Bedaquiline: New anti TB drug: Govt may allow usage by private health sector

Bedaquiline is a TB drug which is also known by the trade name Sirturo. Bedaquiline works by blocking an enzyme inside the Mycobacterium tuberculosis bacteria called ATP synthase. This enzyme is used by the bacteria to generate energy. Without the ability to generate energy, the TB bacteria are killed.

Bedaquiline is used in combination with other TB drugs to treat pulmonary TB in adults when they have multi drug resistant TB (MDR-TB

It should only be used when effective Tb treatment cannot otherwise be provided.

It should be always be used in combination with at least 3 other TB drugs which drug susceptibility testing has shown that the patient is susceptible to. If drug susceptibility testing is not available then bedaquiline should be used with at least 4 other drugs to which the patient is likely to be susceptible.

The safety and efficacy of the drug in the treatment of HIV positive patients with MDR-TB has also not yet been established.

side effects of bedaquiline

The most common side effects are headache, dizziness, feeling sick, being sick, joint pain and increases in liver enzymes. Side effects can be experienced by more than one in ten people.

Another side effect is that QTc prolongation.

The US Food and Drug Administration (FDA) on 28th December 2012 granted approval for bedaquiline to be used to treat drug resistant TB. FDA News Release, 31st December 2012 . In October 2013 the CDC issued new federal guidelines on the use of the drug, for the treatment of multi drug resistant TB.

Government may allow private sector to use key drug used for treating tuberculosis

Around 2.1 million people have TB in India, of which an estimated 30,000 people have MDR-TB. Only 6,500 patients are on the bedaquiline-based treatment regimen, which may cause severe side effects such as heart problems and hearing impairment.

The Union health ministry (India) is considering a proposal to allow bedaquiline, a controlled-access drug used in the treatment of multi-drug resistant tuberculosis (MDR-TB), to be open for prescription in the private sector.

Being a controlled-access drug, bedaquiline is dispensed only by the government to people with MDR-TB. At least four courses of treatment are needed. The drug costs Rs 28,000 per course, which means the cost per patient is Rs 1.12 lakh on medicine alone.

Around 2.1 million people have TB in India, of which an estimated 30,000 people have MDR-TB. Only 6,500 patients are on the bedaquiline-based treatment regimen, which may cause severe side effects such as heart problems and hearing impairment. “Technical opinion is being sought as there is no consensus among experts on opening access to the private sector,” said a senior health ministry official familiar with developments.

The health ministry, in collaboration with the departments of health research, biotechnology etc, is working out an institutional mechanism to give bedaquiline to patients in the private sector. “There is a huge pharma lobby that is building an argument for putting everyone on bedaquiline, but it doesn’t work like that. Even though it is being hailed as a wonder drug, it has side effects that include hearing loss. It’s a new drug, so we don’t really have adequate data on its long-term treatment outcome,” the official quoted above said.

“People generally assume bedaquiline is safer than other drugs but they forget that compared to a 6-8 months course for other medicines, a bedaquiline-based regimen could go up to 18-24 months. The longer duration could have its effects that our experts are looking at,” he added.

The ministry has begun compiling data on treatment outcome for all oral treatment regimens among Indians, which also includes the bedaquiline-related course. “About 20 patients in the private sector in Mumbai have been given conditional bedaquiline access by the government. But the entire private sector can be given access only if they strictly adhere to the drug-compliance regimen for complete cure and to stop the patient developing extremely drug-resistant TB,” the official said.

There will be strict vigilance. “Since it is a long-term regimen, it’s verifiable. A call will be taken soon,” said a second ministry official, requesting anonymity.

The United States Agency for International Development (USAID) has provided 22,000 doses to the government. “We don’t want to deny patients newer drugs if it benefits them, so we are considering the idea,” said the first health ministry official.

May 13, 2019 0

Medical Consumer Protection Act: Root of “Us and Them Syndrome”. Effect on medical profession

In present scenario, when patient is no more “patient” and defined as consumer, doctors is not more than a service provider. With Medical Consumer Protection Act acquired roots, the whole system of medical delivery and healthcare has changed. Most striking is this entire fiasco is the “Us and Them” syndrome that seems to afflicted every one. Doctors are pitted against every one, for example, Doctors vs administrators, doctors vs patients, doctor vs managers. From regulation, insurance and legal system, every change has affected doctors adversely. They have been reduced to just only one component of the industry, who deliver care and remain at receiving end. Other important stake holder are patients. How this change has been beneficial for patients? Suppressed professionals can be used to work more, get less paid and can be dragged to court. So fear of all kinds will make them more careful. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario and act smart in changed business and legal milieu.

reblogged

Negatives effect on medical profession: cons or disadvantages of medical consumer Protection Act

Promotes Defensive medicine: Every patient with any illness has potential to complications. Progression of any disease state can cause death. If doctors start looking at every patient as a potential litigant, especially those who are dealing with very sick ones, practice of defensive practice is a natural consequence. This may manifest as excessive investigations, more use of drugs and antibiotics and even sometimes even refusal to treat very sick patients. Worst scenario of excessive fear will be refusal of very sick patients in emergency situations or non availability of doctors.
Erosion of doctor-patient relationship: stray and occasional Incidents about negligence and the cases in courts or their outcome are given wide publicity in media. People are unable to understand the correct application of such stray incidents to themselves. But they always try to imagine themselves in the scenario applied. Because of prejudiced notions, a sense of mistrust gradually creeps in, which then extends to and involves their own treating doctor .This sense of mistrust multiplies manifold whenever there is some adverse or even small unpleasant Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.
Increased cost of care: With the creeping in of practice of defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to inflated medical costs. Insurance companies and lawyers have positioned themselves in between. They charge everyone heavily for allaying the fears , both patients(medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs , need for insurance, medicolegal suits, high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.
Enhanced insecurity in medical profession : Needless to say, consumer protection act has increased the anxiety and insecurity in the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career or will result in professional hanging or a media trial, with these having real probability in today’s day to day practice.
Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons e.g for sense of revenge or to extract money or simply for not having to pay for services. In an era where family members , brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These are further stoked by the incidents of previous high compensations granted by courts .
Increased paper work: excessive documentation and time consumption: crucial and large chunk of time of doctors and nurses, goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a days more worried about completing paper work as well. Initially it was a symbolic documentation , but now there is requirement of mammoth paper work. It leads to consumption of time that was meant for real discussions for the benefit of patients.
Doctors used as scapegoats for revenge : Any unsatisfied patient can vent his anger by putting complaint or case against the doctor . This is done to some extent for revenge or trying to find some human factor which can be punished. Not uncommonly doctors are used as scapegoat to have a concession on the patient treatment by health organizations. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.
Distraction of doctors from the primary point of intention: Nothing else ever has distracted doctors more than these medico-legal cases and punishments. In many cases, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies and split second life saving and risky decisions which may later be proved wrong by retrospective analysis, complex medico-legal situations are endless distractions that have creep in and are enough to distract doctors from primary point of intention.
Early retirement or burn out: Becoming a doctor and practicing has become a tough job. After people have reached a point of financial security or when near point of burn out, doctors tend to leave practice. No wise man will like to face medico-legal complexities in older age. Taken to court for a genuine decision by self is enough to spoil and tarnish health, wealth and fame earned by grilling the whole life.
Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts ones own life and career to risk, why should one put oneself in that deciding position? Therefore increasingly, financially secure doctors are staying away from the riskier jobs.
Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight. All patients with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.
Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking for whom to blame among themselves. All of them will try to pinpoint other’s mistake. Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately a mutual understanding and team work takes a hit.
Hugely benefited are medical industry, law industry and administrators; Rampant misuse of consumer protection act has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip for doctors by all these three stakeholders. Fear of medico-legal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain out of doctors hard work. Benefits to law industry are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.
Right decisions or wisdom of hindsight?; A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering. What was medically right and judicious decision at that real time situation may look wrong later retrospectively, especially when retrospective analysis is done over years with fault finding approach.
Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed only to repent later.
Instigation by law industry; Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigation of lawsuit against doctors is a major disadvantage for medical profession.

Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous training and then suddenly find themselves working in a hostile environment, at the receiving end of public wrath, law and media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
Subject of continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes. Mistakes are always easy to pinpoint with retrospective analysis and with lawyers pondering over it for years. In such situations , doctors are sitting ducks for any kind of

Positives, Pros or advantages of medical consumer protection act:

Although there are doubts, whether it will have any positive effect in long term, except monitory benefit to patient’s relatives and lawyers.

Quick redressal of grievances: patient will get satisfaction, if there is a genuine negligence case
Better quality of care will increase; medical systems will improve as they will need to lessens the errors and court cases. Better systems from abroad are also copied to improve the efficiency.
Better introspection by medical profession: although doctors from the beginning are sensitive about their work and always look at how better results can be achieved. But act will make this process more formal and official.
Training of medical professionals: it will be difficult to put errors under carpet. Doctor will like to get trained better as no one want to be in soup.
Future learning from court cases: each and every court decisions is viewed carefully by medical fraternity. Improvement in protocol and policy making is a natural consequence.
6. Eye openers for medical profession: court cases and decisions have acted as eye opener for medical profession. It gives an idea, how law looks at medical treatment. It has made clear that medical science and medical law are a bit different. In real time, things are easier to be said than done.
7. Better documentation and communication: Doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting. But now there is lot of stress on documentation.

Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and achieve better results. The real problem lies in the fact that In this age of anxiety prevailing more for care givers, do not get enough relief from stress.

But sad thing about this kind of learning is that it is at the cost of few, unfortunate doctors, who were in difficult situation, actually suffered, did not know the legal implications of their acts or situation. Most of the time, it is a system failure, but blame can be pinpointed to doctor.

May be The Act has good intention, but its practical application in its present form may cause more harm than good. If the core of the health care (medical hands) are harmed, no one can benefit in the long run.

May 12, 2019 0

Work-life imbalance for doctors/nurses & consequences

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

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

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

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

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

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

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

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

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

Consequences of work–life imbalance

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

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

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

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

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

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

May 11, 2019 2

Advantages & disadvantages: pros & cons of medical consumer Protection Act

#Medical-Consumer-Protection-Act: Pros & Cons: Advantages & disadvantages, medico legal, medical negligence

As in last few decades, patients are defined as consumers and Medical Consumer Protection Act takes roots, the whole system of medicine and healthcare has changed. All the new changes in regulation, insurance and legal system have resulted in facilitating and exercising an easy control of medical industry over health care, each revision has affected doctors adversely. They have been reduced to just only one small component of the industry, who deliver care and remain at receiving end for poor outcomes. Other important stake holders are patients. How this change has been beneficial for patients?

Suppressed professionals can be used to work more, get less paid and can be dragged to courts easily. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario, act smart and are able to entrench themselves in changed business and legal milieu.

Disadvantages of medical consumer Protection Act (Negatives, cons)

1 .Promotes Defensive medicine: Every patient with any illness has a potential for complications. Progression of any disease state can cause death. If doctors start looking at every patient as a potential litigant, especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients. Worst scenario of excessive fear will be refusal of very sick patients in emergency situations or non-availability of doctors.

Erosion of doctor-patient relationship: Stray and occasional Incidents about negligence, the cases in courts or their outcome attract wide publicity in media. People are unable to understand the correct application of such stray incidents to themselves. But they always try to imagine themselves being in the chaos or scenario projected. Because of prejudiced notions, a sense of mistrust gradually creeps in, which then extends into and involves their own imagination and circumstances. This sense of mistrust multiplies manifold whenever there is some adverse or even small unpleasant event. Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.

Increased cost of care: With the increasing need for defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to increased medical costs. Insurance companies, medical industry and lawyers have positioned themselves in between doctor and patients. They charge everyone on both sides, heavily for allaying the fears, both patients (medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.

25 factors for rising cost and expensive medical care.

Enhanced insecurity in medical profession: Needless to say, consumer protection act has increased the anxiety and insecurity of the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career, will result in professional hanging or a media trial. There is a real probability of being entangled in these problems in present era in day to day practice.

Disadvantages of being a doctor, health worker

Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons, for example the sense of revenge or to extract money or simply for avoiding to pay for services. In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These ideas are further stoked by the incidents of previous high compensations granted by courts .

Black coat versus white coat

Increased paper work: excessive documentation and time consumption: crucial and large chunk of time of doctors and nurses, goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a day more worried about completing paper work as well. Initially it was a symbolic documentation, but now there is requirement of mammoth paper work. It leads to consumption of time that was meant for real discussions for the benefit of patients.

Doctors used as scape-goats for revenge: Any unsatisfied patient can vent his anger by putting complaint or case against the doctor. This is done to some extent for revenge or just finding a human factor which can be punished. Not uncommonly doctors are used as scape- goats to have a concession on the patient treatment by administrators. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.

Distraction of doctors from the primary point of intention: Nothing else ever has distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight. Complex medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intentions ‘the treatment.

Early retirement or burn out: Becoming a doctor and practising has become a tough job. After people have reached a point of financial security or when near point of burn out, doctors tend to leave practice. No wise man will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the doctor’s whole life.

Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career to risk, why should anyone put himself in that difficult position? Therefore increasingly, financially secure doctors are staying away from the riskier jobs.

11 .Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight. All patients, who are unsatisfied or with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.

Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking for, whom to blame among themselves. All of them will try to pinpoint each other’s mistake. Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately a mutual understanding and team work takes a hit.

Doctors converted to cheap labour: Hugely benefitted are medical industry, law industry and administrators; The ease with which doctors can be harassed has lead to rampant misuse of consumer protection ac and t has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip against the doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain the maximum out of doctors hard work. Benefits to law industry and lawyers are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.

Confusion while treating; Right decisions ? A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering. What was medically right and judicious decision at that real time situation may be looked as wrong later, especially when retrospective analysis is done over years with fault finding approach. So taking medical decisions is becoming more difficult amid future uncertainty of disease.

Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem, but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed. Delay in surgeries or therapies are a common outcome.

Instigation by law industry; Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigation of lawsuit against doctors is a major setback for medical profession.

Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous training and then suddenly find themselves starting the work in a hostile environment. They find it strange to find themselves at the receiving end of public wrath, law and media for reasons, they can’t fathom. They work with continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

Doctors have become ‘Sitting ducks’ for continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes. Mistakes are always easy to be pinpointed with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
Demoralization of medical professionals – as selectively applied: strangely it applies only to doctors. All of other professions are out of it. Selective application is what demoralizes doctors. Considering the uncertainty and kind of work of medical profession, actually it should be other way around.

The consequences are like victimization.

Advantages of Medical Consumer Protection Act: (Positives, Pros)

1. Redressal of grievances: patient will get satisfaction, if there is a genuine negligence case.

Better quality of care; medical systems will improve as they will need to lessens the errors and court cases. Better systems from abroad are also copied to improve the efficiency.

Better introspection by medical profession: although doctors from the beginning are sensitive about their work and always look at how better results can be achieved. But act will make this process more formal and official.

Training of medical professionals: it will be difficult to put errors under carpet. Doctor will like to get trained better as no one want to be in soup.

Future learning from court cases: each and every court decisions is viewed carefully by medical fraternity. Improvement in protocol and policy making is a natural consequence.

Eye openers for medical profession: court cases and decisions have acted as eye opener for medical profession. It gives an idea, how law looks at medical treatment. It has made clear that medical science and medical law are a bit different. In real time, things are easier to be said than done.

Better documentation and communication: for doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting much. But now there is lot of stress on documentation.

Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and achieve better results. The real problem lies in the fact that in this age, anxiety prevailing more for care givers, a sense of injustice prevails . stress generated can alter the ways, the patients get treated. If the core of the health care (medical hands) are harmed, no one can benefit in the long run.

21 occupational risks to doctors and nurses

Reel Heroes vs Real Heroes

25 factors- why health care is expensive

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?

May 7, 2019 140

Missing measles vaccination fueling global spike in measles cases

Measles cases up by 300% in 2019 as vaccinations dip

This has led to a 30% spike in measles cases worldwide since 2016, taking cases to 6.7 million and deaths to 110,000 in 2017. India confirmed 55,399 measles cases in 2018.

High income countries ; children missing vaccination;

USA 2,593000

France —608000

United kingdom– 527000

Argentina — 438000

Italy — 435000

Low & middle income countries; children missing vaccination

Nigeria – 4 million

India – 2.9 million

Pakistan- 1.2 million

Indonesia- 1.2 million

Ethopia – 1.1 million

Children unvaccinated against measles are fuelling global outbreaks, with more than 110,000 measles cases being reported worldwide in the first three months of 2019, up nearly 300% over the same period last year, Unicef said on Thursday.

This has led to a 30% spike in measles cases worldwide since 2016, taking cases to 6.7 million and deaths to 110,000 in 2017. India confirmed 55,399 measles cases in 2018.

Globally, each year around 21.1 million children on average don’t get the first dose of the measles vaccine, which has led to around 169 million children remaining unvaccinated between 2010 and 2017, according to Unicef.

Measles is a highly infectious virus that causes death and debilitating complications, including encephalitis (swelling of the brain membranes), severe diarrhoea, pneumonia, ear infections and permanent vision loss.

India has 2.9 million children unvaccinated against measles, the second highest number after Nigeria, which is home to 4 million children not vaccinated against the disease, said Unicef.

The measles-rubella vaccine is safe and has saved at least 21 million lives since 2000, according to the World Health Organization (WHO), but fake news campaigns spread by anti-vaxxers — those who oppose vaccination , have led to people saying no to vaccination even in countries that have eliminated the disease.

Immunisation coverage must be at least 95% to achieve ‘herd immunity’, the threshold over which unvaccinated people in a community are protected, according to WHO. “It is critical not only to increase coverage but also to sustain vaccination rates at the right doses to create an umbrella of immunity for everyone. The measles virus will always find unvaccinated children. If we are serious about averting the spread of this dangerous but preventable disease, we need to vaccinate every child, in rich and poor countries alike,” said Henrietta Fore, Unicef executive director, in a statement.

The US, which eliminated measles in 2000, tops the list of high-income countries with the most children not receiving the first dose of the of the vaccine between 2010 and 2017, which prompted the American Medical Association last month to urge big social media and technology companies such as Amazon, Facebook, Google, Twitter, Pinterest and YouTube, to stop anti-vaccine groups from spreading misinformation on their platforms.

Since launch of the Measles Rubella (MR) vaccination campaign in India in February 2017, 305 million children in 32 states/ UTs using the Serum Institute of India vaccine is WHO pre-qualified for its quality and safety and used the world over, but the campaign has been stalled by misinformed parents in some parts of India, including Delhi,” said a health ministry official who did not want to be identified.

The MR vaccine being used in the campaign as well as for Routine Immunization, is very safe and effective against measles. It is made in India and is exported for use world over. Two doses of this vaccine provides more than 95% protection against the disease that has been eliminated in four countries (Bangladesh, Bhutan, DPR Korea and Timor Leste) in WHO’s South Asia region and transmission of the virus is likely to have been interrupted in Sri Lanka. Elimination and Rubella Control to review progress in the battle against measles The global coverage of the first dose of the measles vaccine was reported at 85% in 2017, with the coverage for the second dose being at a lower 67%. In high income countries, while coverage with the first dose is 94%, coverage for the second dose drops to 91%, according to the latest data.

About measles

source

April 29, 2019 0

About Measles and Vaccination

Measles is a very contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes. Measles starts with a cough, runny nose, red eyes, and fever. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body.

Cause;;Measles is caused by the measles virus, a single-stranded, negative-sense, enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae.

The virus is highly contagious and is spread by coughing and sneezing via close personal contact or direct contact with secretions. It can live for up to two hours in that airspace or nearby surfaces. Measles is so contagious that if one person has it, 90% of nearby non-immune people will also become infected. Humans are the only natural hosts of the virus, and no other animal reservoirs are known to exist.

Risk factors for measles virus infection include immunodeficiency caused by HIV or AIDS, immunosuppression following receipt of an organ or a stem cell transplant, alkylating agents, or corticosteroid therapy, regardless of immunization status; travel to areas where measles commonly occurs or contact with travellers from such an area; and the loss of passive, inherited antibodies before the age of routine immunization.

Vaccination;;Measles can be prevented with MMR vaccine. The vaccine protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Before the measles vaccination program started in 1963, an estimated 3 to 4 million people got measles each year in the United States. Of these, approximately 500,000 cases were reported each year to CDC; of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles. Since then, widespread use of measles virus-containing vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. However, measles is still common in other countries. Unvaccinated people continue to get measles while abroad and bring the disease into the United States and spread it to others.

CDC recommends that children get two doses of MMR vaccine:

the first dose at 12 through 15 months of age, and
the second dose at 4 through 6 years of age.

Teens and adults should also be up to date on MMR vaccinations.

source

April 27, 2019 1

what is Mechanical ventilator? A machine critical to save life

A medical ventilator (or simply ventilator in context) is a machine designed to provide mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently.

While modern ventilators are computerized machines, patients can be ventilated with a simple, hand-operated bag valve mask.

Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesiology (as a component of an anesthesia machine .

Medical ventilators are sometimes colloquially called “respirators”, a term stemming from commonly used devices in the 1950s (particularly the “Bird Respirator”). However, in modern hospital and medical terminology, these machines are never referred to as respirators, and use of “respirator” in this context is now a deprecated anachronism signaling technical unfamiliarity.

Function

In its simplest form, a modern positive pressure ventilator consists of a compressible air reservoir or turbine, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable “patient circuit”. The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters. When over pressure is released, the patient will exhale passively due to the lungs’ elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient manifold.

Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters (e.g. pressure, volume, and flow) and ventilator function (e.g. air leakage, power failure, mechanical failure), backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by a computer-controlled turbo-pump.

Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient’s needs. Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In Canada and the United States and in many parts of world, respiratory therapists are responsible for tuning these settings, while biomedical technologists are responsible for the maintenance.

The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g. inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the circuit may be either noninvasive or invasive.

Noninvasive methods, which are adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive methods require intubation. For long-term ventilator dependence will normally be a tracheostomy cannula, as this is much more comfortable and practical for long-term care than is larynx or nasal intubation.

Life-critical system

Because failure may result in death, mechanical ventilation systems are classified as a life critical-system and precautions must be taken to ensure that they are highly reliable, including their power supply .

Mechanical ventilators are therefore carefully designed so that no single point of failure can endanger the patient. They may have manual backup mechanisms to enable hand-driven respiration in the absence of power (such as the mechanical ventilator integrated into an anesthetic machine . They may also have safety valves, which open to atmosphere in the absence of power to act as an anti-suffocation valve for spontaneous breathing of the patient. Some systems are also equipped with compressed-gas tanks, air compressors, and/or backup batteries to provide ventilation in case of power failure or defective gas supplies, and methods to operate or call for help if their mechanisms or software fail.

history of ventilator

source

April 17, 2019 2

History of mechanical ventilator

The history of mechanical ventilation begins with various versions of what was eventually called the iron lung, a form of noninvasive negative pressure ventilator widely used during the polio epidemics of the 20th century after the introduction of the “Drinker respirator” in 1928, improvements introduced by John Haven Emerson in 1931, and the Both respirator in 1937. Other forms of noninvasive ventilators, also used widely for polio patients, include Biphasic Cuirass Ventilation, the rocking bed, and rather primitive positive pressure machines.

In 1949, John Haven Emerson developed a mechanical assister for anesthesia with the cooperation of the anesthesia department at Harvard University. Mechanical ventilators began to be used increasingly in anesthesia and intensive care during the 1950s. Their development was stimulated both by the need to treat polio patients and the increasing use of muscle relaxants during anesthesia. Relaxant drugs paralyze the patient and improve operating conditions for the surgeon but also paralyze the respiratory muscles.

In the United Kingdom, the East Radcliffe and Beaver models were early examples, the latter using an automotive wiper motor to drive the bellows used to inflate the lungs. Electric motors were, however, a problem in the operating theaters of that time, as their use caused an explosion hazard in the presence of flammable anesthetics such as ether and cyclopropane .

In 1952, Roger Manley of the Westminster Hospital, London, developed a ventilator which was entirely gas driven, and became the most popular model used in Europe. It was an elegant design, and became a great favorite with European anesthetists for four decades, prior to the introduction of models controlled by electronics. It was independent of electrical power, and caused no explosion hazard. The original Mark I unit was developed to become the Manley Mark II in collaboration with the Blease company, who manufactured many thousands of these units. Its principle of operation was very simple, an incoming gas flow was used to lift a weighted bellows unit, which fell intermittently under gravity, forcing breathing gases into the patient’s lungs. The inflation pressure could be varied by sliding the movable weight on top of the bellows. The volume of gas delivered was adjustable using a curved slider, which restricted bellows excursion. Residual pressure after the completion of expiration was also configurable, using a small weighted arm visible to the lower right of the front panel. This was a robust unit and its availability encouraged the introduction of positive pressure ventilation techniques into mainstream European anesthetic practice.

The 1955 release of Forrest Bird’s “Bird Universal Medical Respirator” in the United States changed the way mechanical ventilation was performed, with the small green box becoming a familiar piece of medical equipment. The unit was sold as the Bird Mark 7 Respirator and informally called the “Bird”. It was a pneumatic device and therefore required no electrical power source to operate.

Intensive care environments around the world revolutionized in 1971 by the introduction of the first Servo 900 ventilator Elema – Schonander . It was a small, silent and effective electronic ventilator, with the famous SERVO feedback system controlling what had been set and regulating delivery. For the first time, the machine could deliver the set volume in volume control ventilation.

Ventilators used under increased pressure (hyperbaric) require special precautions and few ventilators can operate under these conditions. In 1979, Sechrist Industries introduced their Model 500A ventilator which was specifically designed for use with hyperbaric chambers.

In 1991 the SERVO 300 ventilator series was introduced. The platform of the SERVO 300 series enabled treatment of all patient categories, from adult to neonate, with one single ventilator. The SERVO 300 series provided a completely new and unique gas delivery system, with rapid flow-triggering response.

In 1999 the LTV (Laptop Ventilator) Series was introduced into the market. The new ventilator was significantly smaller than the ventilators of that time weighing ~14 lbs and around the size of a laptop computer. This new design kept the same functionality of the in hospital ventilators, while now opening up a world of opportunity of mobility for the patients.

A modular concept, meaning that the hospital has one ventilator model throughout the ICU department instead of a fleet with different models and brands for the different user needs, was introduced with SERVO-i in 2001. With this modular concept the ICU departments could choose the modes and options, software and hardware needed for a particular patient category.

mechanical ventilator

April 16, 2019 3

Reasons of having excessive thirst:

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

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

Dehydration:

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

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

Diabetes

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

Dry mouth

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

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

Dry mouth can present as :

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

Menstrual blood loss

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

Thyroid problems

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

Stress

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

Diuretic and food containing diuretics:

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

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

Low-carbohydrate diets:

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

Pregnancy:

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

Excessive bleeding:

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

Diabetes insipidus:

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

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

April 11, 2019 0

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

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

Re-blog

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

Factors—

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

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

UNIT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

April 10, 2019 0

Government may allow private sector to use key drug used for treating tuberculosis

Around 2.1 million people have TB in India, of which an estimated 30,000 people have MDR-TB. Only 6,500 patients are on the bedaquiline-based treatment regimen, which may cause severe side effects such as heart problems and hearing impairment.

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Consequences of work–life imbalance

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