Doctors’ Dilemma-To Follow Medical Science or Fulfill Medico-legal obligations (contract)


Medical Negligence case- Noida (death due to Covid -19)  is an example that should force the aspiring doctors needs to think whether they should put themselves in such a situation- akin to catching a falling knife.  A case which shows that in difficult situations, legal compulsions have potential to affect the treatment, without realizing what is good for the patient or actually required.  In difficult circumstances, while treating diseases with naturally poor prognosis, they can be still held responsible  for the situations  beyond their control. Doctors can be harassed for just being in a peculiar situation  and for being the only one  on the bedside of patient. Everyone wants some human factor to blame for the loss, which was at the best  God’s wish in real sense.

While  treating emergencies patients, there is  an eternal latent vulnerability that is intrinsic in the way doctors’ work, which turns more evil, just because of an unexpected poor outcome. Due to  misfortune of the patient, the  randomness of the tragic tale imposed on  the doctor becomes difficult to fathom.

No one can forget the dreadful times of Covid pandemic and the sacrifice of doctors. There was severe scarcity of beds, drugs, and even oxygen, a scary situation no one even imagined. There was  no one inside Covid ICU’s, none of the  relatives to support  their patients, except doctors and nurses.

     A patient who comes with 60 % saturation level of oxygen, but wants Remdesivir to be administered. His wish to get administered Remdesivir is taken as a legal contract between doctor and patient. Without  realizing that in such situations  administration of oxygen was   lifesaving but Remdesivir was not.  Doctors know the fact but patients are commonly misguided by the media reports.  Patients insisting upon Remdesivir,  that was not available. But could the doctor refer the patient to some other hospital with 60% saturation- especially in those uncertain times-taking that risk was not a feasible option. What would an average doctor have done? Only option was to  manage the  dangerous and precariously low oxygen levels. That is a standard medical teaching in critical situations. All drugs are of secondary importance. In this case, as proved by later studies – role of Remdesivir turned out to be doubtful, but oxygen was proved to be of real help.

    But patients precondition for admission was to get Remdesivir, a false belief generated more by media than scientific evidence. A false belief hence generated by media gave Remdesivir  the status of  a panacea and lot of money to the company, who sold it.

    But medicolegal compulsions  stamped the administration of Remdesivir as a contract between doctor and patient. A contract that needed to be fulfilled, akin to that of constructing a building. But it is actually different to treat critical human ailments from constructing a building. They cannot be treated merely by wish of the patient. Unfortunately, Remdesivir was not available and all the blame for death was conveniently loaded on the treating doctor.

  Doctors’ dilemma in present era is generated by conflicting solutions given by medicolegal implications and principles of medical science. Needless to say, doctors  will have adopt to defensive practice to save themselves from medico-legal harassments. For example in this case, doctor could have sent patient to some other hospital (in sick condition), according to patients’ wish for Remdesivir. But would that have been a right decision from medical point of view.  But legally it would have been safer for doctors.

 In other words- the blame -patient didn’t die of Covid-19 but because of lack of Remdesivir. What a sad conclusion for doctors? Non-availability of drugs is not doctors’fault.

   To save themselves from such medico-legal predicaments, aspiring doctors needs to think whether they should put themselves in such a situation akin to catching a falling knife.  

NOIDA: Five doctors of a private hospital have been booked under IPC Section 304A (causing death by negligence) in an FIR filed on the recommendation from the health department, whose preliminary inquiry found merit in allegations of a “delay” in administering remdesivir to a 22- year-old college student who died during the second wave of Covid last year. The management of Yatharth Hospital here rejected the charge, saying its doctors did their best to treat the patient, who was admitted in a critical state in April 2021. They also pointed to a remdesivir shortage at the time, and subsequent research that says the antiviral drug does not help in Covid treatment. A top-ranking official of the Indian Medical Association, meanwhile, stressed the need for a central law to safeguard doctors against such “violent action”. In cases of negligence against doctors, the health department has to verify allegations before a case is registered by police. In December 2021, Pradeep Sharma had told UP’s Pandemic Public Redressal Committee that his son Deepanshu (22) was not given the remdesivir injection on the first day of his admission to Yatharth Hospital in Sector 110 on April 30. This was despite the family having paid for the treatment, Sharma, a resident of Vijay Nagar in Ghaziabad, alleged. The committee forwarded the complaint to the health department in January 2022. “The preliminary inquiry has found negligence on part of the doctors as a delay was made in administering remdesivir injection to the patient,” the deputy CMO said in the inquiry report. Police said they would now be able to take up the case for investigation. The hospital administration defended its doctors and their line of treatment. “Deepanshu Sharma was brought to us with severe illness. His oxygen saturation was just around 60% and his lungs were affected. During Covid’s second wave, there were a lot of patients and the remdesivir injection was also not easily available. But we managed to arrange the injection for him in 2-3 days and administered it to him,” said Dr Kapil Tyagi, managing director of Yatharth Hospital. Deepanshu was admitted to the hospital for 35 days, after which his family shifted him to a private hospital in Delhi. He died at the facility in June. His father could not be reached for comment on Monday

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Treating human frailty & hence the vulnerability-Exploitation of Doctors & Nurses


From the book ‘at the Horizon of Life & death’

Treating emergencies and critical patients has become akin to catching a falling knife. There is  eternal latent vulnerability that is intrinsic in the way doctors’ work, which turns more evil when exploited by many in the society for the vested benefit- ‘media and celebrities’ to sell their news and shows,  by ‘law industry’ and ‘industry’s middlemen’.

 Whenever there is an anecdotal episode of adverse event or poor prognosis in hospitals, it  is aired by media as an illustration to portray whole medical professionals as dystopian community. By theatrically deriding hard work of doctors, the celebrities grabbed eyeballs to be at the centre stage of health care. What remained invisible to all is the fact that every day in hospitals, thousands of lives are salvaged back from the brink of death.

The real hidden agenda is an attempt to project ‘Reel heroes’ as ‘Real heroes’. By self-appointing themselves as custodian of health of masses, ’the film stars’ and celebrities give true meaning to their work of ‘Acting’, that otherwise was no more than a trifling entertainment. When masses worship them as their true well-wishers, they feature in advertisements to sell tobacco, soft drinks, junk foods and other sweet poisons to public and children.

The intentional unfairness of the criticism is evident, since the delineation of the cleft that separates doctors from the actual overpowering and controlling health industry is not unveiled, ensuring to sustain the prejudice with its dangerous bias towards health care workers.

 There is gradual transition of doctor-patient interaction to a business transaction. The pharmaceutical  industry, insurance, law industry and administrative machinery remain hidden in the background and have enormously benefitted by the exploitation of doctors and nurses, who have suffered at the front as the face of the ‘veiled and invisible’ colossal medical business.

The evolving system of corporatization and medicine being projected as a purchasable commodity has resulted in an illogical distribution of health care.  The resources spent by people in last few days of life, mostly in a futile quest to have few more, are equivalent to thousands of times the food and medicine for the poor, who lose lives for fraction of that expense. Since in this era, medical therapies are perceived as purchasable and patient has become a consumer. 

There is persistent  fear  of getting a raw deal amidst tricks and traits of the law industry, if any doctor has to  face a malpractice lawsuit. A brilliant mind gets entangled in a useless clutter and gets engulfed by a strange fear for the imminent misfortune. Just because of an unexpected poor outcome,  randomness of the tragic tale imposed on  the doctor  is difficult to fathom. With element of arbitrariness involved in the medicolegal suits, law industry has got benefitted enormously at the cost of medical profession.

But these utterances against the medical community are not without serious side effects and results in   deteriorating doctor-patient relationship. Mistrust resulted in loss of respect for doctors and predisposed them to all types of violence- be it  verbal, physical, legal or financial, as if uncountable lives saved every moment in hospitals were of no consequence.

 The blame for deficiencies of inept system and poor outcomes of serious diseases was shifted conveniently to doctors, who were unable to retaliate to the powerful media.

Not only such projections shifted and pinpointed the attention to inappropriate issues, but created an unbridgeable gap of trust between doctor and patients.  The fear provoked in the patients’ minds would scare patients to seek help from doctors, who they should be trusting.

The sense of gratitude, which doctors deserved from patients, was replaced by the burden of blame. Even a saved life was thought off merely as a duty fulfilled in lieu of some remuneration.

Consequently, more of doctors’ time is being spent on issues, which are assumed to be worrisome but are not, and less time is spent on the issues that really count.

To control the health system, administrators or even legal systems have a tendency to assume that shortcomings in the patient care can be rectified by punishing the doctors and nurses. For doctors, no gain if they succeed thousand times, but agony assured if they fail once?

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

A Child is Born Free till he chooses to be Doctor # Rohtak-Medicos-fight-Unjust-Bonds


Choosing medical career or being a doctor  has become a struggle in present era. Aspiring doctors need to first think- why they want to be a doctor in such circumstances-enduring all kind of exploitation- from all corners of society?

    Unable to give doctors their rightful, there has been an administrators’ wish to enslave medical profession.  Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.” In a new era of  consumerism, when patient is defined as consumer and medical industry controls medical profession and the financial boundaries. All components of medical industry want their pound of flesh from hard work of doctors and nurses.  Every day routine issues turning into medico-legal hassles have put doctors in the corner, resulting in severe distraction from real point of intention-treatment of patients.

      Struggling to get admission in medical college, slogging in wards to learn and earn degrees, work in inhuman conditions, listen to endless abuses, tolerate the false media criticism, dragged in courts for alleged negligence, work with fear of physical assaults, work without proper infrastructure and manpower, endangering their own lives, exploited by medical  industry and administrators, poorly paid and  still not respected.   

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

MBBS  medical  students protest against Haryana Govt Bond Policy-Rohtak

Educating a doctor cost less what   medical colleges  claim- a global phenomenon.

   Instead of   often  repeated statements  about high expense on running medical college and  projecting it   as a  hard  fact, the amount spent  on  medical students by all medical colleges should be made transparent by all institutions. The  frequent  statement  is made that  cost of  making a doctor is very high and  gleefully  propagated  by  the  private medical colleges to extract millions out of  young  medical students . 

Such statements without any actual public data  is repeated  to the   extent  that  it  is  firmly  entrenched  in  public  mind without any real evidence.

      Projection of  high cost  of making a doctor  is  the  reason    with an intention  to  exploit the young doctors in various ways to get cheap labour and extract  millions from aspiring doctors  by  medical colleges.

MBBS  medical  students protest against Haryana Govt Bond Policy-Rohtak

MBBS  medical  students protest against Haryana Govt bond policy detained

In a crackdown on MBBS students protesting against Haryana government’s bond policy for government medical colleges, the Rohtak Police detained around 300 students in the early hours of Saturday and registered a First Information Report in this connection.

The police action came ahead of the visit of Governor, Chief Minister and Home Minister to PGI campus for the convocation of Pt. Bhagwat Dayal Sharma University of Health Sciences, Rohtak.

He added that the students were now co-operating with the administration and a meeting was being facilitated between them and the Chief Minister soon after the convocation.

The Haryana government had come out with a policy to incentivise doctors to opt for government service in the State on November 6, 2020, saying that the candidates selected for MBBS degree course in government medical colleges need to execute an annual bond for ₹10 lakh minus the fee at the start of every academic year. The candidate can pay the entire bond amount without recourse to the loan or the State government will facilitate them for availing an education loan for this bond amount. As per the policy, the government will repay the annual instalments of the loan if the candidate obtains employment with the State government.

However, in view of the protests, the CM had three days ago announced that students need not pay the ₹10 lakh bond amount at the time of admission, but instead have to sign a bond-cum-loan agreement of the amount with the college and the bank.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Demonize Doctors: New Fad of Administrators- Accepted Norm for Populism? #Dr-Raj-Bahadur-VC-BFUHS Resigns


Dr Raj Bahadur, the vice-chancellor of Baba Farid University of Health Sciences (BFUHS) in the state’s Faridkot district Punjab, submitted his resignation to the Chief Minister’s Office late on the night of Friday, July 29.  He has resigned after state health minister allegedly forced him to lie on a dirty mattress at a hospital.

         Administrators, who have never treated a patient in their lifetimes, not only try to control treatment of thousands of patients, but project themselves messiah by demonizing doctors. Lowly educated celebrities and administrators have found a new easy way to project themselves on higher pedestrian by publically insulting highly educated but vulnerable doctors. The biggest tragedy to the medical profession in the present era is the new fad of administrators to discourage and demonize  the  medical profession for their popularity gains.
          Being  so distant from the ground reality, their role should not have been more than facilitators, but they have become medical  administrators. To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.
          Such vulnerability to insult is intrinsic to the doctors’ work, makes them sitting ducks, an easy target for harassment and punishments, if administrators wishes to do so. This vulnerability is exploited by everyone to their advantage. Administrators use this vulnerability to supress them. It is used by media and   celebrities who projected themselves as Messiah for the cause of patients, and sell their news and shows by labelling the whole community of doctors as king of fleece tragedy based on just one stray incident. 

       The painful incident of Dr Raj Bahadur’s   humiliation unmasks the everyday struggle of the doctors in the present era. His resignation  after the public insult  depicts the plight of doctors – being undervalued and demonized by administrators, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment.  The incident has unveiled the despondency, moral burden of mistrust that doctors carry.

  Sadly, the society is unable to realize its loss.

    Bullied by  administrative systems,  indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment.  Is there any punishment for the  administrators for mismanagement or poor infrastructure or lack of funds? Looks impossible but punishment to the sufferers is on the cards.

     Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic  should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world. Role of doctor associations, parent institutes has remained more or less weak, spineless and not encouraging.

     Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who are unable to retaliate to the powerful media machinery.

Faridkot district, submitted his resignation to the Chief Minister’s Office late on the night of Friday, July 29.

 

       New Delhi: The vice-chancellor of a medical college in Punjab has resigned after state health minister allegedly forced him to lie on a dirty mattress at a hospital.

Dr Raj Bahadur, the vice-chancellor of Baba Farid University of Health Sciences (BFUHS) in the state’s Faridkot district, submitted his resignation to the Chief Minister’s Office late on the night of Friday, July 29.

Hours earlier state health minister Chetan Singh Jouramajra had asked him to lie down on a dirty mattress during an inspection of Faridkot’s Guru Gobind Singh Medical College and Hospital, which comes under the BFUHS.

A video clip of the incident that circulated on the social media, showed Jouramajra place a hand on the veteran surgeon’s shoulder as he pointed towards the “damaged and dirty condition” of the mattress inside the hospital’s skin department.

The minister then allegedly forced Bahadur to lie down on the same mattress.

Though the vice-chancellor himself did not confirm his resignation, highly placed sources in the health department confirmed the same to multiple outlets. When approached for comments,  reports that The Tribune Bahadur said, “I have expressed my anguish to the Chief Minister and said I felt humiliated.”

Reports have it that chief minister Bhagwant Mann has expressed his displeasure over the incident and spoken to Jouramajra. Mann has also asked Bahadur to meet him next week.

Speaking to The Indian Express, Bahadur additionally said: “I have worked in 12-13 hospitals so far but have never faced such behaviour from anyone till now. I shouldn’t have been treated this way… it affects this noble profession. It is very painful. He showed his temperament, I showed my humility.”

Bahadur is a specialist in spinal surgery and joint replacement and a former director-principal of Government Medical College and Hospital in Chandigarh. He has also been the head of the orthopaedic department at PGIMER, Chandigarh.

Asked whether new mattresses had been ordered for the hospital, he said: “Two firms sent their quotations and the rate finalisation needs to be done. It is a 1,100-bed hospital and not all mattresses are in bad condition. This mattress shouldn’t have been there but hospital management is the prerogative of the Medical Superintendent.”

Speaking to reporters at the hospital, Jouramajra said: “My intention was not to do any inspection. In fact, I am visiting various hospitals to see what the requirements are so that we can fulfil them.”

Various quarters, including the Indian Medical Association, have criticised Jouramajra.

PCMS Association, a doctors’ body in Punjab, to,  in a statement, strongly condemned the “unceremonious treatment” meted out to Bahadur. PCMSA said the way the V-C was treated was “deplorable”, its reason notwithstanding.

The body expressed its “deep resentment” over the incident and said “public shaming of a senior doctor on systemic issues is strongly condemn-able.”

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes        

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons              

Expensive Medical College  seat- Is it worth it?

Health Ministry Chief Israel rails at ‘atmosphere that permits blood-shed of healthcare providers’


Nachman Ash rails at ‘atmosphere that permits blood[shed] of healthcare providers’; nurses’ union announces it will join work slowdown

   Violence against doctors has become a serious issue across the globe. The underlying basic  reason for the omnipresent malaise is the altered doctor-patient equation globally and growing mistrust in the saviours. The mistrust is propagated by opportunist medical industry, media and law industry for their selfish motives as doctors are shown as front men for the failures.  Poor outcomes are projected because of medical errors and mistakes. Every death is thought to be because of negligence rather than a natural complication of the disease.  Because of the instigation and poor law enforcement in favour of doctors, the response of  lay public to these unfortunate incidents has become extremely erratic and out of proportion. As Governments remain more or less indifferent, and doctors have become punching bags for inept health systems.  Law industry has been enormously benefitted financially due to medico-legal cases against doctors. Media has sold their news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations.  An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors.   There is a little token action by police after routine incident of violence against doctors.

    Consequently violence (legal, verbal or physical) against doctor has acquired an epidemic proportion, omnipresent world-wide. As a result, medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.

   But in Israel, doctors, nurses and health care workers seem to be united against this menace and their associations are actively pursuing the issue. More-over the Government also seem to be sensitive to the issue in Israel.

Nachman Ash rails at ‘atmosphere that permits blood[shed] of healthcare providers’; nurses union announces it will join work slowdown

Nachman Ash rails at ‘atmosphere that permits blood[shed] of healthcare providers’; nurses union announces it will join work slowdown

Health Ministry Director-General Nachman Ash on Wednesday sharply criticized the ongoing violence against healthcare providers, a day after a doctor was badly beaten by a patient at a community clinic.“It’s a general atmosphere that permits the blood[shed] of healthcare providers and for no reason,” Ash told the Ynet news site. “A doctor was busy and couldn’t see a patient so he broke into a room with an iron bar and hit her on repeatedly on the head and other parts of her body.

“I talked to the doctor and I understand that it was very fortunate that it ended the way it did [and wasn’t worse],” he said.

“It’s just shocking, and this violent discourse and behavior must be stopped.”

Ash also linked repeated incidents of violence against healthcare providers to anti-vaccine discourse that became prevalent during the coronavirus pandemic. “The connection exists because any discourse that encourages violence ultimately also leads to violence. These are two things that until now we did not want to link,” Ash said. “The violence toward [officials] is one matter and this violence toward healthcare providers is a second issue. But everything is connected.”

A number of top officials and doctors have faced verbal abuse and threats from anti-vaccine activists. Most notably, Dr. Sharon Alroy-Preis, the Health Ministry’s head of public services and a top COVID adviser to the government, has been repeatedly threatened by anti-vaccine activists and conspiracy theorists who view her as the public face of the health system’s inoculation effort. Ash noted that while there were newly announced plans to station police at hospitals, community clinics were more of an issue.

“It really is a much bigger challenge. I want to say that having police in hospitals will not solve everything either. It is impossible to put a police officer in every clinic — that is clear. I believe that punishment is the key, to create deterrence,” AAsh’s comments came as the suspect in Tuesday’s attack on a doctor in the central city of Be’er Yaakov appeared in court on Wednesday for a remand hearing. Police were seeking to charge him with attempted murder.

According to the Kan public broadcaster, the court was told that the suspect is alleged to have attacked the doctor with a meat tenderizer.According to police, the suspect, a resident of the town in his 30s, went to the clinic for medical treatment. While at the clinic he began to behave wildly. He refused to leave when asked by the doctor to do so, and instead grabbed a weapon and hit her on the head.

The doctor was moderately wounded and taken to a nearby hospital for further treatment. The man was apprehended by police shortly afterwards.Tuesday’s attack was the latest in a string of acts of violence in hospitals and clinics in recent months. In the wake of the latest attack, the doctor’s union announced staff at public hospitals and clinics will go on a two-day strike to protest violence against medics, by operating on a weekend schedule with reduced services for all of Thursday and Friday.

“We have made it clear over the past year unequivocally that any case of violence will encounter zero tolerance on our part,” the chairman of the Israel Medical Association, Prof. Zion Hagay, said on Tuesday.

“The most recent strike has led to an important government decision to place police in emergency rooms and allocate the necessary manpower, but we must look solely at how things are implemented on the ground. As long as we do not see real action in the immediate term, we will intensify our actions until someone here wakes up and understands that violence in the health system is a real epidemic,” he said. The nurses union said Wednesday that it will be joining the strike.

The upcoming strike is the second initiated by the doctors’ union in recent weeks. A labor action was called last month after family members of a patient who died at a Jerusalem hospital attacked medical staff and caused significant damage to an intensive care unit after they were informed of his death.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Obeisance for Dr Archana Sharma: Bigger Role for Doctors’ Associations


The painful incident of Dr Archana Sharma’s Suicide unmasks the everyday struggle of the doctors in the present era. Her supreme sacrifice depicts the plight of doctors- being undervalued and demonized, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment.  Her suicide has unveiled the despondency, moral burden of mistrust that doctors carry. Her death is the result of the apathy of fair justice that eludes medical community. Sadly, the society is unable to realize its loss. Let her sacrifice be a reminder to the whole medical fraternity; either fight against the prevalent injustice or perish, not being able to treat the patients would be a greater disservice to humanity.

Dr Archana Sharma Suicide

      

Dr Archana Sharma Suicide

  It was an incident that was enough to jolt doctors’ and medical associations out of their deep slumber against the everyday sufferings of their members. Protecting and supporting the suffering members against physical and legal assaults should be the need of the hour. But sadly, it was not enough to wake them up. After few days of token protests, everything came  back to routine.  Unfortunately Doctors’ associations have limited their role merely to social gatherings with some token academics.  They have not risen to the real life problems of doctors like goonism, blackmail, physical and legal assaults.  Doctors as individuals remain vulnerable   to these issues and always remain at receiving end of the stick. In this era, doctors’ associations need to play a bigger role especially in cases of medico-legal suits against doctors; to support the sufferers.  As cases of medical negligence may be circumstantial incidents and not real mistakes, courts may not be able to deliver justice to doctors many times. A concern is that in case of poor outcome and case goes to courts, there is an indirect perverse incentive to deliver a guilty verdict against the doctor as a person, who is responsible for life and death.

        Failure of Doctors’ and Medical associations to rise to the occasion even in such a case of blatant cruelty will be a real injustice to DR Archana Sharma.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

#Doctors-‘Earn Hundreds & Pay Back Millions’ #USG-Lab-Nagpur to Pay 1. 25 Cr Compensation


          Is there any other profession, which has such kind of pathetic arrangement? The sufferers of such pitiable deals are doctors. An average doctors studies for decades and treats hundreds of patients for peanuts (Few hundred rupees). For one alleged mistake or just a legal interpretation is forced to pay millions for an incident, which can be merely procedural or circumstantial mistake.

  Why one should be putting his/her future into such pathetic arrangements? The inspiring doctors need to think.

          Large claims granted by courts are incentives for patients and lawyers for putting medical lawsuits. In an era, where people fight with their parents, brothers and sisters for money and property, it will be naive to think that idea of making money from doctor does not exist.

          Now-a-days medical professionals need to not only be thorough with their medical subjects and the medico-legal implications, but also  need to be careful about how courts may interpret the medical processes. What doctors think is a correct   medical process, but it can be interpreted as negligence, in case of an adverse outcome. Other contributing factors that nail down medical profession are the sympathy to the patient and wisdom of hindsight,   which everyone is flushed with as an after event.  

          Large compensations against medical profession are  the single important factor can increase the cost of  healthcare and demoralize medical profession.   Doctors  are always on the receiving end in case of an adverse outcome.    Medical problems are very complex and sometimes it is difficult to judge  the future course of  disease as well as court  interpretation of  medical science, especially  with retrospective wisdom  by courts.  Summarily doctors have to safeguard themselves from treatment as well as legal and documentation hassles.

         Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors.  

     Strangely  doctor’s fee are quite low but lawyers charges and court compensations are really astronomical amounts, which are beyond any logic.

New Delhi: In a landmark order, the National Consumer Commission (NCDRC) has ordered Nagpur-based Ultrasound Scanning and Imaging Center to pay a compensation of Rs 1.2 crore to a disabled child and his parents in a medical negligence case. The firm has been blamed for misreporting of ultrasound on four occasions during pregnancy, resulting in the birth of a child with congenital anomalies.
Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. The commission held that the ultrasonology center also failed to offer to terminate the pregnancy, failing to diagnose defects at an early stage. The newborn had finger pain (complete absence), right leg below the knee and left leg below the ankle joint.
The clinic – Imaging Point – was run by Radiologist Dr Dilip Ghik in Nagpur. Holding him and his clinic responsible for their failure to detect structural anomalies of the fetus at 17-18 weeks, a two-member NCDRC bench comprising Justices RK Agrawal and SM Kantikar asked them to provide for the child’s welfare, future expenses asked to pay compensation for  the treatment and purchase of limb prostheses.
The order said, “The amount shall be kept as a fixed deposit in any nationalized bank (preferably SBI) in the name of the child till he attains the age of majority. Parents can get periodic interest on the FD for regular health check-up, treatment and welfare of their child. It also directed the radiologists and their clinics to pay Rs 1 lakh towards legal expenses.
As per the commission’s order, in October 2006, the child’s mother, who was pregnant at the time, consulted a gynecologist and obstetrician. The next month the doctor referred the patient to the imaging point for ultrasonography of the pelvis. USG Ghik and reported normally. Three more ultrasounds were done by the Ultrasound Scanning Centre. All USGs were reported as “no obvious congenital anomalies in the abdomen and spine of the fetal head”.
But when the gynecologist performed an elective caesarean section and after the baby was born, the mother and all the attendants were shocked to see a “severely deformed male newborn”. The girl’s parents had alleged that all this happened due to the negligent ultrasound of the radiologist.
He had prayed for a compensation of Rs 10 crore to meet future expenses. But the radiologist denied any negligence in the patient’s USG report.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Dr Manjula Case NHS-UK: Semantics-Regulator’s own Fitness to Practice Doubtful? #GMC-UK


Regulation of the medical profession has become a tool to oppress doctors.

  Dr Manjula Arora case (NHS-UK) unmasks the everyday struggle of the doctors in present era. Being undervalued and demonized, forced to work as sub-servant to administrators and regulators are considered new normal and has become an accepted form of harassment.  Fatigue and burnout are thought to be routine side effects of being a doctor or nurse.   The unhindered over-regulation has left no stone unturned in spreading hatred and creating an environment of mistrust against the medical profession.  Single stray or a trivial incident   is projected    as an example to portray poor image of medical profession as generalization and as a token of the ‘excellent’ work done by administrators and regulators.   Doctors have become soft targets because of their nature of work as they deal with life and death.   Any trivial issues such as semantics used by Dr Manjula Arora (in this case) were blown out of proportion  and   GMC finds this  as an  opportunity  to send a strict message to the whole profession.  Such incidence  show that regulators and administrators  can use the nature of doctors’ work to be  used against medical profession to make saviours as an  easy prey for  punishments   on the pretext of  dishonesty, negligence or semantics being used  as  legal weapons by law-enforcers, even in case of a perceived bias. In the process of such ‘tokenism’ administrators prove their relevance to the system.

       Regulation of the medical profession has become a tool to oppress doctors. Driving the narrative of doctors as “perfect” beings causes more harm to the doctor-patient relationship than not. Constantly seeking to attain perfection is the very approach that leads to burn out, and more mistakes- causing patient harm.

Dr Manjula Arora’s case

Dr Manjula Arora’s case

Dr Arora has been a doctor since 1988 and is of good character. She asked her employer for a laptop. For context, most employees would reasonably expect their employer to provide work-related IT equipment. She was told that none were available, but her interest would be noted for the next roll-out. Many people would interpret this positive response to mean that they would get a laptop in due course. Clearly if her employer did not intend for her to have a laptop, they could simply have said so. Dr Arora spoke to her IT department about getting a laptop and said she had been ‘promised’ one.

And that’s it. That is the entire extent of her ‘misconduct’.

One could regard her statement as a minor exaggeration, or loose terminology, or careless language or verbal shorthand over a trivial subject.  But no one  should consider it to amount to ‘dishonesty’ unless interpret it in biased manner.

The tribunal took a different view. They concluded that ordinary, decent people would consider her use of the single word ‘promised’ as dishonest.  The tribunal further decided that this so-called dishonesty amounted to misconduct.

They also considered that the misconduct was serious.

They decided her fitness to practice was impaired, and that it was necessary to suspend her to send a message to the profession.The regulator has a difficult task. Good regulation protects patients. Poor regulation harms patients, because doctors will run away from a toxic regulatory environment.

Manjula Arora case: the GMC stumbles again? -BMJ

      The case of Manjula Arora, a GP in Manchester, who has been suspended for a month for supposed “dishonesty” about a laptop, was picked up by a few colleagues, and social media did its work of ensuring the pick-up rate increased exponentially.  One always worries about the latest “MedTwitter” controversy. But this one has come on back of seething annoyance among many doctors about our regulator—the General Medical Council (GMC)—and its perceived bias, with cases such as those of Hadiza Bawa-Garba and Omer Karim still fresh in our memories.

Couple this with the recent Medical Workforce Race Equality Standard (MWRES) data confirming a clear association of increased referrals and convictions on the basis of racial background—or indeed country of origin as regards training—and this case lit the touch paper.

If one considers the publicly available details of the whole trial, you have to scratch your head and wonder how it got to this stage?   Would this happen if the name of the individual was, for example, Michael Andrews?  

The relevance of this case stood on two things—any harm to the patient population, which, to me, should be the primary aim of the GMC, and then dishonesty and disrepute brought upon the medical community.

This ruling makes it clear that there is no risk of harm to the public: “The Tribunal considered that no issues in relation to patient safety had been identified in this case. Dr Arora is a competent clinician, and there is no necessity to protect the public.” That should have ended the issue. But the complications started when interpretation about honesty came into the picture.

“The Tribunal attached significant weight to the fact that Dr Arora’s misconduct was a single incident in relation to the use of a single word, with no evidence of any other similar episodes of dishonesty before or after the event.” If you go into the details of the case, it becomes even more murky, as it’s the interpretation of a word—subjective at best— against the background of someone for whom English is not their first language. But it was deemed enough to warrant a month’s suspension according to the tribunal: “this period would send an appropriate message to the medical profession and to the wider public that Dr Arora’s misconduct, albeit relating to a single fleeting moment of dishonesty and not a planned deception.”

This raises a multitude of questions. Firstly, there is the principle that one fleeting moment of dishonesty could result in suspension. If that’s the standard, then the profession is indeed in trouble, with the GMC now making subjective judgements and being an arbiter of what is deemed to be honest or not. Where does the line get drawn? Discussions about patients or conversations about whether Santa exists or not?

Secondly, and more importantly, there is the suspicion of bias in how that law is being applied. Daniel Sokol has written a recent column which discusses the notion of doctors as the “saintly being”; the epitome of perfection at all times. Yet, within all of us exist the same prejudices and flaws as for the rest of the population. Sokol suggests that doctors have to be “scrupulously honest—in and out of work—unless the situation obviously allows for ethical dishonesty.” Yet he makes no mention of the fact that the GMC seems to apply that principle unevenly across the board. I accept that it can be difficult to see the “problem” others are complaining about, but I can assure you there are very few international medical graduates who have read about Arora’s case and not thought “I know why this has happened.”

There is professionalism, but there is humanity too, and I would propose that driving the narrative of doctors as “perfect” beings causes more harm to the doctor-patient relationship than not. What is honesty? Saying to patients that they need to wait for another 16 hours to get a bed, or holding the hand of the elderly frail lady, comforting her and saying “I am sure something will come up shortly”? It brings back the concept that being a doctor is a vocation. Constantly seeking to attain perfection is the very approach that leads to burn out, and more mistakes—causing patient harm.

Finally, if the role of the GMC is to protect the public from “single moments of untruth,” as this destroys the view among the public that doctors are saints (although I am pretty sure the public don’t see doctors like that in modern life), then there needs to be a discussion of that concept, of the overreach into personal lives, and of where the line is drawn as regards the GMC’s intrusion and inordinate application of that principle. I would suggest the role of the regulator should be for the rare circumstances when there is an interest in behaviour not being repeated or where it cannot be dealt with effectively by an employer.

I work with the GMC closely these days, and I find it immensely frustrating to see such cases as they undermine some significant hard work that is being done by individuals who are determined to change the narrative that the GMC is biased. I would encourage all concerned to look into this case, review it, learn from it, and offer support to Arora. There is a lot of work in hand to repair the damage from the Bawa Garba case, and this case could reinforce those sentiments, which we must avoid.

The intention may once have been for doctors to be Superman, but modern times and the foibles of individuals only permit a Batman. It’s worth remembering neither of them work to harm the public.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Doctors in Israel Protest Violence against Medics


          Violence against doctors has become a serious issue in India. But problem is a global one to some extent. The underlying basic  reason for the omnipresent malaise is the altered doctor-patient equation globally and growing mistrust in the saviours. The mistrust is propagated by opportunist medical industry, media and law industry for their selfish motives as doctors are shown as front men for the failures.  Poor outcomes are projected because of medical errors and mistakes. Every death is thought to be because of negligence rather than a natural complication of the disease.  Because of the instigation and poor law enforcement in favour of doctors, the response of  lay public to these unfortunate incidents has become extremely erratic and out of proportion. As Governments remain more or less indifferent, and doctors have become punching bags for inept health systems.  Law industry has been enormously benefited financially due to medico-legal cases against doctors. Media has sold their news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations.  An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors.  Local goons have blackmailed doctors over genuine complications and the natural deaths occurring in hospitals.    There is a little token action by police after routine incident of violence against doctors.

  Consequently violence (legal, verbal or physical) against doctor has acquired an epidemic proportion, omnipresent world-wide. As a result, medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.

   But in Israel, doctors seem to be united against this menace and their associations are actively pursuing the issue.

          Doctors in Israel to Protest Violence against Medics 

The strike was called after family members of a patient who died at a Jerusalem hospital on Monday attacked medical staff and caused significant damage to the intensive care unit after they were informed of his death.

The union said the hospitals and clinics would operate on a weekend schedule for 24 hours on Thursday, offering reduced services.

 

 

Union calls for attacks on medical staff to be treated as severely as attacks on police; action comes after patient’s relatives ran amok in Jerusalem hospital

Staff at public hospitals and clinics will strike on Thursday to protest violence against medics, the doctor’s union announced Tuesday.

The Israel Medical Association, announcing the strike, called for a police presence in every emergency room, and said hospitals and community clinics needed improved security systems. The association also urged a change in legislation so that an attack on medical staff would be viewed with the same severity as an attack on a uniformed police officer. The chairman of the Israel Medical Association, Prof. Zion Hagay, said that Thursday’s strike would be just the start of action taken by the medical establishment if changes were not made to protect workers.

“We have long announced that we will not accept any more incidents of violence in the health system, and it has unfortunately become a real epidemic,” Hagay said at the start of the association’s meeting on Tuesday evening. “The lives of doctors must not be abandoned, and this initial strike is only a warning.”

“As long as the Israeli government does not immediately take the necessary steps to increase the personal security of medical staff, we will not hesitate to increase  it.There has been no announcement from the nurses’ union on whether they will be joining the strike.

The strike comes in the wake of violence at the Hadassah Medical Center in Jerusalem after a patient died there on Monday.

An initial investigation found the patient died after taking an overdose, police said, without giving further details.

Relatives of the man arrived at the hospital and were notified of the patient’s death.

After they were given the news, a number of the patient’s relatives broke doors and windows in the unit, damaged the nurse’s station, computers, and equipment, and attacked staff. Two members of staff were lightly injured, requiring medical treatment.

Police said they arrested an East Jerusalem resident in his twenties on suspicion of being involved in the violent clash at the medical center.

Recent months have seen an increased wave of attacks against medical teams and facilities across the country.

In November, nurses at Haifa’s Rambam Medical Center held a strike for several hours in protest of a violent incident in which staff members were beaten and threatened by the family of a dying cancer patient.

Earlier the same month Rambam said it had to forcibly remove dozens of people who gathered outside the facility after a victim of violence was brought there for treatment. According to hospital officials, riot police were called to the scene to prevent the crowd from entering the hospital.

And in Beersheba, four people were hurt and 19 were arrested in a massive brawl outside Soroka Medical Center that included gunfire.

In 2017, in one of the most severe cases in recent years, a man burned 55-year-old nurse Tova Kararo to death at the Holon clinic at which she worked.

Nurses already held multiple strikes this year and last year over severe staff shortages during Covid, which resulted in additional state funding. 

A doctor and three nurses at Rambam Medical Center in Haifa were assaulted last month by relatives of a cancer patient. Staff were beaten and threatened by the family of the patient, who eventually died, The Times of Israel reported.

Chairwoman of the National Association of Nurses, Ilana Cohen, said at the time that if the government did not take action to fight such violence, “we’ll hold a strike throughout the entire health care system.”

“War has broken out here,” Benny Keller, the head of Rambam’s security, told the Kan public broadcaster Wednesday, according to The Times of Israel

“Two or three times a week, the hospital turns into a battlefield between warring clans.”

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

CJI Ramana’s Concern about Violence against Doctors: too Mild a Remedy, Need Concrete Action


            

            While violence against doctors should be a concern to everyone, more so for the public, but sadly everyone in society has preferred to take advantage and reap benefit of the situation at the cost of doctors. Government has remained more or less indifferent, whereas people don’t have minimum basic health amenities and doctors have become punching bags for inept health system.  Law industry has been enormously benefited financially due to medico-legal cases against doctors. Media and celebrities have sold their shows and news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations.  An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors.  Local goons have blackmailed doctors over genuine complications and the natural deaths occurring in hospitals.  There is a little token action by police after routine incident of violence against doctors. Consequently medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.  Actually public needs to be concerned as the society itself is going to suffer in the long run,  not realizing  that people themselves are responsible for their health problems and not the doctors. 

     At this stage, Chief Justice of India N V Ramana on Saturday expressed serious concern over rising violence against upright and hardworking doctors and lodging of false cases against them.  The show of concern is nice gesture, as problem is clearly evident to all, but merely  expressing a concern at this stage is too mild a remedy.  When cancer is in late stages and  needs a radical surgery,  applying an ointment will not work.

Rising violence against doctors saddening, they deserve better: CJI Ramana            

Rising violence against doctors saddening, they deserve better: CJI Ramana

Chief Justice of India N V Ramana on Saturday expressed serious concern over rising violence against upright and hardworking doctors and lodging of false cases against them. The CJI said that he would also like to pay his tribute to the unending spirit of doctors, who work tirelessly round the clock for their patients. Doctors are mentors, guides, friends and counsellors. They should always remain active members of society, and solve problems faced by the people,” he said. The CJI said, “I am extremely saddened to witness rising violence against doctors. Several false cases are being lodged against upright and hardworking doctors. They need a better, and more secure, working environment.  This is where professional medical associations assume great significance. They have to be proactive in highlighting the demands of doctors.”  The CJI also expressed concern about the healthcare system in India and said that more than 70 per cent of the population resides in rural areas where people don’t have minimum basic amenities, forget about the comfort of corporate hospitals.

“Even Primary Health Centres (PHC) are also not properly equipped, if there is a PHC there are no doctors and if there is a doctor, there is no PHC. If both are there, there is no infrastructure. This is the situation in this country and in this scenario this type of affordable technique of detecting cancer through ultrasound at the preliminary stage is very helpful,” the CJI said.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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