Expensive Medical College Seat; A Bad Choice


In the present circumstances, when doctors themselves are doubtful about the advice for choosing medical career, some are naive enough to spend millions on securing an expensive medical college seat.  Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted   about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession. Following are the reasons, why spending a fortune on the medical college seat may be a bad idea, at least for the students from moderate family backgrounds.

1. Medical courses are comparatively lengthy and expensive courses and difficult training with slave like duties. “enslavement of doctors”.

2. Uncertain future for aspiring doctors at time of training:  Nowadays, doing just MBBS is not enough and it is important to specialise. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.  They have to just flow with system ultimately.

3.Hostile environment for doctors to begin: Suddenly young and bright children complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

4. Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.

5. The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.

 6. Blamed for all malaise: The society gets biased because of the   media reports and some celebrity talking glib against medical profession. The blame for  inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.

7. Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.

8. Risk to doctor himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include   tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.

9. Unrealistic expectations of society:  Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.

10. Retrospective analysis of doctor’s every action continues all the life. It could be by  patients and relatives  every day  in the form of  “ Why this was not done before?” Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving, or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

 The decision taken in emergency will be questioned  and  in retrospect they may not turn out to be the best one. But later with retrospective analysis along with wisdom of hindsight with luxury of time, may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

11. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent  people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.

12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.

13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure 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 instigations of lawsuit against doctors is a major disadvantage for medical profession.

14. Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Want to be a doctor? Medical Middleman may get you killed


Increasing murderous attacks and assaults on doctors is  worrisome, an indicator of a lawless, uncivilized society, poor governance and broken health system.

      Think of a profession, where a brilliant student  studies hard for 10 to 15 years, does day and night duties, save innumerable lives. Start earning pittance and get conveniently labelled as thug, thief and butcher by Medical Middleman. These brilliant doctors can be abused, assaulted and  dragged to courts with impunity. They have become sitting ducks for punishments and physical assaults or can get killed because of instigation created by MEDICAL MIDDLEMEN.

Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable.

   Who are these Medical middlemen? How they have benefited enormously by using one single selective negative narrative?

All those, who with some clever tricks, have placed themselves between doctor and patients. They earn money by promoting mistrust between the two actual stake holders. These Middlemen have no stake, but still want to get benefited by stroking emotions.

         One poor outcome out of millions lives saved,  is enough for these  opportunistic parasites to portray whole medical community as dystopian one.

   Most important of these Middlemen  are the ‘Reel heroes’ who in a quest to be projected as Real heroes,  got   placed themselves between doctor and patient by airing vague narratives. By self-appointing themselves as custodian of health of masses, ‘the Reel heroes’ and celebrities gave true meaning to their work of ‘ACTING’ that otherwise was no more than a trifling entertainment.

         Media and many celebrities have used fear in public mind to garner accolades and money for themselves, but at the same time created paranoia in minds of people against medical profession.  And when masses worshipped ‘the Stars’ as  their true well-wishers, they aired advertisements to sell tobacco, soft drinks, junk foods and other sweet poisons to public and children.

   Media and celebrities made money and fame by riding on the vulnerability of medical profession.   By winning the faith by demonization of doctors, all these middlemen sold their products, news items shows  and created a brisk business.

         Words used cleverly by such middlemen are ‘Few Doctors’. What majority of other doctors do to save millions was not of much concern and consequence. Public would not know, how to differentiate good or bad ones.

 But this was merely a posturing on television;  to be a Real hero, actually  signified  nothing for those unknown ‘Few doctors’, but the  denigration of medical profession and  attempts to belittle the whole doctors’ community was full and complete. The mistrust generated and demonization of the real well wishers of the patients was irreversible.

These middlemen instigated masses against health care workers by their acidic comments and vitriolic spewed venomous words.

 The consequence was the loss of trust on their doctors, the only ones, who were in position to help patients in the emergency situations. The taunts and torment on doctors multiplied manifold in many forms verbal, legal, abuse and physical assaults.

 These MEDICAL MIDDLEMEN, with distorted projection   earned huge accolades and money, but they promoted feelings of enmity or hatred between doctor and patient.

 The aspiring doctors need to know the media role in today’s times. They would carry the image, whatever media projects.  A clear understanding in required, before they sacrifice their youth and life without knowing what is in store for them at the end of the long tunnel of study and training.

   Students while choosing medical career, should take a well informed decision before entering this profession, which is dangerous to doctor themselves even when discharging their duties in the best manner.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Doctor’s assault a medical emergency: Silence of authorities appalling


    Attacks and assaults on doctors is an indicator of a lawless, uncivilized society, poor governance and broken health system. Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide  health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.

      Are we a lawless society? More problematic is the government apathy and silence of human right commission. Here comes the point that what is the role of our doctor’s organizations, human right organizations, parent hospitals and institutes.

       Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They projected single stray incident   as an example and portrayed as generalization just to earn money and fame for themselves.

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

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.  

           Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession.  Role of doctor associations, parent institutes have been spineless and not encouraging.

         Such bestiality should create havoc in minds of civilized people but this apathy to such incidents clearly indicates otherwise. Have we become so uncivilized 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 realize that this is the time to unify and condemn such episodes vehemently and prominently so that the miscreants realize that they cannot get away with it.

  Doctors in remote area, where there are minimal medical facilities, doctors are at more risk than ever; they are at mercy of local goons with no protection.

        Silence of lords is a death sentence to the medical  profession as a whole.

    Doctor assault is definitely a poor advertisement for the medical students, who want to be doctors or others who want to buy a private medical college seat by paying millions. Why should one become doctor or  pay millions and bear risk of being beaten or killed, while doing such a stressful duty. People will be fearful to be doctors on a free seat, leave alone on the paid seat.

 The People who rue the scarcity of good doctors, should now introspect, “do they deserve to have good doctors?”

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Allopathy-Ayurveda debate: Media’s Misplaced priorities


The doctors, nurses and healthcare system have been relentlessly hauled over the coals for last one year and further battered emotionally by the cruel adverse media insinuations and taunts. At the peak of pandemic, when the powerful media should be discussing the core issues to control pandemic; issues like oxygen supply, vaccination and improving the health infrastructure, it has found more interest in a futile Allopathic-Ayurveda debate. Even if someone wants to start this kind of discussion, media should have shown more wisdom not to make it a dominant issue. There are more important, urgent and pressing issues where media can play a vital role.

By many media narratives, an impression is being fostered that doctors have made a mess and forfeited their moral right to treat. Suggestions of ineptitude were gleefully aired, causing demoralization of the warriors, who were immersed in the pool of Covid patients, trying to save them.


         Their role should be as facilitators to help doctors to save more lives. One hospital death of out of millions saved, is projected as failure of doctors. They are so distant from the ground reality.  To control the health system, media has a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.

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

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.

      Media people, who have never treated a patient in their lifetime, sway opinion and treatments of the millions just by game of projection and perception. The news items and the content are guided by idea of creating sensation in a quest to sell news, be it a selective negativity. Such  negative and selective projections are causing discouragement and demonization of the medical profession. It is the biggest  tragedy to the medical profession in present era.

      Normal treatment of the sick patients is being projected as gruesome atrocity, inflicted by doctors. Media could have done better in helping to take off spectacles fogged with bias against doctors and recognizing them as real saviours, just as deserving of justice.

       National Media could have helped, had they fueled the right and constructive discussions. The TV channels  could have countered the pandemic with better imagination, sobriety, and exemplary performance rather than creating sensation by cynical and futile debates, which are absolutely inappropriate at this time.  

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Facilitators turn administrators: Biggest tragedy to medical profession in present era


14 Doctors in rural Unnao resign alleging mental harassment and misbehaviour by administrative officers over COVID-19 work.

       Administrators, who have never treated  a patient in their lifetimes, but control treatment of thousands of patients. The  biggest tragedy to the medical profession in present era, causing discouragement and demoralization of medical profession.
         Their role should not have been more than facilitators, but they have become medical  administrators. They are so distant from the ground reality.  To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.
The vulnerability that is  intrinsic to the  doctors’ working makes them sitting ducks, an easy target for harassment and punishments and  is exploited by everyone to  their advantage. Administrators use this vulnerability to  suppress them. It is used by  media and   celebrities who projected  themselves as Messiah for the cause of patients, and  sell their news and shows by labeling the whole community of doctors as dystopian community based on just one stray incident.

     The blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who were unable to retaliate to the powerful administrative machinery.   

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry  and administrators is  not given, in order to maintain the prejudice  with its dangerous bias towards doctors, who are in forefront and are visible to public. Clearly separating the role of health workers and the hidden administrators would not only settle the matter, but is actually essential to project the reality. The correct perception of two fundamentally different components would reveal a real gulf and would help to address the core issues.

    A wish to govern, regulate and punish the medical professional by administrators is not new. Hammurabi 4000 years back had initiated to write the cruel rules of the game, which possibly initiated a change in the global perception and regulatory system and formed the basis for cruel regulation in radical and unprecedented ways.

      In  a quest to control  this difficult area,  which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief, sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects and  the  amalgamation of intricacies of science with legal complexity, doctors are burdened with over-regulation and administrative pressures.

               Consequently the  doctors are the sufferers, as they feel enslaved and suffocated. But ultimately who would be the sufferer, does not need an Einstein brain to guess.

14 doctors resigned, alleging harassment and misbehaviour by administrative officials.

More than a dozen doctors posted in rural hospitals in Unnao district of Uttar Pradesh collectively resigned, alleging harassment and misbehaviour by administrative officials.

The doctors, numbering 14, posted at community health centres and primary health centres submitted their resignation letters to the chief medical officer (CMO) of the district on Wednesday. Speaking to the media, one them said that while their teams would work on the field from noon to 4-5 p.m., isolating COVID-19 positive cases in their home, distributing medicine and carrying out sampling, the local SDM would summon them after that seeking a report of their work. The doctors would have to drive back several km to the tehsil from their place of work just to “prove that they are working,” said the doctor. “Despite continuously working, it has been made to appear like we are not working and that due to this, the COVID-19 situation is going out of control,” he said. The doctors also alleged that they were not provided sufficient drug supply from the government and often faced verbal harassment at the hands of the CMO and the CMS. If the field teams were unable to trace down patients because of submission of wrong phone numbers and addresses, they should not be held responsible for it, said the doctors.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

New book: ‘The Real Issues’ through ‘fictional narratives’


“AT THE HORIZON OF LIFE AND DEATH”

Find it on Amazon :

Description

         This book comprises of stories that capture the pivotal moments in the treatment trajectory of the critical patients facing death.  The times that force the doctor to confront the saddest moments, while battling a terrifying, unbeatable foe, the death monster alongside families’ fears, gloom, indecisiveness, dilemmas about future and saviour’s own predicaments intertwined with medico-legal intricacies and consequent complex emotional interactions.  

        The situations depict ‘the real issues’ through ‘fictional narratives’. 

       The stories reflect life of a doctor in the present era, amidst sick patients in an imposed legal milieu, a mystic journey, an arcane odyssey punctuated with pain and pleasure in the narrow and uncertain lanes at the horizon of life and death, carrying the burden of various vicissitudes like consumerism, legalities, unpredictable course of diseases, mistrust and blame for poor outcomes.   

        The narratives try to unmask the eternal latent vulnerability that is intrinsic in doctor’s work, which is exploited by media, law industry and even celebrities to sensationalize and sell their news and shows. The vulnerability turns more evil as the delineating cleft that separates doctors from the invisible overpowering medical industry is not shown, thus ensuring to sustain the prejudice with its dangerous bias towards health care workers. 

        One negative news story through a ‘portrayal effect’ generates unbridgeable gap in doctor -patient relationship, painful burden of mistrust loaded on doctors, that would heal only if millions of unfettered, unprejudiced, unbiased facts are clearly projected. 

           The book tries to highlight a seemingly illogical and contrary nature of the conflict; the doctors are finding themselves increasingly being engaged into. The dense mazes of consumerism, extensive communication, documentation, unrealistic expectations, negative media insinuations, legal complexities are demoralizing to doctors and certainly counterproductive for patients.

         The futile discords emanate frequently, that are mundane in reality when compared to the actual disease and the real point of intention which is ‘The Treatment of the Patient’.

         But is this what the patients actually need? Does the entanglement of doctors in such a maze help the patients in real sense?

        The author felt morally compelled and attempted to find answers, embedded in a journey that was wondrous and inspirational, but with horrifying moments as well.

        Has the decision to treat human fragility become a mistake in present era?  No reward, if you win the match of life and death but sword hanging; if  one were to lose?     

       Patient will need to decide someday, whether to be a consumer or just remain a patient. 

       Being a consumer may be an overall loss-making deal for the patient.

Disclaimer

   The stories are fictional, but the depiction of the problems to the doctors, nurses and patients are real, based on day to day routine incidents. The episodes do not pertain to any single particular person, patient, doctor, nurse, hospital and organization. All the characters, names and dialogues in the book are figment of imagination of the author and similarity to any person, any situation or organization may be co-incidental.

            The stories are not against any law, word of courts, profession, any government or any organizational set up or rules of any country. They depict the problems commonly faced by doctors in performing their duties hence are likely to affect the patient directly.

REEL HEROES VS REAL HEROES in PANDEMIC


    

 There has been frequent attempts by REEL HEROES and  celebrities, to projected themselves as Messiah for the cause of patients.  By self-appointing themselves as custodian of health of masses, ‘the Reel heroes’ and celebrities gave true meaning to their work of ‘ACTING’ that otherwise is no more than a trifling entertainment.

     An anecdotal episode of adverse event or poor prognosis was enough to be used as an illustration to portray whole medical professionals as dystopian community but what remained invisible to all was the fact that every day in hospitals, thousands of lives are salvaged back from the brink of death.

But the actual bargain was an attempt to project Reel heroes as Real heroes and vice versa.    

         Media and many celebrities have used fear in public mind to garner accolades and money for themselves, but at the same time created paranoia in minds of people against medical profession.  And when masses worshiped them as their true well-wishers, they aired advertisements to sell tobacco, soft drinks, junk foods and other sweet poisons to public and children.

        There is an eternal, latent vulnerability that intrinsic in the way doctors’ work and has potential to make them sitting ducks for harassment and punishments.  It was easy to discern that vulnerability was being exploited and turned more evil, when braided with such  insinuations by media and celebrities.

         The negative projection to create a generalization in minds of people had been demotivating and demeaning to the entire health care workers.  The selective projection had left behind a trail of hopelessness in the mind of people, shattering their trust and instigating against medical profession.

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

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

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

Even a junior doctor saves many lives in a  day in emergencies as compared to the work of a superstar in films.  A teacher, nurse or scientist have a contribution which is more fruitful to our generation.       A  society truly needs the real people, who work and act for them, more than just entertainment. It will need a total change in the attitude of people to deconstruct their perceptions, which are based on mere projections and are away from reality.

21 occupational risk to doctor and nurses

The naivety of masses to perceive the projected character as real one  goes beyond a reasonable thought process and imagination.

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

Point to ponder is that whether society needs people  just  acting like   doctors,  soldiers  and not the  actual and real ones, who saves lives.

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

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

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Ayurvedic Surgery: who should be concerned?


         A strange situation has cropped up after the claim of Ayurvedic doctors doing surgeries has got the CCIM approval. Serious doubts has been raised by Allopathic medical organizations about the consequent safety issues.

       There would always be claims or counter claims about who should be allowed to do surgeries.  But there has to be a neutral and competent authority to decide, rather than claiming the competence.  After all it is question about safety issues of millions of  people.

      Who should really decide about it?

     NABH  has raised concerns about the issue.

    Although it has limitations and can be applicable only to a fraction of hospitals, but still a larger network of hospitals or clinics are not covered by NABH.

      In such situation, who should be worried about the safety? Strangely the stakeholders, who would be affected most are silent on the issue: the patients.

      If patients  have nothing to protest and they feel safe or do not anticipate any danger, why allopathic doctors should make a noise about it? They would be seen as a Jealous cat.

     Use Ayush docs for clinical work and you could lose ACCREDITATION: NABH TO HOSPITALS

         The National Accreditation Board for Hospitals and Healthcare providers (NABH) has warned allopathic hospitals accredited with it that they could face withdrawal of accreditation if they were found employing Ayush doctors for performing clinical duties in ICUs and other patient care areas in place of MBBS resident medical officers (RMOs) and emergency doctors. A “cautionary notice” the board issued on Thursday said, “This is a blatant violation of NABH standards for healthcare accreditation and very much against patient safety norms and compromise quality of modern medicine clinical care outcomes.” TOI had, in October, reported on the use of Ayush doctors in ICUs for night duty being a fairly common practice in many private hospitals, particularly in Maharashtra and Gujarat. Thursday’s notice stated that the NABH has taken a serious note of the matter and reiterated that deploying of Ayush doctors in allopathic hospitals for writing independent orders and clinical work without the supervision of allopathic doctors is not permitted. In case the allopathic hospitals are employing such doctors to work as clinical assistants, under applicable state laws, they should not be involved in direct patient care and should strictly follow job responsibilities as defined by hospital management, it added.  Ayush doctors working in allopathic hospitals will not be considered by the NABH as RMOs during the process of assessment and for the purpose of grant of accreditation, stated the notice, adding that any violation may invite adverse decision by NABH, including withdrawal of accreditation. However, even as the NABH has been carrying out surprise inspections in hospitals in this matter, it is yet to have a definite list of states that allow Ayush doctors to be employed in allopathic hospitals to either prescribe a pre-defined set of allopathic medicines or to do clinical procedures after completing a bridge course. NABH officials clarified that the board’s legal team was in the process of determining the status of the law in different states.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

#Medical-Consumer-Protection-Act: Pros & Cons: Advantages & disadvantages


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.

2. 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.

 3. 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.

4. 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, nurse

5. 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 .

   

6. Increased paper workexcessive 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.

7. 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.

8. 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.

9. 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.

10. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. Instigation by law industryWindfall 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 instigations of lawsuit against doctors is a major setback for medical profession.

17. 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.

18. 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.

 19. 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

2.  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.

3. 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.

4. 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.

5. 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: 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

Violence at #NMMC HOSPITAL VASHI Mumbai- shame on law and order agencies


Attacks and assaults on doctors appears to be  one of the indicators of  a lawless and uncivilized society and  poor governance.  Doctors  have become punching bags for all the malaise prevalent in the  health system. A failing and inept system, which is unable to provide health to people and  security to doctors. The system  hides behind their working  doctors and presents them as punching bags. The  impunity with which attendant easily and brutally assault doctors and vandalize hospitals  is really appalling. Similar violent incidents all over  should be  shameful  to law enforcing agencies. Are we a lawless society? More problematic is the government apathy and silence of human right commission and similar organizations.

     Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession. Silence of authorities, human right commission is really appalling. 

 Media, celebrities, film stars in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable, where stray incidents were portrayed as generalization, just to earn money and fame.

    Empathy, sympathy, compassion and trust  of the doctor towards the patient, will definitely get a hit after these incidents. Everyday  the news of assaults on doctors, court cases against doctors, negative projection of the medical profession   in the media are viewed  by doctor’s community anxiously..

      Merely taking some token  action and showing  protest will not solve the problem. It does not compensate for the  damage done to medical profession. Sympathy, compassion and trust of the doctors towards patients will definitely reduce. Who will be  the ultimate sufferer, does not need a Einstein brain to predict.

                    This insecurity or fear of the uncertainty tends to affect the thinking process of doctors and the way they practice medicine or deal with the patients. Many will like to be defensive in practice, or try not to treat very sick patients.  Why would someone try complex surgeries, if there is greater  risk involved? Few will limit themselves to follow protocols. Going extra mile  along with risk, which not everyone will like to take. Many will become health managers or do something else than do active clinical work. Who should risk his life while doing routine work?

     Patients might get their revenge for the  naturally occurring disease, but they will lose compassion and trust of doctors in the long run. If that is the way to impart justice in this era, doctors will have to find some way to save themselves.

Patient relatives vandalized NMMC Hospital Vashi, Mumbai

Relatives were booked for vandalising the Navi Mumbai Municipal Corporation (NMMC) hospital in Vashi following the death of a 50-year-old man. Of the seven, the four men were arrested. The patient, Venkatesh Suryavanshi, a resident of Juhu gaon, was shifted from a private hospital in Koparkhairane to the NMMC hospital on Tuesday afternoon. At the time of admission, Suryavanshi, who had tuberculosis, was in a critical condition and had very low oxygen levels. An antigen test had declared him negative for COVID-19.“At the time of admission, after checking his condition, vitals and the history papers, we had said that his chances of survival are very less. He was admitted to the ICU ward,” Prashant Jawade, medical superintendent, NMMC hospital, said.Suryavanshi died during treatment around 3.45 a.m. on Wednesday. After getting to know about the death, his sons Rupesh (22) and Sandesh (20), along with their friends Pankaj Jadhav (22) and Rohit Namwad (32) entered the ICU ward and started vandalising the department. Three women who followed them assaulted security guard Satish Dere.“I was told that they also carried a few sharp weapons with them. The security guard has received injuries. Our engineers are analysing the damage and finding the losses that we incurred,” Mr. Jawade said. Chief Medical Officer Majur Shaikh and a few other hospital staff were also allegedly attacked.

According to the police, the seven had vandalised three ventilators, one dialysis machine, two fans, one table fan, and two nurse stations.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

    21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

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