Overuse of Antibiotics: Wrong analysis # Rebuttal Times of India


     The Times of India today   carries an editorial by Mr Sandeep Bansal on over prescription of antibiotics. Although there are few points which may be correct, but the article fails to highlight the basic reasons for the problem, which it was supposed to address.

    The reason for failure to find the correct reasons can be the distant analysis. Someone working in London and trying to analyse the grass root problem of India may not be a perfect idea. People need to work at ground level to identify the real issues. Otherwise the analysis remains half-baked and gives a glimpse  of the bias, which celebrities use commonly for gaining popularity by finding faults of doctors.

 

     The overall picture has to be understood to identify real reasons and hence the proper solution to the problem. The correct steps taken would settle the issue; otherwise the analytical article would   just remain a piece of paper and an matter of discussions for Arm chair preachers.

over prescription of antibiotics

   The author failed to highlight the factors like easy availability of antibiotics. People can directly approach pharmacist and get whatever antibiotic they want.  Pharmacist can sell whatever brand, doses and kind of antibiotic. The uncountable quacks, doctors of alternate medicines use all kind of antibiotics with impunity. Tons of antibiotics are consumed without any proper medical advice. Self-medication by people themselves, as it is easily available can’t be ignored as an important cause.  

       The reasons written by the author in TOI, actually constitute a minuscule fraction (5-10%), as far as use of antibiotics is concerned. By writing imperfect article, without knowing actual problems by a distant analysis, such article provides real misguidance rather than actual solutions to the problems.

         Someone to do justice to such complex and important issues, one has to work at the place and be aware about real issues and ground problems. Otherwise it just remains a method to gain cheap popularity.

   Sadly, in present era, people who do not treat patients,  are away from  truth, but they can influence the treatment of thousands of patients  just by doing an ‘On Table’ analysis.

        Wrong analysis, hence incorrect conclusions can lead to wrong decisions.

     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

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

Ayurvedic Surgery: 10 Technical Questions? About safety concerns


      If there are certain doubts about the safety of the patient, the apprehension needs to be addressed.

      The government has issued a notification which authorises post-graduate practitioners in specified streams of Ayurveda to be trained to perform surgical procedures such as excisions of benign tumours, amputation of gangrene, nasal and cataract surgeries.

    The notification by the Central Council of Indian Medicine, a statutory body under the AYUSH Ministry to regulate the Indian systems of medicine, listed 39 general surgery procedures and around 19 procedures involving the eye, ear, nose and throat by amending the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016.

     Any  Surgery, how-so-ever simple it may look to the people sitting on fence, carries some  risk and needs  some kind of precautions and regulations to make it risk free.  Therefore if there are certain doubts about the safety of the patient, the apprehension needs to be addressed. If the service of surgery by Ayurveda surgeon has to be availed by public, a certain confidence needs to be generated about the safety and quality assurance. Mere push by an enforced law will not lead to genesis of trust and confidence. So there needs to be technical analysis of some kind, whether  it is a genuine original  strategy or merely  an imposed law.

     If it was an accepted practice till now, there was no need for such notification. So apparently,  if the need was felt  to be said in a forceful manner, there has to be something unusual about the practice.

      No doubt, ancient Ayurvedic text referred to surgical practices. But  in present era of consumerism, patients need to know, how it was being practiced for last 200 to 300 years. What are the results and data about complications.

  There are two main categories for the purpose of discussion.

A. Existence of a robust system

B. Individual competencies.

    Firstly, there should be basic robust system  that will generate Ayurvedic surgeons.

To start with, the  CCIM need to  satisfy on following questions. Following are the basic requirements of surgery.

1. What  kind of Anaesthesia  will be used in surgeries by Ayurveda surgeons? Who will be the anaesthesiologist?

2. What are post op pain killers be used in surgeries by Ayurveda surgeons?

3. What antibiotics  will be  used;. Allopathic or ayurvedic?

4. What are principles of pre-op evaluation?

5. How surgical techniques are different. Are they same used in allopathic surgery or different ones described in Ayurveda?

6. How the post op complications are being managed. Is it by using allopathic medications and investigations?

7.  Data of surgeries done in last decade or two in all of  Ayurvedic medical colleges, especially those done by Ayurvedic surgeons.

8. Who is teaching Ayurveda doctors about the  surgeries? Are there ayurvedic teachers  or being taught by allopathic surgeons?

9. Will  the people in higher positions and government  officials be availing such facilities or it is only for the  poor people? 

10. Will the patients be given enough information or an informed consent about such Ayurvedic surgeons before  surgery?

         More than a law, the whole exercise   will require a trust building   in public  along with quality assurance and something unique to make such surgeries practically happen.

     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

Covid-Warriors or Beggars: Doctors without pay


    Imagine a highly skilled professional community, which can be harassed, assaulted, dragged to courts and subjected to cruelty beyond imagination. Ironically, the despise to this community  comes from the  very people, whom they are trying to save.      

     Even the rightful is denied in a shameless manner, as if their lives don’t matter. During pandemic, doctor and nurses treated as dispensable disposables. A mere lip service to call them Covid-warriors  was performed, but real treatment  to these selfless health workers was akin to sacrificial lambs. 

    The plight of doctors of Hindu Rao Hospital is just an indication of the real thought process and apathy of administrators. If doctors are forced to beg for  basic fundamental rights, their situation is worse than beggars. The current unfortunate situation is enough to  convey  a message to the medical profession, the nation and is  demoralizing the entire doctor community, more so to the aspiring doctors.

Doctors at Hindu Rao Hospital unpaid for months

    Irked over non-payment of salaries, doctors and staff members of North Delhi Municipal Corporation’s Hindu Rao Hospital have decided to sit on indefinite agitation from Monday onwards. The emergency services will, however, operate smoothly.

The doctors and staff members of the hospitals have not been paid since June. Last week, the staffers were on a ‘Pen Down Strike’ from 9 a.m. to 12 p.m. to display their ordeal. According to the civic body, the matter is being looked into.

The letter written by the Resident Doctor Association to the hospital administration stated, “We apologise to announce that we are forced to go for an indefinite agitation w.e.f. October 5, 2020 considering strictly ‘No pay, No work’, while operating the emergency services smoothly.”

It added, “The chronic sufferings of the staff have been too agonizing and intractable where it is distressing to one’s mental and physical well-being, We strongly plea to you for releasing 3 months’ pay and giving us an immediate permanent solution. We also demand a formal notice regarding the same.”

The association rued that despite the High Court Order and repetitive intimations in the past, the salaries of North MCD doctors and staff are long overdue for three months and its ongoing four months.

Besides Hindu Rao hospital, doctors and nurses of other hospitals like Maharishi Valmiki Infectious Diseases, Kasturba Hospital, Girdhari Lal Maternity Hospital and Rajan Babu Institute of Pulmonary Medicine and Tuberculosis have also been protesting over non-payment of dues.

   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

#NEET: Paying Irrational Fee for Medical College Seat: An Unwise Idea


At a time when medical students and even doctors are uncertain whether opting for medical college along with the vulnerability and risk associated with   becoming a doctor is worth it or not, some are naive enough to pay millions as fee for medical education and for securing a seat of MBBS.

     A famous axiom “as you sow so shall you reap” has an application to health system. One is convinced that industry selling medical college seats has been quite powerful and practically, every technique to sell seats is prevalent to bypass the merit and deny seat to deserving candidates. These meritorious children, who are denied seats could have been   good doctors and   real custodian for the health of people.  But if for some reason, business prevails and government fails to prevent this cruel and corrupt selling of medical seats, an Einstein brain is not required to guess the whole malaise prevalent in health system

         Truth cannot remain hidden for long.  It has to be realized that getting into medical college is a minuscule component of the process of becoming a good doctor.  Once they opt for this profession, the real tough and prolonged battle begins. Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it, especially those who may have invested in heavy fees and in debt.

   Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession

Paying the irrational fee of medical colleges may be an unwise idea for the candidates, 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 or fail to get residency.

The government should regulate these fees and also ensure that if a heavy fee is charged, then it should be spent on medical education of students only. It should not take a form of just any another money minting industry to be used for other purposes.

        Going by selection criteria  of candidates as doctors, if given a choice, by whom a patient will like to get treated? A candidate who scored 20% – 30 % marks or a person getting 60% or 80% marks. NEET eligibility getting lower and  candidates getting around 30 % of marks  may be able to secure a degree to treat patients.  What will be the deciding factor? So in the end, seats remain unfilled and may be a kind of auction, whosoever can pay millions, takes the seat.

    Ironically, that strange equation is acceptable in lieu of money paid!

It is ironical that the medical profession is regulated, but medical business or medical education is not.  Such business of producing doctors based on their paying capacity should be clearly trounced for the benefit of public. Foundations of healthcare should be on touchstone of merit, ethics and character and not based on business deals.

       Therefore meritorious students, especially from average backgrounds, who opt to become doctors feel cheated when they pay massive fee to buy a seat. It is an insult to the very virtue of merit which should have been the sole criteria for these admissions.

     It is the people and society, who will be the real sufferers in future. Therefore resentment to such system should come from the society.  If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get 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

MCI to NMC: Change of Medical Education Regulator


Some drastic regulation is need of the hour, of the  chaotic and non-uniform medical education system of India. Besides an urgent need for  better standards, uniformity in  standards of medical education and  fee structure is desirable. National Medical Commission Act 2019  has been passed. NMC has replaced MCI. But attainment of desired goals will still  depend upon, how well the future plans are implemented. The  mammoth system needs an herculean overall and honest policy changes from the roots.

The National Medical Commission (NMC), a new body, will function as the country’s top regulator of medical education from Friday, a day after the Centre dissolved the Board of Governors—Medical Council of India (BoG-MCI) through a gazette notification.

The setting up of NMC was a government move to bring reforms in the medical education sector, especially aimed at replacing the MCI, which was tainted by corruption.

The government had dissolved the MCI in 2018 following the corruption charges and replaced it with a BoG, which was chaired by Dr VK Paul, member (health), Niti Aayog.

The body was functioning under the Indian Medical Council (IMC) Act, 1956.

“The BoG-MCI has been dissolved and the NMC replaced it with effect from Friday,” said Dr Paul.

The IMC Act stands repealed, and has been replaced by The NMC Act that came into existence on August 8, 2019.

“Indian Medical Council Act, 1956 (102 of 1956) is hereby repealed with effect from September 25. The BoG appointed under section 3A of the Indian Medical Council Act, 1956 (102 of 1956) in supersession of the MCI constituted under sub-section (1) of section 3 of the said Act shall stand dissolved,” stated the gazette notification issued by the Union Ministry of Health and Family Welfare (MoH&FW).

Professor Suresh Chandra Sharma, former head of the ear nose throat (ENT) department at All India Institute of Medical Sciences (AIIMS), New Delhi, has been appointed as the chairman of the NMC.

Dr Sharma had retired from AIIMS in January and was selected by a seven-member search committee for the post from 300-odd applications received from across the country. He was also one of the five short-listed candidates for the post of director, AIIMS, New Delhi, after the then director, Dr MC Misra, had retired in 2017.

Dr Rakesh Kumar Vats, secretary general, BoG-MCI, has been appointed as the secretary of the NMC by the Appointments Committee of Cabinet (ACC).

The NMC will have four separate autonomous boards: under-graduate medical education, post-graduate medical education, medical assessment and rating and ethics and medical registration.

The common final year Bachelor of Medicine and Bachelor of Surgery (MBBS) examination will now be known as the National Exit Test (NEXT), according to the new medical education structure under the NMC.

NEXT will act as licentiate examination to practice medicine, the criteria for admission to post-graduate (PG) medical courses, and also for screening of foreign medical graduates.

Besides, the National Eligibility and Entrance Test (NEET), NEXT will also be applicable to institutes of national importance such as all the AIIMS in a bid to ensure a common standard in the medical education sector in the country.

Expensive medical college seat: is it worth?

What fuels a doctor?


You have to live a doctor’s life or to very closely watch one’s to understand it.

As a young overburdened doctor, still undergoing the rigours of academics, I used to commit certain silly mistakes of commission and omission which my watchful patients and their attendants would easily catch. And they would gladly discount it or let me know not grudgingly. From a twenty year old boy to a fifty plus oldie – that has kept me going.

It is hard getting into medicine. Equally hard studying it and even harder practising it. The litmus test was declaring a patient dead. Even harder , declaring a neonate dead with its face beautified by the large dead pupils. As if it is going to cry just ! It takes quite some heart to do the ultimate job of declaring the undeclarable. And then you come across patients and people your age who tell you they get all sorts of symptoms upon hearing someone die !!

Doctors live fast, age fast and studies have confirmed, they die faster than the general population. Their youth is almost completely absorbed by the vast study material and rigours of one of the most difficult courses.

Once as a house physician, I encountered a school girl with fever admitted in my ward. As a routine I used to check the vitals of around 30 patients morning and evening before the rounds. She used to laugh at me saying that I had nothing better to do than a nurses’ job. It took us almost a week to diagnose her with a blood cancer. She happened to be a cousin of one of my friends. She lost her hair to chemo drugs. Tired of the disease and confines of the hospital, one evening she insisted to go out.  She was so insistent that her mother requested me if I could take her from the hospital to my room. I refused to oblige her under a veil of principles and legality. After the whole night of  confusion, whether to accede to what may be one wish in her last days, I decided to take her out of ward. I prepared  myself  for a reprimand, I would face in the department. Next morning when I reported for duty , her bed was empty. She had massive bleed at night. I cried. That was about 25 years back. I still cry though very sparingly now, on losing a patient.

Only a doctor would understand this.

Looking back , it is not money , it is not anything but a glint of gratefulness in the eyes of my patients and it is the tolerance of my patients to my mistakes that has kept me going all these years. But that desired emotions are lacking somewhere and myself, at times do not feel the zeal  to continue anymore.

  A sense of gratitude in the  eyes of patients that fueled the doctor inside me,  is no more visible now.

Dr Sandeep Chaudhri

Consultant Internal medicine, Karnal (Haryana)

Doctor & nurses at risk from unknown or mutated germs@ Mystery virus in China


 

First pneumonia death from mystery virus in China, world on high alert

          The  viruses, bacteria are germs  had been discovered only in last one century and many more are still not known. Patients carrying specially unknown germs are  handled by doctor and nurses, who have no clue, what they are dealing with.   Time gap in such  patients coming to the  hospital  and  the exact diagnosis of finding a dreaded disease, may be  quite dangerous to doctors and nurses. To add to the problem, In  large number of patients, exact viruses cannot be diagnosed or even suspected. In many cases of ARDS, the causative organism cannot be  isolated or identified.  It is important for  doctors and nurses  to take universal precautions from the beginning. There can be many more viruses or germs which are yet to be discovered or mutated ones that  are unknown.

21 occupational risk to doctor and nurses

H1N1, Zika,  Ebola,  SARS  are few examples,  just to imagine that they existed and handled by health workers as unknown germs, till they were discovered.

The death of a 61-year-old man  due to pneumonia from a mystery virus in the central Chinese city of Wuhan on Saturday has put the world on high alert against another new life-threatening illness. Seven of the 43 others diagnosed with the disease are in a critical condition, but no new cases have been reported since January 3.

To protect the world still smarting from the lightning spread of devastating viral diseases such as H1N1, Zika and Ebola, the World Health Organisation (WHO) issued this year’s first  international travel and trade alert on  on January 10 that advised all international travellers to report symptoms of fever with breathlessness and difficulty breathing, especially if they have travelled from China.

On January 9, China announced that the cluster of pneumonia cases reported in December in Wuhan in the Hubei Province of China was caused by a new coronavirus.

Only six viruses from the coronavirus family infect humans, which would make the new one the seventh to cause human disease. The coronavirus viruses cause diseases ranging from the common cold to very severe and life-threatening illness from Middle-East Respiratory Syndrome that caused 851 deaths since it was identified in 2012, and the Severe Acute Respiratory Syndrome (SARS), which killed 774 of the 8,098 people infected in an outbreak that started in China in 2002.

“Though currently there is no evidence of human-to-human transmission, we need to remain vigilant. WHO has shared with all Member States technical guidelines on surveillance, testing as well as infection prevention and control practices for suspected cases. WHO is in close contact with national authorities in the region and will extend all possible support to ensure core capacities are geared up for addressing potential cases that may come to countries,” said Dr Poonam Khetrapal Singh, WHO regional director, South East Asia Region.

Unknown threat

Some countries in the region, including Indonesia, Myanmar and Thailand, have started screening passengers travelling from China for pneumonia symptoms at airports. The health ministry reviewed the situation with WHO experts on Wednesday and plans to start providing travellers with risk-reduction information at airports and other ports of entry, travel agencies and conveyance operators.

“We are waiting and watching as entry screening at ports of entry like airports, seaports, train stations and border check-posts are not cost-effective. It is resource-intensive but offer little benefit,” said a health ministry official, who did not want to be named.

Though no pneumonia have been reported outside Wuhan, which has a population of 11 million, WHO said there is need for caution as the city is a major domestic and international transport hub with heavy population movement. Travel in the region is expected to significantly increase during the Chinese New Year in the last week of January, which increases the potential of infected travellers carrying to other parts of China and the world.

New viruses are formed when mutate to jump species and cause infection in humans. SARS jumped from the civet cat into humans, MERS from dromedary camel, H1N1 from pigs, and Ebola from bats, just to name a few.

The Wuhan City cases have been linked to the South China Seafood Wholesale Market, where some of the patients worked as dealers or vendors. The Huanan Seafood Wholesale Market deals with fish and other seafood, including sea mammals, along with chicken, bats, rabbits and snakes.

Signs of trouble; The clinical signs of the new lung infection are mainly fever, with a few persons reporting difficulty in breathing. Clinical signs include chest x-rays showing bilateral lung infiltrates (markings) associated with pneumonia and tuberculosis.

With no infection among health care workers treating the patients, preliminary information suggests there is no significant human-to-human transmission, but till the mode of transmission is clearly established, it’s best to take precautions to stay safe.

The WHO advises people travelling in or from affected areas (currently Wuhan) to avoid close contact with people with acute respiratory infections; wash hands frequently, especially after direct contact with ill people or their environment; and avoid close contact with live or dead animals. In case of respiratory symptoms before, during or after travel, travellers must seek medical attention and share their travel history with the doctor.

“The WHO advises against travel or trade restrictions on China based on the information currently available on this event,” said Dr Singh.

 

 

Blog at WordPress.com.

Up ↑

%d bloggers like this: