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

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Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

CJI Ramana’s Concern about Violence against Doctors: too Mild a Remedy, Need Concrete Action


            

            While violence against doctors should be a concern to everyone, more so for the public, but sadly everyone in society has preferred to take advantage and reap benefit of the situation at the cost of doctors. Government has remained more or less indifferent, whereas people don’t have minimum basic health amenities and doctors have become punching bags for inept health system.  Law industry has been enormously benefited financially due to medico-legal cases against doctors. Media and celebrities have sold their shows and news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations.  An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors.  Local goons have blackmailed doctors over genuine complications and the natural deaths occurring in hospitals.  There is a little token action by police after routine incident of violence against doctors. Consequently medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.  Actually public needs to be concerned as the society itself is going to suffer in the long run,  not realizing  that people themselves are responsible for their health problems and not the doctors. 

     At this stage, Chief Justice of India N V Ramana on Saturday expressed serious concern over rising violence against upright and hardworking doctors and lodging of false cases against them.  The show of concern is nice gesture, as problem is clearly evident to all, but merely  expressing a concern at this stage is too mild a remedy.  When cancer is in late stages and  needs a radical surgery,  applying an ointment will not work.

Rising violence against doctors saddening, they deserve better: CJI Ramana            

Rising violence against doctors saddening, they deserve better: CJI Ramana

Chief Justice of India N V Ramana on Saturday expressed serious concern over rising violence against upright and hardworking doctors and lodging of false cases against them. The CJI said that he would also like to pay his tribute to the unending spirit of doctors, who work tirelessly round the clock for their patients. Doctors are mentors, guides, friends and counsellors. They should always remain active members of society, and solve problems faced by the people,” he said. The CJI said, “I am extremely saddened to witness rising violence against doctors. Several false cases are being lodged against upright and hardworking doctors. They need a better, and more secure, working environment.  This is where professional medical associations assume great significance. They have to be proactive in highlighting the demands of doctors.”  The CJI also expressed concern about the healthcare system in India and said that more than 70 per cent of the population resides in rural areas where people don’t have minimum basic amenities, forget about the comfort of corporate hospitals.

“Even Primary Health Centres (PHC) are also not properly equipped, if there is a PHC there are no doctors and if there is a doctor, there is no PHC. If both are there, there is no infrastructure. This is the situation in this country and in this scenario this type of affordable technique of detecting cancer through ultrasound at the preliminary stage is very helpful,” the CJI said.

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 comparison of imparting Justice Vs Health: Grave injustice to medical professionals


        Justice is needed for satisfaction of soul and peaceful mind, is of same importance what is to the health of body. Justice delayed gives a sense of hurt and pain to soul. Pendency in courts simply reflects the grave injustice people are living with.

 Pendency in courts casts a ‘pall of gloom’, presents a hopeless situation: AG

          Justice and Health- Both are crucial for happiness of the living beings as well as society as a whole.  Hospitals are full of patients and so are courts with litigants. None of the people go to hospital and courts happily and everyone invariably wants early relief.

   Compare the situation in courts with a hospital.  Once a patient visits hospital, he will be treated almost instantaneously; irrespective how many patients’ doctors might have to examine in a day or night. There is almost nil pendency in hospitals, be it day or night, emergency or routine cases.

     Now can we expect similar treatment at courts? Do the people visiting courts are imparted justice in real sense.  Doctors get few minutes to decide. Most of the time, for the investigations and the treatment few visits are required. But there is no pendency. In Government hospitals, even appointments are not given. A doctor sitting in outdoor will see hundreds of patients. On emergencies night duties, doctor will not be able to count how many he/she has stabilized or numbers treated.

      Even in such chaotic systems, doctor can be punished, dragged to courts or assaulted for unintentional mistakes, that are  almost always secondary to load of patients or inept infrastructure.

     The work at hospital continues day and night, 24 hours and 365 days, despite almost always lesser number of doctors and required manpower. Systems in hospitals  are designed and maintained meticulously   to have no pendency what-so-ever situation is.   Larger number of patients go back home treated well and very few unfortunate patients are unable to recover, but still whatever is required- is done invariably.

Pendency in courts casts a ‘pall of gloom’ , presents a hopeless situation: AG

NEW DELHI: India’s top law officer K K Venugopal on Friday said litigants’ fundamental right to speedy justice lay in tatters and implored country’s top judges to take drastic measures to arrest their waning confidence in justice delivery system caused by monstrous pendency of 4.8 crores cases, many for decades. When we look at the pendency, a pall of gloom settles. We find that we are in a hopeless situation,” Venugopal said, “How has the justice delivery system deteriorated to this extent? If you look at the pendency over the years, we realise that over a lakh of cases are pending for more than 30 years at trial court level and 10-15 years in HCs. How do you believe that so far as litigants are concerned they would have confidence in the justice delivery system?” “But against whom the poor litigant can complain, or an under trial who is incarcerated for a number of years which he would have undergone had he been convicted and punished? Do they file a case for enforcement of their fundamental right? But against whom?

44 million pending court cases: How did we get here?

       There are about 73,000 cases pending before the Supreme Court and about 44 million in all the courts of India, up 19% since last year.

According to a 2018 Niti Aayog strategy paper, at the then-prevailing rate of disposal of cases in our courts, it would take more than 324 years to clear the backlog.

Grave injustice for medical professions:

  1.  A doctor making wrong diagnosis (gets few minutes to decide) can be prosecuted, but courts giving wrong verdicts (get years to decide) are immune?

     2. Compare the remuneration of lawyers to doctors. Doctors gets few hundreds to save a life (often with abuses) and lawyers can get paid in millions (happily).

      3. Doctors treat the body and larger is still not fully known about mechanisms. Still doctors can be blamed for unanticipated events. Whereas  law is a completely known and written subject.

   4. If health is citizen’s right so should be a timely justice.

         Despite doing so much for patients, still people’s behaviour to doctors and hospitals is not respectful. Doctors are punished for slight delays and people and courts remain intolerant to unintentional mistakes. But people can’t behave in the same manner to courts and legal system and keep on tolerating the blatant injustice for years. 

     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?

   

‘Doctor- Save Yourself’: Court Convicts Doctors For Operating Woman Without Ventilator


A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other lifesaving equipment.  This was despite the fact that  the committee constituted by the District Surgeon to verify the allegation of medical negligence in its final report has said there is no negligence on the part of the accused during the performance of the LAVH surgery and also shows  *how the accused have tried to save the deceased.”*

What is worrying for the doctors is that every death during medical treatment can be a blame against the doctors. If the courts were to impose criminal liability on the hospital and doctors for everything that goes wrong, the doctors now should be more worried about their own safety than giving all the best treatment to their patients.     Both Government and Private  small hospitals carry out  thousands of routine surgeries every day. Occasionally complications may arise  in simplest looking procedures – for example even in   normal deliveries; what to say about routine surgeries.         How many hospitals (Government and private) in districts, town in peripheries are equipped with a ventilatory support system?  Perhaps  they are too less, although an honest count would  be some  interesting data.  Still, surgeries of the type mentioned are conducted  routinely  in almost all of these small centres.

So based on one incident of this kind, the thousands of surgeries done in such areas are going to be affected. In other words, doctors will not dare to conduct surgeries in peripheries.       As per the verdict of the court, many of the surgical speciality’s doctors in periphery are indulging in blameworthy activities every day in their routine work. Why should they risk their lives and profession in such circumstances?   That raises  another question , as many  Government  Hospitals are also without ventilators in the periphery. Should Govt doctors also  refuse surgeries without an ICU setup?  Any Surgery or even normal delivery in rare circumstances can get complicated and  the patient may require ventilator. Usually anaesthetist use Ambu-bag for an emergency situation and transport the  patient to other facility. So absence of a  ventilator is not life threatening in a real sense.     In peripheries, a large number of  deliveries are conducted  by ANMs, and nurses, and complications may arise occasionally.  So what are the facilities expected and available at a sub-centre? In reality   almost nothing is available.      Merely having a ventilator  does not solve the problem and  is not enough . The hospital  requires much more  arrangements to keep a patient  on ventilator.  Do all Govt hospitals where surgeries are  being done have ventilator and trained doctors  and support staff to operate those ventilators? It needs round the clock trained  doctors  and nurses, ABG  machine, portable X-ray , bed side Echo dialysis etc. Doctors in ill-equipped Govt   centres  are forced to conduct deliveries.  What should be the SOP in such circumstances? A real and honest data would be an eye opener and interesting.

Doctor need to  ponder over the issue of saving themselves before they save the patient.

 

 

Medical Negligence: Karnataka Court Convicts Three Doctors For Death Of Woman Operated Without Ventilator Facility & Other Life Saving Equipment* “A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other life saving equipment. BIDAR: Four people, including three doctors, have been handed jail terms and slapped with fines by a local court for a botched surgery which claimed the life of a woman.The II Civil (senior) and JMFC Court judge Abdul Khadar sentenced well-known medical practitioners Dr Rajshree Biradar and Dr Vaijinath Biradar, and Saibanna, to two years imprisonment and fined them Rs 10,000 each. If they fail to pay the fine, they will have to serve an additional six months in prison. Dr Rajshekar Patil was sentenced to six months imprisonment and fined Rs 5,000. He will have to serve additional imprisonment of one month if he fails to pay the fine.The case dates back to October 12, 2014, when Sampavati, wife of Ghaleppa Auradakar, got herself admitted to Sushrut Nursing Home in the city for a hysterectomy procedure. But after a five-hour surgery, she died due to alleged medical negligence.However, without disclosing her condition to the family, she was shifted to Dr Rajshekhar Patil’s Shree Hospital in an ambulance. Dr Patil continued the treatment without disclosing her condition, it was alleged in the chargesheet.

Nursing home was negligent in not having ventilator: Court

Later, it was revealed that Sampavati had died at Sushrut Nursing Home itself due to the lack of ventilator facility. The court, while convicting the accused, observed that the nursing home authorities were negligent in not having a ventilator facility for such a risky procedure.

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?

Typical Story of Blackmail by Goons &Vulture journalism #Dr-Archana-Sharma-Suicide


       Painful story of Dr Archana Sharma Suicide unmasks the everyday struggle of the doctors in present era. Although not ideal but being undervalued, dis-empowered and demonized, forced to work as sub-servant to bureaucrats are considered new normal and is an accepted form of harassment.  Fatigue and burnout are thought to be routine side effects of being a doctor or nurse. Venomous media, celebrities, film stars and prominent personalities have left no stone unturned in spreading hatred and creating an environment of mistrust against the medical profession.  They project   single stray incident   as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors have become prone to the verbal, physical as well as legal assaults.  Dr Archana Suicide unmasked an organised crime and propagators were local goons, politicians and vulture journalist, who usually managed an orchestrated racket to blackmail the doctors and extort money. Doctors being soft targets because of their nature of work as they deal with life and death.   Any death gives them opportunity to all to blackmail the doctors on the pretext of negligence, a legal weapon used by law-enforcers.

          Dead doctor’s husband demands action against ‘vultures’ and ‘blackmailers’

          Dead doctor’s husband demands action against ‘vultures’ and ‘blackmailers’

       JAIPUR: The husband of gynaecologist Dr Archana Sharma, who committed suicide on Tuesday, lodged an FIR against one Shiv Shankar Ballya Joshi for exerting pressure on the doctor and organising protests in her hospital. Hours before his transfer, Dausa SP Anil Kumar said police have seen the CCTV footage wherein Joshi was belting out abusive slogans against the doctor in the hospital. Police said they were investigating Joshi’s role in the case. The entire incident began when a 22-year-old woman was brought to Sharma’s Anand Hospital on Sunday night with labour pain. Though she was taken to the labour room, her condition deteriorated allegedly due to excessive bleeding and she died on Monday. On the same day, Dausa police registered an FIR under Section 302 (Murder) of the IPC which names Dr Archana Sharma and her husband Dr Suneet Upadhyay. The FIR put Rajasthan police in a tight spot because several doctors alleged that cops could have filed the FIR under Section 304A (causing death by negligence) of the IPC, instead of slapping murder charges on doctors. 4/1/22, 3:20 PM Rajasthan: Dead doctor’s husband demands action against ‘vultures’ and ‘blackmailers’.  Kumar, however, said the police only registered the FIR on the basis of the complaint filed by the patient’s family. In an emotional video message, Dr Upadhyay alleged that Joshi had promised the family a hefty compensation and brought them back with the body to the hospital. “Joshi called other BJP leaders to the hospital too. Joshi has been trying extortion and blackmailing in the hospital,” he said, adding that the police have been shielding Joshi due to a senior BJP leader of Dausa. Sharma’s husband Dr Suneet Upadhyay in his FIR said that some “vultures” played politics on the patient’s body as they gheraoed the hospital and forced the local administration to file a case of murder against the doctor. Upadhyay alleged that Joshi played a key role in this entire affair. He has been accused in the FIR of threatening the hospital multiple times in the past. As per the FIR, many complaints were filed against Joshi at the police station, but cops took no action against him, which further emboldened the accused. Upadhyay said Joshi was hurling invectives during the protest at the hospital and his wife could not tolerate such insults because she was a reputed surgeon who had saved the lives of several women and children. He said she was stalked by fears that Joshi could send her to jail even though she was innocent. The complaint also mentions that Sharma read a report of the incident in a local newspaper, but there was no mention of the hospital’s version there.

          According to Upadhyay, the family members of the deceased patient had returned from the hospital with complete satisfaction because they had witnessed the doctors struggling for nearly two hours to save her life. He said the family of the deceased patient were preparing for her last rites when Joshi stepped in and brought the body back to the hospital. Joshi allegedly called up people over the phone and gathered a large crowd at the hospital. He wanted to file a case of murder against the doctor even though the family of the patient had not given any complaint. The FIR states that vultures like them have made the lives of doctors in the country very difficult and told cops to act against such blackmailers. Dausa police said they have booked Joshi under Section 306 (abetment of suicide), 304 (extortion) and 384 (extortion by threat of accusation of an offence punishable with death or imprisonment for life, etc) of the IPC. Police said Joshi is a local leader, whereas, they are probing the journalist’s involvement.

     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?

The Book-‘At the Horizon of Life & Death’:Blackmail of Doctors by opportunist goons, legal industry, Vulture Journalism


      While doctors are usually blamed for any mishap, be it natural poor prognosis or genuine complications, rarely people get to know their side of the story — how a dying patient affects their psyche, how they deal with these patients and their kith and kin, what are the kinds of abuse and threats made when they are not able to save a life despite their best efforts.  Book describes stories the blackmail doctors face from opportunist goons, legal industry and vulture kind of journalism. Every day blackmail by legal industry, journalist and local goons, similar to what Dr Archana Sharma went through and others doctors are  facing have been described.

         Dr Pankaj Kumar, Director Critical Care at a Delhi Hospital, India has come out with an insightful account of these very aspects of a doctor’s life.

    The 300-page book (English) contains 20 stories divided into three parts viz – Larva & Pupa Syndrome, Hope & Fear & Medical Lawsuits. The book is available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive  etc.

         His book ‘At the Horizon of Life & Death’ is a Reality Fiction that reflects the sensitivity involved in dealing with patients facing death.

     Through the eyes of its protagonist Dr Anand, the book captures significant moments in the treatment trajectory of critical patients. The book tries to create awareness regarding pertinent issues faced by the medical professionals like demoralisation, expensive medical education, the extreme pressure and suicidal ideation, the plight of the nurses and support staff, assaults and violence and the medico-legal intricacies involved in day-to-day practice among others. The author has also taken care to guide aspiring doctors to make well-informed career decisions.

     Part One (Larva & Pupa Syndrome)-  talks about the expensive medical education, and the issues students face in medical college.

    Part Two (Hope & Fears) talks about the beginning of doctors’ professional journey, the disease demons they face while dealing with critical patients, dilemmas of doctors and patients near death situations.

    Part Three (Medical Lawsuits) is about how doctors are always working under the threat of medico-legal lawsuits.

        While stories are fictional, the scenarios and the problems in them are very real — things that he faced or saw his colleagues facing.

     Medical profession has become victim of mistrust generation and blame culture. Everyone keeps harping about the few black sheep in the community, while larger good work of doctors is not highlighted enough.

    The stories span from Dr Anand’s initial days in the emergency room and capture his struggles in complex medico-legal scenarios over the next four decades. This book is an effort to bring back focus on the treatment of the patient as opposed to the mistrust, legal frameworks and policies surrounding the healthcare practice.

Suicide by Dr Archana Sharma has exposed the blackmail; medical professionals are going through in current era. Doctors have become sitting ducks for punishments complaints, blackmail, and legal complexities besides every day harassment. Negligent police, indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment.  It may not be a good idea to opt for a medical career any more.

More naïve would be to pay millions to be a doctor.

     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?

Any Fine Morning can be Harbinger of Doomsday for doctors #lady-doctor-suicide


Working of a doctor and nurses is not free from risk to themselves which can be verbal, physical as well as legal assaults. Everyday globally, the doctors and the nurses greet the new day and return to their work of taking care of their patients, knowing well the risk involved. None of the   doctors can guess which one fine morning becomes a harbinger to their doomsday, especially when serving an anarchic and hostile society. No doctor can anticipate which one patient can cause deadly harm to health care workers, while trying to save the one.  Unfortunate incident of PPH (Post-partum Bleeding – a natural complication of pregnancy) and subsequent agitation by mob and over-reactive FIR by hostile Police was enough for a brilliant Obstetrician to commit suicide in Jaipur.  Possibly doctors are not assured of getting justice anymore from our system.

Jaipur- A woman doctor booked for death of a pregnant woman in Rajasthan committed suicide

Jaipur- A woman doctor booked for death of a pregnant woman in Rajasthan committed suicide

Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. According to police, the pregnant woman died at the hospital run by Dr Archana Sharma and her husband on Tuesday. An FIR was registered against Archana at the Lalsot Police Station after family members of the pregnant woman held a demonstration outside the hospital and demanded immediate action against the erring doctor. Stressed over the FIR, Archana hanged herself to death, police said. “The doctor was booked for the death of the pregnant woman due to negligence in treatment. Today afternoon, the doctor hanged herself to death at her residence above the hospital,” Additional SP (Dausa) Lal Chand Kayal said.

    The risk is generally underestimated, although often it may be major risk to life.  Majority of people, society and governing bodies and even doctors themselves do not perceive or acknowledge the possible harms to health care workers in present era.  But since these risks are increasing exponentially, they should be known to students, who want to take medicine as a profession. There are lesser set procedures, lack of awareness, not protective equipment or hostile society, lack of governance and laws and doctors continue to work in dangerous environment.

         Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.

            Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project   single stray incident   as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors need to be careful and remain careful about saving themselves from verbal, physical as well as legal assaults.

Doctor- ‘save the patient but to save themselves also’.

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?

Medical Consumer Protection Act: A Loss making deal for patients too?


       With the evolving medical science and health care getting intertwined with business, braided changes in medical regulation and law are not an unexpected development. New models of medical regulation, business and law in health care have emerged and progressed in last few decades.  Despite a wish to govern and regulate medical profession strictly, the laws and regulations still have to go a long way to provide real justice to everyone.   No one really knows how to regulate this difficult area,  which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and  relief , sadness and happiness, smiles and sorrow and other uncountable emotions, all intertwined with financial aspects.But the wish of administrators to govern medical profession strictly with punishments is not new.  Hammurabi (5000 years back) at the start of civilization believed that doctors needed to be punished in case there was a poor outcome. Strangely it was at a time, when no one understood the complexity of human body and the limitations of medical science; even basic anatomy and physiology of body was not discovered.  

      Considering the limitations of medical science along with uncertainties and complexities of human body, regulation of medical profession and system of punishments still remains somewhat unfair to doctors, even after 5000 years.  It is still based on principles of revenge and retributions rather than developing a robust system by learning from mistakes. By application of an average wisdom, doctors can be easily blamed for poor outcomes, as they are always and universal a common visible link between treatment and poor outcome. 

           One of the examples of easy punishments for doctors is Medical consumer protection act that was implemented in 1995 for medical services. Patients were defined as consumers and hence doctors were converted to service providers in lieu of some money.  Consequently the changed definitions altered the doctor-patient relationship in an irreversible way.   

    The reality is that neither doctors, nor patients are ready for such a legal relationship. More-over   the system is not robust enough for such a change.   To work with weak infrastructure, non-uniform medical education, poor numbers of support staff, inept health system along with legal complexities has pushed doctors into a shell and predisposed them to harassment. 

          Rather than   developing a system to promote   good doctor-patient relationship, Medical Consumer Protection Act has created a situation of ‘us versus them syndrome’. It caused erosion of doctor-patient relationship and escalated cost of care.   Propagation of stray and occasional incidents about negligence case in court or their outcomes are given disproportionate wide publicity in media. The patients are unable to understand the correct application of such stray incidents to themselves. Such cases may be frivolous,  just one in million or a rarity, but people always try to imagine themselves being in the hospital chaos due to the   scenario projected.  It gives a negative projection about medical services and enhances patients’ fear to seek treatment at right time.

    There is a growing mutual mistrust; doctors too have started looking at every patient as a potential litigant. Especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients. 

    With the mandate to practise evidence based medicine, doctors need to document everything and to offer everything possible, leading to skyrocketing medical costs.  To save themselves, doctors have to do mammoth paper work, leading to consumption of time that was meant for real deliberations for the benefit of patients.

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

       Not uncommonly doctors are used as scape goats to have a concession on the patient’s treatment from administrators.  

       Medical consumer protection act has increased the anxiety and insecurity among   medical professionals.   Doctors can be dragged to courts for trivial reasons, for example the sense of revenge, simply for non-satisfaction, to extract money or simply for avoiding paying for services.  In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctors does not exist. These money-making ideas are further stoked by the much publicized incidents of high compensations granted by courts.

     Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on their confidence and belief, which takes a lifetime to build.

     Whenever there is adverse outcome in any patient, all the doctors involved start looking for whom to blame among themselves. Due to legal pressure they try to pinpoint each other’s mistakes.  Mutual understanding takes a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other,  creating a strange sense of enmity among medical professionals.

    The ease with which doctors can be harassed has led to rampant misuse of medical consumer protection act and it has instilled a sense of deep fear and insecurity in the mind of medical professionals. The act has been used as a whip against the  doctors by all, including  medical industry, law industry and administrators.  Only doctors are visible as those who deliver care, so they remain at receiving end for poor outcomes and all these industries remain invisible.    The industry has used the protective systems against medicolegal cases to gain  maximum benefits  out of doctors’ hard work.   

      In court cases, a certain element of doubt always remains in mind of a doctor whether he will get justice in the long run, or will end up being  a victim of sympathy towards patient or clever lawyering.  So taking medical decisions in critical situations is becoming more difficult  in view of the future uncertainty of disease.

             Windfall profits for lawyers is a strong  incentive   for  law industry to promote   instigation  of patients by against doctors .  One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements on ‘sharing and commission basis’. There is no dearth of such relatives and lawyers who are ready to try their luck sometimes in vengeance and sometimes for the lure of money received in compensations. 

       Consequently doctors are now an easily punishable human link for poor outcomes.  Medical professionals work with continuous negative publicity, poor infrastructure, and preoccupied negative beliefs of society and burden of mistrust.

  Strangely  Medical Consumer Protection Act applies  only to doctors, that too selectively. All  other professions and services  are   out of it, not even other constituents of health services. Selective application is what is  demoralizing the doctors.  Considering the uncertainty and kind of work done by  medical professionals, actually it should be other way around.Mistakes are always easy to be picked with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.

            Nothing else has ever distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Decision making also becomes difficult  by uncertainty of prognosis,  grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight with luxury of time and fault-finding approach.  The possibility of complex medico-legal situations in doctor’s  mind are enough to distract doctors from their primary point of intentions ‘the treatment’.

          Therefore increasingly, financially secure doctors are staying away from the riskier jobs. No wise person will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by  slogging  the  entire  life.     

     Patients can have poor outcomes for many reasons. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. Whatever court decides,  while consuming years, the harassment of doctor is full and permanent. Even if court decides in favour of the doctor, there is no compensation possible for the sufferings and agony spanning over years.  Therefore, a single mistake can undo all the good work of past, and the illustrious future work that could have been accomplished.

        If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career at risk, why would anyone put himself in that difficult  position?  

         Medical Consumer Protection Act  has become a tool to harass doctors and money making tool for lawyers, medical industry or administrators. But  it would be naïve to assume that by whipping doctors and regulating them in such a harsh manner will be helpful to patients in long run.  The consequent insecurity among doctors, practise of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment)  are few of the  side effects, which will  definitely be passed on to the patients inadvertently.  After all doctors have to save themselves as well. As a result,  now the battle of life and death will be fought with less zeal, with subdued and demoralized soldiers.

          Patients are unable to realize their loss for punishing their saviours. For doctors, no rewards if you win, but sword hanging if one loses.  Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Consequently being consumer may be overall a loss making deal for the patients.

     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

Quack Menace: Infant loses glans in botched circumcision


Infant loses glans in botched circumcision done by quack

        In an era, when even licensed and qualified doctors are finding it difficult to practice medicine, it is strange that unqualified and unlicensed are having a field day. Why strict regulations do not apply to them, is beyond any reasoning and logic. If a medical facility or clinic is functional, it is difficult for the patient, especially in emergency, to check or even doubt its credentials. How such facilities are open, functional and thriving. Sadly our regulation is trying to regulate, who are already regulated. It is trying to punish those who are qualified and licensed, but turns a blind eye towards unlicensed and unqualified doctors.

     Such fake doctors own medical set ups, may conduct surgeries, sometimes run hospitals with little help from qualified doctors  and do procedures. Another problem is that they   promote fake rumours about genuinely qualified doctors and create a mist of mistrust to propagate their fake medical business.

A toddler has died Australia after circumcision

Quack Menace: Infant loses glans in botched circumcision

 The glans of an infant’s penis shrivelled and fell off after a quack tied a horse’s hair around it ‘to prevent bleeding’ after a ritual of circumcision. The child was rushed to hospital, where a surgery was performed to ensure that the baby will be able to urinate normally, but the boy has lost his glans.. A quack had conducted the religious ritual of circumcision on November 22, 2021, and tied a horse hair to the child’s penis. He then bandaged it and told the family to go home.

The child was born in October 2021. Ten days later, the family members noticed that the glans had come off along with the dressing. Families choose to get their male infants circumcised by neighbourhood quacks. This is not just unhygienic, but can lead to major complications as well. Other unhealthy practices like sprinkling ash on the wound after circumcision are also prevalent.

A toddler has died in Australia after circumcision

A toddler has died and his baby brother has required life-saving surgery in hospital after a medical procedure, understood to have been a circumcision, went horribly wrong in Perth’s south-east. The brothers were rushed to hospital in Armadale by family Tuesday evening following the surgeries. The West Australian reports a two-year-old boy was pronounced dead at the hospital’s emergency department. His infant brother – aged between seven and eight months – was rushed to Perth Children’s Hospital for emergency surgery.7NEWS reports he has since been discharged from hospital. WA Police have confirmed the toddler’s death is not being treated as suspicious. “It can be confirmed the boy underwent a medical procedure at a registered medical centre prior to his death,” a police spokeswoman said.

Circumcision is one of the oldest surgical procedures and one of the most commonly performed surgical procedures in practice today. Descriptions of ritual circumcision span across cultures, and have been described in ancient Egyptian texts as well as the Old Testament. In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by paediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

Complications of circumcision

Bleeding- Bleeding is the most commonly encountered complication of circumcision.

Infection, Insufficient Foreskin Removed, Excessive foreskin removed, Adhesions / Skin , Bridges, Inclusion Cysts, abnormal Healing

Meatitis, Meatal Stenosis, Urinary Retention, Phimosis, Chordee, Hypospadias, Epispadias

Urethrocutaneous Fistula, Necrosis of the Penis, Amputation of the Glans

Death—    death is an extremely unlikely complication of neonatal circumcision, but it has been reported.

     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


US Doctor hailed-Indian Doctor Jailed for Same Surgery & gap of 25 years


      

In a medical first, doctors transplanted a pig heart into a patient in a last-ditch effort to save his life and a Maryland hospital said Monday that he’s doing well three days after the highly experimental surgery. While it’s too soon to know if the operation really will work, it marks a step in the decades-long quest to one day use animal organs for life-saving transplants.

   In 1997, Dr Dhani Ram Baruah, along with Hong Kong surgeon Dr Jonathan Ho Kei-Shing, carried out a pig-to-human heart and lung transplant in Guwahati (India). The transplant stirred controversy all over and both the doctors were arrested within a fortnight for culpable homicide and under the Transplantation of Human Organs Act, 1994, and imprisoned for 40 days.

       The fault of Dr Baruah was that he was on the wrong side of the laws prevailing at that time. But now after 25 years USA has provided evidence that he was scientifically ahead of his times; hence punished and sent to jail for the same reason.  Instead of updating the laws, accepting and promoting the scientific advancement and encouraging the brilliance of the doctor, he was put in jail. The result is that now everyone is hailing the feat of doctors in USA for the same surgery that Dr Baruah dared to perform 25 years ago.

        In a patient with terminal  heart  failure, life is  only possible if heart transplant is done. Human heart is difficult to be procured.

     The point to ponder is that whether Laws should be made or may be updated to promote or help scientific brilliance or it is wise to follow them blindly without application to  future wisdom. Instead of punishing and sending Dr Baruah to jail, Laws could have been modified or updated to help the path breaking advancement, which could have helped patients and saved lives.

       Such high handedness of authorities just point to an ecosystem, where scientific advancements and individual brilliance  are not respected.

       As doctors in the United States hail the path-breaking surgery in which a patient is recovering after receiving a heart from a genetically modified pig in Maryland, it evokes memories of an Indian doctor who had attempted the same over 20 years ago in Assam.

For those who haven’t read, US doctors transplanted a pig heart into David Bennett, a 57-year-old Maryland handyman, in a last-ditch effort to save his life and a Maryland hospital said that he’s doing well three days after the highly experimental surgery.

We go back in time to take a look at the case in which Dr Dhani Ram Baruah, a transplant surgeon from Assam conducted a pig-to-human heart and lung transplant in Guwahati and why that incident got shrouded in controversy and led to him being imprisoned for 40 days.

The incident                                                   

In 1997, Dr Dhani Ram Baruah, along with Hong Kong surgeon Dr Jonathan Ho Kei-Shing, carried out a pig-to-human heart and lung transplant in Guwahati.

Times of India report says that Dr Baruah transplanted a pig’s heart into a 32-year-old man, who had a ventricular septal defect, or hole in the heart.

According to Dr Baruah, the surgery — conducted at his very own facility, the Dhani Ram Baruah Heart Institute, and Institute of Applied Human Genetic Engineering at Sonapur outside Guwahati — was completed in 15 hours.

However, the 32-year-old man “developed new anti-hyperacute rejection biochemical solution to treat donor’s heart and lung and blind its immune system to avoid rejection”, reported the Indian Express, and he died a week later.

The transplant stirred controversy all over and both the doctors were arrested within a fortnight for culpable homicide and under the Transplantation of Human Organs Act, 1994, and imprisoned for 40 days.

The Assam government formed an inquiry into the case and found that the procedure was unethical.

The inquiry also found that the Dr Dhaniram Heart Institute and Research Centre had “neither applied for nor obtained registration” as required under the transplant laws.

What happened next?

After being in jail for 40 days, the doctor returned to his clinic but found it to be destroyed. A Times of India report added that he spent the next 18 months under virtual house arrest.

But, the doctor, who faced taunts, continued his research.

Controversy’s child?

Dr Baruah hit the headlines again in 2008 when he claimed that he had developed a ‘genetically engineered’ vaccine that would correct congenital heart defects.

In 2015, he once again became popular after claiming to have discovered the ‘cure’ for HIV/AIDS and that he had ‘cured’ 86 people in the past seven-eight years.

He also wrote to the UNAIDS, WHO and the National Institute of Health of USA to tell them of his ‘successes’ and was open to scrutiny.

     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

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