the real truth.

Only 3.4% beds on Delhi Govt Hospitals have ventilator facility against the minimum requirement of 10% in every state run medical center. For  over 10,000 beds,  only 348 ventilators are there. That is an extremely low number.

52 of 400 ventilators in Delhi hospitals non-functional, state tells HC.

After 3-year-old Farhan died in the national Capital for an alleged want of proper ventilator care earlier this month, the state government of Delhi has told the High Court that a substantial number of ventilators in its government hospitals are not working. The state also told the HC on Tuesday that they were aiming to have a web portal up and running within two months, which would provide an online daily update on ventilator and bed availability across Delhi’s government hospitals.

After directions were issued by the HC, the state asked all its hospitals to provide a status update on ventilators and according to the information received from the government hospitals, up to 52 ventilators (13 per cent) of the total of 400 ventilator beds (including 300 ICU and 100 non-ICU) available in the hospitals are non-functional. “Fifty-two ventilators are non-functional and efforts are being made to get them repaired. The procurement of 18 ventilators is under process,” said the reply filed by the state government in the High Court on February 12.

The state government also stated in its reply that as far as maintaining real-time information on the availability of vacant beds in Delhi government hospitals goes, it may not be feasible to implement real-time availability information in the initial phase and the Delhi State Health Mission should be advised to start uploading information on bed availability in all the hospitals once a day in the morning.

The state government also said the State Programme Officer (MIS) of the Delhi State Health Mission has been requested, in

a letter dated January 31, to prepare a web portal for online bed/ ventilator availability and that such a Web portal should be made functional within two months.

The state government through an email sent on February 7 has also requested all the hospitals to complete repair, condemnation and procurement of ventilators at the earliest, according to Nutan Mundeja, Director General of Health Services.

After the matter of alleged unavailability of healthcare to Farhan came to light, the High Court moved a motion against the Union of India and sought a reply.

The number of ventilators as compared to bed strength in government hospitals is meager. “In private hospitals, there is one ventilator bed for every four normal beds. In government set-ups though, even as we have over 10,000 beds, we have only 348 ventilators. That is an extremely low number. Also, these ventilators may not be evenly distributed across the city,” pointed out  stated U Jhamb, Director, Professor and Head, Department of Paediatrics at the hospital.

 

#Soldier/Nurse/doctor vs Filmy superstar: Reel Heroes or Real Heroes. what does the society Need/desire/deserve?


The old adage  “All that glitters is not Gold” is particularly relevant  in current era of media domination where media  projection shapes the perception and may defy  the  reality.  Media has dominated our lives and can sway the  opinion formation of masses.  Written media, television, social media  can collectively influence the mass opinion.

Society, in general, needs to be wise  enough  to realize the importance   of  getting  rid of  these blinders in  real life . One such factor that causes an illusional mist in the  thoughts of masses is projection in films. They create a mirage of illusional glitter wherein  there is blurring of real life from the reel life of heroes. The larger-than-life unreal persona of the celebrities on screen looks too charming and sometimes becomes undeniable and dominates mind of masses. The super-human characters played out in films appear to be real. The problem arises when the imaginary characters of the reel life stories are emulated in real life. Individuals as projected character fill in  peoples’ imagination and are perceived as real and   becomes ingrained in mind. The naivety of masses to perceive the projected character as real one  goes beyond a reasonable thought process and imagination.

 

These roles played in films are  not  really act of   inspiration  in real life  as  the actual purpose accomplished in the end of a movie  is entertainment of society and business for themselves. A recent  candid  admission  by the actor Mr Irrfan Khan  that film stars should  not be role models  was impressive (Hindustan times) .

   At the best, a particular projected character  (and  not individual acting star) may be a  role model. An actor or super star, is simply doing his work of “acting” in  the end. This work of acting may bring an entertainment of few hours at the most.

One  cannot stray away from the wisdom to  choose between what we consume merely for our entertainment and  what we believe or face in real life. One needs to differentiate between rationale truth behind the celebrity gimmicks in the media and exaggerated sensationalism. Sensation created merely for a commercial successful venture should not be allowed to overpower the judgments of real life.

 

But the problem starts, when these false perceptions created merely   by a projected  glimmer    takes the shimmer  away from the real worthy. The real  professionals and people who are worthy of glory become invisible behind  the glittery mist, a haze, which is unreal and unhelpful in real life.

   A  soldier contributes to our society much more in real terms. Even a junior doctor saves many lives in a  day in emergencies as compared to work of a superstar in films.  A teacher, nurse or scientist have contribution which is more fruitful to our generation. Also the scientists, who contribute immensely and bring about the  real change in our lives. Their contribution is huge to our society and much more than doing just acting on screen. The reel actor merely imitates the real life lived and actual work done by real heroes like soldier, doctor or teacher. Someone who only acts and  behaves like one, is respected and paid thousand times or more than the real one. In reality, people need  more than mere entertainment and reel role models and actors in their real lives.

 

Compare the trivial  amount of  remuneration, fame  and respect the real worker  gets  as compared to the film stars, who merely imitate their actions. Reel projection for purpose  of entertainment is more easier to enact and more profitable  than actual performance  in real life.  It is easier to become a reel hero, as it requires little hard work or just connections to get an opportunity.  Some one can be a reel hero just  by  dynastic factor  easily. Hard work is definitely required but that may or may not be prerequisite.

 

Even good films  may raise some social problem, which everyone knows already and offer no practical solution in reality. Therefore what good it brings to the public, beyond entertainment, is any body’s guess. The persona, actors usually  project on screen, may actually be far from his or her real personality. In most of cases, what he does in movies and reel life, is actually away from  possibility of real life . But strangely in present era, people lose sight of what is mere perception. It is clearly a story, tale, a drama, a myth and is not the real identity of the people, we see on-screen.

 

 

In present era, real contributions by people, who are saviours of human life and  the real heroes, remain unappreciated. People are so besotted by  fame and money that they fail to appreciate the sacrifices made by real heroes. Filmy super hero  just imitates  a doctor, soldier,  dacoit or a street hooligan and just pretends to be one on the screen.

 

But there are  real life heroes that exist around us. Doctors awake at night saving lives every minute or soldier in freezing cold are worthy  of more respect and are real heroes.  And it is up to the society  to look beyond the superficial and reel story, and focus on the real life actors. There has to be an true effort to make, respect and appreciate  real heroes.

Point to  ponder  is that whether society needs people  just  acting like   doctors,  soldiers  and not the  actual and real ones, who saves lives. Does Society need  only  entertainment, because respect  which is paid to someone who is  just  an   actor, is  not extended to real doctors, soldiers or other altruistic professions.

 A reel hero who acts like a soldier, is famous  and richer and than the  actual soldier, who dies unnamed and in penury.   Children of today’s times will strive  to become, who is worshiped and paid respect  by society and  therefore will prefer  to become reel heroes.

 

A  society truly needs the real people, who work and act for them, more than just entertainment. It will need total change in attitude of people to deconstruct the perceptions, which are based on mere projections and are away from reality.

It is time to recreate and worship real heroes, who have become invisible behind the glittery mist.

Society needs to envisage the bigger real picture, and should not be mistaken for another projected story.                          

The perception of the projection will decide, what does the   society actually  need- or desire-or deserve , “Reel Heroes or Real Heroes”.

Expensive medical education ? Future may be “free medical education”: NYU offers free education for all its medical students


     At a time when students, parents and even doctors are uncertain whether opting for medical college along with the vulnerability and risk associated with   becoming a doctor is worth it or not, some are naive enough to pay millions as fee for medical education and for securing a seat of MBBS.

Truth  cannot remain hidden for long.  It has  to be realized that getting into medical college is a minuscule component of the process of becoming a good doctor.  Once they opt for this profession, the real tough and prolonged battle begins. Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it, especially those who may have invested in heavy fees and in debt.

Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession

Paying the irrational fee of medical colleges may be an unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way forward or fail to get residency.

The New York University School of Medicine will provide free tuition for all present and future students, the university announced.

Citing the risk of “overwhelming” debt, it says every student will qualify regardless of merit or financial need.  NYU said financial worries were driving graduates to more lucrative specialities, pushing doctors away from more general positions. The scholarship covers annual tuition costs of up to $55,000 (£43,000). A study produced by the Association of American Medical Colleges estimated that in 2017 75% of medical students graduated in debt. The university has reportedly been working for more than a decade to accrue the necessary funds to pay for tuition, and hopes to raise a total of $600 million (£472m) to make the scholarships available permanently. NYU School of Medicine made the surprise announcement at its annual White Coat Ceremony on Thursday – when new students receive a white lab coat as they begin their studies. In their statement, the university said debt is “fundamentally reshaping the medical profession in ways that are adversely affecting healthcare”.Graduates move towards higher-paying areas of medicine over paediatrics, primary care or gynaecology due to their “staggering student loans”. Aspiring physicians and surgeons should not be prevented from pursuing a career in medicine because of the prospect of overwhelming financial debt”. Robert Grossman, dean of the medical school and chief executive officer of NYU Langone Health, said: “This decision recognises a moral imperative that must be addressed, as institutions place an increasing debt burden on young people who aspire to become physicians.”To date, only a handful of institutions have tried to make medical education tuition-free, according to Julie Fresne, senior director of student financial services of the Association of American Medical Colleges, a nonprofit organisation that represents medical schools. At UCLA’s David Geffen School of Medicine, a $100m (£79m) fund announced several years ago pays for the entire cost of medical school for all four years, including tuition, fees, books and living expenses for about 20 per cent of its students. But that program is based on merit, not need.

Meanwhile, a small medical school affiliated with Case Western Reserve University at the Cleveland Clinic covers the tuition and fees for its five-year programme focusing on research. Most of the roughly 20,000 students per year enrolled in US medical schools take out sizeable federal loans to support their studies. According to the Association of American Medical Colleges, in 2017, the median debt for graduating medical students was $192,000 (£151,000).The median cost of medical school attendance, including living expenses, was $60,945 (£47,906) a year for public medical school and $82,278 (£64,675) for private medical school.

This may be a indicator of the future days to come, the need for medical education   to be cheap or made free,  to encourage young generation to become doctors. Society has the choice to encourage and nurture good doctor for itself or discourage them by financial exploitation and subjecting them to debt trap. NYU has wisely decided on its choice.

 

Real failures of Dr Hazida Bawa case: Five issues to ponder-why doctors suffer?


 The case of  Dr Hazida Bawa  is of importance worldwide in many ways, an opportunity  for learning some hard and truthful lessons, as it touched upon various crucial aspects involved in medical treatment, especially in difficult situations. Every one has sympathy for the deceased, but  to blame a human factor, doctors should not be presented as sacrificial lambs.

       The current verdict is nearer to reality and away from a feeling of revenge and harsher penalties. It  gives a hope  that now there will be  acknowledgement of the difficult circumstances and limitations of medical system in health care environment.  To make doctor scapegoat for the  system limitations, poor prognosis or severe disease may be satisfying for some but not sensible. In this case doctors lodged their protest, collected money for lawsuit and the decision was re-looked legally. But every  doctor may not be  lucky enough and may have to suffer  in silence.

 Real failure in this case will be ignoring the factors that actually cause huge suffering for doctors-

  1. Presumptive failure by retrospective analysis: Retrospective analysis of any treatment will always show few things at hindsight that could have been done and would have proved life saving.  One may presume that omission or commission  of certain actions during treatment would have saved the  life,   but one can’t be sure whether these additional presumed treatment would really have benefited the patient.  Therefore a  perception-reality gap is created and with  negative perception towards doctors, it is interpreted as a  failure of doctor merely on presumptive basis and hence declared as negligence.  The doctors who deal with life and death know that it is not correct interpretation, and no one can ever be sure of what the real outcome would be. They just do what they think will be most effective for the patient, and it may not eventually turn out to be the best ever.
  2. Variable interpretation: Same evidence, incidence and circumstances are interpreted and  judged differently by people and  even courts. Some will say it is negligence and other will say it is not. Some will bay for doctor’s blood and other will not. This variation in perception is not only in minds of lay men but also in the learned courts, who  decide  differently.  At the time of death of patient, a constant and  universal last link is only the doctor, that is visible. He is an unfortunate victim, a human factor   and blamed for  the harm done because of variable thought process.

 

  1. Medical knowledge vs wisdom: People who do not treat patients, may be very wise and may acquire medical knowledge by various sources. But medical wisdom comes  only after years of medical practice,  by observing varied situations and spectrum of diseases. An understanding of what can happen in given circumstances comes only by treating such   emergencies.         For non doctors, it is very difficult to  comprehend the medical complexities and real time scenarios. Even doctors, who do not treat regularly emergency patients, can attribute the harm as doctor’s  mistake.

 

  1. Feeling of revenge:  in case of an  adverse event, negative thoughts prevail all over. In present scenario with legal powers with the sufferer and common sentiments against doctors, it is easier to identify and blame some human factors.   Adverse outcome is frequently covered by media to create a sensation among masses.  Real circumstances can only be felt by doctors  but that remains unheard. Harm to patient, media cry and negative sentiments against the service providers creates a sense of revenge in mind of people.

 

  1. Doctor’s negligence vs system inadequacy; This visibility of doctor at the time of  declaration of death  or while treating the patient on his bedside, makes him vulnerable to all kinds of accusations. By application of an average wisdom, all deaths can be easily attributed or linked to fault of the doctor. Subtle presentations of severe disease, rapid deterioration, multi organ complexities, under staffing and sub optimal systems, inadequate equipment and  other innumerable shortcomings of the whole system may not be visible or not given consideration in the  haze, as compared to  publicity and attention  given to only doctor’s faults.

 

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