Category: doctors

Ancient traditional Chinese medicine


Assorted  plant and animal parts used in traditional Chinese medicines: dried Lingzhi, ginseng, Luo Han Guo, turtle shell underbelly, and dried curled snakes.

China also developed a large body of traditional medicine. Much of the philosophy of  traditional Chinese medicine derived from empirical observations of disease and illness.  and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or mystical, correlate as the expression of the natural order of the universe.

The foundational text of Chinese medicine is the Huangdi neijing , written 5th century to 3rd century BCE.  Near the end of the 2nd century AD, during the Han dynasty, Zhang Zhongjing, wrote a  Treatise on cold damage, which contains the earliest known reference to the Neijing Suwen. The Jin Dynasty practitioner and advocate of acupuncture and moxibustion, Huangfu Mi (215-282), also quotes the Yellow Emperor in his Jiayi jing, c. 265. During the Tang dynasty, the Suwen was expanded and revised, and is now the best extant representation of the foundational roots of traditional Chinese medicine. Traditional Chinese medicine that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years.

In the 18th century, during the Qing dynasty, there was a proliferation of popular books on traditional medicine. Jesuit missionaries introduced Western science and medicine to the royal court, the Chinese physicians ignored them.

Finally in the 19th century, Western medicine was introduced at the local level by Christian medical missionaries from the London Missionary Society (Britain), the Methodist Church (Britain)

Because of the social custom that men and women should not be near to one another, the women of China were reluctant to be treated by male doctors. The missionaries sent women doctors such as Dr.  Mary Hannah Fulton (1854–1927). Supported by the Foreign Missions Board of the Presbyterian Church (USA) she in 1902 founded the first medical college for women in China, the Hackett Medical College for Women, in Guangzhou.

 

Link    https://en.wikipedia.org/wiki/History_of_medicine

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Artemis doctors, CEO booked for negligence: how to save medical lawsuit in case of post operative complications?


Doctors save the patient, but save yourself also.

News of this kind brings tsunami of fear in minds of doctors all over. Not only doctors, but patients also fear that something like this should not happen to them. In general, it will also create a negative impact on trust of patients, because it reflects that harm is a result of blunder done by doctors.

Artemis Hospital Gurgaon, its CEO, medical director, medical superintendent, and three other doctors of the hospital were booked on  Sunday, based on the complaint of the husband of a patient who died in the hospital in August last year after undergoing treatment in it for two months. (link)

http://timesofindia.indiatimes.com/city/gurgaon/artemis-docs-ceo-booked-for-negligence/articleshow/59008481.cms

Reality and impact of this scenario may be a bit different from what is usually conveyed and is suffocating medical profession as a whole, all over the world, in some form or the other. Loss to the patient is immense and with sympathy wave against the doctor, everybody will cry for harshest punishment for the doctors. For a human error (which is called negligence), an unintentional harm and failure to anticipate a difficult situation has landed doctors in a soup. The   situations, which are detected by retrospective analysis along  with wisdom of hindsight are challenging and are real trouble. Real time diagnosis  may not always be possible to anticipate and often difficult.

As a doctor, I am forced to ponder whether by punishing the doctors in harshest way for unintentional errors, especially for one incident is the solution to the problem.

  • Can treatment and surgeries be made complication free anywhere? Unless everything is done by a Robot and computers.
  • If consequences of one mistake are such horrifying, will doctors be able to do work, especially in difficult situations free of fear? Or really should they opt for being in such situations?
  • If lots of doctors do not want difficult situations, what will happen to patients?

Difficult scenario for doctors, as even simple surgeries can lead to big complications in certain situations.  Not frequently, situations are unpredictable. So, what should doctors do to avoid to be in such difficult scenario?

How to survive medical lawsuit in post operative complications: Reality is that complications are part and parcel of treatment and surgeries. There will always an element of unintentional harm, whatsoever treatment is being done.No doctor can guess, which patient is going to have complications and give saviour the lifetime pain and shame. It is like a bad lottery. Only improvement can be made is to decrease the number of complications and timely recognition.  How to avoid such problems?

  1. Just be extra careful, extra conscious. Always have in mind that something can happen. It may lead to defensive practice, but that may be the need of the hour.
  2. Due to irony of present era, the preparation of saving yourself, the doctor has to start from the time the preparation of surgery starts. Most important part is consent. Doctor cannot predict, which patient will have what kind of complications. Detailed consent with detailed list of complications have to be mentioned and told to patient and relatives and duly signed with witness. Complications, although rare must be mentioned.
  3. Separate consent for anaesthesia to be obtained along with complications.
  4. Must check for coagulation profile and presence of infection in body.
  5. Risk to be assessed besides actual surgery, for other factors.
  6. Simple surgeries become high risk because of malnutrition, infections, low albumin levels and presence of other medical illness like diabetes, cancer, cardiac ailments. In presence of other factors, high risk consent to be taken.
  7. Never ever risk is to be understated, for the thought that patient will not agree, in case he is told about all the possible complications and risks.
  8. Careful surgery, with high index of suspicion for possibility of complications is required. Never be overconfident. Complication can happen in hands of most experienced people also.
  9. Post operatively : maintain a good record of vitals and pain. If patient is having problem, go to every detailed investigations to rule out your worst fears. Investigations will cost some money and people may accuse you temporarily of getting extra investigations. But it is better not to be accused later for criminal charges and losing all your peace of mind and reputation.
  10. Never discharge a patient, while problems are unresolved. May get a CT scan done and let people accuse you again for getting extra investigation . Time is such that doctors will be blamed and accused for something or the other by retrospective analysis. Let us take a smaller accusation. Later there no body will be forgiving.
  11. If you are not convinced or patient is unable to understand the risk, opt out of surgery. Doing few less procedures will not harm you.
  12. Upgrade quality assurance program of hospital and your department. With aim to minimize complications and early detection.
  13. Periodic audit of medical records.
  14. Medical Indemnity insurance: importance of indemnity insurance is immense these days. Be careful of not disclosing the medical indemnity insurance coverage, because litigant lawyer or patient may exploit it for litigation purposes.

 

Not infrequently, whole scenario becomes a story of revenge against the doctor, even for routine complications and naturally poor prognosis of disease. Therefore, Doctors – save the patient, but save yourself also.

 

 

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Ancient Indian medicine


Ancient Indian medicine

The Atharvaveda, a sacred text of Hinduism  dating from the Early Iron age, is one of the first Indian text dealing with medicine. The Atharvaveda also contain prescriptions of herbs for various ailments. The knowledge to use of herbs to treat ailments later formed bases for the large part of Ayurveda.

Ayurveda, means  the complete knowledge for long life is another medical system of India. Its two most famous texts belong to the schools of Charaka and Sushruta. The earliest foundations of Ayurveda were built on a synthesis of traditional herbal practices and  theoretical conceptualizations.  There after new  therapies dating from about 600 BCE onwards, and coming out of the communities of thinkers who included the Buddha and others.

According to the compendium of Charaka and  the Charakasamhita , health and disease are not predetermined and life may be prolonged by human effort. The compendium of Susruta, the Susrutasamhita, defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Susrutasamhita is notable for describing procedures on various forms of  surgery, including  rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures. Most remarkable is Sushruta’s penchant for scientific classification: His medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to aging and mental illness. The Sushruta Samhita describe 125 surgical instrument, 300 surgical procedures and classifies human surgery in 8 categories.

The Ayurvedic classics mention eight branches of medicine: kayacikitsa (Internal medicine), salyacikitsa  (surgery including anatomy), salakyacikitsa  (eye, ear, nose, and throat diseases), kaumarabhrtya  (pediatrics), bhutavidya  (spirit medicine), and agada tantra (toxicology), rasayana (science of rejuvenation), and vajikarana (Aphrodisiac). Apart from learning these, the student of Āyurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalies. The teaching of various subjects was done during the instruction of relevant clinical subjects. The normal length of the student’s training appears to have been seven years. But the physician was to continue to learn.

As an alternative form of medicine in India, Unani medicine got deep roots and royal patronage during medieval times. It progressed during Indian sultanate and Mughal periods. Unani medicine is  similar to  Ayurveda. Both are based on theory of the presence of the elements (in Unani, they are considered to be fire, water, earth and air) in the human body. According to followers of Unani medicine, these elements are present in different fluids and their balance leads to health and their imbalance leads to illness.

By the 18th century A.D., Sanskrit medical wisdom still dominated. Muslim rulers built large hospitals in 1595 in Hyderabad, and in Delhi in 1719.

 

Link    https://en.wikipedia.org/wiki/History_of_medicine

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Early civilizations Egypt: ancient Egyptian medicine


One of  the large, earliest and meaningful medical traditions were developed in Ancient Egypt.  Herodotus described the Egyptians as one of healthiest people because of possessing the notable public health system.  He found the practice of medicine very specialized. Although Egyptian medicine, to a considerable extent, dealt with the supernatural, it eventually developed into more practical use in the various  fields  of medicine.

Medical information in the Edwin Smith Papyrus may date to a time as early as 3000 BC. Imhotep  in the 3rd dynasty may be founder of ancient Egyptian medicine and with being the original author of the Edwin Smith Papyrus, detailing cures, ailments and anatomical observations. The Edwin Smith Papyrus is regarded as a copy of several earlier works and was written in 1600 BC, contains earliest recorded reference to brain. It is an ancient textbook on surgery almost completely devoid of magical thinking and describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments.

The Kahun Gynecological Papyrus treats women’s complaints, including problems with conception. Dating to 1800 BCE, it is the oldest surviving medical text of any kind.

Medical institutions, referred to as Houses of Life are known to have been established in ancient Egypt as early as 2200 BC.

Ancient Egypt also had one earliest known physician Hesy- Ra . He was Chief of Dentists and Physicians for King Djoser in the 27th century BCE. Also, the earliest known woman physician,  Peseshet, practiced in Ancient Egypt  at the time of the 4th dynasty . Her title was Lady Overseer of the Lady Physicians. In addition to her supervisory role, Peseshet trained midwives at an ancient Egyptian medical school in Sais.

 

 

Link    https://en.wikipedia.org/wiki/History_of_medicine

 

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Unfair prejudice against doctors distressing : shortage of docs and still delivering best, but punished and assaulted


Shortage of docs ails AIIMS emergency only one technician each for ventilator, ECG (link)

http://timesofindia.indiatimes.com/city/delhi/shortage-of-docs-ails-aiims-emergency/articleshow/58831115.cms

Times of India yesterday carried a news article which highlighted the problem of shortage of doctors and trained staff in AIIMS hospital emergency.  The number of doctors  available are less than half of those required. And if this is the scenario in a premier Institute, it does not need an Einstein brain to figure out how the problem at other places in remote areas would be.

Everybody desires to have themselves treated within few minutes of their arrival in a hospital to the best of standards, but there are many obstacles to it in the form of large patient overload and shortage of doctors. Despite shortage of staff, each and every doctor tries his best to see as many patients as possible while sacrificing his own personal life. In any civilized society, this kind of work should bring in appreciation and respect for those who deliver. But for some strange reason, possibly due to vicious campaign against doctors by media and even celebrities, the respect and appreciation for this profession is sadly lacking. Possibly it is due to inadequate root cause analysis of the real issues. News items like these will probably help public realize the problems doctors face.

Despite working in such conditions, they are still abused, assaulted, beaten and taken to court for reasons, which are not justifiable in a civilized society. With all such problems and heavy hearts, this wonderful community still continues doing their noble work day and night to give each patient the best possible treatment within a reasonable time frame.  As compared to other professions the amount of work is more and appreciation much less.

Let’s take an example of courts where people spend lot of money and time and their cases still drag on for years. Crores of cases are pending in courts and thousands die without getting justice in their life time.  In contrast, even if there is shortage of doctors, relief to uncountable patients is provided and the quality of work is much better than other professions. As nature of work of this saviour is very high in moral hierarchy as compared to any other profession, it is time our society realized about the constraints doctors face before blaming them for the loss of optimal health care provision. Surely society owes much more to this wonderful community, but sadly this realization is unlikely in present era.

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Ray of hope for doctors :Honourable President and Delhi high court show concern about violence against doctors


At last, Delhi high court has expressed concern  over growing instances of attacks on doctors by irate patients. It also identified lack of adequate number of medical experts in government hospitals, as a possible cause. It also made a note of  government’s  failure to increase the number of doctors despite multifold increase in patient load. And the next date for hearing is fixed for 10 days later, on 29th May.

Our Honourable President Mr Pranab Mukherjee too, has disapproved of the violence against doctors, thus giving hope to  doctors that their fundamental right  of safe working environment may be restored in near future.

Although good working conditions still remain a distant dream for doctors but this raises hope of getting atleast a safer environment which is absolute  necessary for a doctor to practise.

Although points raised by courts are well known and basic but are very important to begin with. But still until now, none of the government authorities had extended help to the doctor’s community. Isn’t it ironical that in 21st century, when sky is the limit for advances in majority of the professions, the most educated and a hard working community of the country is fighting for its basic and fundamental right of a safer workplace? It is just unthinkable that doctors still have to struggle for their basic  right in present era.

 

Honourable President Mr Pranab Mukherjee too, has disapproved of the violence against doctors(link)

Attacks on doctors by relatives of patients unacceptable: President Pranab Mukherjee

Delhi high court has expressed concern  over growing instances of attacks on doctors by irate patients.(Link)

http://timesofindia.indiatimes.com/city/delhi/hc-seeks-report-on-docs-safety/articleshow/58504721.cms

 

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Real story of a female doctor assault : Routine affair for uncivilized society


Few words here can’t describe the plight of a female doctor, who was brutally assaulted by a mob at her residence, for no fault of hers. This incidence happened few months back, about 200 KM away from Delhi.

It was an evening time and a boy had an accident with a bus. He was brought to a community health center.  Female medical officer who had her residence inside the hospital in staff quarters examined the patient and found that he was already dead. She explained the situation to the family members with due sensitivity, did all the paper work and returned to her residence in about an hour. Mob kept on gathering and after half an hour, they barged into the house of the lady medical officer.

They dragged her by hair in front of her teenage daughter. Mob started assaulting her with fists and legs along with a rod. Her daughter cried and shouted for help.   Mob even tried to set her on fire. This brutal and devilish assault continued till neighbours from other staff quarters saved her with great difficulty and took her away. Mob continued rampage in her house and hospital, trying to break everything.

She sustained severe head injuries and was admitted in a hospital for about ten days. What was her fault and why mob did this to her? Is being a doctor and working in remote area her fault? Everybody knew that the reason for death of the boy was what happened outside the hospital.  There was an errant bus driver, who was responsible.  Then why was she made a punching bag for venting out emotions of the bereaved relatives. Nothing and really nothing can justify this barbaric act. Emotions should not be allowed to take such a demonic form. This is simply jungle raj, goonism and  expression of a most  uncivilized kind of society, which simply cannot be excused by any sort of reasoning. The incident was protested by the professional bodies as is the routine and after few day things normalized for everybody else except that terrorised family. The said lady medical officer took posting elsewhere and as is usual, nothing much happened to the accused.

Woman doctor assault : Era worse than MAHABHARATA for female doctors

There was again same silence and little concern shown by our media, courts, prominent people, celebrities, human right commission, woman right activists and women commission. This again brings forth the hypocrisy of these people and organizations, who otherwise cry about woman rights and empowerment.  Whenever a female is assaulted, there is an outrage but the same support is not extended to a female if she is a doctor. Such bestiality should create havoc in minds of civilized people but this apathy to such incidents clearly indicates otherwise. Have we become so uncivilised that an incident such as this just remains as a small news item in a local paper? Can’t we see that such incidents are harbinger of many more in future? It is important to realise that this is the time to unify and condemn such episodes vehemently and prominently so that the miscreants realise that they cannot get away with it.

Beti bachao Beti padhao vs Violence against female doctors

Violence against female doctors: Silence of human and  woman right commissions

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How to survive medial lawsuit for central venous line insertion


 “ doctor- save the patient, but save yourself also”.

Consent must before invasive procedures: consumer panel  

National Consumer Disputes Redressal Commission has said that doctors must take consent of a patient or his family members for any invasive procedure during treatment. (11.5.2017 Times of India link below).

I really feel sad for the doctors, who sometimes due to overwork or zeal to do things  find themselves in a soup, because of lack of paperwork.  But they are learning the lessons the hard way. Law and media call them a mistake but I think the errors in documentation are due to lack of proper training and poor understanding of legal requirements of profession in consumer’s era. The ignorance is about necessity to save thou self, when we try to save the patient. These documentation have become all the more necessary in current scenario because of the non-acceptability of even common complications. If a complication occurs during treatment, prolonged retrospective analysis goes on at leisure by lawyers with an intention to find fault. They are driven by money as an incentive, and with the wisdom gained on the hindsight, they may find some fault almost always in some way. Thus, doctors are at great disadvantage on this issue. choosing medical career a disadvantage to doctors.

It is high time for doctors to learn how to save themselves. It is important to have a thorough documentation. I am mentioning certain aspects which should be taken care of, while putting a central line .

  1. As already in news “consent” is very important. Take care to write patient identity, age sex and all other relevant columns. Explain and write all benefits and possible complications of procedure. Get signature of patient, relative and a witness. Put doctor’s signature with date and time.
  1. Always try to use ultrasound to help you to locate lines. Patient can be obese, having short neck and it may be difficult anatomy. Ultrasound will help you in differentiation of artery and vein and avoid arterial puncture as in above case.
  1. Be sure before dilatation that you are in vein. Sometimes it is difficult to differentiate between artery and vein. Do everything to prove that you are in vein before dilatation.
  1. Take suitable precautions for to prevent sepsis, air embolism
  1. If it is not emergency always check coagulation profile.
  1. Make sure doctor who is doing the procedure is well trained for it.
  2. Upgrade quality assurance program by keeping record of adverse events during procedures.

These are simple steps, although documentation is cumbersome. But it is worth because it can help the doctor from future litigation, harassment and so many problems. This is need of the hour. Bottom line is “save the patient, but save yourself also”.

http://timesofindia.indiatimes.com/city/delhi/consent-must-before-invasive-procedures-consumer-panel/articles how/58618137.cms

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Generic vs. branded medicine: Doctor’s stake : just stringent check on quality of medicine.


Doctors should have no issues to what Honourable Prime Minister Mr Narender Modi himself has spoken, for putting in place a legal frame work to ensure that doctors prescribe only generic drugs. This practice can be easily followed if apprehensions about quality of medicines are allayed.

There have always been concerns regarding quality of generic drugs sold under various trade names since the control over their quality is not foolproof. Implementation has to come along with stringent laws regarding drug testing and quality assurance, otherwise it may be dangerous to patients and in turn to doctors, in the present scenario.

   Generic drug are low cost version of a formulation that should ideally be equivalent to a branded product as far as its production quality, dosage, strength, route of administration and efficacy is concerned. Most generic products are allowed to enter the market only after expiry of the patent protection duration granted to the drug’s original developer.

   Branded drugs are expensive and there is a huge price variation between different branded drugs containing same molecule which is inexplicable. How can doctors interpret the price variation which can be sometimes many times for the different brands of same molecule. Is this price variation because of some difference in efficacy? How to interpret this much price gap and how to keep track of newer names launched at lower prices? Doctors do not manufacture drugs nor are they responsible for printed high retail prices variation in drug prices. I feel the biggest problem is the lack of documentation on efficacy of different brands of same molecule, which if done could guide the doctor. Some regulatory agency needs to be responsible for guiding doctors and patients regarding relationship of quality of drugs and prices. Therefore it is actually not correct to hold doctors responsible for these cost variations.

Huge price variation:  But all said and done, none of the arguments can explain the huge price variation for the different brand of same molecule. This malpractice of pharmaceutical industry has gone on for years without any check and this needs a solution which cannot be found at the door of doctors alone.

The quality control mechanism need to be strengthened and made more stringent. Before using a generic drug, the doctor or patient has to be well assured about  consistent quality of various drugs of same molecule and their pharmacological properties and also the fact that they have been manufactured using the standard practices  and meet the quality controls as per the regulations laid down. Concerned agency should check, verify and certify each and every drug.

 Bioavailability equivalence: There has to be a stringent legal mechanism to guarantee the bio equivalency of the compound for the drug made available in the market. Even a bioequivalent drug can fail efficacy test because of factors like heat, humidity and stability issues. There should be a strict quality control with best manufacturing and packing practices followed for generic and branded medicines alike.

Quality assurance of every drug is a patient’s right and a doctor’s too. They both have a right to know about relationship of quality, efficacy and price. It is of paramount importance to the patient who is ultimately    the consumer.

 Doctors can be victim of this anomaly in a bigger way: They can be in big trouble if quality of the drug prescribed by them is lacking in its quality and efficacy. Major adverse effects and even deaths have been reported due to poor quality of drugs or contaminated drugs. For example deaths in a sterilization camp in Chhattisgarh (FIR 11.11.14) have been attributed to use of contaminated drugs. Think of the plight and suffering of the doctor who was then portrayed as a criminal. He was lucky that court ultimately found out about the poor quality drugs as the cause. But in a day to day routine practice, it is very difficult even to think of such possibilities and prove it and consequently doctor has to suffer the blame of being negligent. Most of the time, it is taken as incompetency and failure of the doctor while the actual problem lies with the drug. If a doctor makes a correct diagnosis and advises medicines correctly but the patient still does not get well, it is the doctor who is blamed for the lack of improvement. Sometimes, if patient does not get well or if a life is lost, doctor may be abused, assaulted or dragged to court. Consequently most doctors try to play safe and prescribe drugs of pharmaceutical companies of sound background. So doctor’s concern should be to ensure and demand strict quality control of medicines because it has a real bearing on the ultimate practice of the doctor. It is really unfortunate that for the lack of poor regulatory mechanisms and greed of pharmacy industry, doctors suffer.

 Doctors just need stringent quality control, law and mechanisms to guarantee effective medicine be it generic or branded. 

It is not a problem to a doctor whether patient gets a generic or branded medicine, as long as it is effective.  Nor does it concern them whether a drug company or chemist make 100% or 1000% of profit out of medicine. The latter should be regulated by government agencies.

It needs a sincere effort by the Government to maintain stringent quality of drugs so as to ensure that both generic as well as branded drugs have same quality and efficacy. The recent initiative by our prime minister can usher in a new era and can be path breaking if strict measure are in place for quality control and standard manufacturing practices are followed.

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NEET implementation vital and will decide quality of doctors in future


NEET, the common test for MBBS admission all over nation, is perceived as most basic step  towards uniformity of medical education. It is a welcome single most important step to transform the medical education. But its effective implementation is extremely vital for it to be successful and that is possible only if government takes strong measures to implement it in a true spirit. NEET can reform medical education, weed out corruption and in turn can radically transform healthcare. This new system should allow fair play, transparency and should set an example for promotion of merit in other arenas too. But it needs to be seen how NEET is finally implemented. It will be very unfortunate if it is diluted for any reason and merit becomes another casualty in accommodating other priorities, rather than having best doctors. It  is a now or never situation for the country to pick up best brains of country for  training as prospective doctors , decided purely on basis of merit.  By diluting the merit criterion, not only do less deserving people get ahead of deserving ones, but it breaks the faith and enthusiasm of the best and deserving people in the system, thereby generating a negativism in the whole system. Failure to implement NEET effectively and strictly should be interpreted as government’s inability to control vested interests in the system.

Enthusiasm and the zeal is what we need here in medical care. With the shortage of thousands of doctors, and our infant and maternal mortality rates matching sub-Saharan countries, it is not only the number of doctors which matters. The most important factor, I think, will be quality and enthusiasm of the people who are working for the system.

Besides Infant and maternal mortality rates, innumerable diseases like tuberculosis, heart and respiratory, cancer, neurological and mental ailments, accident and trauma etc need work on war footing.  But the medical system has to be built on the touchstone of merit and enthusiasm for a greater impact. Merely creating number of doctors is not the solution. The need of the hour is more but pure meaning on pure merit. If that does not happen sufferers will be poor genuine aspiring doctors and casualty will be medical profession and ultimately health system and its users.

Let merit not be made a casualty of the system. The ball is now in government’s court and they should ensure that NEET is implemented in its true spirit, to fulfil the dream for which it was envisioned and introduced which is to bring medical care in India to its most cherished peak.

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