Aberrant Evolution of medical profession: will it help the patient?


With advances in medical science, simultaneously there has been aberrant evolution of medical profession, education, regulation and medical industry. By provoking controversy about doctors for varied reasons, medical industry and law has been positioned between the doctor and  patient and  taken a center stage in health care. Till now, doctor patient interaction was the central point of the health industry, a core around which medical industry revolved. But now   this interaction, treatment and  almost everything is controlled by industry and regulated in some manner. There have been technical advancements to promote better treatment and diagnosis but these, at the same time, increase the cost of treatment, involvement of industry and hence dependence on investors.

 There has been advancements, but are they in right direction?

Discouragement  of medical fraternity:  The adage “To err is human” probably does not apply to the doctors anymore. Doctors are definitely regarded different from rest of the humans and are not supposed to have privileges that other persons of humankind are guaranteed. Hence they are harassed often for any adverse clinical outcome even though it may be because of poor prognosis of patient. They work under continuous fear and stress and are punished for each small or big error.

Commercial evolution of medical education: medical student are now forced to pay exorbitant fee with lower standards of education.  

Evolution in medico legal  procedures:  extensive and complex communication, technical advancements and legal interactions has taken a toll on the doctors. But more importantly, how that has improved the patient care or  doctor patient relationship? I feel, it has created fear in mind of doctors and deterioration of doctor patient relationship.

 Evlution of Doctor patient relationship and Trust :In all the complexity, trust between doctor patient has taken a hit. A good paternistic relationship, now has been converted to more of a legal one. Trust has been replaced by  mutual fear.

Evolution of Complex medical regulation and documentation: There has been overzealous regulation of medical profession. Time and resouces which should have been utilized for treatment of patients,  has to be used for complex documentation.

Evolution of media and social media: Painful retrospective analysis of work of doctor by media, courts and public contuse. Decisions which doctors has to take in moments are analysed retrospectively by everyone with wisdom of hindsight over years, without understanding complexities involved.

Evolution of Insurance sector: increasing cost of treatment and  medicolegal component has made both patients and doctors paying to insurance companies.

            This kind of aberrant evolution of medical profession has increased the problems of doctors and patients and it is not helping anyone. Ultimately it will help everyone except doctor and patient. Ultimately discourage the excellence in medical care.

 

Swachh Bharat obstacle: declare “open defecation free zone” only if free of infectious, toxic dog & animal poop


I truly admire and applaud Mr Narender Modi, Hon’able Prime Minister for drawing attention of 100 billion people to the issue of cleanliness outside their homes. No one had ever thought that a Prime minister would refer to this so called trivial issue and make a heartfelt appeal to people. Lot of public interest has now been generated and there is a race among public officials to get their area declared as free from open defaecation. Even celebrities and movie actors like Amitabh Bachchan, Akshay Kumar have backed this cause. All these efforts are really appreciable, but the prime credit still goes to Modiji who spearheaded this movement.

But there is still a serious issue, which is a stumbling block to the realisation of a ‘Swatch Bharat’ dream and remains unattended. I want to draw attention of everyone  towards the problem of animal poo in our country. It is all around us. It is an obstacle to fulfilment of Swachh Bharat Abhiyaan and  a pan-Indian problem. It is actually even a bigger health problem than open defecation by humans. Humans defecate in country side and in open fields. But stray animals and dogs are everywhere. Owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

       Life threatening infections : As a doctor, I would like to bring to your notice that dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. A dog’s digestive system can handle just about anything that it eats and this makes its poop very toxic. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. These heavy loads of bacteria increase the risk of infections in the community. But pregnant women, children and people with suppressed immune systems may are more prone to these infectionsMany diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like  Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms,    Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources in our country. This can lead to a widespread source of waterborne illnesses. Dry  poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment.  This may be an important cause of high rates of community acquired infections among our population.

             Transform health of the country: Hence it should be mandatory that all the  dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering and eventually reduce use of antibiotics. It can help reduce mortality, morbidity, drug resistance and medical costs by preventing many infections. It is my request to highest authorities to create awareness, form policies about disposal and control of animal waste and implement them strictly  to  bring a turnaround in infection rates in our country.

      It is missing key component  TOWARDS A SWACHH BHARAT. My request is to create awareness and form proper policies by higher authorities to cure millions and reduce infections in whole country.

 

If you agree please sign the petition

 

https://www.change.org/p/prime-minister-of-india-swatch-bharat-declare-open-defecation-free-zone-only-if-free-of-infectious-dog-animal-poop?recruiter=821371489&utm_source=share_petition&utm_medium=copylink&utm_campaign=share_petition

 

NEET Scams: Is unfair selection at medical college seat, root cause for poor health system?


A famous axiom “as you sow so shall you reap “  has an application to health system. As NEET has been implemented and there has been some effort to find out information about  admissions to medical colleges, at least tip of the  iceberg is getting visible.  More you know or read the news items about NEET, more one is convinced that industry  selling medical college seats has been quite powerful and practically every technique to sell seats is prevalent to by pass 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.  Foundation  of  medical system is suffused with sand rather than touch stone of merit. It is the business and fraud which is rampant.

Astronomical fee of medical colleges  without proper facilities and medical education can be born only by investors and not good candidates.   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 every one is happy by the arrangement , then one has to introspect, whether they really deserve  kind of  doctors, they wish.

 

Following may be MEAGER TIP OF THE  ICEBERG

 

Sitting, retired HC judges under scanner for MBBS admissions scam http://timesofindia.indiatimes.com/india/sitting-retired-hc-judges-under-scanner-for-mbbs-admission-scam/articleshow/60772522.cms

As medical education hit by scams, planned reforms remain in backburner

http://timesofindia.indiatimes.com/india/as-medical-education-hit-by-scams-planned-reforms-remain-in-backburner/articleshow/60787796.cms

How NEET high scorers, pvt institutes colluded to make a quick buck | HT Special

http://www.hindustantimes.com/education/some-neet-top-scorers-blocked-seats-that-were-later-sold-to-low-rank-holders-by-pvt-institutes/story-UgVXOeOZ5xgIAWkRj3s6fO.html

 

 

 

 

Medical college education: NEET cut off variation: any moral questions by society, celebrities and media?


Going by selection of candidates as doctors, If given a choice, by whom  a patient will like to get treated? A candidate who scored 20 % marks or a person getting 60% or 80%  marks.   NEET eligibility getting lower and  a  candidate getting around 20 % of marks  may be able to secure a degree to treat patients.  What will be the deciding factor? The criteria as to why a person with 60%  marks will  not be given a seat and with 20% marks will be able to secure. It will depend upon, whether  a student  is able to pay the exorbitant fee or not. Present system and mechanism of admission permit and accept such huge  variation! That strange equation is acceptable in lieu of money paid!

In this whole process, who will be the sufferer?

Is it only the  meritorious  and honest candidate. children who has worked hard are going to lose faith in system, besides irreversible damage to career.

– the people and society, who wish for best doctors.

– in general, honesty and hard work and merit is a causality.

– But in the long run candidate, who purchase degrees with money  may also suffer. As in the times of consumerism and risk associated with less desirable medical services. Candidates may themselves be at risk. Rich candidates may be capable of becoming health investors and health managers by money power, so as to evade  the increasing litigation. But  those from average family backgrounds ,who practice as doctors, will  be at some risk in today’s  difficult environment   for doctors.

 Exit  exams from these paid colleges  need to be better regulated. These colleges are minting money for distributing degrees. Likely is that, ultimately  most of the  students will pass and try to recover  their investments.

Infrastructure ,  number of teachers and investment on training is unlikely to be uniform in such colleges.   It is a matter of speculation, how much facilities a student gets, specially at a time uncertainty  about uniformity of medical education is a matter of great debate. It is also doubtful that money charged  from students as fee, is spent on medical education of the aspiring doctors.

      National exit exam may solve uniformity issues to some extent, but like NEET, its correct  implementation is a big   uncertainty itself.  Doctors have to listen comments about quality of doctors everyday. Rather than doctors themselves, it is the system to select them  needs improvement, which permit and accepts such huge variation in marks and fee.  Someone will definitely ponder, why one should not get best available candidate as doctor?  

 

 

Expensive medical college seat:Is it worth it.


 

At a time when students, parents 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. The noble intentions of NEET were to minimize wastage of seats due to multiple admission procedures running concurrently and to do away with the variable criteria for selection used for admissions. But this time there has been unregulated steep increase in fees of private medical colleges. 

(http://timesofindia.indiatimes.com/home/education/news/under-new-rules-less-than-50-private-mbbs-seats-filled/articleshow/60200421.cms).

Isn’t it surprising  that a coveted course, with more than a million  students vying for it, ends up with vacant seats especially in private colleges?  The answer is not difficult to guess. There has been a huge increase in fees by private colleges, which along with disillusionment about medical profession has lead to change in mind of candidates.

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.

Truth  cannot remain hidden for long.  It is 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 candidates who may have invested in heavy fees or bought a seat in medical colleges with hefty amount. Some of them, who invested millions for becoming doctors, will be even probably unable to recover their investments. The students with strong financial backgrounds may be more benefited as they can become investors or health managers. But for others, it could be a dream turning into a nightmare.

Those who invest heavily for getting medical education would eventually try  to recover their money after securing a degree. This definitely clouds their judgement in any future decisions that they make as doctor. On the other hand, meritorious students may not be able to get a seat. These will eventually have an impact not only on the quality of doctors but also on their attitude towards this profession.

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.

The foundation of  medical education should not be based on principles of business but should be on pure merit alone. There is a need for uniformity,  proper infrastructure and regulated standards for these heavily priced medical colleges. There is a need to set up quality medical colleges instead of launching lot of inferior institutions every year who just work for minting money rather providing good doctors to the society. Our society needs good doctors, selected on the basis of merit and their medical education has to be cheap and good. If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors.

Suicide by medical student : Global, world wide Rotten system of medical education


A Resident doctor student of Surgery at GMC  Surat allegedly committed suicide last week by jumping from ninth floor. He blamed work pressure and torture in his suicide note. Actions and conversations are generated only after some terrifying incident and finish with making few scapegoats to blame for  one, like five seniors doctors in this case. But the whole system continues to function in same      inhuman way.  This rotten system ignores the deleterious culture of medicine and dangerous working conditions to which junior doctors are subjected.

http://timesofindia.indiatimes.com/city/surat/5-booked-for-abetting-suicide-of-gmc-doctor/articleshow/59463184.cms

Medical students enter medicine as inspired, intelligent, compassionate humanitarians. Soon they turn into cynical and exhausted humans. How did all these totally amazing and high-functioning people get so disillusioned so fast?

Problem does pertain to doctors all over the world, as evidenced by suicide by Dr Chloe Abbott in Australia in January. Her sister Micaela said she was Eaten Alive by the medical profession.

http://www.dailymail.co.uk/news/article-4325812/Investigation-medical-profession-suicide-epidemic.html

 

Inhuman duties, neglect, apathy of regulators towards genuine problems, chaotic  system of working have left doctors, specially in residencies vulnerable to mental illness. Sometimes even driving them to suicides  because of  system failures of medical  administration and inaction by Government.

The terrible conditions have engulfed not only junior phase of doctors, but continue for longer period of their lives, for most of doctors. Because medical professionals find themselves  at the wrong end of stick of government, courts, media for brutal expectations. They face public wrath for system failure.  There is an urgent need for change in work culture and regulations, to make conditions safe for doctors. Grueling shifts, inhuman working hours have to end now, if society really wants to be treated by good doctors.

 

Untenable working conditions, long inhuman hours, unrealistic expectations of patients and thereby creating pressure situations, fear of complaints, physical assaults and medical lawsuits have killed profession largely. Bullying and harassment from all possible quarters is unavoidable consequence.

My earlier article “ enslavement of medical profession” highlights the plight of doctors.

  Almost every doctor will have horror stories to tell, about working conditions. For which medical regulators should be ashamed, there is nothing to be proud of.

      

Happy doctors day:  merely a hollow slogan?


On 1st of July, doctors are usually greeted from multiple quarters. Newspapers, media and some prominent people  congratulate doctors in their speeches or on their social media pages. However, what doctors need are not just verbal wishes but reinforcement of public’s belief in them . It is this renewal of faith in their saviour which will help  doctors in discharging their duties smoothly and in alleviating their problems.

National Doctor’s Day: India, USA

Despite the paucity of the highly trained medical professionals, the identity of medical professionals as a community in society is not getting its due right  because of  misplaced priorities of  certain people. The society tries to impose a stereotype role on them in an effort to control them fully. And as a result of these various controls, regulations and public pressure, doctors experience unrealistic performance pressure on professional front.

     Doctor is the pivot  point between patients, medical industry, government and insurance sector. Huge number of patients, expensive medicines, poor medical infrastructure has produced tremendous resentment against medical system amongst public. But the brunt of this entire angst has to be borne by the doctor or medical professionals alone. Often they are blamed for circumstances beyond their control and punished for system failure. Fear of public wrath and lawsuits is smothering the medical profession.  And increasingly there is a feeling amongst medical professionals that they are getting a raw deal despite doing their very best.

     In such a situation, there should be some introspection by all stakeholders every year, on doctor’s day. The doctor’s day should be more than just greetings and wishes for doctors. Some real resolutions need to be  taken so that their working atmosphere and eventually delivery of medical care is improved and this ultimately will benefit patients only.  I can think of some much needed changes-

1.       Government should take some concrete decision to improve medical  infrastructure and manpower. A better planning needs to be done to spend more for health of people, availability of resources and for improving the working conditions for doctors. Government should ensure that doctors are better protected.

2.       Medical industry should collectively think of protecting doctors or there should be provision for some financialresponsibility of medical lawsuits of all doctors.  Pharmacy industry, medical device industry, insurance industry  and others earn huge profits because doctors need to use their products. Although medical industry makes huge profits still they remain behind the scene.

3.       Police should provide  assured protection to  doctors better against physical violence.

4.       Medical education institutes should resolve to promote the education of best doctors and not indulge in profiteering in education of doctors.

5.       Courts should take an initiative to protect doctors against frivolous lawsuits ( which are often done to prevent paying their bills), revengeful attitude of patients  and harassment?

6.       On doctor’s day, public should resolve that they will not unnecessarily fight or abuse the doctor.

7.       And last but most important is that all medical practioners , be it allopathic, ayurvedic, unani, homoeopathic or others who play a role in maintaining health of patients, affirm that they will do everything to protect dignity and integrity of this profession.

If the above are not practised and followed, then mere sloganeering on doctor’s day  makes no sense . The  effort to improve training and working condition of doctors has to come from the bottom of the heart of all those involve, both giver and taker.  Mere tokenism on a day in a year is of no real purpose. If the present scenario continues, soon a common man will have problem in accessing good medical care which is currently available at nominal cost . One needs to ponder seriously, if we do not save doctors, who will save us? 

Death declaration by doctor: complex communication skill. “No negligence in alive baby declared dead: hospital “


The death pronouncement is one of the most sensitive and complex part of communication in and out of hospital, intensive care. It comprises more than the actual declaration of death. It may be a relatively straight forward when the death is expected and the family is mentally prepared and accepting the outcome. However, when the doctor is interacting with a grief-stricken family, dealing with the death of a child, or coming to terms with the death of a personal patient, a death pronouncement becomes complex. Problem is compounded often in presence of violent relatives, non acceptance of death, medico legal cases and   especially in cases of unnatural causes for the death. Relatives often refuse to accept death and within no time mobs swell in number, threatening of physical and verbal assaults and revenge against the doctor in various forms. Although there can be specific protocols and hospital policies, it will still depend upon the timely thoughts and skills of the doctor, how to handle the situation. Doctors should be better trained for handling of death as it can put them in risky situation, because of following reasons.

  1. Death itself is a complex issue. Even today modern science has not reached scientifically at the bottom of life and death.
  2. Communication of death is complex. It varies with each patient, type of relatives, place, country and every situation in same hospital is different.
  3. Declaration of death is a legal matter. How a doctor verifies death, communicates and documents death, it can create legal and other problems for doctor.

Any problem related to declaration of death is immediately picked by media and the initial reaction is to blame the doctors. The doctors in such cases are projected as incompetent and callous, and that makes a media news. Invariably one stray incidence is used as to project whole medical community in negative manner. Later inquiries and further inquiring continue, and even later truth emerges, that is not enough to bring back the lost prestige for medical profession.

Take for example the latest news of “ Alive Baby declared dead.”

http://timesofindia.indiatimes.com/city/delhi/alive-newborn-declared-dead/articleshow/59208765.cms

Later after two days, news was “ hospital enquiry claims No negligence in alive baby declared dead”

link   http://www.dnaindia.com/india/report-no-medical-negligence-in-case-where-newborn-was-declared-dead-2479826

Above news just conveys the complexity of situation, doctors often face. My aim here is to convey  that communication of death is a very complex subject. Ironically no structured training of emotional, communicative and legal issues is imparted to medical students. But they are supposed to face the situation everyday, when they function as doctors.

 

Most legal determinations of death are certified by medical professionals who pronounce death when specific criteria are met. Two categories of legal death are death determined by irreversible cessation of heartbeat and breathing (cardiopulmonary death), and death determined by irreversible cessation of functions of the brain (brain death).

Especially new doctors need to realize that the structure of modern society is to make life and death, medical and then legal matters, and to subject the most basic elements of our existence to professional authority. The birth certificate and the death certificate are signed by doctors, and then registered by the civil authorities.  Because of all  these sensitive issues, emotional aspects and legal dimensions of death being  huge, so need more attention. .

In remote areas doctors are totally alone and helpless, so security issues will remain. There is no solution in sight for these problems. Already I have written about a “real story of female doctor assault”.

Problem is that doctors during training days or residency are not trained in such kind of communication. Although while doing their duties they observe seniors and learn how they are communicating. But still when actual situations arise, which can be diverse, complex and challenging, and everyday getting more demanding. In view of current scenario against doctors, they need better training on these issues. Basic question is, if doctor needs help, where can he turn to for help or information. The resources, other staff and the setup is not of much help in difficult scenarios.  It is not uncommon that doctors are left to themselves, if a difficult situation arises. Medical education and Hospital systems need to be better equipped to provide more support to doctors in present era. For doctors, if they make a mistake, there is no one to support them or save them from verbal, physical assaults, law and medico legal cases.

Harassment is tremendous. Therefore   doctors, be careful – save the patient, but save yourself also.

NEET implementation vital and will decide quality of doctors in future


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

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

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

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

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