Violence against doctors: No support – Saviours need to save themselves


 

More of a law and order issue, the physical assault on doctors reflects that they are serving an uncivilized society.  Such news is viewed by medical community anxiously and is definitely a poor advertisement for younger generation to take medicine as profession. The medical students need to think, why they wish to enter medical profession in such an unsupportive environment?

     Strangely media, courts, prominent people, celebrities, human right commission, right activists are little concerned about the blatant injustice done towards doctors.  This again brings forth the hypocrisy of our society and law enforcement agencies, which otherwise cry hoarse about human rights, but practically doctors (while they save others), need to fend for themselves when ugly situations arise.  

NEW DELHI: The Central government has decided not to enact separate legislation for prohibiting violence against doctors and other healthcare professionals, the Rajya Sabha was informed on Tuesday.

In a written reply, Union Health Minister Dr Mansukh Mandaviya said that a draft of the Healthcare Services Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, 2019 was prepared and was also circulated for consultations.

“Thereafter it was decided not to enact a separate Legislation for prohibiting violence against doctors and other health care professionals,” he said to a question on the reasons for the withdrawal of the Bill, which intended to protect healthcare professionals and institutions.

No separate law to prohibit violence against doctors & Health care workers

Mandaviya said that the matter was further discussed with relevant ministries and departments of government as well as all stakeholders, and an ordinance namely The Epidemic Diseases (Amendment) Ordinance, 2020 was promulgated on April 22, 2020.

However, the government, on September 28, 2020, passed the Epidemic Diseases (Amendment) Act, 2020 under which acts of violence against healthcare personnel during any situation were considered cognizable and non-bailable offences.

Speaking with TNIE, Dr Rohan Krishnan, National Chairman, FAIMA Doctors Association, said that there have been many cases of violence against doctors and health professionals in the past few months inside the government hospitals, but the union health ministry has not taken their demand to have a separate law for providing safety and security to healthcare workers and doctors seriously.

“The government needed us during the Covid-19 pandemic and came out with rules and regulations. We also felt safe and secure. But now that Covid-19 is declining and we were able to bring normalcy, the government is showing its true colours. It is shameful,” he said.

“The government is not standing up to its promise of bringing a separate law to prohibit violence against doctors and healthcare professionals,” he added.

“On the one hand, it has failed to provide mental and physical safety and security to the doctors and healthcare professionals; on the other hand, instead of having verbal communication with us regarding this matter, the government is denying any scope of providing a separate law in the future. This is a very serious issue. We will raise this issue at every level,” Dr Krishnan said.

Under the Epidemic Diseases (Amendment) Act, the commission or abetment of acts of violence or damage or loss to any property is punishable with imprisonment for a term of three months to five years, and with a fine of Rs 50,000 to Rs 2,00,000.

In case of causing grievous hurt, imprisonment shall be for a term of six months to seven years and with a fine of Rs 1,00,000 to Rs 5,00,000.

In addition, the offender shall also be liable to pay compensation to the victim and twice the fair market value for damage to property.

Since, law and order is a state subject, State, and Union Territory governments also take appropriate steps to protect healthcare professionals/institutions under provisions under the Indian Penal Code (IPC)/Code of Criminal Procedure (CrPC), the minister said.

To another question on the number of security guards hired/outsourced by government hospitals in the country, the Minister of State for Health Dr Bharati Pravin Pawar said that public health and hospitals are state subjects, therefore no such data is maintained centrally.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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

Comparing airline industry & health care is fallacious, an oversimplification; apples to musk-melons


 

 

The issue of patient safety has been gaining increased traction year on year and the issue is in right direction.  Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety.   Patient safety is of paramount importance; therefore it is an serious issue. It should be achieved by good ground work and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources.

There is a recurrent old argument and temptation to ask about why healthcare can’t be as safe as airline travel.   There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies,  have  insight looking at life and death situations directly,  know  that comparing both would be just an oversimplification of the real basic issues.

  At most of the points, the comparison is a complete fallacy; and like comparing apples to musk-melons.

It is beyond doubt that air-industry maintains truly an impressive system which is well-designed to achieve the safety results that it does.  But , the kind of  comparison  that  some health care safety leaders make in which they compare the  mortality data of acute hospital care and airline fatal accident rates is more of a word play and not so appropriate. This comparison is dangerous because it misses the key points for improvement. Such comparisons  merely present over-simplified and convenient tool for the health quality experts, who themselves have never been a front line health workers at any point of time, but still pretend to pioneer the  quality in health industry.  For the quality improvement the leaders need to be grounded in the reality of emergency front line medicine to be really effective.

  1. Aircrafts  are engineered to be in the best possible shape before they fly. Patients, on the other hand, patients  are in the worst shape when they enter the emergency of the hospital.

Medicine is by nature, a much more risky work than flying along with vulnerability to death always.

  1. The aircrafts are required to regularly demonstrate that the performance of their critical systems meets or exceeds strict standards. If systems are not operating well the plane will not be allowed to fly.

But all the patients, (aeroplane metaphor) are already sick; doctors are expected to fly such aeroplanes, who are in crashed condition universally. Doctors do not have the luxury to replace any part.  For example, when doctors treat an elderly with heart failure, chronic kidney failure and pneumonia, they try to keep them “flying” despite multiple sub optimally functioning critical systems.

  1.  In other words, doctors have to fly crashed planes always on every day basis, something that never happens even once in aviation industry.
  2. Has any Pilot ever tried to fly  a plane in which engine power is only 25 percent of normal with  other systems are functioning  sub optimally  and  the fuel tank is leaking?  What will be standard procedure (SOP)  for Pilot to fly this plane? But everyday doctors try to fly such planes and they have to fly it no matter how many systems are non-functional.  Moreover, doctors can be sued on some flimsy grounds in case they fail or an accident happens in an effort to keep this plane in the air.  Treating a critical illness is like an effort to keep such planes in air with suboptimal functioning systems.

Obviously the comparison is a bit overzealous.

  1.   What would be chances that a fully checked plane with a trained pilot will crash after flight takes off. Now compare the chances of patient who lands in emergency, and treatment is started.

By a simple common sense, are two situations comparable?

Former has no chance (almost Zero percent) of crash whereas in a critical emergency patient, the chances of crash are 100 % to start with.

  1. Communication of passengers to the pilot about what he should do and what he should not while flying the plane is nil. Whereas doctors are continuously bombarded with google knowledge of patients and interference by relatives and questioned about every action.
  2.   Doctors are expected to make future prediction about what can happen, how he will be able to keep the crashed plane in the air and take consent, based on few assumptions. Doctors can be harassed and dragged to courts if such predictions fail.
  3. Airlines will always have full staff to serve promptly during a flight. The pilot will be totally dedicated to flying the plane, and will not fly without the co-pilot and crew. On the other hand, front line healthcare workers know it well the fact that patient safety incidents and errors tend to occur when they are struggling with staffing levels and feel grossly overworked.

Fatigue and overwork is too common scenario among front line healthcare staff in clinical settings.

  1. A pilot is also only ever going to fly one plane at a time. It is not realistic for a doctor or nurse to be allocated to just one patient, but the workflow is very different, with healthcare tasks frequently interrupted with new clinical issues and emergency situations. Consequently, insufficient staffing can have an acute effect on outcomes and the ability to perform safely.
  2. Aviation industry is too predictable and on the contrary, health care is combination of uncountable unpredictable risk factors, be it allocation of staff or risk of death or resource prediction and complexity of communication.
  3. Aviation is more of mechanical milieu, whereas health care deals with emotion and compassion. The two industries are vastly heterogeneous, and to say that safety in medicine should follow in the path of flying airplanes, grossly oversimplifies a complex problem.
  4.    Last but not the least; health care involves lot of financial uncertainties and arrangements. Needless to say, doctors carry the blame for financial hardship of the patients, even if they are not responsible for costs. The mammoth industry remains hidden and doctors are blamed as they are the only front man visible.
  5. Basic difference lies in the fact that patients are real living people, whereas airplanes are simply machines, whose codes and protocols are well defined and limited to within human capabilities. The importance of human contact, empathy, compassion, interact and listen to concerns, and the ability to spend adequate time with patients,  should be  always be the first pillar of promoting a culture of safety.
  6.   Exhortations by armchair preachers to learn oversimplified improvement examples from aviation can provoke considerable frustration and skepticism among clinicians exposed to the unique challenges, difficult working conditions and everyday complexities.  Patients are not aeroplanes, and hospitals are not production lines.

Most unfortunate part is the assumption that every sick person who dies in a hospital from an adverse event is an example of a truly preventable death rather than clinicians trying their best to keep someone alive and eventually failing.

  1.  Checklists and documentation to improve systems are wonderful in mechanical areas like operative care and inserting central lines, but have limited role and can only go so far without the most important virtues of being a doctor or nurse. It means more than mechanically following protocols and doing paper work in real sense.

In health care merely providing check list and doing extra- paper work may be counterproductive for many reasons.  Increase in time for voluminous documentations will consume time and forces health care workers to focus on paper work and takes them away from patient’s real issues.

Completed paper work and excessive documentation provides a false assurance of quality work, which may or may not reflect true picture of patient care. Even after full documentation,  still  it will be required  to be carried out in a diligent manner, a  task which is different from mechanical  task of mere check list  of other  industries . Learning from other industries seems to offer a simple shortcut to anyone trying to improve healthcare, but its utility is limited only for documentation purposes and not real quality. Caring for patients is radically different from flying aeroplanes. Healthcare is unique in the intimacy, complexity, and sensitivity of the services it provides as well as the trust, compassion, and empathy that underpin it.

Merely completing protocols mechanically and excessive documentation will result in decline in quality actually.  Simply importing and applying a ready-made tool will lead to situation, where quality will exist only on papers and merely  reduced to a number to the satisfaction of so called ‘pioneers’ of quality.

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

 

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

Comparison of AIIMS (medical) and IIT (Engineer) graduate with 5 years invested. Do doctors deserve better salaries?


       Let us compare the start of career for medical and engineering graduates. To have a balance, comparing apples to apples, comparison of AIIMS graduates (premier institute –medical) to IIT graduates (Premier institute -Engineering) looks justified.  This goes without any need to emphasize that students selected in both are exceptionally brilliant and toppers of the country.

    Although this comparison is not a secret and everyone knows about it, but still it need an attention from a different point of view. It should be an eye opener not only to medical students or aspiring doctors but to the society as well. It projects the severe disparity to an extent of blatant injustice towards medical students.

  When engineering students after a course of  4 years  (at 21 years of age )are placed with package of 1.2 to 3.6 crores (1-4 lakh dollars), the medical students are starting with internship. Medical students still need to study for at least 5 years more (at 21 years of age ) to start earning maximum 12 -15 lakh per annum ( 15 thousand dollars). It may be raised to 24-30 lakhs (30000 dollars) per annum after 10 years, still one tenth of their contemporaries from IIT. Remember we are talking about only premier institutes, what happens to others is still a matter of luck.

   When engineering students earn crores, do jobs and get experience about the real world, medical students are worrying about the problems, which should not have been there in the first place. The common issues bogging down the medical students are trying to get into post graduate courses, inhuman duties lasting 24-48 hours, payment of unjustified fee of medical colleges, trying to fend off bond policies, court cases, bearing with assault on doctors, working in poor and inept health care infrastructure- just to name a few.  With all these problems lingering for years, doctors remain unwise in worldly matters, financially illiterate and sitting ducks for punishments due to excessive regulation and unjustified moral burden.  

      This comparison is essential to be kept in mind by aspiring doctors when they choose medical career. The respect and money associated with the hard work to be a good doctor is no more available even to the best.


   A Point to  ponder for everyone, what is the reason for such disparity?  Why doctors do not deserve better salaries? What is the need for  aspiring doctors to choose lowly  paid jobs for more hard work and more noble work? A fodder for thought for society  and administrators as well.

IIT hiring: Domestic offer hits record Rs 1.8 crore

IIT hiring: Domestic offer hits record Rs 1.8 crore

MUMBAI: After a lull in the first pandemic year, crore-plus job packages returned with a bang on premier IIT campuses. On the opening day of the season, several IITians entered the crore-plus salary club, as the highest domestic package touched an all-time high of Rs 1.8 crore and international offers crossed the Rs 2 crore mark. While Uber picked one student each from at least five IITs, including IITBombay and Madras, for a package of Rs 2.05 crore (or $274,000), one student at IIT-Roorkee received an international offer of Rs 2.15 crore ($287,550) and three others got domestic offers ranging from Rs 1.30 crore to Rs 1.8 crore. In the first slot at IITB, the highest offer after Uber came from cloud data management company Rubrik, with a Rs 90.6 lakh (or $121,000) package.  Of the domestic roles, investment management firm Millennium picked students for a package of Rs 62 lakh in the first slot, while WorldQuant offered Rs 52.7 lakh and Blackstone Rs 46.6 lakh. IIT-Madras students get 176 offers in first session on day 1 ALSO READ IIT-BHU student bags Rs 2 crore package from US company in placement . The highest numbers of domestic offers were made by Google, Microsoft, Qualcomm, Boston Consulting Group (BCG), Airbus and Bain & Company. IT/software, core engineering and consulting were the leading sectors to hire from the institute in the first slot. As many as 11 international offers were made at IIT-Madras on day one, said professor CS Shankar Ram, adviser (training and placement), IIT Madras. The institute recorded 407 offers in the first session of the placements, its best ever, including 231 PPOs. In all, 11 students received offers that crossed Rs 1 crore and of them 10 got domestic offers and 13 students signed up for an international offer, of which 12 opted for packages less than Rs 1 crore to take up jobs in Japan and Singapore.

Record Rs 3.6cr offers to 3 from Delhi, Bombay, Madras IITs for Hong Kong posting

MUMBAI: Hong Kong and Singapore seems to be the destinations where IITians are heading to this placement season, with most big-ticket offers being offered by trading firms there. Jane Street, a quantitative trading firm, has picked at least one student each from IIT-Bombay, Delhi and Kanpur for its Hong Kong office for a record package of Rs 3.6 crore. These, however, were made as pre-placement offers (PPOs) before the season kicked off on December 1. Another high-frequency trading firm Quantbox Research has made an offer of Rs 1.6 crore at multiple IITs for its Singapore office. one IIT-Bombay student, there are other PPOs that have made offers to students of close to Rs 2 crore,” said a source at IIT-B. On-campus job offers have not touched the Rs 2 crore mark. “There are several Rs 1 crore job offers and there are 15 companies with international locations, On the first day of placements, IIT-Bombay had 46 companies interviewing candidates either online or in-person. Of the 250 job offers on Day 1, more than 175 were accepted. On Day 2, a total of 48 companies were at IIT-B. The highest package so far this year domestically is Rs 1.9 crore, while there are a good number of packages from international recruiters as well.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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

Assault on a Woman Doctor #Kerala: Medics Serving Uncivilized Society with Poor Law & Order


THIRUVANANTHAPURAM- Kerala: The assault on a woman doctor at Thiruvananthapuram Government Medical College has made doctors preparing for a career in the medical profession worried. A bystander kicked the woman doctor on her lower abdomen in front of an ICU in the middle of the night on November 23. The CCTV visuals showed that she was surrounded by a group of bystanders.

    The physical assault on a lady doctor reflects that doctors are serving an uncivilized society.  Such news is viewed by medical community anxiously and is definitely a poor advertisement for younger generation to take medicine as profession.

     Strangely media, courts, prominent people, celebrities, human right commission, woman right activists and women commission are little concerned about the blatant injustice done towards doctors.  This again brings forth the hypocrisy of these people and organizations, who otherwise cry hoarse about woman rights and empowerment.  Whenever a female is assaulted, there is an outrage but the same support is not extended to a female if she is a doctor. Such bestiality should create havoc in minds of civilized people but this apathy to such incidents clearly indicates otherwise. Have we become so 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.

     Brutality against doctors reveals a deep prejudice and lawlessness, merely on the basis of perceived negligence. Government is either unwilling to act and establish a strong culture of deterrence, so justice been elusive for medical professionals.

Even murderous assaults on doctors are not enough to shake administrators, courts  and doctors’  organizations  out of slumber.  Definitely such violence, if unabated will be   poor advertisement for   next generation to take medical profession as a first choice.

Media and celebrities   have proudly  projected in films and television that doctors can be beaten and assaulted, in case there are unexpected results or in case of dissatisfaction. The “Reel Heroes” depicting violence against the doctor is seen as a routine and looked as an   easily do-able- adventure due to unwillingness of  Government  to take stringent action. As patients will continue to get treatment in hospitals and few cannot be saved, so every death declaration may be a harbinger to such attacks in future.

A notion has been propagated   that   assaulting a doctor under emotional  outburst  to be taken as normal and should not be punished.

THIRUVANANTHAPURAM: The assault on a woman doctor at Thiruvananthapuram Government Medical College has made doctors preparing for a career in the medical profession worried. A bystander kicked the woman doctor on her lower abdomen in front of an ICU in the middle of the night on November 23. The CCTV visuals showed that she was surrounded by a group of bystanders. She survived the attack and is recuperating. But the incident has left her shattered. “I am reconsidering my decision to become a neurosurgeon and even the career of a doctor,” she told Sulphi N, IMA state president, when he visited her in the hospital.The Kerala Medical Post Graduate Association has taken up her cause and demanded justice.

They are worried that such attacks would happen again and there would be a new victim. “It is unnerving that such attacks happen in medical colleges which are supposed to be a secure location. What will happen to us if we go to peripheral hospitals for practice,” said Dr Ruwise E A, Thiruvananthapuram unit president of Kerala Medical Post Graduate Association.He came to know from police officers that an arrest was unlikely on Friday and the accused was trying to secure bail. “The government should have arrested the culprit immediately and sent a message to the public that such attacks are not tolerated,” said Dr Ruwise.KMPGA plans to strengthen the strike if there is no arrest till Sunday. The doctors association has extended support to the protest by residents. “We cannot leave the students alone on this issue. It was an assault on a woman who was doing her duty. If it was a senior doctor who received such a kick on the lower abdomen he or she would not have survived the attack,” said Dr Nirmal Bhaskar, state president of Kerala Government Medical College Teachers Association (KGMCTA).The doctors share their angst as there was not enough support from government and society even when the attacks keep repeating. They did not take the Facebook post by Health Minister Veena George condemning the attack seriously.There are health experts who think that a multi-pronged approach is necessary to prevent such attacks. It involves reducing the crowd by strengthening peripheral hospitals, increasing staff and providing better security.“The government health system has become an easy target nowadays. Such attacks do not happen in private hospitals where bystanders pay the remaining hospital bills without uttering a word of protest even after the patient could not be rescued,” said Dr Althaf A, secretary of IMA, Thiruvananthapuram branch. He pointed out that there are no trained administrative cadres to manage a 4,000-bed MCH. All of this is managed by a superintendent who is also a professor with teaching responsibilities.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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

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


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

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

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

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

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

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

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

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

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

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

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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

SC Rejects Greedy decision by Govt & Private Medical College-Fee Hike


 

    The Supreme Court set aside an Andhra Pradesh government order of 2017 prescribing a seven-fold increase in MBBS fees that made it ₹24 lakh per annum.

The Supreme Court in a judgment on Monday held that education is not a business to earn profit as it set aside an Andhra Pradesh government order of 2017 prescribing a seven-fold increase in MBBS fees that made it ₹24 lakh per annum.

Directing the private colleges to refund the amount collected in excess of the fees last fixed by the state government in 2011, a bench of justices MR Shah and Sudhanshu Dhulia said, “Education is not the business to earn profit. The tuition fee shall always be affordable.”

The order came on a petition filed by the Narayana Medical College challenging a September 2019 decision of the Andhra Pradesh high court striking down the fee increase and ordering refund to students admitted in the college since the academic year 2017-18. The apex court dismissed the petition with cost of ₹5 lakh to be borne equally by the petitioner college and state government and deposited in court within six weeks. The amount was directed for use in legal services by the Supreme Court Mediation and Conciliation Committee and the National Legal Services Authority.

The top court agreed with the conclusion made by the high court and said, “To enhance the fee to ₹24 lakh per annum, I.e., seven times more than the fee fixed earlier was not justifiable at all.” The aggrieved medical students who had to pay through their nose had said that the government order raising the fees issued on September 6, 2017 was done without awaiting the recommendation of the Admission and Fee Regulatory Committee (AFRC).

The bench held the order passed by the state government to be “wholly impermissible and most arbitrary”. The court even went to the extent of saying that the hike was done “only with a view to favour or oblige the private medical colleges.”

“Any enhancement of the tuition fee without the recommendation of the AFRC shall be contrary to the decision of this court in case of P.A Inamdar in 2005 and the relevant provisions of the 2006 AFRC Rules (prevailing in the state). The high court has rightly quashed and set aside the GO dated September 6, 2017.”

The students pointed out that in 2011, the tuition fee hike was introduced by the state after consulting AFRC. However, in 2019, the state acted solely on representations received from private medical colleges. Rule 4 of the Admission and Fee Regulatory Committee (for Professional Courses offered in Private, Unaided Professional Institutions) Rules, 2006 mandated the state to seek a prior report from AFRC before altering the fee.

This rule required AFRC to factor in the location of the institution, nature of professional course, cost of available infrastructure, expenditure on administration and maintenance, reasonable surplus required for growth and development of the institution, revenue foregone on account of waiver of fee in respect of students from reserved category or economically weaker sections (EWS) of the society.

The top court said, “Determination of fee/review of fee shall be within the parameters of the fixation rules and shall have the direct nexus on the factors mentioned in Rule 4 of the 2006 Rules…the state government enhanced the tuition fee at an exorbitant rate of ₹24 lakh per annum, almost seven times the tuition fee notified for the previous block period.”

The next question arose regarding refund as ordered by the high court in its order of September 24, 2019. The high court said that the colleges cannot take benefit of the unjust enrichment in fees that was wrongly increased. Accordingly, it asked the colleges to refund the students after adjusting the amounts payable under the earlier fee structure recommended by AFRC and issued in June 2011.

The bench upheld this part of the high court order and said, “The medical colleges are the beneficiaries of the illegal GO which is rightly set aside by the high court.” The bench was conscious of the hardships faced by students who arranged to pay the amount by obtaining loan from banks and financial institutions at high rate of interest. “The management cannot be permitted to retain the amount recovered or collected pursuant to the illegal GO,” it held.

The college told the Supreme Court that between 2011 and 2017, they incurred added expenses due to the requirement introduced in 2016 to pay stipend to students even as the fee remained unchanged since 2011. The bench told the college that this component would be compensated as and when the higher tuition fee is fixed by AFRC. However, the court did not permit the college to retain the illegally collected amount.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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

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


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

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

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

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

MBBS  medical  students protest against Haryana Govt Bond Policy-Rohtak

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

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

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

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

MBBS  medical  students protest against Haryana Govt Bond Policy-Rohtak

MBBS  medical  students protest against Haryana Govt bond policy detained

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

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

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

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

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

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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

Compare Reaction to  Death of “Hundreds of healthy people” to  single “perceived negligence” in Hospital  #Morbi-Gujarat


Reaction to ‘Death’ in this  new era  of consumerism has become a story of paradox. Massive civil negligence  and 141 deaths but there are no punching bags  as are  doctors  for revenge in case of a hospitalized death.     Just Compare the media  projection, burden of negligence and accountability of  hundreds of healthy deaths by civic negligence   to the  one hospital death by disease. 

     Death is the inevitable conclusion of life, a universal destiny that all living creatures share.   Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. 

Multiple Deaths in healthy people by civic negligence:

Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. The number of   people dying are in hundreds and thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of   negligence here is massive and these deaths are unpardonable.  Timely action could have prevented these normal people from death. 

Collapse of a pedestrian bridge that killed at least 141 people. #Morbi-Gujarat.

Police in the Indian state of Gujarat have arrested nine people in connection with the collapse of a pedestrian bridge that killed at least 141 people. Four of those detained are employees of a firm contracted to maintain the bridge in the town of Morbi.

Hundreds were on the structure when it gave way, sending people screaming for help into the river below in the dark.

Hopes of finding more survivors are fading. Many children, women and elderly people are among the dead.

The 140-year-old suspension bridge – a major local tourist attraction – had been reopened only last week after being repaired.

Single  Death in Hospital due to disease:

      Reaction to single “in Hospital” medicalized death  is a paradox.   The media has instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient.  However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault. 

     In present era, the expectation of medicalized death has come to be seen as a civic right and Doctors’ responsibility. People now have less understanding and acceptance of hospital  death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.

Point to ponder-Misplaced priorities:

Who is to be blamed for the deaths of healthy people which occur because of civic negligence?  Here relatives are actually  helpless and the vital questions may go unanswered .  There are no punching bags  as are  doctors  for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media  forgetting the fact that thousands of patients are saved everyday by  Doctors.   

      It is time to check the  emotional reactions to single hospital death due to a disease as compared to hundreds of death  of healthy people due to civil negligence.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

ZERO Percentiles Requirement to be a Super Specialist Doctor- a Cruel Joke


          MUMBAI: With hundreds of medical super specialty course seats vacant, the authorities have removed the qualifying mark criterion for aspirants. So, rock-bottom scores or a zero percentile would be acceptable for a course at this level.

            Such decisions appear to be   cruel joke to the life of patients. A wise decision would be to review into reasons for vacant seats for example- policies, fee structure, facilities, demand for the course, and disillusionment of students by existing system or falling percentages to be a super-specialist doctor.  

          Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who   secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college.  Even   an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 15-20 % marks also becomes eligible to become a doctor. That is now further diluted to nearly Zero percentile. Answer to that is simple.  To select and find only those students, who can pay millions to become doctors,  and hence marks and quality of doctors don’t matter?  

   If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, especially those who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way  forward.  

So, rock-bottom scores or a zero percentile would be acceptable for a course at this level.

      Society needs to choose and nurture a force of doctors carefully with an aim to combat for safety of its own people. If society has failed to demand for a good doctors and robust system, it should not rue scarcity of good doctors. Merit based cheap good medical education system is the need of the society. This is in interest of society to nurture good doctors for its own safety.      The quality of doctors who survive and flourish in such system will be a natural consequence of how society chooses and nurtures the best for themselves.

    MUMBAI: With hundreds of medical super specialty course seats vacant, the authorities have removed the qualifying mark criterion for aspirants. So, rock-bottom scores or a zero percentile would be acceptable for a course at this level. “Seats have been going vacant every year. The government felt that as a one-time measure, in the larger context of things, we can even accept students with a zero percentile. This will not have any precedence. It is being taken up as a test case. After all, the entrance test was not conducted to eliminate students, but merely to grade them,” said a senior officer from the health ministry. With 748 super speciality seats unfilled after four rounds of admission this year, the Medical Counselling Committee (MCC) took the drastic step. As a one-time measure, any candidate who had taken the NEET super speciality 2021 exam can participate in the special mop-up admission round irrespective of his/her scores.

When admissions began this year, two rounds conducted by the MCC got a cold response. This led to a special mop-up round with the qualifying bar lowered by 15%. Yet, there weren’t many takers. Now the second mop-up round is open to all aspirants. India has about 4,500 super specialty medical seats. There is more vacancy in the surgical branches than the clinical ones. “Candidates have realised that having a broad speciality gives them a good career and money. Hence, many do not want to spend more time in pursuing a super specialty course,” said Dr Pravin Shingare, former head of the Directorate of Medical Education and Research (DMER). “If you look at Grant Medical College, 80% seats in super specialty have been lying vacant for 10 years. At GS Medical College, 40% seats in the last 4-5 years have been unfilled,” he added. But the trend has extended to the non-surgical branches too in the past three years. The bias in selecting programmes often is dictated by considerations that in the case of a surgical branch, a candidate needs to work with a team, have an operation theatre, but a clinical course allows the doctor to work independently out of a clinic.

Parent representative Sudha Shenoy said the problem also lies with the long bond that candidates need to serve if they join a government college. “Any candidate who joins a super specialty programme would be at least 30 years old. If they have to serve a 10-year bond, when will they start earning? So, government hospitals go off most students’ choice list. And when it comes to private and deemed institutes, the fee is out of bounds for most,” explained Shenoy

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes        

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons              

Expensive Medical College  seat- Is it worth it?

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