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


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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

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 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

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

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


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

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

Multiple Deaths in healthy people by civic negligence:

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

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

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

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

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

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

Single  Death in Hospital due to disease:

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

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

Point to ponder-Misplaced priorities:

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

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

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Time to Regulate Health Administrators & Pharmaceuticals like Doctors #CBI- arrests-Joint-Drugs-Controller


  CBI has arrested Joint Drugs Controller for allegedly taking a ₹4 lakh bribe to clear injections made by  Biocon Biologics .The CBI has arrested Joint Drugs Controller S Eswara Reddy for allegedly receiving a Rs 4 lakh bribe from a conduit to waive the Phase 3 clinical trial of the ‘Insulin Aspart’ injection, an under development Biocon Biologics product to manage Type 1 and Type 2 diabetes, officials said on Tuesday.

        The incident may be just a tip of the iceberg, to indicate collusion between administrators and various industries. It is the time to regulate all important components of health industry including health administrators as doctors are regulated – to achieve real cost effective health care.

          In last few decades, as doctor-patient relationship has been getting more complex and medical industry has controlled the financial interaction, the medical costs have become expensive. Hence the health insurance industry is gradually becoming indispensable. As doctors are at the front and remain the visible component, they are blamed for the expensive medical treatments.  The tremendous rise in health care expenses is usually borne by the government, taxpayer, insurance or patient himself.  Therefore there has been an increasing dependence on investors in health care, along the lines of an industry to ensure its financial viability. 25 factors- why health care is expensive

      Complex interplay of various industries  like pharmaceutical, consumable industry and other businesses associated with  health care  remain invisible to patients. Various important components for example pharma industry, suppliers, biomedical, equipment, consumables remain unregulated.  There is large number of administrators involved in such processes.  Although doctors are strictly regulated and kind of over-regulated but such administrators and financial controllers who play important part in medicine, cost, sale and purchase, remain largely unregulated. Because of such undeserved criticism, doctors have actually been alienated from financial aspect but still they are often perceived as culprits for cost escalation.

CBI has arrested Joint Drugs Controller for allegedly taking a ₹4 lakh bribe to clear injections

       The CBI has arrested Joint Drugs Controller S Eswara Reddy for allegedly receiving a ₹4 lakh bribe to waive the phase three clinical trial of the Insulin Aspart injection, a product of Biocon Biologics under development to manage Type 1 and Type 2 diabetes, officials said on Tuesday.

CBI has arrested Joint Drugs Controller for allegedly taking a ₹4 lakh bribe to clear injections made by  Biocon Biologics

Biocon Biologics is a subsidiary of the  Biocon. The company has denied allegations.The agency has also arrested  director at Synergy Network India Private Limited, who was allegedly giving Reddy a bribe, they said.

After completing the necessary paperwork, the CBI has arrested Reddy and Dua, nabbed during a trap operation on Monday while the alleged bribe exchange was going on, the officials said.

The CBI has also booked Associate Vice President and Head-National Regulatory Affairs (NRA), Biocon Biologics Limited, Bangalore, L Praveen Kumar, as well as Director, Bioinnovat Research Services Private Limited, Delhi, Guljit Sethi in the case under IPC sections of criminal conspiracy and corruption. 

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     25 factors- why health care is expensive

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   Medical-Consumer protection Act- Pros and Cons

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Important Points for Fire Safety in Hospitals


      An overstressed  hospital system unable to bear the rising patient load is an important factor for the frequent fire incidents.  Overstressed ICUs, ACs, lot of oxygen flowing, other combustible chemicals, gases, and electrical equipment all around make hospitals a dangerous place for the incidents of fire.  

    Last year Hospitals increased beds, equipment and staff to admit more Covid patients, but it is not possible to immediately expand the electrical wiring system. Medical equipment or wires carrying current beyond their capacity can overheat. That is what is happening in many hospitals. Besides looking at fire

audit, an electrical audit is also needed.

      Fire prevention and safety  is a matter of vital importance concerning everyone in the hospital industry. After another incident in Delhi, have further raised the concerns about safety of patients in hospitals.  Unawareness of safety measures especially among staff of hospital can increase death toll  among patients as well as health care workers. Such incidents happening frequently have become  an eye opener for government, health administrators as well as health care providers.
NABH and Fire Safety
For fire prevention and safety in hospital, certain modifications in  building design are required to deal with  various potential emergency situations to avoid further incident and damage. The main objective of fire safety design of buildings should be assurance of life safety, property protection and continuity of operations or functioning.

120 patients died due to hospital fires since April 2020
     Even the roads inside big hospitals, which should be 6 metres wide, are blocked with parked vehicles. If a fire breaks out, the fire tenders cannot even enter. Therefore norms & codes for building design & fire safety should be followed not only for high rise hospital buildings but also for small set up or nursing homes properly. Fire Codes process is a complex process which integrates many skills, products and techniques into its system.
Hospital engineering service provision for Fire Protection according to NABH:

1. Fire fighting installation approval must be obtained
2. Location of control room should be easily accessible.
3. Control panel & manned, PA equipment should be connected with detection system or fire alarm system.
4. Pumps and pump room
5. 2 separate pumps i. e .Electric and diesel pump should be available
6. Provision of Forced ventilation should be there.
7. Arrangement of filling Fire tenders
8. 4 way fire inlet must be present in case of emergency
9. Proper access for Fire tender to fire tanks
10. Fire Drill should be performed
11. Yard Hydrants should be available
12. Ring main and yard hydrants should be as per strategic locations.
13. 2 way fire heads to charge the ring main
14. Landing Hydrant & Hose reels
15. Wet riser system must be installed
16. First aid Fire fighting appliances must be in working conditions
17. First aid equipment cabinets
18. Provision of Escape routes – escape stairs
19. Sprinklers system – basement & bldg. above 15 M in height
20. Automatic Smoke detectors / heat detectors
21. Provision of Fire Alarm System & Fire extinguishers
 
Regulations as per National Building Code 2005 : 

1. All high-rise buildings need to get NOC as per the zoning regulations of their jurisdiction concerned. 
2. A road which abuts a high rise should be more than 12 metres wide, to facilitate free movement of Fire Services vehicles, especially the Hydraulic Platform and Turn Table Ladder.
3.Entrance width and clearance should not be less than 6 metres or 5 metres, respectively.
4. At least 40 per cent of the occupants should be trained in conducting proper evacuation, operation of systems and equipment and other fire safety provisions in the building, apart from having a designated fire officer at the helm.
5. The buildings should have open spaces, as per the Zonal Regulations.
6. Minimum of two staircases with one of them on the external walls of the building. They should be enclosed with smoke-stop-swing-doors of two-hour fire resistance on the exit to the lobby.

General Recommendations:

1. Hospitals of high rise buildings are found to be utilising the cellars for generators and transformers, which is strictly prohibited. 
2. Canteens, OP blocks, dormitories and pathological labs are not allowed in cellars.
3. Regular refresher training courses for the fire brigade personnel.
4. Recommendation for creating Rural Fire Services in areas which are not at present under any full time Fire Service cover.
5. Augmentation of Municipal Hydrant System.
6. Adoption of best practices from other city codes like Mumbai Delhi and Hyderabad by State Government for fire safety.
7. Clarifying position of CFO and Fire Protection Consultant in approval procedures.
8.  Recommendation for establishment of Disaster Control Room for cities.
9. A passing reference to NBC rules like provision of fire doors, fire separating walls, fire exit & fire lifts should not be overlooked. 

Fire safety Measures have 4 Parameters namely means of access through approach roads, open spaces, means of escapes like external Staircases & Fire fighting equipment. Thus provision of all these is necessary from safety point of view within hospital premises. An effective fire program calls for an understanding of the hospital fire plan & the active participation of every employee at all times. Also at least 1 well trained fire officer should be elected at every hospital. There is no better protection against fire than constant vigil to detect fire hazards, prompt action to eliminate in safe conditions & a high degree of preparedness to fight fire.

Everyone should remember that every big fire starts from small one therefore nothing should be considered insignificant within hospital premises. Some hospitals lack trained staff to handle such emergencies therefore frequent mock as well as evacuation drills must be taken. Panic & confusion are the greatest hazards of fire & they can be countered only by sufficient preparedness which should be avoided by means of hospital staff in case of fire emergency.

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?

Obeisance for Dr Archana Sharma: Bigger Role for Doctors’ Associations


The painful incident of Dr Archana Sharma’s Suicide unmasks the everyday struggle of the doctors in the present era. Her supreme sacrifice depicts 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 is the result of the apathy of fair justice that eludes medical community. Sadly, the society 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.

Dr Archana Sharma Suicide

      

Dr Archana Sharma Suicide

  It was an incident that was enough to jolt doctors’ and medical associations out of their deep slumber against the everyday sufferings of their members. Protecting and supporting the suffering members against physical and legal assaults should be the need of the hour. But sadly, it was not enough to wake them up. After few days of token protests, everything came  back to routine.  Unfortunately Doctors’ associations have limited their role merely to social gatherings with some token academics.  They have not risen to the real life problems of doctors like goonism, blackmail, physical and legal assaults.  Doctors as individuals remain vulnerable   to these issues and always remain at receiving end of the stick. In this era, doctors’ associations need to play a bigger role especially in cases of medico-legal suits against doctors; to support the sufferers.  As cases of medical negligence may be circumstantial incidents and not real mistakes, courts may not be able to deliver justice to doctors many times. A concern is that in case of poor outcome and case goes to courts, there is an indirect perverse incentive to deliver a guilty verdict against the doctor as a person, who is responsible for life and death.

        Failure of Doctors’ and Medical associations to rise to the occasion even in such a case of blatant cruelty will be a real injustice to DR Archana Sharma.

     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?

#Doctors-‘Earn Hundreds & Pay Back Millions’ #USG-Lab-Nagpur to Pay 1. 25 Cr Compensation


          Is there any other profession, which has such kind of pathetic arrangement? The sufferers of such pitiable deals are doctors. An average doctors studies for decades and treats hundreds of patients for peanuts (Few hundred rupees). For one alleged mistake or just a legal interpretation is forced to pay millions for an incident, which can be merely procedural or circumstantial mistake.

  Why one should be putting his/her future into such pathetic arrangements? The inspiring doctors need to think.

          Large claims granted by courts are incentives for patients and lawyers for putting medical lawsuits. In an era, where people fight with their parents, brothers and sisters for money and property, it will be naive to think that idea of making money from doctor does not exist.

          Now-a-days medical professionals need to not only be thorough with their medical subjects and the medico-legal implications, but also  need to be careful about how courts may interpret the medical processes. What doctors think is a correct   medical process, but it can be interpreted as negligence, in case of an adverse outcome. Other contributing factors that nail down medical profession are the sympathy to the patient and wisdom of hindsight,   which everyone is flushed with as an after event.  

          Large compensations against medical profession are  the single important factor can increase the cost of  healthcare and demoralize medical profession.   Doctors  are always on the receiving end in case of an adverse outcome.    Medical problems are very complex and sometimes it is difficult to judge  the future course of  disease as well as court  interpretation of  medical science, especially  with retrospective wisdom  by courts.  Summarily doctors have to safeguard themselves from treatment as well as legal and documentation hassles.

         Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors.  

     Strangely  doctor’s fee are quite low but lawyers charges and court compensations are really astronomical amounts, which are beyond any logic.

New Delhi: In a landmark order, the National Consumer Commission (NCDRC) has ordered Nagpur-based Ultrasound Scanning and Imaging Center to pay a compensation of Rs 1.2 crore to a disabled child and his parents in a medical negligence case. The firm has been blamed for misreporting of ultrasound on four occasions during pregnancy, resulting in the birth of a child with congenital anomalies.
Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. The commission held that the ultrasonology center also failed to offer to terminate the pregnancy, failing to diagnose defects at an early stage. The newborn had finger pain (complete absence), right leg below the knee and left leg below the ankle joint.
The clinic – Imaging Point – was run by Radiologist Dr Dilip Ghik in Nagpur. Holding him and his clinic responsible for their failure to detect structural anomalies of the fetus at 17-18 weeks, a two-member NCDRC bench comprising Justices RK Agrawal and SM Kantikar asked them to provide for the child’s welfare, future expenses asked to pay compensation for  the treatment and purchase of limb prostheses.
The order said, “The amount shall be kept as a fixed deposit in any nationalized bank (preferably SBI) in the name of the child till he attains the age of majority. Parents can get periodic interest on the FD for regular health check-up, treatment and welfare of their child. It also directed the radiologists and their clinics to pay Rs 1 lakh towards legal expenses.
As per the commission’s order, in October 2006, the child’s mother, who was pregnant at the time, consulted a gynecologist and obstetrician. The next month the doctor referred the patient to the imaging point for ultrasonography of the pelvis. USG Ghik and reported normally. Three more ultrasounds were done by the Ultrasound Scanning Centre. All USGs were reported as “no obvious congenital anomalies in the abdomen and spine of the fetal head”.
But when the gynecologist performed an elective caesarean section and after the baby was born, the mother and all the attendants were shocked to see a “severely deformed male newborn”. The girl’s parents had alleged that all this happened due to the negligent ultrasound of the radiologist.
He had prayed for a compensation of Rs 10 crore to meet future expenses. But the radiologist denied any negligence in the patient’s USG report.

     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?

A Central Law Needed for Violence against Doctors: IMA to NMC


 

Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being.

Unfortunately, abusive and violent behaviour by patients or relatives or those accompanying patients has become one of the attendant risks of the medical profession. It is no surprise then that the medical fraternity has once again called upon the government to enact stringent laws and their proper implementation to curtail this kind of behaviour with the National Medical Commission (NMC) proposing that registered medical practitioners (RMPs) refuse to take on such cases.

The NMC (which replaced the Medical Council of India) is a body that regulates medical education and professionals.

The NMC’s Ethics and Medical Registration Board has issued draft regulations inviting comments from the public, experts, stakeholders and organisations on “National Medical Commission, Registered Medical Practitioner (Professional Conduct) Regulations 2022”.

Comments and suggestions on the draft proposal can be sent by June 22.

A Central Law Needed for violence against doctors: IMA to NMC

“In case of abusive, unruly, and violent patients or relatives, the RMP can document and report the behaviour and refuse to treat the patient. Such patients should be referred for further treatment elsewhere,” the draft proposal says.

 “If a change of RMP is needed (for example, the patient needs a procedure done by another RMP), consent should be obtained from the patient himself or the guardian. The RMP who attends to the patient will be fully accountable for his actions and entitled to the appropriate fees,” it added.

Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being. Sahajanand Prasad Singh, president, Indian Medical Association (IMA, a panel that represents doctors and their interests), said a doctor would be ethically wrong if he or she refuses treatment to someone in need. So the need of the hour is to have a central law to check such untoward incidents, said Dr Singh.

“The government passed an Epidemic Diseases (Amendment) Act in 2020 which provided acts of violence against healthcare personnel during any situation akin to current pandemic to be cognizable and nonbailable offences. This law should remain in force forever. If the NMC wants the welfare of doctors, they should work in that direction,” he added.

“The commission or abetment of such acts of violence shall be punished with imprisonment for a term of three months to five years, and with fine of Rs 50,000 to Rs 2,00,000,” says the Epidemic Diseases (Amendment) Act, 2020.

Former IMA president Rajan Sharma, who led a nationwide protest condemning violence against doctors in India, said without a Union home ministry law against attacks on doctors, these proposals would do very little to prevent incidents against healthcare workers.

“There has to be strong laws to deal with the rising cases of violence. The regulations made by NMC should be in tandem with the stringent laws from the Union home ministry,” Dr Sharma said.

On his part, IMA general secretary Jayesh Lele, “It’s only a draft regulation, we are going to submit our important observations to the NMC.”

Anuj Aggarwal, general secretary, Federation of Resident Doctors Association of India, said the RMP Professional Conduct Guidelines offers some breather for resident doctors but has some way to go.

“The guidelines give rightful exceptions to patients with life-threatening conditions, which is justified. However, it is important to consider that most of the events in which a patient’s attendants turn violent are when the patient is very critically ill. So this proposal has no role to play in the majority of such scenarios,” he said.

Dr Aggarwal said that while it is a welcome step to curb the issue of rising violence against doctors, a central law would be a better and more effective deterrent.

The government did propose a central protection act and a draft was put in the public domain in 2019 for feedback but it was put on the back burner.

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Dr Manjula Case NHS-UK: Semantics-Regulator’s own Fitness to Practice Doubtful? #GMC-UK


Regulation of the medical profession has become a tool to oppress doctors.

  Dr Manjula Arora case (NHS-UK) unmasks the everyday struggle of the doctors in present era. Being undervalued and demonized, forced to work as sub-servant to administrators and regulators are considered new normal and has become an accepted form of harassment.  Fatigue and burnout are thought to be routine side effects of being a doctor or nurse.   The unhindered over-regulation has left no stone unturned in spreading hatred and creating an environment of mistrust against the medical profession.  Single stray or a trivial incident   is projected    as an example to portray poor image of medical profession as generalization and as a token of the ‘excellent’ work done by administrators and regulators.   Doctors have become soft targets because of their nature of work as they deal with life and death.   Any trivial issues such as semantics used by Dr Manjula Arora (in this case) were blown out of proportion  and   GMC finds this  as an  opportunity  to send a strict message to the whole profession.  Such incidence  show that 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’ administrators prove their relevance to the system.

       Regulation of the medical profession has become a tool to oppress doctors. Driving the narrative of doctors as “perfect” beings causes more harm to the doctor-patient relationship than not. Constantly seeking to attain perfection is the very approach that leads to burn out, and more mistakes- causing patient harm.

Dr Manjula Arora’s case

Dr Manjula Arora’s case

Dr Arora has been a doctor since 1988 and is of good character. She asked her employer for a laptop. For context, most employees would reasonably expect their employer to provide work-related IT equipment. She was told that none were available, but her interest would be noted for the next roll-out. Many people would interpret this positive response to mean that they would get a laptop in due course. Clearly if her employer did not intend for her to have a laptop, they could simply have said so. Dr Arora spoke to her IT department about getting a laptop and said she had been ‘promised’ one.

And that’s it. That is the entire extent of her ‘misconduct’.

One could regard her statement as a minor exaggeration, or loose terminology, or careless language or verbal shorthand over a trivial subject.  But no one  should consider it to amount to ‘dishonesty’ unless interpret it in biased manner.

The tribunal took a different view. They concluded that ordinary, decent people would consider her use of the single word ‘promised’ as dishonest.  The tribunal further decided that this so-called dishonesty amounted to misconduct.

They also considered that the misconduct was serious.

They decided her fitness to practice was impaired, and that it was necessary to suspend her to send a message to the profession.The regulator has a difficult task. Good regulation protects patients. Poor regulation harms patients, because doctors will run away from a toxic regulatory environment.

Manjula Arora case: the GMC stumbles again? -BMJ

      The case of Manjula Arora, a GP in Manchester, who has been suspended for a month for supposed “dishonesty” about a laptop, was picked up by a few colleagues, and social media did its work of ensuring the pick-up rate increased exponentially.  One always worries about the latest “MedTwitter” controversy. But this one has come on back of seething annoyance among many doctors about our regulator—the General Medical Council (GMC)—and its perceived bias, with cases such as those of Hadiza Bawa-Garba and Omer Karim still fresh in our memories.

Couple this with the recent Medical Workforce Race Equality Standard (MWRES) data confirming a clear association of increased referrals and convictions on the basis of racial background—or indeed country of origin as regards training—and this case lit the touch paper.

If one considers the publicly available details of the whole trial, you have to scratch your head and wonder how it got to this stage?   Would this happen if the name of the individual was, for example, Michael Andrews?  

The relevance of this case stood on two things—any harm to the patient population, which, to me, should be the primary aim of the GMC, and then dishonesty and disrepute brought upon the medical community.

This ruling makes it clear that there is no risk of harm to the public: “The Tribunal considered that no issues in relation to patient safety had been identified in this case. Dr Arora is a competent clinician, and there is no necessity to protect the public.” That should have ended the issue. But the complications started when interpretation about honesty came into the picture.

“The Tribunal attached significant weight to the fact that Dr Arora’s misconduct was a single incident in relation to the use of a single word, with no evidence of any other similar episodes of dishonesty before or after the event.” If you go into the details of the case, it becomes even more murky, as it’s the interpretation of a word—subjective at best— against the background of someone for whom English is not their first language. But it was deemed enough to warrant a month’s suspension according to the tribunal: “this period would send an appropriate message to the medical profession and to the wider public that Dr Arora’s misconduct, albeit relating to a single fleeting moment of dishonesty and not a planned deception.”

This raises a multitude of questions. Firstly, there is the principle that one fleeting moment of dishonesty could result in suspension. If that’s the standard, then the profession is indeed in trouble, with the GMC now making subjective judgements and being an arbiter of what is deemed to be honest or not. Where does the line get drawn? Discussions about patients or conversations about whether Santa exists or not?

Secondly, and more importantly, there is the suspicion of bias in how that law is being applied. Daniel Sokol has written a recent column which discusses the notion of doctors as the “saintly being”; the epitome of perfection at all times. Yet, within all of us exist the same prejudices and flaws as for the rest of the population. Sokol suggests that doctors have to be “scrupulously honest—in and out of work—unless the situation obviously allows for ethical dishonesty.” Yet he makes no mention of the fact that the GMC seems to apply that principle unevenly across the board. I accept that it can be difficult to see the “problem” others are complaining about, but I can assure you there are very few international medical graduates who have read about Arora’s case and not thought “I know why this has happened.”

There is professionalism, but there is humanity too, and I would propose that driving the narrative of doctors as “perfect” beings causes more harm to the doctor-patient relationship than not. What is honesty? Saying to patients that they need to wait for another 16 hours to get a bed, or holding the hand of the elderly frail lady, comforting her and saying “I am sure something will come up shortly”? It brings back the concept that being a doctor is a vocation. Constantly seeking to attain perfection is the very approach that leads to burn out, and more mistakes—causing patient harm.

Finally, if the role of the GMC is to protect the public from “single moments of untruth,” as this destroys the view among the public that doctors are saints (although I am pretty sure the public don’t see doctors like that in modern life), then there needs to be a discussion of that concept, of the overreach into personal lives, and of where the line is drawn as regards the GMC’s intrusion and inordinate application of that principle. I would suggest the role of the regulator should be for the rare circumstances when there is an interest in behaviour not being repeated or where it cannot be dealt with effectively by an employer.

I work with the GMC closely these days, and I find it immensely frustrating to see such cases as they undermine some significant hard work that is being done by individuals who are determined to change the narrative that the GMC is biased. I would encourage all concerned to look into this case, review it, learn from it, and offer support to Arora. There is a lot of work in hand to repair the damage from the Bawa Garba case, and this case could reinforce those sentiments, which we must avoid.

The intention may once have been for doctors to be Superman, but modern times and the foibles of individuals only permit a Batman. It’s worth remembering neither of them work to harm the public.

     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?

Fish Bile ‘Treatment’ Lands Woman in Hospital- Folly of Fringe Theories in medicine


    It has become a common practice to advertise health products or therapies 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. Needless to say, the objective evidence or global neutral trial for the claimed efficacy or about real side effects is always missing.

    Companies have created huge fortunes based on circulation of such pedagogic narratives and social knowledge. But in real sense, these are actually chemical and have biological actions and reactions. Chemical derived from natural sources can have side effects and contain impurities.  Global neutral trials to validate effects and side effects remain an urgent need of the hour for all health products.

   Suffering for the common public is immense. Doctors’  sincere warning had no effect rather they were called as medicine mafia.   Unfortunately  false beliefs  like local religious figures can cure cancer and kidney diseases  cause they could communicate with invisible spirits  and gain knowledge. Unsurprisingly the cranks  have been  wrong and innocent patients suffer.   Doctors objecting to  elevation of  crank theories were painted as  western medicine agents,  or nattering nabobs of negativity.

 Here is an example of the folly of following fringe  theories.

Fish bile ‘treatment’ lands woman in hospital

Fish bile ‘treatment’ lands woman in hospital

 A 52-year-old homemaker from Dum Dum had to undergo a few rounds of dialysis and was put under intense critical care for a renal failure, triggered by ‘fish bile poisoning’. The patient had ingested raw fish bile for four consecutive days as a treatment to cure her diabetes prior to being rushed to Manipal Hospitals Kolkata with acute abdominal pain. Doctors at the Salt Lake hospital found the patient had low blood pressure and was in a state of shock. Initial reports showed a significant derangement of liver and kidney functions. It led doctors to treat common causes of liver and kidney injuries or drug induced organ damage. When further tests didn’t match with these diagnoses, the team started looking for a possible cause. The patient then revealed she had ingested bile of Rohu fish for four days to control her diabetes. “Consuming fish bile causes acute kidney and liver injury with the need to go for long term dialysis. This patient had to be put under dialysis within 72 hours of admission,” said internal medicine and critical care consultant. She was discharged from hospital after a month.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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