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

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

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

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

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

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

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

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

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

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

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

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August 25, 2024 2

Mpox (monkeypox)

Key facts

Mpox (monkeypox) is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus. Two different clades exist: clade I and clade II
Common symptoms of mpox are a skin rash or mucosal lesions which can last 2–4 weeks accompanied by fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.
Mpox can be transmitted to humans through physical contact with someone who is infectious, with contaminated materials, or with infected animals.
Laboratory confirmation of mpox is done by testing skin lesion material by PCR.
Mpox is treated with supportive care. Vaccines and therapeutics developed for smallpox and approved for use in some countries can be used for mpox in some circumstances.
In 2022–2023 a global outbreak of mpox was caused by a strain known as clade IIb.
Mpox can be prevented by avoiding physical contact with someone who has mpox. Vaccination can help prevent infection for people at risk.

Overview

Mpox (monkeypox) is an infectious disease caused by the monkeypox virus. It can cause a painful rash, enlarged lymph nodes and fever. Most people fully recover, but some get very sick.

Anyone can get mpox. It spreads from contact with infected:

persons, through touch, kissing, or sex
animals, when hunting, skinning, or cooking them
materials, such as contaminated sheets, clothes or needles
pregnant persons, who may pass the virus on to their unborn baby.

If you have mpox:

Tell anyone you have been close to recently
Stay at home until all scabs fall off and a new layer of skin forms
Cover lesions and wear a well-fitting mask when around other people
Avoid physical contact.

The disease mpox (formerly monkeypox) is caused by the monkeypox virus (commonly abbreviated as MPXV), an enveloped double-stranded DNA virus of the Orthopoxvirus genus in the Poxviridae family, which includes variola, cowpox, vaccinia and other viruses. The two genetic clades of the virus are clades I and II.

The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research and the first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the Congo (DRC, 1970). Mpox can spread from person to person or occasionally from animals to people. Following eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, mpox steadily emerged in central, east and west Africa. A global outbreak occurred in 2022–2023. The natural reservoir of the virus is unknown – various small mammals such as squirrels and monkeys are susceptible.

Transmission

Person-to-person transmission of mpox can occur through direct contact with infectious skin or other lesions such as in the mouth or on genitals; this includes contact which is

face-to-face (talking or breathing)
skin-to-skin (touching or vaginal/anal sex)
mouth-to-mouth (kissing)
mouth-to-skin contact (oral sex or kissing the skin)
respiratory droplets or short-range aerosols from prolonged close contact

The virus then enters the body through broken skin, mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract. Mpox can spread to other members of the household and to sex partners. People with multiple sexual partners are at higher risk.

Animal to human transmission of mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses, or eating animals. The extent of viral circulation in animal populations is not entirely known and further studies are underway.

People can contract mpox from contaminated objects such as clothing or linens, through sharps injuries in health care, or in community setting such as tattoo parlours.

Signs and symptoms

Mpox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system.

Common symptoms of mpox are:

rash
fever
sore throat
headache
muscle aches
back pain
low energy
swollen lymph nodes.

For some people, the first symptom of mpox is a rash, while others may have different symptoms first.

The rash begins as a flat sore which develops into a blister filled with liquid and may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off.

Some people may have one or a few skin lesions and others have hundreds or more. These can appear anywhere on the body such as the:

palms of hands and soles of feet
face, mouth and throat
groin and genital areas
anus.

Some people also have painful swelling of their rectum or pain and difficulty when peeing.

People with mpox are infectious and can pass the disease on to others until all sores have healed and a new layer of skin has formed.

Children, pregnant people and people with weak immune systems are at risk for complications from mpox.

Typically for mpox, fever, muscle aches and sore throat appear first. The mpox rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and evolves over 2-4 weeks in stages – macules, papules, vesicles, pustules. Lesions dip in the centre before crusting over. Scabs then fall off. Lymphadenopathy (swollen lymph nodes) is a classic feature of mpox. Some people can be infected without developing any symptoms.

In the context of the global outbreak of mpox which began in 2022 (caused mostly by Clade IIb virus), the illness begins differently in some people. In just over a half of cases, a rash may appear before or at the same time as other symptoms and does not always progress over the body. The first lesion can be in the groin, anus, or in or around the mouth.

People with mpox can become very sick. For example, the skin can become infected with bacteria leading to abscesses or serious skin damage. Other complications include pneumonia, corneal infection with loss of vision; pain or difficulty swallowing, vomiting and diarrhoea causing severe dehydration or malnutrition; sepsis (infection of the blood with a widespread inflammatory response in the body), inflammation of the brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis) or urinary passages (urethritis), or death. Persons with immune suppression due to medication or medical conditions are at higher risk of serious illness and death due to mpox. People living with HIV that is not well-controlled or treated more often develop severe disease.

Diagnosis

Identifying mpox can be difficult as other infections and conditions can look similar. It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with mpox may also have another sexually transmissible infection such as herpes. Alternatively, a child with suspected mpox may also have chickenpox. For these reasons, testing is key for people to get treatment as early as possible and prevent further spread.

Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox. The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. Testing blood is not recommended. Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.

More information on laboratory confirmation of mpox can be found here.

Treatment and vaccination

The goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems.

Getting an mpox vaccine can help prevent infection. The vaccine should be given within 4 days of contact with someone who has mpox (or within up to 14 days if there are no symptoms).

It is recommended for people at high risk to get vaccinated to prevent infection with mpox, especially during an outbreak. This includes:

health workers at risk of exposure
men who have sex with men
people with multiple sex partners
sex workers.

Persons who have mpox should be cared for away from other people.

Several antivirals, such as tecovirimat, originally developed to treat smallpox have been used to treat mpox and further studies are underway. Further information is available on mpox vaccination and case management.

Self-care and prevention

Most people with mpox will recover within 2–4 weeks. Things to do to help the symptoms and prevent infecting others:

stay home and in your own room if possible
wash hands often with soap and water or hand sanitizer, especially before or after touching sores
wear a mask and cover lesions when around other people until your rash heals
keep skin dry and uncovered (unless in a room with someone else)
avoid touching items in shared spaces and disinfect shared spaces frequently
use saltwater rinses for sores in the mouth
take sitz baths or warm baths with baking soda or Epsom salts for body sores
take over-the-counter medications for pain like paracetamol (acetaminophen) or ibuprofen.

Do not

pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or
shave areas with sores until scabs have healed and you have new skin underneath (this can spread the rash to other parts of the body).

To prevent spread of mpox to others, persons with mpox should isolate at home, or in hospital if needed, for the duration of the infectious period (from onset of symptoms until lesions have healed and scabs fall off). Covering lesions and wearing a medical mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk getting mpox but will not prevent spread from skin-to-skin or mouth-to-skin contact.

Outbreaks

After 1970, mpox occurred sporadically in Central and East Africa (clade I) and West Africa (clade II). In 2003 an outbreak in the United States of America was linked to imported wild animals (clade II). Since 2005, thousands of suspected cases are reported in the DRC every year. In 2017, mpox re-emerged in Nigeria and continues to spread between people across the country and in travellers to other destinations. Data on cases reported up to 2021 are available here.

In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions, with 110 countries reporting about 87 thousand cases and 112 deaths. The global outbreak has affected primarily (but not only) gay, bisexual, and other men who have sex with men and has spread person-to-person through sexual networks. More information on the global outbreak is available here with detailed outbreak data here;

In 2022, outbreaks of mpox due to Clade I MPXV occurred in refugee camps in the Republic of the Sudan. A zoonotic origin has not been found.

WHO– monkeypox

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August 22, 2024 0

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

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

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

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

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

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

Chocolates come as ‘Ayurvedic Aushadh’

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

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

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

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August 21, 2024 0

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

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

Strangely media, courts, prominent people, celebrities, human right commission, woman right activists and women commission are little concerned about the blatant injustice done towards doctors. This again brings forth the hypocrisy of these people and organizations, who otherwise cry hoarse about woman rights and empowerment. Whenever a female is assaulted, there is an outrage, but the same support is not extended to a female if she is a doctor. Such bestiality should create havoc in minds of civilized people but this apathy to such incidents repeatedly clearly indicates otherwise. Can’t we see that such incidents are harbinger of many more in future? It is important to realize that this is the time to unify and condemn such episodes vehemently and prominently so that the miscreants realize that they cannot get away with it.

Brutality against doctors reveals a deep prejudice and lawlessness. Everyday violence against doctors is common merely on the basis of perceived negligence. Government is either unwilling to act and establish a strong culture of deterrence, so justice been elusive for medical professionals.

Even murderous assaults on doctors in the past are not enough to shake administrators, courts and doctors’ organizations out of slumber. Such violence, if unabated will be poor advertisement for next generation to take medical profession as a first choice.

Media and celebrities have proudly projected in films and television that doctors can be beaten and assaulted, in case there are unexpected results or in case of dissatisfaction. The “Reel Heroes” depicting violence against the doctor is seen as a routine and looked as an easily do-able- adventure due to unwillingness of Government to take stringent action. As patients will continue to get treatment in hospitals and few cannot be saved, so every death declaration may be a harbinger to such attacks in future.

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

August 19, 2024 0

Selling of the Medical Seats near Bubble Burst: lower percentiles #NEET

Now, super specialty medical seat cut-offs slashed to 20 percentile MUMBAI: Post-graduate doctors scoring as low as 20 percentile in NEET-SS will now be eligible for superspecialty seats in the country. Despite two rounds of admissions, over one-fifth of the seats in the courses are lying vacant. To ensure these seats do not go wasted, the National Board of Examinations in Medical Sciences slashed the cut-offs to 20 percentile from 50. In some of the courses, the raw scores for eligibility have dropped even to 188 or 217 out of 600. 2/10/23, 6:39 PM Now, superspecialty medical seat cut-offs slashed to 20 percentile.

Lowering NEET Percentile In PG or SS Making seats available at a lower percentile (15 -20) in post graduate and Super specialities courses will jeopardize the already crumbling quality of Medical Education and will result in bidding for the seats.

This potpourri portends to be a travesty of quality, not just of medical education but more seriously, of the quality of doctors. Allotment of medical seats is being left to the vagaries of populism and commercialism, through a false sense ‘the illusion of merit’ secured via NEET. Admission criteria whittled down to mere 10-20 percent, will result in an irreversible and regressive compromise with quality of doctors. Will patients approve such dizzying choice and at what cost?

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

Lowering NEET Percentile In PG or SS is an illusion of merit. Overplayed narrative of fewer doctors in the country, rather than a system for proper utilization is an effort to increase numbers of doctors is associated with dilution of merit. But this goal needs to be achieved with preserving quality of medical education.

Selling the medical seats is heading towards bubble burst, when despite declining demand for poor quality and expensive medical education, new private colleges being approved along with lowering merit to a dismal percentage.

Future doctors getting admissions by scoring just 10-20 percent of marks, poor teacher student ratio, seats being awarded to highest bidder are few pointers to the poor quality of medical education. Few years back NEET percent system was changed to percentile and now the bar is lowered further, just to accommodate more ‘bidders’ with less marks, to be able to buy medical seats.

Now, super specialty medical seat cut-offs slashed to 20 percentile

MUMBAI: Post-graduate doctors scoring as low as 20 percentile in NEET-SS will now be eligible for superspecialty seats in the country. Despite two rounds of admissions, over one-fifth of the seats in the courses are lying vacant. To ensure these seats do not go wasted, the National Board of Examinations in Medical Sciences slashed the cut-offs to 20 percentile from 50. In some of the courses, the raw scores for eligibility have dropped even to 188 or 217 out of 600. 2/10/23, 6:39 PM Now, superspecialty medical seat cut-offs slashed to 20 percentile.

On February 8, the board issued a circular announcing the special mop-up round in NEET-SS counselling and also the revised cut-offs in different specialty groups. The schedule for the mop-up round will be released soon. An official from the ministry of health and family welfare said that approximately 1,000 seats are vacant out of close to 5,000 superspecialty seats in the country. The Federation of Resident Doctors’ Association India had requested the Centre to relax the eligibility criteria to ensure there is no wastage of seats, after receiving representations from aspirants, said Dr Kulsaurabh Kaushik, a member. He said sometimes seats go vacant in private colleges because of higher fees. Dr Avinash Supe, former dean of KEM Hospital, said, “Total SS seats in the country have gone up tremendously in recent years and students have become selective. For instance, in the surgical group, many are now preferring urology, gastrointestinal (GI) surgery and surgical oncology, whereas there is not much demand for paediatric, or cardiovascular and thoracic surgery. You need larger set-ups for these, which many cannot invest in. On the contrary, urology and GI surgeries need smaller set-ups and there is a demand too,” said Supe. He added in some courses, supply is higher than demand in the country. For a long time, even KEM did not get students for courses such as paediatric surgery. Last year, the Centre brought down the cut-off to 15 percentile after seats remained vacant in superspecialty courses.

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February 10, 2023 0

Projection of Inflated Cost of Medical Education- Global Exploitation of Young Doctors

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

Educating a doctor cost less what medical colleges claim- a global phenomenon.

Instead of often repeated statements about high expense on running medical college and projecting it as a hard fact, the amount spent on medical students by all medical colleges should be made transparent by all institutions. The frequent statement is made that cost of making a doctor is very high and gleefully propagated by the private medical colleges to extract millions out of young medical students .

Such statements without any actual public data is repeated to the extent that it is firmly entrenched in public mind without any real evidence.

High cost is the reason with an intention to exploit the young doctors in various ways to get cheap labour and extract millions from aspiring doctors by private medical colleges.

The basis of such calculation should be transparent for every medical college and all institutions.

In any medical college, only the Departments of Anatomy and Physiology are purely for medical students. The remaining subjects taught in medical colleges across the country are related to patient

care and medical education is only a by-product. All the medical teachers are actually doctors involved in treatment of patients, running the hospital and students observe the treatment and learn medicine. The interns and postgraduate students provide the cheap and labour and actually save the costs of running the hospital.

Therefore if some college is actually spending millions to produce one MBBS doctor , it is a either an inefficient model or costs are inflated and exaggerated to exploit the young doctors.

Educating a doctor cost less what medical colleges claim

The average cost of producing a doctor or nurse went down across most parts of the world between 2008 and 2018, but almost tripled in China and doubled in India, a Lancet study shows. Despite this, the estimated expenditure per medical graduate in China at $41,000 is higher only than in sub-Saharan Africa and about 42% lower than in India ($70,000) against a global average of $114,000. The pattern was the same for nurses with the estimated expenditure per nursing graduate dropping across the world while it went up by 167% in China and doubled in India. The only other region where the per graduate cost went up was in North Africa, where cost per doctor went up by 47% and by 25% for nurses. Approximately $110 billion was invested globally by governments and students’ families in medical and nursing education in 2018. Of this, $60.9 billion was invested in doctors and $48.8 billion was invested in nurses and midwives, the study estimated.

The paper looks at important developments in medical education to assess potential progress and issues with education of health professionals after the Covid-19 pandemic. Mean costs in 2018 were $114,000 per doctor and $32,000 per nurse. In 2008, China had the lowest estimated expenditure per medical graduate at just $14,000 (Rs 6 lakh) followed by India, where it was just $35,000 (Rs 15 lakh at the 2008 exchange rate of Rs 43 to a dollar). This is much lower than the estimate of Rs 1 crore or more that Indian colleges widely claim as expenditure per medical graduate.

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October 30, 2022 48

Why buying a medical college seat & paying millions may be a blunder?

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

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. In the present circumstances, when doctors themselves are doubtful about the advice for choosing medical career, some people are naïve enough to spend millions on securing an expensive medical college seat. Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.

Disadvantages of being a doctor, Drawbacks of Medical profession:

Choosing medical career or being a medical professional a disadvantage to doctor in comparison to other professions?

Medical courses are comparatively lengthy and expansive study course and difficult training with slave like duties. “enslavement of doctors”.
Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice. They have to just flow with system ultimately.

3.Hostile environment for doctors to begin: Suddenly young and bright children complete training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
Blamed for all malaise: The society gets biased because of the media reports and some celebrity talking glib against medical profession. The blame for inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
Risk to doctor himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.
Unrealistic expectations of society: Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.
Retrospective analysis of doctor’s every action continues all the life: It could be by patients and relatives every day in the form of “Why this was not done before?” Every day irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

The decision taken in split seconds will be questioned, which in retrospect may not turn out to be the best one. But later retrospective analysis along with wisdom of hindsight with luxury of time (in courts) may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with patients makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.
Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: It is heart-breaking to watch zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigations of lawsuit against doctors is a major disadvantage for medical profession.
Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic Oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients. They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, which use pressure tactics to get their own way.

It may be a naïve idea or just a blunder 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?

April 20, 2022 0

NEET-PG-Counselling: A larger public emergency issue due to Pandemic

NEET PG Post-Graduation after MBBS is an entrance qualification exam, one of toughest and important exam not only for medical students but for medical colleges and hospitals. As this exam will decide and form the back bone of the health care system in the whole country. Ultimately this exam will be the check gate to supply specialist doctors to medical colleges, hospitals and private health institutions in all the states. Post graduate trainees form the bulk load of doctors performing the duties. Needless to say these doctors form the back bone of the total health system across the country. For last two years, these junior doctors were at the forefront of the fighting the pandemic.

Since NEET PG was to be conducted in Jan 2021, but due to pandemic got postponed to Sept 2021 and result were declared few months back.

NEET PG counselling is not only issue for doctors but an actually a larger public health issue and kind of emergency due to pandemic, which will decide the availability of doctors to public.

Actually it is in patient’s interest to have early counselling.

It is a sad situation, when the world is preparing to tackle the wave of pandemic due to Omicron Variant, other countries are ramping up their health care infrastructure and manpower, and Indian doctors are being dragged on roads by police instead of employing them in hospitals.

Its importance assumes an emergency situation in face of looming pandemic. If the administrators had perceived it as merely a trivial doctors’ issue and remained complacent, it had been a grave mistake.

What was the emergency to change and frame new rules when a pandemic of such a large proportion was going on?

A delay in academic counselling means a wasted year for the NEET PG aspirants. It also means that 50000 doctors are missing from the medical system and the health care force because of bureaucratic delays, at a time when health care staff is overworked and in desperate need of more hands.

Point to ponder here is that is it the doctors who desperately need help? More precisely and in reality it is the patients and public who need doctors desperately. An early counselling is in public interest actually, the point administrators have failed to understand.

But sadly, it is up to the wisdom of administrators that decides “what is emergency and what is not” rather than medical wisdom, a case of misplaced priorities.

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

December 30, 2021 1

“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—

Earning
Prolonged tough training
Satisfaction of treating patients
Satisfaction of making diagnosis
Emergency & odd hour duty
Stress of life and death
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.

April 10, 2019 0

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