“EDG scale of doctor’s comfort: guide for medical students” – How to choose medical specialty


Choosing a medical specialty is possibly one of the most important variable factor in doctor’s life. This one factor will decide the rest of the  life of the doctor. General rough guide to the factors involved, which persist forever and throughout the life, after a doctor chooses a specialty is given below. There can be individual variation depending upon the individual attitudes, compromises and way to do practice. Therefore there will be some variation in all the fields for individuals, places, systems and countries.

Re-blog

There can be extremes and variations  on either side of spectrum, but are exceptions. Following article does not include satisfaction and earning gained from   other businesses done by doctors, running nursing home or hospitals, commercial gains  from pharmaceuticals etc. this is on basis of income purely from professional work of treating patients.  These  factors and units can be used as a scale for guidance of medical students and hence named as EDG scale of doctor’s comfort (Extinct doctor good)

Factors

  1.      Earning
  2.      Prolonged tough training
  3.      Satisfaction of treating patients
  4.      Satisfaction of making diagnosis
  5.      Emergency & odd hour duty
  6.       Stress of life and death
  7.       Legal complexity and stress

The Unit—-Single * or (I) is  one unit. With experience and years of work , this unit  (for same doctor) will also multiply with age.

UNIT

India ( * or 1) is  1  million  rupees/annum

Advanced countries- (* or 1)== one lac or 100,000 dollars/ annum

 

General practice

 

 
       1.  Earning **to ***      2-3
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**
Internal medicine

 

 
       1.  Earning **to****        2-4
       2..   Prolonged tough training

 

**to***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***

 

cardiology

 

 
       1.  Earning **to*******  2-7
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****

 

gastroenterology

 

 
       1.  Earning **to******   2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

**

 

Neurology

 

 
       1.  Earning **to******  2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                  3

 

Nephrology

 

 
       1.  Earning **to******   2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***           3

 

Pulmonary medicine

 

 
       1.  Earning **to*****     2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***                    3

 

 

Emergency  Medicine

 

 
       1.  Earning **to****     2-4
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****                4

 

Anaesthesia

 

 
       1.    Earning **to*****     2-5
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

**
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****                 4
Endocrinology

 

 
       1.  Earning **to*****       2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**                2
Psychiatry

 

 
       1.  Earning **to*****       2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                  2

 

 

 

 

paediatrics

 

 
       1.  Earning **to*****       2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

****                  4

 

Critical care

 

 
       1.  Earning **to*****   2-5
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****           4

 

Paediatric critical care

 

 
       1.  Earning **to*****     2-5
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

General Surgery

 

 
       1.  Earning **to*****      2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

Minimal access surgery

 

 
1.          Earning **to******    2-6
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***                3

 

 

Cardiac surgery- CTVS

 

 
       1.  Earning **to******    2-6
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

Urology

 

 
       1.  Earning **to******    2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                 3

 

Gastro-surgery

 

 
       1.  Earning **to******    2-6
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****            4

 

Neurosurgery

 

 
       1.  Earning   **to******   2-6
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****            4

 

Head and Neck surgery

 

 
       1.  Earning **to******   2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***               3

 

Orthopaedics

 

 
       1.  Earning **to******                2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                             3

 

Ophthalmology

 

 
       1.  Earning **to*****             2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                           2

 

Radiology

 

 
       1.  Earning **to******   2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

*
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                  2
ENT

 

 
       1.  Earning **to*****    2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                 2

 

Dermatology

 

 
       1.  Earning **to*****   2-5
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

*                1

 

Gynaecology/obstetrics

 

 
       1.  Earning **to*****   2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****

 

Plastic Surgery

 

 
       1.  Earning **to******    2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

*
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**              2

 

 

Oncology

 

 
       1.  Earning **to*****   2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**               2

 

Onco-surgery

 

 
       1.  Earning **to******     2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**                    2

 

Anatomy

 

 
       1.  Earning **to***     2-3
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Physiology

 

 
       1.  Earning **to***
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Biochemistry

 

 
       1.  Earning **to***    2-3
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Microbiology

 

 
       1.  Earning **to****    2-4
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

0 to*
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

 

Pathology

 

 
       1.  Earning **to ****    2-4
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

NIl
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

Medical administrator/Manager

 

 
       1.  Earning **to********  2-8

sometimes multiple

       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

. There can be extremes and variations  on either side of spectrum, but are exceptions.

If the reader have some different view, or want to add something, they are welcome to  write in comments. This table just  highlights a trend of factors and may not be perfect. But it gives the factors which need to be taken into account,  before choosing specialty.

How to choose medical specialty? Variation of doctor salary, earning & important factors


Choosing a medical specialty is possibly one of the most important variable factor in doctor’s life. This one factor will decide the rest of the  life of the doctor. General rough guide to the factors involved, which persist forever and throughout the life, after a doctor chooses a specialty is given below. There can be individual variation depending upon the individual attitudes, compromises and way to do practice. Therefore there will be some variation in all the fields for individuals, places, systems and countries.

There can be extremes and variations  on either side of spectrum, but are exceptions. Following article does not include satisfaction and earning gained from   other businesses done by doctors, running nursing home or hospitals, commercial gains  from pharmaceuticals etc. this is on basis of income purely from professional work of treating patients.

Factors

  1.      Earning
  2.      Prolonged tough training
  3.      Satisfaction of treating patients
  4.      Satisfaction of making diagnosis
  5.      Emergency & odd hour duty
  6.      Stress of life and death
  7.      Legal complexity and stress

The Unit—-Single * or (I) is  one unit. With experience and years of work , this unit  (for same doctor) will also multiply with age.

UNIT

India ( * or 1) is  1  million  rupees/annum

Advanced countries- (* or 1)== one lac or 100,000 dollars/ annum

 

General practice

 

 
       1.  Earning **to ***      2-3
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**
Internal medicine

 

 
       1.  Earning **to****        2-4
       2..   Prolonged tough training

 

**to***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***

 

cardiology

 

 
       1.  Earning **to*******  2-7
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****

 

gastroenterology

 

 
       1.  Earning **to******   2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

**

 

Neurology

 

 
       1.  Earning **to******  2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                  3

 

Nephrology

 

 
       1.  Earning **to******   2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***           3

 

Pulmonary medicine

 

 
       1.  Earning **to*****     2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***                    3

 

 

Emergency  Medicine

 

 
       1.  Earning **to****     2-4
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****                4

 

Anaesthesia

 

 
       1.    Earning **to*****     2-5
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

**
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****                 4
Endocrinology

 

 
       1.  Earning **to*****       2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**                2
Psychiatry

 

 
       1.  Earning **to*****       2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                  2

 

paediatrics

 

 
       1.  Earning **to*****       2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

****                  4

 

Critical care

 

 
       1.  Earning **to*****   2-5
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****           4

 

Paediatric critical care

 

 
       1.  Earning **to*****     2-5
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

General Surgery

 

 
       1.  Earning **to*****      2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

Minimal access surgery

 

 
1.          Earning **to******    2-6
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***                3

 

 

Cardiac surgery- CTVS

 

 
       1.  Earning **to******    2-6
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

Urology

 

 
       1.  Earning **to******    2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                 3

 

Gastro-surgery

 

 
       1.  Earning **to******    2-6
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****            4

 

Neurosurgery

 

 
       1.  Earning   **to******   2-6
       2..   Prolonged tough training

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****            4

 

Head and Neck surgery

 

 
       1.  Earning **to******   2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***               3

 

Orthopaedics

 

 
       1.  Earning **to******                2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                             3

 

Ophthalmology

 

 
       1.  Earning **to*****             2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                           2

 

Radiology

 

 
       1.  Earning **to******   2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

*
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                  2
ENT

 

 
       1.  Earning **to*****    2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                 2

 

Dermatology

 

 
       1.  Earning **to*****   2-5
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

*                1

 

Gynaecology/obstetrics

 

 
       1.  Earning **to*****   2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****

 

Plastic Surgery

 

 
       1.  Earning **to******    2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

*
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**              2

 

 

Oncology

 

 
       1.  Earning **to*****   2-5
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**               2

 

Onco-surgery

 

 
       1.  Earning **to******     2-6
       2..   Prolonged tough training

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**                    2

 

Anatomy

 

 
       1.  Earning **to***     2-3
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Physiology

 

 
       1.  Earning **to***
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Biochemistry

 

 
       1.  Earning **to***    2-3
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Microbiology

 

 
       1.  Earning **to****    2-4
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

0 to*
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

 

Pathology

 

 
       1.  Earning **to ****    2-4
       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

NIl
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

Medical administrator/Manager

 

 
       1.  Earning **to********  2-8

sometimes multiple

       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

. There can be extremes and variations  on either side of spectrum, but are exceptions.

If the reader have some different view, or want to add something, they are welcome to  write in comments. This table just  highlights a trend of factors and may not be perfect. But it gives the factors which need to be taken into account,  before choosing specialty.

Medical device harms, hidden by regulator: policies akin to protection @USFDA


        

                   Modern medicine has been captivated by the  industry. In the name of people’s health, business and industry  receives a kind of  protection  by none other than regulator itself.  The report about USFDA,  hiding the adverse events or device failure and harm is just one example how  powerful  industry has become.  It is not always possible to identify  complications arising out of device failure and there can be possibility of  these  not  being reported. The numbers that are hidden may also represent a fraction of  actual number of harms related to device.  A sad truth of present era, where doctors are punished  and blamed for human errors or even  natural poor prognosis,  Medical industry remains not only  hidden behind the scenes, but  receives  policies akin to protection  by regulator.

USFDA ‘hid’ reports of medical device snags The US Food and Drug Administration (FDA), which claims to have stringent processes in place to ensure safety of medical devices, has been found to maintain a “hidden database” of reports of serious injuries and malfunction of devices. Since 2016, over a million incidents that were reported went to the hidden database rather than to the publicly available database of suspected device-associated deaths, serious injuries and malfunctions. This was revealed in an investigation carried out by Kaiser Health News, a US-based non-profit news service covering health news. The revelation has serious implications for India, which approves a lot of devices based on USFDA approval. KHN found that “about 100” devices including mechanical breathing machines and balloon pumps were granted “reporting exemptions” over the years. The investigation revealed that many doctors and engineers dedicated to improving device safety not only did not know the issues raised in these reports, they didn’t even know about the existence of the “hidden database” or the exemptions. While the agency hid such crucial information about device risks, lawsuits and FDA records show that patients have been injured, hundreds of times in some cases, noted KHN. According to KHN, FDA confirmed that the “registry exemption” was created without any public notice or regulations. “Any device manufacturer can request an exemption from its reporting requirements,” an FDA spokesperson told KHN. The USFDA’s public database that tracks medical device failures, Manufacturer and User Facility Device Experience (MAUDE), receives thousands of medical device reports that are used to detect potential device-related safety issues, and contribute to benefit-risk assessments of these products. These reports are submitted by mandatory reporters — manufacturers, importers and device user facilities — and by voluntary reporters — healthcare professionals, patients and consumers. MAUDE is used by doctors to identify problems or to check the safety record of a particular device. But they could reach the wrong conclusion as they would be unaware of and have no access to the reports on the “registry exempted” products, pointed out a former FDA official to KHN. For instance, KHN found that in 2016, while reports of only 84 stapler injuries or malfunctions were submitted to the public database, nearly 10,000 malfunction reports were included in the hidden database. Medtronic, which owns Covidien, considered to be the market leader in surgical staplers, had used reporting exemption. Surgical staplers are used to cut and seal tissues or vessels quickly, especially during minimally invasive surgeries and if the device fails the patient could bleed to death unless the doctors moved quickly to resuscitate the patient and seal the tissue/vessel. After the KHN report was published, the FDA has written to doctors expressing concern about the safety of surgical staples and staplers. The agency said it has received reports of 366 deaths, over 9,000 serious injuries and over 32,000 malfunctions. The letter also acknowledged that the FDA was aware that “many more device malfunction reports during this time frame” were submitted as “summary reports”. The agency said it was analyzing the reports and that the results would be made public. According to the KHN report, the FDA has deemed manufacturers of over 5,600 types of devices including cardiac stents, leadless pacemakers and mechanical heart valves, eligible to file “voluntary malfunction summary reports”, one of the many exemption programmes. Ironically, in India, doctors and regulators have argued that FDA has the most stringent regulation for devices compared to regulators in Europe, Canada, Australia or Japan and have even sought to make it mandatory for devices to have USFDA approval to be eligible for government procurement tenders. This was especially evident during the efforts to cap the price of stents when top cardiologists argued for higher prices or even price cap exemption for USFDA-approved stents.

Black coat vs white coat. What if money part is taken out of medico legal cases?


What if  financial part  is taken out of medico-legal issues, like compensation and lawyers fee?  The cases will drop down drastically?  If money part is zero, only errors will be identified and punished. Few  will remain only for idea of revenge.  In an era where people cheat their brothers, sisters and spouses for money, it will be naïve to think that idea of money extracting from doctors does not exist.

Financial  zeroing  can be done  in larger public interest to  keep down the cost of medical expenses.  It is  because of career building of few professions, that medico-legal cases are being fueled. Medical errors and complications are integral part of the treatment . Even simplest of diseases carry some amount of risk.  These  will still remain, even if doctors are hanged to death. Natural complications, poor prognosis can be attributed to errors by clever lawyering and because of benefit derived by other professions.

     Many careers  are  shining in name of preventable deaths  and medical errors at the cost of medical profession.  The managers, right activists, media   and lawyers  have made their career and wealth out of it. Ask any doctor really, are these issues really preventable after a point.  The  line separating errors or natural complications is really blurred and arbitrary. People who work in life and death situation know it well that  even natural poor prognosis can be labelled and proved as error by retrospective analysis and wisdom of hindsight and more certainly with luxury of time at disposal for lawyers and courts.

     Lawyers  and courts  should also be given those fraction of moments to decide same as is available to doctors. Otherwise it becomes a unbalanced match specially when the amount of money which was paid to doctor to save a life was peanuts as compared to now being paid to punish him.

Doctor need to train themselves for “ Cool” communication with patients to save themselves.@ Supreme court on insensitive comments by Shimla Doc


Doctors are sitting ducks for revenge, which can be in many forms. It is necessary  not to make unnecessary comments during discussions with patients and relatives.  A sweet talk or even  stoic silence is still better than  making  irrelevant  and insensitive comments. Sometimes, in emergencies doctors are too busy, feeling harassed, and in heat of moment , they  utter some words. But later, no one will take into account the amount of distress in emergency situations.  Irrespective of the number of patients, try to refrain from uttering the words, which are non- professional.  But few words said  in disgust will be remembered by patient and interpreted by courts in  retrospective analysis can be held against the doctors..

Supreme court granted an additional Rs 10 lakh in compensation to a woman from hills in medical negligence case on finding about the insensitive  comment  made by doctor at hospital in Shimla

 Few points, which should be followed are as under to save themselves from future harassment. There can be many more.

  1. Do not have a word match with patient or attendants.
  2. If attendant are shouting or angry, restrain your mind and do not answer to give back in same words. Better to be silent.
  3. Try to avoid being in that situation, specially if you are being irritated and some thing goes out of your mouth.
  4. If the situation is arising because diagnosis is not clear or not able to treat, try to refer the patient, without  making  comments.
  5. Try to have cool and calm communication and make a record of it.
  6. Communication should be  regarding only professional matters. Rest all irrelevant communication to be avoided.
  7. Unreasonable and unrealistic demands are not uncommon . Just tell calmly about the same. Do not make angry or sarcastic comments.

But sometimes when  during ongoing  medico legal lawsuits, a feeling  of revenge prevails  or as guided by lawyers,  such uttered words may cause unnecessary problems.

  “Documenting  the communication”

  • examine, investigate, diagnosis , treat correctly and communicate
  • Make a note of plan of treatment and prognosis, and communicate to patient or attendants.
  • Sign yourself and ask the patient or nearest relative to sign.
  • It is not uncommon that relative will refuse to sign. In that case just write a note and mention that attendant refuses to sign.
  • It is also a common issue that after listening to everything, relative will say that he does not understand or will ask his uncle or aunt. These are difficult moments and commonly happen. Just make a note of everything. Besides it wastes crucial time.
  • Can use camera for communication in difficult cases.
  • Never rely on verbal communication. It has little value.  Commonly people refuse to admit verbal communication, and will say that they were not told anything.

As time for everything is limited in life, be it treatment, communication, consent or documentation. . “Talk less and write more”. You will be judged by documents after many years.

Doctors need to train themselves to restrain and avoid irrelevant comments, to save themselves.

Illegal Organ (Kidney)transplant trade : Defined as crime, but saves life


A paradox, where a defined crime saves a life and following law and regulation correctly will result in end of life. If some one is asked to choose between a certain death or follow regulations, the choice will be very predictable. A patient , who has an irreversible organ failure, will try to defy death at all cost. People who can afford, can not see their children or loved ones to die, just for the sake of following law and regulations. Genuine concern here will be that If a patient can be cured of disease, why he should be left to die for just regulations. The wish to live is the basic reason, why the procedures, which are termed illegal, will flourish. They will thrive underground or in countries, where laws are lax. Touts, agents and liaison managers are people, who will be beneficiary and mint money by organization of the procedure. The people who can afford, get gift of life, in the bargain.

Organ transplant may be termed illegal, in certain circumstances as defined by Law. But legal or illegal, it gives life . It gives another chance to people to live or have their kith and kin, children , spouses and parent to live another life. Because of gap in demand and supply, when legal means do not help, adoption of illegal means becomes a compulsion. If following law and rules means death, they are unlikely to be complied with.

The gap in demand and supply of organs is the reason behind these activities. Nearly four lakh people suffering from end stage kidney failure need transplant and only 8000 get it. (Times of India). The recipient has two choices for Kidneys. It can be living donor and deceased donor or cadaveric in cases of brain death. 90% come from relatives, rest are cadaveric. The rest has to undergo repeated dialysis to survive.

After the enactment of The Human Organ Transplantation Act of 1994, transplants became less in India. But it was followed by booming market of donors In other countries like Pakistan, Philippines .

But given the circumstances of life and death, the underground market may still be existent.

The ACT also allows unrelated donors to give one of the kidneys if there is sufficient evidence to show that they know the recipient for a long time and are donating organs out of affection. The loophole has potential to be exploited. The affection or the papers for affection can be easily generated in today’s era in lieu of money or other favors in case of high profile cases. Therefore, the mediator’s work becomes easier to generate the papers projecting affection and tutoring and training of donors and recipient.

Alternatively, the procedure can be done in nearby countries. Therefore the role of doctor or surgeon doing a transplant (although the key point) is much smaller than the agent organizing the whole process. Thereby the agents , who can manage and organize the show, are thriving. The wish to defy a certain death is stronger than following the regulation. That will remain so till demand supply gap reduced , better awareness for brain death, medical infrastructure, organ retrieval and transport and supporting facilities are uplifted. Till it happens, even if it is defined as crime, the fruits will outweigh the risks, because of shear margin of money temptations and wish to live.

Thousands Healthy deaths vs one hospital death. Perception of moral burden of negligence (# SUPREME COURT on pothole deaths)


There is a  infernal  difference in  the kind of  media  projection, burden of negligence and accountability of preventable multiple healthy deaths by civic negligence   as compared to one hospital death occurring due to severe  disease. In fact the burden of   negligence here in healthy deaths is massive and  these deaths are unpardonable. But reality is opposite.  Strangely  “alleged and perceived negligence” ( with no proof and no investigation )  in death of someone already having disease  and death in hospital  during treatment attracts more scrutiny and   stringent  punishment   as compared to a naked “negligence  in deaths of healthy people” in such cases  of civic negligence.  

Massive civic negligence  leading to  entirely preventable loss of lives. These incidents bring fore the misplaced priorities of media and society which too have  contributed to  some extent to these unabated ongoing preventable   deaths  of  thousands of  healthy people.

 

Deaths due to potholes ‘unacceptable’,  Supreme court

The bench,  said the number of deaths from 2013 to 2017 in accidents due to potholes indicated that the authorities concerned were not maintaining the roads. The Supreme Court Thursday expressed concern over 14,926 people being killed in road accidents due to potholes in last five years and termed it “unacceptable”. A bench said the large number of deaths caused due to potholes across the country was “probably more than those killed on border or by the terrorists”. Terming the situation as frightening, the top court had asked the Supreme Court Committee on Road Safety to look into the matter. The bench had also said that people who have lost their lives as a result of accidents due to potholes should be entitled to compensation. 

 

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. These deaths  of people are in 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

 

       Single  Death in Hospital due to disease:

The media has always, 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.  Media has been responsible for creating a misunderstanding about the whole process of treatment and creating  something sensational out of nothing.

 

Point to ponder-Misplaced priorities:

Who is to be  blamed for  the deaths of healthy people which occur because of civic negligence? Here relatives may be helpless and  the vital questions  may go unanswered or taken as a routine.  There are no punching bags like doctor  for revenge. But on the contrary, 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. But media instead chose to defame medical profession by igniting the emotions of people by sensationalizing death of diseased and ill,  who probably were already at risk of death and did not give due importance to highlighting prevention of healthy  and absolutely 100% preventable deaths.

Right issues raised at right time will save thousands of healthy preventable deaths. Multiple  healthy deaths should carry more burden of negligence than  one death due to disease.

      

Story of Unlabeled drugs and Fraud In name of Ayurvedic treatment


         A myth, that any plant extracted drug is useful, free of side effects, is a belief ingrained deep in the minds of people. Such unscrupulous advice is followed blindly without even verifying the authenticity of the source. A hope of miracle is flashed to patients who have been given a “no hope” by scientific medicine, are an easy prey for such fraudsters.

   Another major problem is that medicines and syrups distributed in such manner are without name of drug, contents and doses. It is not uncommon to get lethal substances like steroids, hormones and heavy metals in dangerous doses.  

     Ayurvedic medicines and practitioners  belong to a  stream, also based on a  science. The medicines and treatment has to be  controlled and regulated in the same way, as for allopathic  stream.  So that criminals, who are not trained in ayurvedic stream can not play with lives of gullible people, giving them false hope.  Such acts  are  real crime to society, done with an intention to cheat rather than treating them.

   Any one distributing medicines or medical advice of any kind, has to be registered with a council, for those particular medicines. advertisement of such drugs or products should be on some scientific basis.

Regulating Ayurvedic medicines and practice will help  not only the genuine  Ayurvedic  doctors but also go a long way  in benefiting the ancient system of medicine and promote research.  

  Following may be just one of the cases, millions may remain unnoticed.

False ayurveda hopes to the hopeless

Tarun Mandal has spent almost all of his savings trying to get his son, suffering from acute jaundice since his birth, treated for the past one and a half years. A desperate Mandal recently paid a youth Rs 65,000 for an ayurvedic cure. However, his wife’s suspicion about the ‘gold ash’ tasting like churan led cops to an inter-state racket cheating terminally ill patients with a promise of cure. Mandal, who sells food items on a cart at the Sarojini Nagar market, was not the only one to fall in the trap. Cops have found at least 40 people who had been duped by the gang. Most of the victims are family members of children from different states getting treated in the capital’s top government hospitals.
“I gave away all my savings to them. They even guaranteed that all my money would be returned if the medicines failed. But when I went back to the same shop, they refused to recognise me,” said Mandal, who has already spent Rs 2 lakh and needs more money for a surgery.
The gang has also duped the grandfather of a seven-year-old thalessemia patient from Uttarakhand.

other incident dangerous chemicals in alternate medicines

Real failures of Dr Hazida Bawa case: Five issues to ponder-why doctors suffer?


 The case of  Dr Hazida Bawa  is of importance worldwide in many ways, an opportunity  for learning some hard and truthful lessons, as it touched upon various crucial aspects involved in medical treatment, especially in difficult situations. Every one has sympathy for the deceased, but  to blame a human factor, doctors should not be presented as sacrificial lambs.

       The current verdict is nearer to reality and away from a feeling of revenge and harsher penalties. It  gives a hope  that now there will be  acknowledgement of the difficult circumstances and limitations of medical system in health care environment.  To make doctor scapegoat for the  system limitations, poor prognosis or severe disease may be satisfying for some but not sensible. In this case doctors lodged their protest, collected money for lawsuit and the decision was re-looked legally. But every  doctor may not be  lucky enough and may have to suffer  in silence.

 Real failure in this case will be ignoring the factors that actually cause huge suffering for doctors-

  1. Presumptive failure by retrospective analysis: Retrospective analysis of any treatment will always show few things at hindsight that could have been done and would have proved life saving.  One may presume that omission or commission  of certain actions during treatment would have saved the  life,   but one can’t be sure whether these additional presumed treatment would really have benefited the patient.  Therefore a  perception-reality gap is created and with  negative perception towards doctors, it is interpreted as a  failure of doctor merely on presumptive basis and hence declared as negligence.  The doctors who deal with life and death know that it is not correct interpretation, and no one can ever be sure of what the real outcome would be. They just do what they think will be most effective for the patient, and it may not eventually turn out to be the best ever.
  2. Variable interpretation: Same evidence, incidence and circumstances are interpreted and  judged differently by people and  even courts. Some will say it is negligence and other will say it is not. Some will bay for doctor’s blood and other will not. This variation in perception is not only in minds of lay men but also in the learned courts, who  decide  differently.  At the time of death of patient, a constant and  universal last link is only the doctor, that is visible. He is an unfortunate victim, a human factor   and blamed for  the harm done because of variable thought process.

 

  1. Medical knowledge vs wisdom: People who do not treat patients, may be very wise and may acquire medical knowledge by various sources. But medical wisdom comes  only after years of medical practice,  by observing varied situations and spectrum of diseases. An understanding of what can happen in given circumstances comes only by treating such   emergencies.         For non doctors, it is very difficult to  comprehend the medical complexities and real time scenarios. Even doctors, who do not treat regularly emergency patients, can attribute the harm as doctor’s  mistake.

 

  1. Feeling of revenge:  in case of an  adverse event, negative thoughts prevail all over. In present scenario with legal powers with the sufferer and common sentiments against doctors, it is easier to identify and blame some human factors.   Adverse outcome is frequently covered by media to create a sensation among masses.  Real circumstances can only be felt by doctors  but that remains unheard. Harm to patient, media cry and negative sentiments against the service providers creates a sense of revenge in mind of people.

 

  1. Doctor’s negligence vs system inadequacy; This visibility of doctor at the time of  declaration of death  or while treating the patient on his bedside, makes him vulnerable to all kinds of accusations. By application of an average wisdom, all deaths can be easily attributed or linked to fault of the doctor. Subtle presentations of severe disease, rapid deterioration, multi organ complexities, under staffing and sub optimal systems, inadequate equipment and  other innumerable shortcomings of the whole system may not be visible or not given consideration in the  haze, as compared to  publicity and attention  given to only doctor’s faults.

 

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