Medical Emergencies- Flying a crashed plane. Comparing airline industry to healthcare is incorrect

Comparing airline industry & health care is fallacious, an oversimplification; apples to musk-melons Basic difference is that ‘Patients are not aeroplanes, and hospitals are not production lines’. 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.

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 a serious issue. It should be achieved by good groundwork 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 muskmelons.

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 worker 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 effective.

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.

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.

In other words, doctors have to fly crashed planes always on every day basis, something that never happens even once in aviation industry.
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.

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.

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.
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.
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.

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.
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.
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.
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.
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.
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.

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.

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September 15, 2024 1

Physical/Legal violence against doctors: reminiscent of realms of ancient Hammurabi medical regulation

The painful incident of Kolkata Doctor rape and murder had unmasked the everyday struggle of the doctors in the present era. Her supreme sacrifice depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment. Her murder has unveiled the despondency, moral burden and injustice that doctors work with.

With the evolution of medical science and medical care intertwined with medical business, braided changes in medical regulation is not an far off expectation. But reticulation of evolution to modern medicine and health care has not happened in isolation. Simultaneously there has been progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care has also ushered. Every one now wishes to live longer and dreams of better quality of life with support of progressive medical care. Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and investors putting money into health care, which was unthinkable few decades back in the past. This reticulation of business and health care allowed health care to be controlled in some way by administrators and investors. Away from the health providers, who actually treated the patients.

As it is no more simply treating a disease and involves many more issues. New model of medical regulation and business in health care is still not a mature process. It has emerged and progressed in just for few decades, as compared to medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a long way to do real justice to every one. No one really knows how to regulate this difficult area, which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is amalgamation of intricacies of science with minds of patient and doctor’s skill in newly evolved milieu of financial complexities. Results are not encouraging for the medical profession.

An effort to govern or regulate the medical profession is not new. Hammurabi had initiated to write the rules of the game. This single professional species was managed with cruel regulation around 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi 5000 years ago, was not even at the doorstep of medical science, but he promulgated some rules. It is difficult to say whether he was naive or brilliant enough to make it more mathematical. He fixed heavy prize for saving lives and used to cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved. After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still remains somewhat unfair to doctors. In other words, it has not attained enough evolution and maturity.

Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to regulate medical profession, even when the medical science was not even developed enough to deal with most of diseases. Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times. Almost universally, the earlier work or contribution of a doctor to society is not taken into account. Even for complexities of medical science and uncertainties of the outcome, blame can conveniently be passed on doctors due to application of average wisdom.

Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished.

Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake. Such harsh regulatory systems will dissuade other good people joining the profession, again resulting in further inhibition and flourishing of profession for the good. Obviously, harsher penalties will discourage a physician surplus.

Today the global system of medical regulation, is becoming somewhat similar, to those ancient regulations in terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is even though now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era

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August 25, 2024 2

Spurious medicine hits high- Ganja-laced chocolates as Ayurvedic medicine for Diabetes

In the absence of strict Government control, all kinds of dubious assertions are available about curing all types of ailments. These alleged remedies, and the belief systems, are based on the facts that can neither be proved nor disapproved. They are dangerous to life of patients, which is why it is necessary to fight them and refute them. But who should fight? Patients themselves are blinded by a projected faith and false belief about definite cure.

While pharmaceuticals and scientific drugs are regulated to some extent, but side effects and harms associated with various health products worth billions of market remain untested and unregulated.

It has become a common practice to advertise health products (especially alternate medicine) that claim to be panacea for all ailments, enhance immunity, to increase power and health by creating an impression on minds on various platforms. Instead of producing scientific evidence, such products and therapies are sold under disguise of natural therapies or alternate medicines. The objective evidence or global neutral trial for the claimed efficacy or about real side effects is always missing.

No one can deny that the knowledge circulated through various media plays an important role in reframing the narrative in patient’s or people’s mind. These can be in form of advertisements in television or articles in newspapers. The subjectivity of such advertisements creating new impressions and replacing previous ones, right or wrong cannot be denied.

A frightening scenario is emerging as there seems to be an epidemic about fake or substandard medicines, spurious drugs and heightened belief in marketed therapies by advertisements. An epidemic of ignorance that causes people to believe in pseudoscience or merely in projected promise of cure. A hope of miracle is flashed to patients, who have been given a ‘no hope’ by scientific medicine. Such patients are an easy prey for such fraudsters. It is not uncommon that lethal substances like steroids, hormones and heavy metals are given in dangerous doses.

Chocolates come as ‘Ayurvedic Aushadh’

Synopsis Cyberabad police raided a kirana store in Petbasheerabad, seizing ganja-infused chocolates marketed as ayurvedic medicine. The chocolates contained 14 grams of cannabis per 100 grams and claimed to treat indigestion. The Telangana anti-narcotics bureau has notified UP and Rajasthan police about manufacturers in these states producing similar drug-laced products. In an emerging trend, ganja-laced chocolates made in Uttar Pradesh guised as ayurvedic medicine are making becoming popular in Hyderabad. Wrapped in attractive packaging, the chocolates come with ‘Ayurvedic Aushadh’ printed on wrappers, reported ToI. On Sunday, Cyberabad police seized a substantial shipment of drug-infused chocolates from a kirana store in Petbasheerabad. The packaging of the seized chocolates indicated that each 100 grams contained 14 grams of cannabis.

Additionally, the label suggested that the chocolates could be consumed twice daily to alleviate indigestion and other stomach-related problems when mixed with water.

The chocolate cover also mentions that it can be consumed twice a day to treat indigestion and other stomach-related issues, is also used as a medication for diabetes. Meanwhile, Telangana anti-narcotics bureau has identified several private players in UP and Rajasthan manufacturing ganja-laced chocolates and has alerted the respective state police departments.

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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.

August 21, 2024 0

Difficult to serve uncivilized society-poor Governance and pathetic law & order #Kolkata-Lady-Doc-murder

The brutal assault and murder on a woman doctor at R G Kar Medical college Kolkata has made doctors preparing for a career in the medical profession worried. This shameful act on a lady doctor reflects that doctors are serving an uncivilized society. Such news is viewed by medical community anxiously and is a poor advertisement for younger generation to take medicine as profession. Aspiring medical students need to think- whether they should enter the ring-on-fire, opt to become doctors to serve an uncivilized society.

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 repeatedly clearly indicates otherwise. 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. Everyday violence against doctors is common 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 in the past are not enough to shake administrators, courts and doctors’ organizations out of slumber. 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.

After such big hue and cry after this incidence, Courts and Government have woken up and there is a hope that real culprits and preparators will be caught. People need to know the truth and not merely hanging the scapegoats.

August 19, 2024 0

Differential justice- Evaluation & compensation of ‘hundreds of healthy deaths’ vs one hospital death #Odisha-train-accident

But the evaluation and compensation of ‘Death’ in this new era of consumerism has become a story of paradox. Compare the situation when someone is admitted in hospital for a serious ailment to a healthy person who is travelling happily in train. It doesn’t require an Einstein’s brain to compare, who is more at risk for death. Although death in both situation is sad but the differential compensation formulas applied by courts and justice systems require a relook in these both the situations. Accidents can happen everywhere. It can be on roads, trains or in the air and more possible in the hospital, when doctors are trying to save a critically sick patients. Chances are more in hospital as situation is akin to as doctors are trying to fly a defective aeroplane. Medical accidents are usually interpreted as medical negligence. Ironically, genuine mistakes or even a natural poor outcome, an impression is created as if the doctors have killed a healthy person and is assumed as a doctor’s fault. Not uncommonly doctors become punching bags as a revenge in case of a hospitalized death. The

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. But the evaluation and compensation of ‘Death’ in this new era of consumerism has become a story of paradox. Compare the situation when someone is admitted in hospital for a serious ailment to a healthy person who is travelling happily in train. It doesn’t require an Einstein’s brain to compare, who is more at risk for death. Although death in both situation is sad but the differential compensation formulas applied by courts and justice systems require a re-look in both the situations.

Accidents can happen everywhere. It can be on roads, trains or in the air and more possible in the hospital, when doctors are trying to save a critically sick patients. Chances are more in hospital as situation is akin to as doctors are trying to fly a defective aeroplane.

Medical accidents are usually interpreted as medical negligence. Ironically, for genuine mistakes or even a natural poor outcome, an impression is created as if the doctors have killed a healthy person and is assumed as a doctor’s fault. Not uncommonly doctors become punching bags as a revenge in case of a hospitalized death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event. But all these issues are variable and depend upon understanding level and wisdom of people. What is surprising is the non-uniformity of courts and justice systems in evaluating and compensation of death. For hospital death alleged due to medical negligence – compensation formula is applied that is not used for other hundreds of healthy deaths.

Coromandel –Odisha- train accident

An unfortunate incident of train accident causing hundreds of untimely deaths happened yesterday. In fact the burden of negligence here (like a train accident- hundreds of deaths) in healthy deaths is massive and these deaths are unpardonable.

It will be interesting to see how courts apply the formula for compensation in hundreds of healthy deaths due to negligence as is applied in cases of medical negligence when someone has poor outcome.

That brings forth a fundamental question. Why compensation to death is not uniform? Why medical profession is handed over a harsher punishment and pays a higher compensation (while trying to treat) for a death which is more natural and consequence to some disease? Why for compensation in hundreds of healthy deaths that was completely unnatural – same formula is not applied?

Such differential evaluation and compensation of death is not only illogical and unreasonable but a grave injustice to medical profession. Point to ponder- if trying to save someone’s life raises a risk of heavy compensations, why should doctors do it?

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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.

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June 4, 2023 10

Exploitation of Medical professionals fuelling Doctors’ revolt

The painful incident of Dr Archana Sharma’s Suicide (one year back) had unmasked the everyday struggle of the doctors in the present era. Her supreme sacrifice depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment. Her suicide has unveiled the despondency, moral burden of mistrust that doctors carry. Her death was the result of the apathy of fair justice that eludes medical community. Sadly, the society still is unable to realize its loss.

Let her sacrifice be a reminder to the whole medical fraternity; either fight against the prevalent injustice or perish, not being able to treat the patients would be a greater disservice to humanity.

Such incidents show that goons, public, regulators and administrators can use the nature of doctors’ work to be used against medical profession to make saviours as an easy prey for punishments on the pretext of dishonesty, negligence or semantics being used as legal weapons by law-enforcers, even in case of a perceived bias. In the process of such ‘tokenism’ goons and administrators prove their relevance to the medical system.

Private health care has become a predominant mode of health care delivery. The failure of public sector is mainly due to poor infrastructure and inept health management. Sadly health is being managed by administrators, who have never treated a patient in life-time. Inadequacy of public sector stems from the government inability to take responsibility of delivering quality accessible healthcare. This has added to the distress and has accelerated privatisation of health care.

Instead of making the process of opening a health care centre or hospital an easier process, it has been made a herculean task. Getting many dozens of licences is not easy. Doctors who try to open hospitals complain about numerous hurdles, but possibly are left with no option. It is still easier for big hospitals with investors’ money but difficult for doctors on their own. Running the hospital is no more an easy task due to bureaucratic and public pressures.

Private health sector especially smaller hospitals feel burdened by government schemes because of unrealistically low reimbursement rates for surgeries or procedures. Not only unreasonably low reimbursement payments are forced upon doctors but are delayed due to many unpleasant factors in government system.

There is no protection to doctors against physical assaults. Local goons and mobs easily get away with abusing and attacking doctors. The health care workers have become scapegoats for the inadequate and inept medical system.

Rather than developing a system to promote good doctor-patient relationship, Medical Consumer Protection Act has been imposed and created a situation of ‘us versus them syndrome’. It caused erosion of doctor-patient relationship and escalated cost of care. Propagation of stray and occasional incidents about negligence case in court or their outcomes are given disproportionate wide publicity in media. The patients are unable to understand the correct application of such stray incidents to themselves.

There is a growing mutual mistrust; doctors too have started looking at every patient as a potential litigant. Especially while dealing with very sick ones, practice of defensive medicine is a natural consequence.

To save themselves, doctors have to do mammoth paper work, leading to consumption of time that was meant for real deliberations for the benefit of patients.

Consequently insurance companies, medical industry and lawyers have become indispensable and have positioned themselves in between doctor and patients. Besides creating a rift between doctor and patient, they charge heavily from both sides; from patients (medical insurance, lawyer fee) and doctors (indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated.

In reality it is not only the #RTH, it is the overall unfair, unsupportive and exploitive and punitive ecosystem for doctors, which is painful. Doctors are finding actually difficult to work in such environment.

Possibly it is a last cry before they quit or perish, if still remain unheard.

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.

Exorbitantly expensive medical education and lowered merit

April 4, 2023 2

Doctor’ Revolt- a Mutiny long due globally- for professional dignity #RTH

Administrators’ wish to govern or regulate the medical profession cruelly is not new. Hammurabi 5000 years (King of Babylonia) ago had initiated to write the rules of the game. Although he was not even at the doorstep of medical science, but he promulgated some rules. It is difficult to say whether he was naive or brilliant enough to make it more mathematical. He fixed heavy prize for saving lives of rich people and used to cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.

No one really knows how to regulate this difficult area, which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is amalgamation of intricacies of science with minds of patient and doctor’s skill in newly evolved milieu of financial complexities. Results are not encouraging for the medical profession.

With the evolution of medical science and medical care intertwined with medical business, braided changes in medical regulation is not an far off expectation. But reticulation of evolution to modern medicine and health care has not happened in isolation. Simultaneously there has been progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care has also ushered. Every one now wishes to live longer and dreams of better quality of life with support of progressive medical care. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and investors putting money into health care, which was unthinkable few decades back in the past.

This reticulation of business and health care allowed health care to be controlled in some way by administrators and investors. These people actually controlling health care are away from the health providers, who treated the patients. The rulers are unaware of the limitation of medical science and the uncertainties and complexities of human body, so the regulation remains somewhat unfair to doctors.

Today the global system of medical regulation, is becoming somewhat similar, to those ancient codes in terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects.

Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge, but the law has failed to keep in mind the poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body.

In such unfavourable and hostile circumstances, opting for a medical career is like getting into a trouble zone and getting entrapped into a system of exploitation and may be a self-bought disaster. It looks like as an absurd thought and highly ill advised.

Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.

Doctors have been left with only two ways either to persist, fight or perish. Silently quitting their beloved profession is going on for some time all over the world. Even in developed countries, there has been a fading enthusiasm to be a doctor

Increasing cruelty and unreasonable regulation is leading to doctors’ revolt. For example #NO-TO-RTH-AGITATION is a movement, the result of failure of Government to create public health system, but it has potential to fail the existing private doctors’ system as well. Smaller hospitals are already on verge of closure, will be forced to shut down.

It is a cry for survival for the doctors, if short-sighted bureaucracy can understand the real problem.

Slow or acute revolt is long due globally- no less than mutiny- a struggle for professional dignity.

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.

Exorbitantly expensive medical education and lowered merit

April 2, 2023 1

RTH-AGITATION-A Cry for Survival-Smaller hospitals need support

$#RTH-AGITATION- Rajasthan - Sadly doctors are fighting for their genuine rights and dignity against all. No one is with them - media, judiciary, Government and not even patients whom they have saved. Aspiring doctors should know the reality and introspect- why they wish to be a doctors in such circumstances? Smaller hospital and individual doctors' clinics are backbone of the health care system in India. Their contribution towards public health can’t be ignored. Be it Covid care or treatment of daily ailments, they are actually helpful to the public and indispensable in real sense. Their contribution to society is huge especially in view of broken public health care system. They provide health care near to public near their residential area at affordable cost. From an another angle, they generate employment to the workers as well as small businesses associated with their small hospitals. In a populous country like India, strengthening these smaller hospital is a desirable step. To strengthen the health care, Government can actually do well to support these hospitals and achieve health care to all. Supporting them will require a fraction of resources, as compared to the money needed in case Govt has to provide to public itself. It will be a short-sightedness of the Government policies, if instead of supporting them, Govt wishes to exploit their resources to give free health care to public.$

#RTH-AGITATION- Rajasthan – Sadly doctors are fighting for their genuine rights and dignity against all. No one is with them – media, judiciary, Government and not even patients whom they have saved.

Aspiring doctors should know the reality and introspect- why they wish to be a doctors in such circumstances?

Smaller hospital and individual doctors’ clinics are backbone of the health care system in India. Their contribution towards public health can’t be ignored. Be it Covid care or treatment of daily ailments, they are actually helpful to the public and indispensable in real sense. Their contribution to society is huge especially in view of broken public health care system.

They provide health care near to public near their residential area at affordable cost. From an another angle, they generate employment to the workers as well as small businesses associated with their small hospitals.

In a populous country like India, strengthening these smaller hospital is a desirable step. To strengthen the health care, Government can actually do well to support these hospitals and achieve health care to all. Supporting them will require a fraction of resources, as compared to the money needed in case Govt has to provide to public itself.

It will be a short-sightedness of the Government policies, if instead of supporting them, Govt wishes to exploit their resources to give free health care to public.

But administrators and bureaucratic system has failed on both fronts. Neither they were able to develop a dependable health care system for public, nor they tried to support smaller health systems. What they tried to do was akin to the ancient story of ‘ the farmer and the Golden goose’. The Greedy farmer wanted all the golden eggs instantly without feeding the bird and therefore killed the duck. Government with its short-sighted bureaucracy is killing its golden health care and not realizing the real potential and benefits.

In the present day, ebbed from all sides, doctors need to earn back the dignity of profession and resist oppression. The phenomenon of oppression of doctors in the name of regulation is a global issue. The populist oppressive schemes in the misleading names like #RTH-Rajasthan (RIGHT TO HEALTH) are prevalent everywhere globally in some form or another. Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.

Will Rajasthan’s Right to health bill do more harm than Good

Acquiring kind of skill , the years of passionate, merciless, excruciating medical learning is placed at the disposal of administrators, who themselves have failed to develop a good health care system in real sense.

#NO-TO-RTH-AGITATION is a movement , the result of failure of Government to create public health system, but it has potential to fail the existing private doctors’ system as well. Smaller hospitals are already on verge of closure, will be forced to shut down. It carries the risk of extinction of neighbourhood friendly doctor and hospitals.

The basic problem is the intentions for the task of developing a good health care system. The agenda of administration is to control the health care workers rather than developing a good health care system for citizens.

What NO-TO-RTH-AGITATION is actually doing? It is a cry for survival of the smaller hospitals- not only for themselves but for Indian Health care system, if short-sighted bureaucracy can understand the real problem.

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March 27, 2023 1

What is wrong with medical profession? Choosing medical career- a mistake?

It is not easy to practice as doctor these days. Media full of doctors bashing, credibility crisis and regulators perpetually hounding doctors, who are forced to work under imposed medicolegal sword. There is no day that passes when system does not perpetuate negativity against medical profession. Doctors, ebbed from all sides, have lost the dignity and independence. Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.

The complex medical skill, the years of passionate, merciless excruciating medical learning is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense. Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived by administrators -by sprouting the fraudulent generalities.

All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry – except the well-being of the doctors and nurses.

In todays’ era there has been bullying of doctors by administrative systems, new unreasonable laws, which use pressure tactics on medical professionals to get their own way – no less than enslavement.

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.

Medical courses are comparatively lengthy and expensive study course and difficult training with slave like duties. “enslavement of doctors”.
Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. 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.
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.
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 treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
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.
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.
Risk doctoring 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.21 occupational risks to doctors and nurses
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.
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 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: zero fee and fixed commission ads on television by lawyers in health systems are a common advertisement to harass doctors. 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 instigation of lawsuit against doctors is a major disadvantage for medical profession.

14. Overall, a complex scenario for doctors: There is increasing discontentment among 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.

In this era, a thought is gradually getting prevalent-‘Is choosing medical career or becoming a doctor is a mistake?

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March 26, 2023 0

Struggle for professional independence: #RTH-Rajasthan doctors are global leaders

In the present era, Doctors are ebbed from all sides, need to earn back the dignity of profession and resist oppression. The phenomenon of oppression in the name of medical- regulation is a global issue. The oppressive schemes in the misleading names like #RTH Rajasthan (RIGHT TO HEALTH) are prevalent everywhere globally in some form or another.

Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.

Doctors in Rajasthan India have shown first of its kind revolt, that is just waiting to happen globally at some stage.

Will Rajasthan’s Right to health bill do more harm than Good?

By certain laws and Acts like RTH, an effort is on to place medicine under State control. Acquiring kind of skill , the years of passionate, merciless excruciating medical learning is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense.

Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived by administrators -by sprouting the fraudulent generalities.

All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry – except the well-being of the doctors and nurses.

Doctors have often wondered at the smugness with which administrators assert their right to enslave them, to control their work, to force their will, to violate their conscience, to stifle their mind. Irony is that while administrators do this, still they depend on the same doctors for saving lives -whose life they have throttled, who resent the treatment meted out to the health care workers. Like the failed medical system, administrators have failed to realize that all the negativity perpetuated against doctors, who are working with the burden of mistrust under medico-legal sword is going to make them less safe.

Administrators, who have never treated a patient in their lifetimes, not only try to control treatment of thousands of patients, but project themselves messiah by demonizing doctors. Lowly educated celebrities and administrators have found a new easy way to project themselves on higher pedestrian by publicly insulting highly educated but vulnerable doctors. The biggest tragedy to the medical profession in the present era is the new fad of administrators to discourage and demonize the medical profession for their popularity gains.
Being so distant from the ground reality, their role should not have been more than facilitators, but they have become medical administrators. To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.

Slow or acute revolt is long due. Doctors have only two ways- either to persist, fight or perish. Silently quitting their beloved profession is going on for some time all over the world. Even in developed countries, there has been a fading enthusiasm to be a doctor. But doctors of Rajasthan have shown the way. The way to persist and resist the indignity handed over to medical profession. The have shown that the struggle was not that difficult that it looked to be. They have chosen the correct path of struggle for Independence (Professional). That makes them global leaders without any doubt.

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.

Exorbitantly expensive medical education and lowered merit