25 RANDOM FACTS ABOUT SLEEP


  1. Man is the only mammal that willingly delays sleep.
  2. The higher the altitude, the greater the sleep disruption. Generally, sleep disturbance becomes greater at altitudes of 13,200 feet or more. The disturbance is thought to be caused by diminished oxygen levels and accompanying changes in respiration. Most people adjust to new altitudes in approximately two to three weeks.
  3. In general, exercising regularly makes it easier to fall asleep and contributes to sounder sleep. However, exercising sporadically or right before going to bed will make falling asleep more difficult.
  4. Divorced, widowed and separated people report more insomnia.
  5. Six in ten healthcare professionals do not feel that they have enough time to have a discussion with their patients about insomnia during regular office visits.
  6. More than eight in ten survey respondents think that people often or sometimes misuse prescription sleep aids.
  7. Caffeine has been called the most popular drug in the world. All over the world people consume caffeine on a daily basis in coffee, tea, cocoa, chocolate, some soft drinks, and some drugs.
  8. In general, most healthy adults need seven to nine hours of sleep a night. However, some individuals are able to function without sleepiness or drowsiness after as little as six hours of sleep. Others can’t perform at their peak unless they’ve slept ten hours.
  9. We naturally feel tired at two different times of the day: about 2:00 AM and 2:00 PM. It is this natural dip in alertness that is primarily responsible for the post-lunch dip.
  10. Sleep is just as important as diet and exercise.
  11. According to the International Classifications of Sleep Disorders, shift workers are at increased risk for a variety of chronic illnesses such as cardiovascular and gastrointestinal diseases.
  12. Newborns sleep a total of 14 to 17 hours a day on an irregular schedule with periods of one to three hours spent awake.
  13. When infants are put to bed drowsy but not asleep, they are more likely to become “self- soothers,” which enables them to fall asleep independently at bedtime and put themselves back to sleep during the night.
  14. Eighty-two percent of healthcare professionals believe that it is the responsibility of both the patient and the healthcare professional to bring up symptoms of insomnia during an appointment.
  15. The body never adjusts to shift work!
  16. There are individual differences in the need to nap. Some adults and children need to nap. However, the majority of teenagers probably nap in the afternoon because they are not sleeping enough at night.
  17. Snoring is the primary cause of sleep disruption.
  18. Scientists still don’t know — and probably never will — if animals dream during REM sleep, as humans do.
  19. Some studies show promise for the use of melatonin in shortening the time it takes to fall asleep and reducing the number of awakenings, but not necessarily total sleep time. Other studies show no benefit at all with melatonin.
  20. One of the primary causes of excessive sleepiness may be self-imposed sleep deprivation.
  21. Many people drive drowsy or fall asleep while driving.
  22. Sometimes at few places employer allows employees to nap during breaks and some provide a place to do so.
  23. People who don’t get enough sleep are more likely to have bigger appetites due to the fact that their leptin levels (leptin is an appetite-regulating hormone) fall, promoting appetite increase.
  24. Rates of insomnia increase as a function of age, but most often the sleep disturbance is attributable to some other medical condition.
  25. Seasonal affective disorder is believed to be influenced by the changing patterns of light and darkness that occur with the approach of winter?

There may be infinite number of other facts.

source

Supreme Court judgement on End of Life & Living Will: Partaking moral and ethical dilemma of doctors and relatives


A welcome, long awaited judgement, where law has come to help the doctors and relatives of terminally ill patients. Doctors are often accused of over treatment, without realizing that law does not permit them the termination of treatment as desired by patients or relatives. commonly  doctors come to face these difficult situations, where moral and ethical dilemma  is larger than treatment itself.

The Supreme Court ruled on Friday that individuals have a right to die with dignity, in a verdict that permits the removal of life-support systems for the terminally ill or those in incurable comas.

The court also permitted individuals to decide against artificial life support, should the need arise, by creating a “living will”.

 Living will

A ‘living will’ is a concept where a patient can give consent that allows withdrawal of life support systems if the individual is reduced to a permanent vegetative state with no real chance of survival.

It is a type of advance directive that may be used by a person before incapacitation to outline a full range of treatment preferences or, most often, to reject treatment. A living can detail a person’s preferences for tube-feeding, artificial hydration, and pain medication when an individual cannot communicate his/her choices.

In its verdict on Friday, SC has attached strict conditions for executing “a living will that was made by a person in his normal state of health and mind”.

The US, UK, Germany and Netherlands have advance medical directive laws that allow people to create a ‘living will’.

 Active and passive euthanasia

Active euthanasia, the intentional act of causing the death of a patient in great suffering, is illegal in India. It entails deliberately causing the patient’s death through injections or overdose.

But passive euthanasia, the withdrawal of medical treatment with the deliberate intention to hasten a terminally ill patient’s death was allowed by the Supreme Court in Friday’s landmark verdict.

The court also laid down guidelines on who would execute the will and how a nod for passive euthanasia would be granted by a medical board set up to determine and carry out any “advance directive”.

In cases where there is no “advance directive”, the patient, family, friends and legal guardians can’t take the decision on their own, but can approach a high court for stopping treatment .

 Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill

In 2012, the union health ministry posted a draft of the Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill on its website and invited public reactions.

The Bill is popularly referred to as the Passive Euthanasia Bill although its draft did not use the emotive word “euthanasia” to skirt complications around the term, a health ministry official told HT in 2016. It says every advance medical directive (also called ‘living will’) or medical power of attorney executed by a person shall be taken into consideration in matter of withholding or withdrawing medical treatment but it shall not be binding on any medical practitioner.

 Misuse of law

A major concern is the misuse of the law. If it is legal to passively allow or hasten death, what’s to say an aged parent won’t be hastened in favor of an inheritance, or a spouse have treatment withdrawn for the sake of a hefty insurance payout? That is why there are legal provisions  in the judgement  by Supreme court, to safe guard the patients.

The bench also stipulated strict conditions for the execution of the living will, which includes the setting up of two medical boards and certification by the judicial magistrate. It also directed high courts to maintain a record of all living will documents prepared within the state.

 Euthanasia in other countries

Euthanasia and physician-assisted suicide have been legal in The Netherlands and Belgium since 2001 and 2002. In the US, Switzerland and Germany, euthanasia is illegal but physician-assisted suicide is legal. Euthanasia remains illegal in the UK, France, Canada and Australia.

Source- Hindustan times

20 interesting facts about the kidneys : World Kidney Day


  1. Kidneys are very important   and   fundamental organs of human body.  They are extremely complex in mechanism and they have two functions  that is blood purification and  waste elimination.
  2. An adult kidney weighs around  142 grams and  is the size of  human fist.
  3. In case of new born human babies, the kidney to body weight ratio is 3 times the kidney to body weight ratio in adults. In case of adults, kidneys form only 0.5% of the entire body weight.
  4. Largest kidney stone recorded was of coconut size and weighed 1.1 kg.
  5. If a child is borne without a kidney, the one kidney will grow and weigh the same as of two kidneys.
  6. The right kidney is below the liver ( largest organ ) and smaller than left kidney.
  7. There are 1.1 million nephrons ( very tiny filters that are capable of filtering blood) in the body. If stretched end to end,  they  will be 8 KM long.
  8. Kidney filter blood around 400 times a day.
  9. If kidney detect fall in Blood pressure, they signal blood vessels to shrink.
  10. A single kidney with only 75 % of its functional capacity can sustain life very well.
  11. They are capable of activating vitamin D in our body. This vitamin is usually produced by special skin cells when they are exposed to sunlight.
  12. Kidneys cleanse 1.3 liters of blood every minute to produce about the same quantity  of urine in a day.
  13. Most common cause of renal stones is not drinking enough water.
  14. About 25 % of the blood from heart, goes to kidneys.
  15. High BP and diabetes can both lead to failure of kidneys.
  16. When the kidney functions are completely lost, it is known as ESRD or End Stage Renal Disease.
  17. People suffering with ESRD can live longer with help of kidney transplant or dialysis.
  18. The first ever kidney transplant was conducted by Yuri Voronoy, a Russian surgeon in year 1933, but was unsuccessful.
  19. The first ever successful kidney transplant was conducted by Dr. Joseph E. Murray in December 1954, in Massachusetts at Peter Bent Brigham Hospital.
  20. A kidney transplant would be normally put in pelvis and  disabled kidney will not be extracted.

 

source

Cervical cancer: myths and facts


Of all the cancers affecting  women, cervical cancer has emerged as one of most common cause of cancer.

Women between 15 and 44 years of age are particularly at risk.

Cervical cancer is mostly caused by the Human Papilloma Virus or HPV. It is a condition that affects lining of the cervix, or the lower part of the uterus. This cancer develops gradually and becomes full-blown over time.

HPV infection can spread through sexual or skin-to-skin contact. Though this infection usually goes away on its own over time in most women, in others, it can persist and cause precancerous changes in the cells of the cervix.

Some symptoms of this cancer include abnormal vaginal bleeding, vaginal bleeding after menopause or sex, bleeding or spotting between periods, longer or heavier menstrual periods than usual, other abnormal vaginal discharge, and pain during sexual intercourse

As with any other disease, there are certain myths associated with cervical cancer as well.

Myth 1: Women without a family history of cervical cancer do not need to get screened.

Those without a family history of this condition may also be at risk. This is because the HPV infection can spread through sexual contact. It is, thus, important to get take preventive measures and get Pap tests done.

Myth 2: Pap tests should be done every year

There is no need to get a Pap test every year if this test and the one for HPV are normal. The recommended schedule is once in three years in women between 21 and 29; and once every five years in women between 30 and 64. Those above the age of 64 should follow their doctor’s advice.

Myth 3: It is not possible to prevent cervical cancer

Cervical cancer is one of the most preventable cancers. A Pap test can help determine any kind of changes in the cells of the cervix. Once any such change is detected, it is possible to start treatment early and prevent the cancer from developing. Pap test is imperative for anyone who has been sexually active or in women who have HPV and are smokers.

Myth 4: Women with no symptoms need not get tested

HPV infections do not show any symptoms in most cases. While there are different types of HPV, some high-risk types are associated with cervical cancer and can go undetected until the development of abnormal cells. This makes it important for women to get tested on a regular basis.

Myth 5: Women who have had a hysterectomy do not need to get tested

It is imperative to undergo a screening for cervical cancer irrespective of whether a woman has had a hysterectomy. Only those who have undergone a total hysterectomy (a process where both cervix and uterus are removed) need not get screened.

Myth 6: Pap test is similar to a pelvic exam

Pelvic exam is a physical examination of the pelvis, vagina, and pelvic floor (the area encompassed by the hip bones), whereas, in a Pap test, cells from the cervix are gently scraped away and examined for abnormal growth.

Myth 7: Condoms can prevent HPV

Condoms can help prevent certain sexually transmitted infections (STI). However, this may not be true for HPV as the virus can inhabit areas that condoms do not cover.

Myth 8: Cervical cancer treatment can cause infertility

Advances in medicine and surgery have ensured that cervical cancer treatment does not affect fertility in a woman. These surgical treatments can help a woman conceive by removing only the cervix and not the uterus.

Timely screening and detection are two very important aspects of combating cervical cancer, as it is a completely treatable condition. Apart from this, women should make some basic lifestyle changes to avoid contracting an infection. These include avoiding sexual contact with multiple partners; getting screened on a timely basis; quitting smoking; consuming a healthy diet rich in fruits, vegetables, and whole grains; and maintaining a healthy weight. All these can go a long way in preventing cervical cancer.

source;

https://www.deccanchronicle.com/lifestyle/health-and-wellbeing/010218/8-myths-and-facts-about-cervical-cancer.html

 

Reversal of medical advancement, reversion of the enemy : ANTIBIOTIC RESISTANCE


Substances with antibiotic properties had been used for various purposes since ancient times.

Before the early 20th century, treatments for infections were based primarily on medicinal folklore. Mixtures with antimicrobial properties that were used in treatments of infections were described over 2000 years ago. Many ancient cultures, including the ancient Egyptians and ancient Greeks, used specially selected mold and plant materials and extracts to treat infections.

For their successful development of penicillin, which Fleming had accidentally discovered but could not develop himself, as a therapeutic drug, Chain and Florey shared the 1945 Nobel Prize in Medicine with Fleming.

Germ theory and discovery of antibiotics has contributed a lot to development of modern medicine. Treatment of advanced multi system diseases, complex surgeries, advanced procedures have become easier to handle because of  advent of antibiotics.  

Over the last several decades, antibacterial drug use has become widespread with their misuse being an ever‑ increasing phenomenon. Consequently, antibacterial drugs have become less effective or even ineffective, resulting in a global health security emergency. These infections will be associated with a high consumption of healthcare resources manifested by a prolonged hospital stay and high mortality. The World Health Organization  has identified antimicrobial resistance as one of the most important problems for human health with significant adverse impacts on clinical outcomes and higher costs due to consumption of healthcare resources.

Antibiotic resistance is a serious problem in all parts of the world including Asia–Pacific, Latin America, Middle East, Europe and North America regions. A particular concern is the misuse or overuse of antibiotics, which has led to the development of resistant or super-resistant bacterial strains.

Reasons for widespread antibiotic resistance:

  1. High burden of infectious diseases
  2. Poor control of infectious diseases and lack of prevention.
  3. Easy availability of antibioics.
  4. Liberal prescription and crosspathy. Common and unrestricted use  by alternative medical system doctors, non doctors and quacks.
  5. Over the counter sale of antibiotics by pharmacists.
  6. Self administration of antibiotics by patients.
  7. Shorter courses and irregular intake of antibiotics by patients.
  8. Inappropriate doses of antibiotics, specially if given by non trained person.
  9. Pressure by patients for early recovery, resulting in over prescription.
  10. Presence of large number of generics of molecules and their quality not ensured.
  11. Poor environmental sanitation, widespread  water contamination, animal waste.
  12. Lack of proper regulation and control of quality of antibiotics
  13. Unregulated  use of antibiotics in animal industry, agriculture, and aquaculture.

 

It is not uncommon to see patients not responding well to treatment. Such scenario increase difficulty for doctors, besides they may be blamed for not doing enough. Reasons may be any of the  above.  Bacteria have been the occupants around us in environment  and also in our body, have acquired deadly weapons  quickly.  Discovery of antibiotics have not lasted even 100 years. Over enthusiasm and euphoria  created by  mass production and use of antibiotics may prove lethal for human race. Antibiotic resistance has potential to undo all the advancement and is a threat of return to pre- antibiotic era .

 

 

Misdiagnosis of health care, wrong and misdirected treatment of real problem


       Yesterday, there was a painful news in paper about the death of a child due to rabies.  It is really painful  loss of life due to a preventable disease. Every one sympathizes with child and parents. But equally strange was the suggestion  that action will be taken  against the  doctor.  Newspaper also  fails to raise a point that,  why at all a preventable disease should happen?  Similar trend we always see in media, when some death occurs due to diseases like dengue and malaria, it is a doctor, who treated the patient or trying to fight with the advanced complications is punished or made a scapegoat and projected as a villain in the story by media.

  No one including administration,  government, courts or media raises a point, that why at all the diseases which  are  completely preventable,  should happen and  keep on happening.  In my previous article, I mentioned the misplaced priorities of media about the same.  At least public, who is suffering should understand that dog bite and mosquito bite is preventable. Therefore more emphasis should be on preventing these bites. That should be made a priority. If  that bite is not prevented and no action is taken to prevent that, these diseases will keep on happening in  a large proportions.  Beds  and doctors are limited in number and will be unable to treat it, specially in advanced stage. So we need really good people to make a proper diagnosis  of our health care. Every time such cases happen and these are preventable disasters, doctors are sacrificed as scapegoats.  Some one sensible need to do a root cause analysis of preventable deaths.  Media people will  have to  find the correct remedy  and demand for it. Otherwise it is not going to help and treat sufferings of common people.

NMC bill, Medical crosspathy and antibiotic resistance : recipe for potential global catastrophe


   Genesis of a system, where every body will suffer and no one is beneficiary.  There has been lot of debates going on  about the Government willingness to allow crosspathy. There has been indications in newspapers about possibility of government  allowing Ayurvedic,  homeopathic and Unani medicine graduates and others  to practice modern allopathic medicines.  Most importantly which medications will be allowed to be practiced? Will  thousands of alternate medicine graduate will dispense all antibiotics,  anticancer , anti diabetic , cardiac medications. It is hard to think about hundreds of potentially dangerous medicines being given without structured training and  proper exams in this system of crosspathy. No one is bothered about the fact that every allopathic medicine is a potential hazardous chemical, if not used properly.

              It will be done through some bridge course. The structure and effectiveness of the said course is yet to be knowm. Whether it will be of 3 days or 3 months?  Who will be able to do it ? whether some level of efficiency  will be expected or every body will be allowed to just dispense allopathic medicine. What ever some one may argue, bridge courses can not be substitute to proper training for these complex diseases and drugs. Following may be side effects of dilution  of medical education and crosspathy:

  1. Alternative or ayurvedic medicine systems themselves: detrimental to these systems themselves because of many reasons. If  the  ayurvedic doctors   start allopathic practice, how we expect ayurvedic stream to florish and respected. It will be diluted to no end. After few years no one will be left will ayurvedic practice.  In my opinion it is a death sentence to ayurvedic system.

       Secondly,  the decision is not respectful to ayurvedic stream itself. Stream of                Ayurveda will suffer.

  1.  Public and patients: crosspathy clearly means a diluted and suboptimal medical services. Government may create few area of need and implement the scheme in selected areas, and selected simple drugs.
  2. Allopathy will be clearly a sufferer. If every body can practice allopathic medicine, why one should go for rigorous training. It will discourage the people who have opted and got admission to allopathic courses. They are paying and slogging hard for their training.
  3.  Dangerous to human race and potential global catastrophe:  All  allopathic medicines are hazardous chemicals in inexperienced hands. But  incorrect and massive use of antibiotics will  cause antibiotic resistance, which has global ramifications. From this angle, it is a retrograde step. When  all over the world,  need is being  felt that there has to be better control of antibiotic prescription.  We are entering an era, where antibiotics are getting useless and more so because of rampant misuse of antibiotics.  Rather than exercising a better control, it can be a catastrophic to human race world over by causing antibiotic resistance.
  4. have our public and people given consent for such diluted medical  excellence and services? It is  public  ultimately who  accepts  a decision for suboptimal medical service. Government may create few area of need and implement the scheme in selected areas, and selected simple drugs. But that also has not been planned.

 

25 factors -Medical treatment costs becoming expensive: are doctors responsible?


Although doctors are blamed for expensive medical treatment, but the real cause  is the aberrant evolution of medicine and medical education to almost an industrial model. There has been tremendous rise in health care  expenses in last few decades and it is usually borne by the government, taxpayer, insurance or patient himself. Discontent is all the more if patients  are unable to bear these expenses and if the results are not as per  expectations ( realistic or unrealistic).

Following features have led to increasing dependence on investors in medical field which then has to run along the lines of an industry to ensure its financial viability-

1.Newer technology and  rapid advances in newer innovations in medical fields  for improvement in diagnostic and newer treatment modalities. If a hospital or doctor does not upgrade, it will be regarded as  having obsolete technology.  Most of these medical technologies  are extremely expensive and owned and marketed  by big multinational companies who  sell them.

Since cost involved is very high, there can be various types of deals involved between  middlemen  involved in selling and buying these equipments and technologies. Doctors  are the  end users of these technologies, but  not part of business process. They are actually the consumers and users  for  these technologies.

2.Expensive real estate:  A self made doctor at the start  or even during his life time, does not have the kind of finances  to build  a hospital which needs a large parcel of land with commercial location. Therefore there  is a need for big investment or investor to pitch in and invest funds.  And if they invest, obviously they would look for some returns.

3.Equipping the Hospital: Building of hospital with the  infrastructure  and equipping it well needs lot of money and investment which only an investor can provide. Same is true for maintenance of equipment, bills,  insurances, AMC  etc.

4.Staffing of Hospital: A hospital needs lot of skilled human resources, health care being a highly labour intensive industry.  Doctors , nurses,  technicians, para medical, administrative and clerical staff is required.  Employment of non medical  in hospital industry too has been increasing because of various regulatory requirements and complex processes other than just treating patients.

5.High regulatory requirements:  globally the requirements of regulatory authorities have been sky rocketing and it requires  a lot of manpower to maintain such data. Getting accreditation etc are  processes which requires manpower, time, and a legal team. All these legal  requirements are expensive.

6.Consumer protection act:  This single important factor can increase the cost of  healthcare for the patient. As doctors are increasingly scared of being dragged to court, they are always on backfoot and are forced  to do defensive practice. Investigations are required for documentation. Patient and courts will ask for proof and goes by documentation.  Medical problems are very complex and  sometimes it is difficult to judge  the future course of disease or decisions for surgery, or how patient will behave before or after surgery. A doctor, thus, will always try to play safe legally  in present scenarios. Because everything he does will be scrutinized later, with retrospective wisdom,  by courts. And   since doctors manage  so many patients everyday, they never know which one will harass and deceive them  later.  Mistrust has increased to such an  extent that patient relatives do not understand even if things are told in good faith and in patient’s interest.  Summarily doctors have to safeguard themselves from treatment as well as legal and  documentation hassles.

7.Expensive legal services:  Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors. Increasing mistrust and unhappiness in patient’s mind definitely does not  help patients and doctors. Strangely  doctor’s fee are quite low but lawyers charges them astronomical amounts, which are beyond any logic.

8.Increased expectation of patients : People want exceptional care, best in the world with best technology,  that also at a price less than  even a meal in restaurant, and then they want a quick relief!!  This is an expectation almost impossible to fulfil. Even government hospitals, which are funded by taxayer’s money find it difficult to provide free treatment with quality.

9.Large claims given by courts:  in a country where people  fight with their parents, brothers and  sisters for money and property, it will be naive to think that idea of making money from doctor  does not exist. With court compensations going into crores, doctors  can sense many times that some patient relatives  try to use the opportunity. They have nothing at stake so they try to make some noise on social media and harass the doctor in court or on social platforms. Even for patients, who had poor prognosis at the very onset of treatment, relatives can create problems. Doctors have no protection from these nuisanse. All these factors further enhance insecurity in doctor’s mind.

  1. Expensive and time consuming Medical education, on sale: Although an open secret , as reported routinely in news, medical seats are big business. Each private medical college seat sells for huge money. Such doctors, who have purchased seats have already  behaved as investors. Once these  doctors are in practice, they will try to  recover the investment. This can obviously push up the health care costs not to mention vitiation of the medical fraternity.

11.Requirement for maintaining huge data and audits:  to maintain standards, to have accreditions, for medicolegal issues , large data storage, audits and surveillance is required. These systems also need  new systems and manpower.

12.Employment of large numbers of  non-medical personnel:  earlier management work was handled by doctors. All senior doctors were given small and differnet  departments of  administrative work at very little  or no extra cost. But now for all these works separate administrators  are appointed. Now a days ratio of doctors to nondoctors is higher as compared to previous years. Increased regulatory and  and insurance system needs more non- medical staff.

But  productivity of hospital still remains by  doctor-patient interaction.  This change in arrangement in Hospitals has caused  increase in costs and hence pushed the health care  expenses. Advantages and disadvangages of these changes  in arrangement will be known  with time in future.

13.Non regulation of  businesses  associated with large health care industry: for example pharma industry,  suppliers , biomedical, equipments, consumables. Such individuals,  although play important part in medicine, cost, sale and purchase, but are largely  unregulated. Unlike doctors, who are regulated by multiple governing bodies. But doctors are  often perceived  as culprits for these costs escalation.

 

14.Increasing extinction of Single doctor and  small setups: for them it will be difficult to keep pace with newer technology and buying expansive equipments. It will be difficult  for them to manage requirements of new medical system, legal problems . At the most they will continue to provide cheap medical services,  but for only common and simple ailments. It will be difficult to manage serious patients and sick and complex patients in view of high public expectations . These set ups are under severe security threat and pressure because of non – acceptance of even genuinine complications of treatment.  As legal requirements increase,  these systems will become unviable and option of common public for cheaper, friendly services may become extinct. So it will decrease  the  easy and  sometimes last option of  doctors to settle with a small set up. Chances of them to work for investors  and insurance companies will increase, and they will be cheap labour for industry.

15.Medical and health Insurance becoming indispensible:  Insurance companies are every where.  They sell policies to patients , as well as doctors.  In fact, they are  positioned between doctor and patients. They make money from both sides. Obviously more expensive the treatment, more dependence on insurance. Therefore a cycle has been set up.  Increase in  insurance cost  will push health care  more expensive and a vicious cycle is set up. One should not be surprised, if in future treatment to a large extent will be dictated by insurance companies.

 

16.Conversion to a industry:

Because of above reasons Medical and health care has become an industry and needs investors. So as it is business proposition. Funded by investors and run on commercial principles, the  doctors are being slowly reduced to  skilled labour, alienated from the core.

  1. Aging, multiple diseases : as life expectancy is increasing, it is leading to multiple diseases and more complex diseases  and new expensive treatments.  In this changed scenario and  all people  want to prolong life as much as possible. Cost of prolonging life with multiple problems is quite high. It consumes more medication and resouces and hence consequently pushes up the cost of medical treatment.

18.Evolution of complex infections:

    Advent of antibiotics   and germ theory was thought to be game changer in medical history. But because bacteria proved to be smarter than humans and acquired resistant. New and expensive antibiotics have been gradually being rendered useless. Need for more antibiotics is causing treatment to be costlier.

 

19.Evolution  of  advanced treatment:  Invention  of Expensive and new diagnostic techniques along with highly technical treatments by industry is not without added cost.  Although it may be useful in certain patients, but how much it will help overall in masses, for general treatment, as it increases the  cost of overall treatment.

20.Increasing  need for heightened security:  It is not uncommon to have mobs causing physical harms to medical workers  and  damaging hospital properties. These incidents have caused increased need for security for the premises and adding to the cost.

 21.Complex interplay of various industries eg pharma industry and consumable industry:  large  number of consumables pharmaceuticals, sutures,  surgical instruments, IT industry, drugs, implants, medical supplies are required.  These industries supply their items on a price commanded by them and there is complex interplay  of various industries.

  1. Non uniform and variable care and cost:  each city has multiple hospitals. Care and cost varies in  every set up. Even all government set ups are  not uniform in facilities and cost. Private setups  vary in cost and care, to the extent of  maximum possible variations. All this non-uniformity has created confusion in the mind of patients and variation in financial issues.
  2. Poor public health care facilities: due to less expenditure on health care, government health care facilities have been under developed.  Less  investment by government has given way to private health care to flourish.

24: Conversion to a industry model  and entry of Investor: all the above investments are very expensive. Doctors usually do not have that much money to invest. Therefore   Investors and financers  have become indispensible part of health.   once investor invests money, it will be driven on business principles.

 

  1. Future course: I do not see in future that this arrangement is going to change , rather it will be strengthened more and more and quality care will become more costly. Doctors will  be totally  alienated  from financial  and business aspect, because industry will  not be sustainable without an investor.

 

As we look at reasons above, Doctors are no where in the financial picture and  to be blamed for increase in overall health cost.  But since only doctors are visible part of industry, who treat and interact with patients, often they are blamed for  the cost. They have actually being alienated from financial aspect, barring small percentage of doctors, who are financially literate. Consequently, the doctors who will be unable to entrench themselves in the business milieu will be unfit  in future and hence extinct.

Save the doctor to save yourself: An era when genesis of diseases is not punished, but treatment is.


            “Young girl killed by doctors at Fortis Gurugram” and “alive baby declared dead by doctors at Max Hospital Delhi”. These two news items  have recently jolted everyone in medical fraternity. Doctors have  yet  to come to terms with harsh reality  in order to   realize about the  harm   that can happen to themselves, when they just  say yes to treat the complex cases. A worst form of dengue already complicated, or a premature delivery at 22 weeks. I am sure doctors will know, how many patients and pregnancies have survived at this stage in the world, in both of these conditions.

     We have all kind of preventable diseases happening around us. Thousands of people suffering and many loose life, just because of worthless causes. Even healthy people are killed because of preventable calamities like open pot holes, floods, heat or preventable fires, accidents and so on. But strangely when disease happens and gets complicated in one patient, death due to these complications in the hospital is taken very severely. Although it may  have been  just untreatable at some point, but whole burden of death and punishments are  passed  over to doctors very conveniently.

   In both these complex cases, there are no clear cut guidelines by government. In whatever way doctor will act, he can be blamed easily on some pretext or another. By such yardsticks,  all complicated cases and subsequent  deaths happening in hospital settings can be termed as ‘ negligence’ by a fault finding retrospective approach. Now doctors have become scared  to treat complex cases.  

   It is sad to see that our leaders, media and all stakeholders have no knowledge of complex medical issues. I do not see any solution to these kind of exploitation and extortion of medics in near future.  But   are all complicated cases and deaths in hospital are Negligence?  This is going to be tough time for doctors but subsequently for patients.  These are worst days for doctors, where genesis of disease is overlooked and unnatural death of hundreds is not taken care of. But doctor who is working with intentions to treat the complex situation is being punished.  But society should be able to count its losses after few years, if such trend continues.  Good doctors will easily quit or shift to safe positions. Society has to save doctors, if it wants to save it’s people.

     

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