My second book has been released on Amazon worldwide. The book ‘A Midnight Adieu during Indo-Pak Partition 1947’ is a story of Dr Paras Ram family. Today story is about the book, so it is little different from usual medical topics of this blog.
The Massive Betrayal- No One to Blame
In this book, Narain has narrated the true incidents of his life during Indo-Pak partition in 1947. His story depicts the tragedy of millions during riots amidst celebrations for independence by others. Innocent Hindus and Sikhs, who had nothing to do with politics, went through a nightmare and the worst phase of their life because of weak statesmanship and poor capabilities of their leaders. It was highly impractical to assume that Muslims in Pakistan would remain neutral to Hindu minority, who were left behind.
The painful truth that his father, Dr Paras Ram was killed by Baloch’s own army and not by rioters still burns Narain inside. How human greed intertwined with religious fanaticism and communalism changed life of millions of families overnight, still haunts him. With no serious policing, coupled with Government indifference, the partition turned out to be unthinkable nightmare for the masses.
The book is a kaleidoscope of Narain’s pained soul where he only has one unanswered question for his countryman far and near; were these atrocities borne by minorities worth their unanimous dark lives. Why masses as humans refuse to take lessons from such inhumane religious conflicts and never take refuge in any recourse for alleviating inhuman act and conflicts for our generations to grow with.
For the victims, neither religion nor Government was helpful. The differences over faith and religion had put people through beastly times. If this was all in the name of religion, one would say it is better not to have religion at all.
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.
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.
Thyroid gland creates and produces hormones that play a role in many different systems throughout your body. When your thyroid makes either too much or too little of these important hormones, it’s called a thyroid disease. There are several different types of thyroid disease, including hyperthyroidism, hypothyroidism, thyroiditis and Hashimoto’s thyroiditis.
What is the thyroid?
The thyroid gland is a small organ that’s located in the front of the neck, wrapped around the windpipe (trachea). It’s shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of your throat. The thyroid is a gland. You have glands throughout your body, where they create and release substances that help your body do a specific thing. Your thyroid makes hormones that help control many vital functions of your body.
When your thyroid doesn’t work properly, it can impact your entire body. If your body makes too much thyroid hormone, you can develop a condition called hyperthyroidism. If your body makes too little thyroid hormone, it’s called hypothyroidism. Both conditions are serious and need to be treated by your healthcare provider.
Your thyroid has an important job to do within your body — releasing and controlling thyroid hormones that control metabolism. Metabolism is a process where the food you take into your body is transformed into energy. This energy is used throughout your entire body to keep many of your body’s systems working correctly. Think of your metabolism as a generator. It takes in raw energy and uses it to power something bigger.
The thyroid controls your metabolism with a few specific hormones — T4 (thyroxine, contains four iodide atoms) and T3 (triiodothyronine, contains three iodide atoms). These two hormones are created by the thyroid and they tell the body’s cells how much energy to use. When your thyroid works properly, it will maintain the right amount of hormones to keep your metabolism working at the right rate. As the hormones are used, the thyroid creates replacements.
This is all supervised by something called the pituitary gland. Located in the center of the skull, below your brain, the pituitary gland monitors and controls the amount of thyroid hormones in your bloodstream. When the pituitary gland senses a lack of thyroid hormones or a high level of hormones in your body, it will adjust the amounts with its own hormone. This hormone is called thyroid stimulating hormone (TSH). The TSH will be sent to the thyroid and it will tell the thyroid what needs to be done to get the body back to normal.
What is thyroid disease?
Thyroid disease is a general term for a medical condition that keeps your thyroid from making the right amount of hormones. Your thyroid typically makes hormones that keep your body functioning normally. When the thyroid makes too much thyroid hormone, your body uses energy too quickly. This is called hyperthyroidism. Using energy too quickly will do more than make you tired — it can make your heart beat faster, cause you to lose weight without trying and even make you feel nervous. On the flip-side of this, your thyroid can make too little thyroid hormone. This is called hypothyroidism. When you have too little thyroid hormone in your body, it can make you feel tired, you might gain weight and you may even be unable to tolerate cold temperatures.
These two main disorders can be caused by a variety of conditions. They can also be passed down through families (inherited).
Who is affected by thyroid disease?
Thyroid disease can affect anyone — men, women, infants, teenagers and the elderly. It can be present at birth (typically hypothyroidism) and it can develop as you age (often after menopause in women).
Thyroid disease is very common, with an estimated 20 million people in the Unites States having some type of thyroid disorder. A woman is about five to eight times more likely to be diagnosed with a thyroid condition than a man.
You may be at a higher risk of developing a thyroid disease if you:
Have a family history of thyroid disease.
Have a medical condition (these can include pernicious anemia, type 1 diabetes, primary adrenal insufficiency, lupus, rheumatoid arthritis, Sjögren’s syndrome and Turner syndrome).
Take a medication that’s high in iodine (amiodarone).
Are older than 60, especially in women.
Have had treatment for a past thyroid condition or cancer (thyroidectomy or radiation).
SYMPTOMS AND CAUSES
What causes thyroid disease?
The two main types of thyroid disease are hypothyroidism and hyperthyroidism. Both conditions can be caused by other diseases that impact the way the thyroid gland works.
Conditions that can cause hypothyroidism include:
Thyroiditis: This condition is an inflammation (swelling) of the thyroid gland. Thyroiditis can lower the amount of hormones your thyroid produces.
Hashimoto’s thyroiditis: A painless disease, Hashimoto’s thyroiditis is an autoimmune condition where the body’s cells attack and damage the thyroid. This is an inherited condition.
Postpartum thyroiditis: This condition occurs in 5% to 9% of women after childbirth. It’s usually a temporary condition.
Iodine deficiency: Iodine is used by the thyroid to produce hormones. An iodine deficiency is an issue that affects several million people around the world..
A non-functioning thyroid gland: Sometimes, the thyroid gland doesn’t work correctly from birth. This affects about 1 in 4,000 newborns. If left untreated, the child could have both physical and mental issues in the future. All newborns are given a screening blood test in the hospital to check their thyroid function.
Conditions that can cause hyperthyroidism include:
Graves’ disease: In this condition the entire thyroid gland might be overactive and produce too much hormone. This problem is also called diffuse toxic goiter (enlarged thyroid gland).
Nodules: Hyperthyroidism can be caused by nodules that are overactive within the thyroid. A single nodule is called toxic autonomously functioning thyroid nodule, while a gland with several nodules is called a toxic multi-nodular goiter.
Thyroiditis: This disorder can be either painful or not felt at all. In thyroiditis, the thyroid releases hormones that were stored there. This can last for a few weeks or months.
Excessive iodine: When you have too much iodine (the mineral that is used to make thyroid hormones) in your body, the thyroid makes more thyroid hormones than it needs. Excessive iodine can be found in some medications (amiodarone, a heart medication) and cough syrups.
Is there a higher risk of developing thyroid disease if I have diabetes?
If you have diabetes, you’re at a higher risk of developing a thyroid disease than people without diabetes. Type 1 diabetes is an autoimmune disorder. If you already have one autoimmune disorder, you are more likely to develop another one.
For people with type 2 diabetes, the risk is lower, but still there. If you have type 2 diabetes, you’re more likely to develop a thyroid disease later in life.
Regular testing is recommended to check for thyroid issues. Those with type 1 diabetes may be tested more often — immediately after diagnosis and then every year or so — than people with type 2 diabetes. There isn’t a regular schedule for testing if you have type 2 diabetes, however your healthcare provider may suggest a schedule for testing over time.
If you have diabetes and get a positive thyroid test, there are a few things to you can do to help feel the best possible. These tips include:
Getting enough sleep.
Exercising regularly.
Watching your diet.
Taking all of your medications as directed.
Getting tested regularly as directed by your healthcare provider.
There are a variety of symptoms you could experience if you have a thyroid disease. Unfortunately, symptoms of a thyroid condition are often very similar to the signs of other medical conditions and stages of life. This can make it difficult to know if your symptoms are related to a thyroid issue or something else entirely.
For the most part, the symptoms of thyroid disease can be divided into two groups — those related to having too much thyroid hormone (hyperthyroidism) and those related to having too little thyroid hormone (hypothyroidism).
Symptoms of an overactive thyroid (hyperthyroidism) can include:
Experiencing anxiety, irritability and nervousness.
Hair loss is a symptom of thyroid disease, particularly hypothyroidism. If you start to experience hair loss and are concerned about it, talk to your healthcare provider.
Can thyroid issues cause seizures?
In most cases, thyroid issues don’t cause seizures. However, if you have a very severe cases of hypothyroidism that hasn’t been diagnosed or treated, your risk of developing low serum sodium goes up. This could lead to seizures.
Sometimes, thyroid disease can be difficult to diagnose because the symptoms are easily confused with those of other conditions. You may experience similar symptoms when you are pregnant or aging and you would when developing a thyroid disease. Fortunately, there are tests that can help determine if your symptoms are being caused by a thyroid issue. These tests include:
Blood tests.
Imaging tests.
Physical exams.
Blood tests
One of the most definitive ways to diagnose a thyroid problem is through blood tests. Thyroid blood tests are used to tell if your thyroid gland is functioning properly by measuring the amount of thyroid hormones in your blood. These tests are done by taking blood from a vein in your arm. Thyroid blood tests are used to see if you have:
Hyperthyroidism.
Hypothyroidism.
Thyroid blood tests are used to diagnose thyroid disorders associated with hyper- or hypothyroidism. These include:
The specific blood tests that will be done to test your thyroid can include:
Thyroid-stimulating hormone (TSH) is produced in the pituitary gland and regulates the balance of thyroid hormones — including T4 and T3 — in the bloodstream. This is usually the first test your provider will do to check for thyroid hormone imbalance. Most of the time, thyroid hormone deficiency (hypothyroidism) is associated with an elevated TSH level, while thyroid hormone excess (hyperthyroidism) is associated with a low TSH level. If TSH is abnormal, measurement of thyroid hormones directly, including thyroxine (T4) and triiodothyronine (T3) may be done to further evaluate the problem. Normal TSH range for an adult: 0.40 – 4.50 mIU/mL (milli-international units per liter of blood).
T4: Thyroxine tests for hypothyroidism and hyperthyroidism, and used to monitor treatment of thyroid disorders. Low T4 is seen with hypothyroidism, whereas high T4 levels may indicate hyperthyroidism. Normal T4 range for an adult: 5.0 – 11.0 ug/dL (micrograms per deciliter of blood).
FT4: Free T4 or free thyroxine is a method of measuring T4 that eliminates the effect of proteins that naturally bind T4 and may prevent accurate measurement. Normal FT4 range for an adult: 0.9 – 1.7 ng/dL (nanograms per deciliter of blood)
T3: Triiodothyronine tests help diagnose hyperthyroidism or to show the severity of hyperthyroidism. Low T3 levels can be observed in hypothyroidism, but more often this test is useful in the diagnosis and management of hyperthyroidism, where T3 levels are elevated. Normal T3 range: 100 – 200 ng/dL (nanograms per deciliter of blood).
FT3: Free T3 or free triiodothyronine is a method of measuring T3 that eliminates the effect of proteins that naturally bind T3 and may prevent accurate measurement. Normal FT3 range: 2.3 – 4.1 pg/mL (picograms per milliliter of blood)
These tests alone aren’t meant to diagnose any illness but may prompt your healthcare provider to do additional testing to evaluate for a possible thyroid disorder.
Additional blood tests might include:
Thyroid antibodies: These tests help identify different types of autoimmune thyroid conditions. Common thyroid antibody tests include microsomal antibodies (also known as thyroid peroxidase antibodies or TPO antibodies), thyroglobulin antibodies (also known as TG antibodies), and thyroid receptor antibodies (includes thyroid stimulating immunoglobulins [TSI] and thyroid blocking immunoglobulins [TBI]).
Calcitonin: This test is used to diagnose C-cell hyperplasia and medullary thyroid cancer, both of which are rare thyroid disorders.
Thyroglobulin: This test is used to diagnose thyroiditis (thyroid inflammation) and to monitor treatment of thyroid cancer.
Talk to your healthcare provider about the ranges for these thyroid blood tests. Your ranges might not be the same as someone else’s. That’s often alright. If you have any concerns or worries about your blood test results, talk to your provider.
Imaging tests
In many cases, taking a look at the thyroid itself can answer a lot of questions. Your healthcare provider might do an imaging test called a thyroid scan. This allows your provider to look at your thyroid to check for an increased size, shape or growths (nodules).
Your provider could also use an imaging test called an ultrasound. This is a diagnostic procedure that transmits high-frequency sound waves, inaudible to the human ear, through body tissues. The echoes are recorded and transformed into video or photographic images. You may think of ultrasounds related to pregnancy, but they are used to diagnose many different issues within your body. Unlike X-rays, ultrasounds do not use radiation.
There’s typically little or no preparation before your ultrasound. You don’t need to change your diet beforehand or fast. During the test, you’ll lie flat on a padded examining table with your head positioned on a pillow so that your head is tilted back. A warm, water-soluble gel is applied to the skin over the area that’s being examined. This gel won’t hurt your skin or stain your clothes. Your healthcare provider will then apply a probe to your neck and gently move it around to see all parts of the thyroid.
An ultrasound typically takes about 20 to 30 minutes.
Physical exam
Another way to quickly check the thyroid is with a physical exam in your healthcare provider’s office. This is a very simple and painless test where your provider feels your neck for any growths or enlargement of the thyroid.
Your healthcare provider’s goal is to return your thyroid hormone levels to normal. This can be done in a variety of ways and each specific treatment will depend on the cause of your thyroid condition.
If you have high levels of thyroid hormones (hyperthyroidism), treatment options can include:
Anti-thyroid drugs (methimazole and propylthioracil): These are medications that stop your thyroid from making hormones.
Radioactive iodine: This treatment damages the cells of your thyroid, preventing it from making high levels of thyroid hormones.
Beta blockers: These medications don’t change the amount of hormones in your body, but they help control your symptoms.
Surgery: A more permanent form of treatment, your healthcare provider may surgically remove your thyroid (thyroidectomy). This will stop it from creating hormones. However, you will need to take thyroid replacement hormones for the rest of your life.
If you have low levels of thyroid hormones (hypothyroidism), the main treatment option is:
Thyroid replacement medication: This drug is a synthetic (man-made) way to add thyroid hormones back into your body. One drug that’s commonly used is called levothyroxine. By using a medication, you can control thyroid disease and live a normal life.
Are there different types of thyroid removal surgery?
If your healthcare provider determines that your thyroid needs to be removed, there are a couple of ways that can be done. Your thyroid may need to be completely removed or just partially. This will depend on the severity of your condition. Also, if your thyroid is very big (enlarged) or has a lot of growths on it, that could prevent you from being eligible for some types of surgery.
The surgery to remove your thyroid is called a thyroidectomy. There are two main ways this surgery can be done:
With an incision on the front of your neck.
With an incision in your armpit.
The incision on the front of your neck is more of the traditional version of a thyroidectomy. It allows your surgeon to go straight in and remove the thyroid. In many cases, this might be your best option. You may need this approach if your thyroid is particularly big or has a lot of larger nodules.
Alternatively, there is a version of the thyroid removal surgery where your surgeon makes an incision in your armpit and then creates a tunnel to your thyroid. This tunnel is made with a special tool called an elevated retractor. It creates an opening that connects the incision in your armpit with your neck. The surgeon will use a robotic arm that will move through the tunnel to get to the thyroid. Once there, it can remove the thyroid back through the tunnel and out of the incision in your armpit.
This procedure is often called scarless because the incision is under your armpit and out of sight. However, it’s more complicated for the surgeon and the tunnel is more invasive for you. You may not be a candidate for this type of thyroid removal if you:
Are not at a healthy body weight.
Have large thyroid nodules.
Have a condition like thyroiditis or Graves’s disease.
Talk to your doctor about all of your treatment options and the best type of surgery for you.
How long does it take to recover from thyroid surgery (thyroidectomy)?
It will take your body a few weeks to recover after your thyroid is surgically removed (thyroidectomy). During this time you should avoid a few things, including:
Submerging your incision under water.
Lifting an object that’s heavier than 15 pounds.
Doing more than light exercise.
This generally lasts for about two weeks. After that, you can return to your normal activities.
OUTLOOK / PROGNOSIS
How long after my thyroid is removed will my tiredness go away?
Typically, you will be given medication to help with your symptoms right after surgery. Your body actually has thyroid hormone still circulating throughout it, even after the thyroid has been removed. The hormones can still be in your body for two to three weeks. Medication will reintroduce new hormones into your body after the thyroid has been removed. If you are still feeling tired after surgery, remember that this can be a normal part of recovering from any type of surgery. It takes time for your body to heal. Talk to your healthcare provider if you are still experiencing fatigue and other symptoms of thyroid disease after surgery.
If part of my thyroid is surgically removed, will the other part be able to make enough thyroid hormones to keep me off of medication?
Sometimes, your surgeon may be able to remove part of your thyroid and leave the other part so that it can continue to create and release thyroid hormones. This is most likely in situations where you have a nodule that’s causing your thyroid problem. About 75% of people who have only one side of the thyroid removed are able to make enough thyroid hormone after surgery without hormone replacement therapy.
Should I exercise if I have a thyroid disease?
Regular exercise is an important part of a healthy lifestyle. You do not need to change your exercise routine if you have a thyroid disease. Exercise does not drain your body’s thyroid hormones and it shouldn’t hurt you to exercise. It is important to talk to your healthcare provider before you start a new exercise routine to make sure that it’s a good fit for you.
Can I live a normal life with a thyroid disease?
A thyroid disease is often a life-long medical condition that you will need to manage constantly. This often involves a daily medication. Your healthcare provider will monitor your treatments and make adjustments over time. However, you can usually live a normal life with a thyroid disease. It may take some time to find the right treatment option for you and control your hormone levels, but then people with these types of conditions can usually live life without many restrictions.
The medical profession and education have become a business and now the regulation of medical education has also gone that way which is the nation’s tragedy, an anguished Supreme Court said on Tuesday, giving one chance to the Centre to put its “house in order” and take a call on reversing the changes made to the NEET Super Speciality Examination 2021 syllabus.
The apex court was not satisfied with the justification given by the Centre, National Board of Examination (NBE) and National Medical Commission (NMC) on making the last minute changes after the notification for examination was issued in July.
“This is how botched up our education system has become,” it said.
A bench of Justices D Y Chandrachud, Vikram Nath and B V Nagarathna in an over two hour hearing gave time to the Centre, NBE and NMC to come up with a solution by Wednesday morning and said it will continue hearing the matter to avoid any prejudice to the young doctors.
“This matter is part heard and you can still put your house in order, we will give you time until tomorrow. We will not adjourn the part heard matter now as this will only cause prejudice to the students but we hope better sense prevails. If there is a sense of obduracy, then we are armed with law and they are long enough to reach out to the obduracy. We are giving you one opportunity to reform,” the bench said.
The top court was hearing a batch of pleas of 41 Post Graduate doctors and others who have challenged the last minute changes made to the syllabus after the notification for examination was issued on July 23 for the test to be held on November 13 and 14.
Additional Solicitor General (ASG) Aishwarya Bhati, appearing for the Centre, said the court should not get the impression that the last minute change in syllabus was done to fill vacant seats in private colleges and they will try to persuade the court to dispel this notion.
“We are getting a strong impression that the medical profession has become a business, medical education has become a business and the regulation of medical education has also become a business. That’s the tragedy of the nation,” the bench said.
The authorities should show some concern for the students, as these are the students who do not start preparation for these course two or three months in advance but right from the time they join a Postgraduate course, they aspire for a super speciality, which requires years of commitment, it said.
The government has to balance out the investment made by the private sector in these medical colleges but it should equally think in the interest of the medical profession and the interest of students, the top court said.
“The interest of students must weigh far higher because they are the people who are going to be a torch bearer of providing medical care and it seems perhaps we have forgotten them in the whole process,” it said.
The top court said that prior to 2018, 100 per cent questions came from the feeder courses; from 2018 to 2020 there was major modification under which 60 per cent marks were from super specialisation and 40 per cent from the feeder super specialisation courses.
“Now what is sought to be done is one hundred per cent questions will be from primary feeder speciality which is general medicines. It is completely overlooking the facts that you are fundamentally changing the examination pattern and you are doing it for an examination announced to be held in November, 2021,” it said.
The bench added that NBE and NMC are not doing any favour in asking the court to push back the examination by another two months.
It told Bhati, “It does not matter as these doctors will join the Super Speciality courses two months later, so long the seats are filled up it does not matter. This shows us the length to which your clients are willing to go to ensure that seats are filled up. Nothing should go vacant”.
Bhati said that seats going vacant is not the only consideration that has weighed on experts but it is the comparative opportunity and comparative ease which will be in larger public interest of the students that has weighed with the experts.
The bench said, “So what really happened is this for all specialisation of super speciality, starting from critical care medicines, cardiology, clinical haematology and other courses the specialisation is only going to be and the examination will be on general medicines.”
“The idea is that general medicine has the largest pool, the largest group in PG, so tap and fill up the vacant seats. That seems to be the logic behind this, nothing more and nothing less”.
The top court said, “You may have a rationale; we are not saying you may not have a rationale. The question is that all changes, which you have brought has caused serious prejudice to the students. Problem is that you didn’t plan for the future. You did not have a vision and all that you do is that just because you have a certain degree of authority you will exercise it in whatever time you want”.
The bench asked Bhati and senior advocate Maninder Singh, appearing for NBE, what was the great hurry to do it for this year as heavens would not have fallen except for the fact that some 500 seats would have remained vacant in some private medical colleges.
On September 27, the top court said, “Don’t treat young doctors as football in the game of power,” and warned the Centre that it may pass strictures if it is not satisfied with justification for last minute changes to the syllabus.
Medical care intertwined with health business, further braided with changes in medical law presents a more complex problem rather than just treating a patient well. In present era, many kinds of organizations have positioned themselves between doctor and the patient.
This era belongs to a transitional phase, when gradual conversion of doctor-patient interaction to a business transaction is being controlled by industry’s middlemen . One such middle industry is Insurance industry. The medical industry, insurance, law industry and administrative machinery remain hidden in the background and enormously benefitted at the cost of doctors and nurses, who suffered at the front, as face of the veiled colossal medical business and remain the only visible components. Insurance industry is in a position to extract business from doctor as well as patients. One such example is published in Times of India, where insurance company has paid bills between 45-80%. Each one of the medical industrial component trying to have their pound of flesh, will not only push the cost of health care upwards, but would leave both the main stakeholders, doctors and patients feel dissatisfied.
As the number of people hospitalised due to Covid rise, many find that they have to settle a big chunk of the bill out of their own pockets despite having health insurance. Policyholders are again caught in the crossfire between hospitals and insurers over the treatment of consumables like personal protection equipment (PPE) kits resulting in only 45% to 80% of hospital bills being recoverable by customers. For 81-year-old diabetic and hip fracture patient K Saraswathi, who was treated for Covid-19 for eight days got only Rs 56,500 reimbursed of the total Rs 1.18 lakh bill from third-party administrator Raksha. Among other things that were disallowed included Rs 17,600 for PPE claims. While insurers cite General Insurance Council (GIC) norms their argument may not hold water as IRDA has not approved any norms. “How can a hospital treat a patient without PPEs?” asked an official at the Insurance Ombudsman office which is snowed under with complaints for short-settlement. “We used to get a few cases last year, now we have 88 pending cases, 70% to 80% of which are short settlements,” the official said.
For some insurers, the exclusions amount to a third of hospital bills. Liberty General officials said around 35% of the bill does not fall under the ambit of insurance coverage. Its VP and national claims manager for accident & health, Amol Sawai said, “On the industry level, the average Covid claim severity is Rs 1,40,000, the settlement severity is about Rs 95,000 of the claimed amount. We have seen almost 20% of the total bill is attributed to PPE costs.” India’s largest health insurer Star Health settles nearly 80% to 90% of claims under cashless settlement within two hours of receiving claims. S Prakash, MD of Star Health said, “One doctor who takes a round in the same PPE kit, cannot charge for each of ten patients he visits. The controversy is not in the reimbursement for PPEs, but in the number of PPEs covered. One cannot claim for ten PPEs per day. For ICUs, we allow a higher number of PPE kits compared to the ward,” he said.
According to the GIC officials, the referral rate for PPE kits is Rs 1,200 per day for moderate sickness and Rs 2,000 per day for severe sickness.
“We also see a spike in claims made for CT scans per person. We allow maximum two CT scans per patient,” he added. Officials at the GI Council blamed the hospitals for this situation. “Why are no directions given to hospitals on billing?” asks a council official. He points out an instance where a Tamil Nadu hospital charged Rs 14,000 for medicines, Rs 55,000 for diagnostics and Rs 50,000 for PPE besides room rent. When the insurer raised a red flag, the bill was halved to Rs 1.5 lakh.
“Is it okay for hospitals to loot with such high bills, whose money are we paying? It is the public’s money. If the premium doubles next year, will anyone even think of medical insurance. If we raise our hands and give up covering medical insurance, can anyone force us to provide a cover,” the official asked. The short settlement by insurance companies is resulting in a rise in complaints at the office of Insurance Ombudsman in Chennai.
“Insurers are citing some GI Council norms for claims settlement. Whatever they are saying does not hold water as IRDA has not approved any norms. How can a hospital treat a patient without PPEs?,” an official at the Insurance Ombudsman office said. Hospitals on their part blame the westernization of healthcare where insurance companies call the shots. “How can an insurance company decide on medication? A Dolo works for some while a Combiflam works for another, both these have a price differential. Now to say I will pay Dolo charges for a Combiflam or vice versa is plain stupidity. We need someone who looks at the bill and the patient and not one size fits all,” a MD and head of infectious diseases in a private hospital said. “The need is a regulator who understands medicine,” he said.
You have to live a doctor’s life or to very closely watch one’s to understand it.
As a young overburdened doctor, still undergoing the rigours of academics, I used to commit certain silly mistakes of commission and omission which my watchful patients and their attendants would easily catch. And they would gladly discount it or let me know not grudgingly. From a twenty year old boy to a fifty plus oldie – that has kept me going.
It is hard getting into medicine. Equally hard studying it and even harder practising it. The litmus test was declaring a patient dead. Even harder , declaring a neonate dead with its face beautified by the large dead pupils. As if it is going to cry just ! It takes quite some heart to do the ultimate job of declaring the undeclarable. And then you come across patients and people your age who tell you they get all sorts of symptoms upon hearing someone die !!
Doctors live fast, age fast and studies have confirmed, they die faster than the general population. Their youth is almost completely absorbed by the vast study material and rigours of one of the most difficult courses.
Once as a house physician, I encountered a school girl with fever admitted in my ward. As a routine I used to check the vitals of around 30 patients morning and evening before the rounds. She used to laugh at me saying that I had nothing better to do than a nurses’ job. It took us almost a week to diagnose her with a blood cancer. She happened to be a cousin of one of my friends. She lost her hair to chemo drugs. Tired of the disease and confines of the hospital, one evening she insisted to go out. She was so insistent that her mother requested me if I could take her from the hospital to my room. I refused to oblige her under a veil of principles and legality. After the whole night of confusion, whether to accede to what may be one wish in her last days, I decided to take her out of ward. I prepared myself for a reprimand, I would face in the department. Next morning when I reported for duty , her bed was empty. She had massive bleed at night. I cried. That was about 25 years back. I still cry though very sparingly now, on losing a patient.
Only a doctor would understand this.
Looking back , it is not money , it is not anything but a glint of gratefulness in the eyes of my patients and it is the tolerance of my patients to my mistakes that has kept me going all these years. But that desired emotions are lacking somewhere and myself, at times do not feel the zeal to continue anymore.
A sense of gratitude in the eyes of patients that fueled the doctor inside me, is no more visible now.
The pages of history celebrates Amrit Kaur’s determination to drive out the British, her feminist zeal, and also the many contributions she had made to the health infrastructure of the country.
Most of people know about the OPD block of AIIMS (premier Institute of India) named after Rajkumari Amrit Kaur, but how the vision of having an institute of excellence was converted into reality is largely unknown. The Indian Express carries a beautiful report about how the visionary Princess and Health Minister of India turned a dream into reality.
On February 18, 1956, the then minister of health, Rajkumari Amrit Kaur, introduced a new bill in the Lok Sabha. She had no speech prepared. But she spoke from her heart. “It has been one of my cherished dreams that for post graduate study and for the maintenance of high standards of medical education in our country, we should have an institute of this nature which would enable our young men and women to have their post graduate education in their own country,” she said.
The creation of a major central institute for post-graduate medical education and research had been recommended by the Health survey of the government of India, a decade ago in 1946. Though the idea was highly appreciated, money was a concern. It took another 10 years for Kaur to collect adequate funds, and lay the foundation of India’s number one medical institute and hospital.
Kaur’s speech in the Lok Sabha sparked a vigorous debate in the house over the nature of the institute. But the bill moved fast, gaining the approval of members of both the houses, and by May that year, the motion was adopted.
The All India Institute of Medical Sciences (AIIMS) was born. “I want this to be something wonderful, of which India can be proud, and I want India to be proud of it,” said Kaur, as the bill was passed in the Rajya Sabha.
In the past few months, as India has been battling a global pandemic, the role of the country’s apex medical body has come under discussion on several occasions. Significantly, it is the first prime minister of the country, Jawaharlal Nehru, who is credited for the heights reached by AIIMS. It is true that AIIMS came to be under the Nehru government. However, the real driving force behind it was Kaur.
A princess of the Kapurthala princely state, a student at Oxford university, a devout follower of Mahatma Gandhi, and an important member of the Constituent Assembly, Kaur was all of this and much more. Members of her family like to remember her as someone who believed in simple living and high thinking. The pages of history, on the other hand, celebrates her determination to drive out the British, her feminist zeal, and also the many contributions she had made to the health infrastructure of the country.
The Kapurthala princess
As a member of the Kapurthala princely family, Kaur had an interesting history. Her father, Raja Sir Harnam Singh, had converted to Protestant Christianity after a chance meeting with a Bengali missionary named Golakhnath Chatterjee in Jalandhar. Singh went on to marry his daughter, Priscilla, and had ten children with her. Kaur, the youngest among them was born on February 2, 1889.
Kaur, therefore, was brought up as a Protestant Christian. After spending her early years in India, she was sent off to England for her education. “Princess Amrit Kaur was as much a product of Edwardian England as she was of India,” suggested her obituary in the New York Times in 1964. She completed her schooling from the Sherborne School for Girls, in Dorset, and then went to study at Oxford University. Thereupon, she returned to India in 1908 at the age of 20, and embarked on a life of nationalism and social reform.
The Gandhian and social reformer
Upon her return from England, Kaur was immediately drawn towards the ideas of nationalism, as she interacted with leaders like Gopal Krishna Gokhale and Mahatma Gandhi. She was mesmerised by the teachings of Gandhi, and shared an enduring, special friendship with him, as is evident from the collection of letters shared between the two, that have been compiled in the book, ‘Letters to Rajkumari Amrit Kaur’.
“What drew me to Bapu was his desire to have women in his non-violent army and his faith in womankind. This was an irresistible appeal to a woman in a land where women were fit for producing children and serving their lords as masters,” she is quoted as having said by American philosopher Richard Gregg in his introductory note in ‘Letters to Amrit Kaur.’
Though she wanted to join the naionalist movement soon after she returned, her family was against her involvement in the struggle, and therefore she kept away till her father passed away in 1930. During this period though, she was actively involved in social reforms particularly those related to women. Consequently, she waged a battle against the purdah system, the devadasi system, and child marriage. In 1927, she helped in the founding of the All India Women’s Conference and later served as its president.
By 1930, as she joined the Gandhian movement, she was imprisoned for her participation in the Dandi march. She gave up all her princely comforts to join Gandhi at his ashram in Sabarmati. “I remember Rajkumari sitting at the spinning wheel and eating along with other ashramites, the simple fare prescribed by Gandhiji,” wrote political activist Aruna Asaf Ali about her fondest memory of Kaur. “Rajkumari Amrit Kaur belonged to a generation of pioneers. They belonged to well- to-do homes but gave up on their affluent and sheltered lives and flocked to Gandhiji’s banner when he called women to join the national liberation struggle,” she added.
In her battle for a free India, she became one of the few women members of the Constituent assembly. She along with Hansraj Jivraj Mehta were the only female members to be ardently in support of the uniform civil code in the constitution.
The passionate health minister who created AIIMS
Nihar Mahindar Singh, the 58-year-old grand niece of Kaur, recalls that as a child she would visit Kaur’s house in New Delhi frequently, as she was getting treated at AIIMS. “I never received any preferential treatment for being her family member. I remember spending hours at a stretch on the corridors of AIIMS. I didn’t even know back then that aunt B (as Kaur was referred to in her family), had created the hospital,” she says, adding that it was much later, and by word of mouth from her family members that she learned of her grand aunt’s contribution in building AIIMS.
As an institute of healthcare and medical research, AIIMS had to have some unique features. To begin with, it was the first of its kind in Asia to prohibit doctors from private practise of any kind. Secondly, the doctors at AIIMS were to devote their time not only to treating patients and teaching, but also to carry out research. “All the staff and students were to be housed in the campus of the Institute in the best traditions of the Guru-Sishya ideal to stay in close touch with each other,” writes V. Srinivas, the deputy director of administration at AIIMS in his article, ‘The making of AIIMS: The parliamentary debate’.
As health minister, Kaur was the pivotal force in ensuring the unique status enjoyed by AIIMS. Yet, it is worth noting, that she was in fact not the first choice of Nehru to be part of the cabinet. “In August 1947, for the woman member of the cabinet, Nehru thought of Hansa Mehta, but took Rajkumari Amrit Kaur at Gandhi’s insistence,” writes author Sankar Ghose, in his book, ‘Jawaharlal Nehru – A Biography’. Writing about why Kaur was not preferred, he explains, “she was sometimes indiscreet and intemperate in her criticism of Congressmen.”
It is surprising that doctors and nurses, who can save many lives, have to put their own lives at risk for the want of proper PPE’s. The cost of PPE’s is not more than few hundred rupees. Even such a cheap facility is not available to the saviors for their own protection. Such episodes are not only painful to the medical fraternity but also expose the hypocritical attitude of the administrators as well as the insensitive approach of society towards health care workers, although everyone expects doctors and nurses to be sensitive towards every one. Such incidents demoralizes and causes deep discouragement to the front line doctor and nurses, but sadly remains a routine business for administrators. The pain of being treated like a dispensable disposables remains as a deep hurt within.
At least 10 senior resident doctors deputed on Covid-19 duty at government hospitals and 70 nurses in private facilities have quit their jobs, with most citing poor protective gear to combat the virus as a reason.
While the senior residents said they were dejected with the poor state-of affairs at hospitals and the looming threat of contracting the infection, some individual doctors and nurses took a break from the profession, until the pandemic, gets over. These doctors are from the Osmania Medical College (OMC) and Mahatma Gandhi Memorial (MGM) hospital Warangal among other government hospitals. So far, 300 doctors and other medical personnel in the government sector alone have contracted the virus, with worries of sub-standard protective gear and long working hours, forcing doctors to even go on strike. Some senior resident doctors deputed from the OMC to the Chest Hospital never reported for duty, while others served for one or two months before putting in their papers. “The problem is not just that there was a threat of infection and we didn’t get proper personal protection equipment (PPE) kits, it seemed like a waste of effort. Even if a patient was dying in front of me, I could do nothing at all,” said one of the senior resident doctor who had resigned from the OMC .
“We didn’t have staff, we didn’t have the infrastructure, we didn’t have proper PPE kits or any other provision required. It seemed like a futile effort,” he said. Despite the guilt of having resigned in the middle of an ongoing pandemic, the doctors said that their presence or absence hardly made any difference to the situation. Authorities ignored repeated complaints It was like there is everything wrong, but no one was there to take responsibility. I felt bad about resigning but after over a month of working and making repeated requests for additional doctors and nurses, there was no difference. It was just a blame game,” another doctor told TOI. From the medicine department at Osmania General Hospital (OGH), six senior residents have resigned, while few others have resigned at the MGM hospital, said Dr Mahesh Kumar, president, Healthcare Reforms Doctors Association (HRDA). “At the beginning of the pandemic, there was a lot of issues with PPE kits and infrastructure and despite repeated representations they were not sorted out. Most of the residents resigned in the first two months of the pandemic, discouraged by the situation and fearing for their personal safety,” he added. Apart from doctors, 70 nurses who are at the frontline have gone missing from work too. “A least 30 of these nurses went missing from a single corporate hospital. Currently, there is a huge shortage of nurses as most are reluctant to do Covid-19 duties,” said Laxman Rudavath, president, Nursing Officers Association of Telangana.
In present era, these are toughest times for health care staff and hospitals as well. Warriors on the front lines are doctors and nurses, whereas hospitals are grappling with financial constraints. What should have been most desirable at this crucial time, was the encouragement and psychological support to these warriors. Administrators were supposed to give some moral boosting and financial support or at least, the rightful, so that health staff should work willingly and inspire next generation for future catastrophe like this. Instead of armchair preaching to health care staff, there should have been robust rules and guidelines to protect health care staff and health systems as doctors and nurses are working under tremendous psychological pressure.
But the desired did not happen, as the chaotic management due to economical compulsions or just trying to be projected as an outstanding administrator turned out to be a real possibility rather than exception.
Moral and legal compulsions thus caused immense pressure on health care workers and they became an easy subject to moral and legal blackmail. The pressure to perform their duties in sub-optimal and below par conditions became a new norm.
Every day when doctors and nurses, while going to work have this thought in mind. But still they continue to work amid their own tensions, worries about families.
The non-payment of salaries, disrespect to health care staff and being made to work in below par conditions, without PPE’s at some places has caused tremendous discouragement to the medical profession.
The courts should not be involved in the issue of non-payment of salary to health care workers and government should settle the issue, it said.
NEW DELHI: “In war, you do not make soldiers unhappy. Travel extra mile and channel some extra money to address their grievances,” the Supreme Court said on Friday taking serious note of non-payment of salary and lack of proper accommodation to doctors engaged in fight against Covid-19.
The courts should not be involved in the issue of non-payment of salary to health care workers and government should settle the issue, it said.
The top court was hearing a plea by a doctor, who alleged that front line healthcare workers engaged in fight against Covid-19 are not being paid salaries or their salaries are being cut or delayed.
The doctor also questioned the Centre’s new SOP making their 14-day quarantine non-mandatory.
“In war, you do not make soldiers unhappy. Travel extra mile and channel some extra money to address grievances. Country cannot afford to have dissatisfied soldiers in this war which is being fought against Corona,” said a bench of Justices Ashok Bhushan, S K Kaul and MR Shah.
Solicitor General Tushar Mehta, appearing for the Centre, said that if there are better suggestions coming forward, they can be accommodated.
The bench said that there are reports coming that many areas doctors are not being paid.
“We saw report that doctors went on strike. In Delhi, some doctors have not been paid for past three months. These are concerns that should have been taken care off. It should not require court intervention.”
The bench further said, “You (Centre) need to do more. Must make sure their concerns are addressed”.
The bench posted the matter for further hearing next week.
On June 4, the Centre had told the top court that a “large number” of make-shift hospitals will have to be built in the near future to accommodate the constant rise in the number of newly infected people.
The Centre also contended that though hospitals are responsible for implementing the Infection Prevention and Control (IPC) activities, the final responsibility lies with the health care workers to protect themselves from COVID-19.
It further said mandatory quarantine for 14 days after the duty of healthcare workers of 7/14 days is “not justified and warranted”.
“It is most respectfully submitted that number of cases of COVID-19 are constantly increasing and at some point of time in near future, apart from existing hospitals, large number of temporary make-shift hospitals will have to be created in order to accommodate COVID-19 patients requiring admission, medical care and treatment,” the Ministry of Health and Family Welfare said in an affidavit.
The affidavit was filed on a plea by Arushi Jain who questioned the Centre’s new Standard Operating Procedure (SOP) of May 15 for front line COVID-19 healthcare workers by which it ended the 14-day mandatory quarantine for them.
The ministry in its reply affidavit had said healthcare workers (HCW) are properly protected by Personal Protective Equipments (PPE) in workplace settings and carry no additional risk to their families or children.
It had said grievances raised by the petitioner alleging infirmities in the May 15 guidelines of the health ministry are completely presumptuous, vacuous, ill-founded and sans any empirical or medical evidence.
Justifying its advisory and SOPs, the health ministry said it is a step in the right direction and that the guidelines emphasise the role of taking adequate preventive measures by all health care workers in the hospital setting against the likelihood of contracting infection at their work place.
On April 8, the apex court had observed that the doctors and medical staff are the “first line of defence of the country” in the battle against COVID-19 pandemic, and directed the Centre to ensure that appropriate PPEs are made available to them for treating coronavirus patients.
About the medicines and substances, that are consumed by masses under a false hope of immunity enhancement. Every substance, which claims to alter human physiological functions should undergo strict international neutral trials and not allowed to be sold by mere advertisements.
Tremendous misguidance is propagated by giving a false hope to people of doing some treatment.
Every day we read in media the various pronouncements claiming to enhance the immunity especially in the days of Covid-19. It automatically implied or interpreted that the said product will save the people from Corona and hence a brisk business starts. No one has studied the real effectiveness, correct doses or side effects of preparation in real sense.
A myth, that any plant extracted drug is useful, free of side effects, is a belief ingrained deep in the minds of people. Such unscrupulous advice is followed blindly without even verifying the authenticity of the source. A hope of miracle is flashed to patients who perceive a “no hope” by scientific medicine, are an easy prey for such fraudsters.
Another major problem is that medicines and syrups distributed in such manner often are without name of drug, contents and doses. It is not uncommon to get lethal substances like steroids, hormones and heavy metals in dangerous doses. Such acts are real crime to society, done with an intention to cheat rather than treating them.
Any one selling medicines in name of alternative medicines, food supplements or medical advice of any kind, has to be registered with a council, for those particular medicines. advertisement of such drugs or products should be on some scientific basis and neutral trials.
Most of these are not validated at all by international or national authorities, not even considered as drugs. No impartial, neutral trials conducted about effects, side effects or toxicity. Mere media or social media words, which are paid, are considered as Gospel Truth and substances are consumed by masses under a false hope of immunity enhancement. Most of them marketed as herbal or alternate medicines, which are advertised as harmless but beneficial. They are sold by propagated words of benefit and advertisements rather than a solid proof.
Slowly these medicines become part of conventional wisdom rather than considered as drugs and chemicals or heavy metals. In reality, being a settled medical science issue, it remains a fake news at the basis.
There is no dearth of quacks, who sell unknown and unlabelled substances, merely to earn money, but the dangers of such products are high and unassuming consumers remain oblivious to side effects.
Any substance is considered effective only after rigorous testing through randomised clinical trials and additional laboratory analyses. The substances that are merely propagated on social media or claims of company or advised by quacks will not help and merely remain as part of immunity business. They provide a false hope and thereby earn money because of fear in the minds of masses.
Any substance which claims to alter the physiology of a person or patient, cannot be consumed without undergoing rigorous, neutral and international safety trials. If found to be good, all homo sapiens in the world should be benefitted. If not, let the gullible masses not be misguided and trapped into a false hope. There has to be a strict Government control about the products to be consumed, which claim to alter human physiology.
Evolution of Medical profession-Extinction of good doctors 