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‘A doctor who always operated on ear, irrespective of problem’: Role of media in Fortis and Max hospital Delhi incidents


        During my  days as medical student, we laughed at a story wherein a doctor always operated on patient’s  ear for all their ailments. Whatever may be the problem in the body, it was only the ear which received the cut always.  Similar treatment is being given to doctors by media.  Now-a days, for every progression of the disease and for genuine poor prognosis or death of the patient, media  is prompt to start the  blame game of doctor- doctor. Media even does not try to verify the facts. The real medical issues in treatment of these cases are still not emphasized by media, like whether these cases were salvageable or not.  For example why so many preventable disease like dengue, malaria happen every year   to thousands of people every year and are still progressing?  Take the case of foetus at 22 weeks…… how many have survived in India or in  the  world? In this case and that of  the complicated dengue case, the survival chances were quite dismal, even in developed world medicine.  Inability of media people to analyze the difficulty on scientific parameters, unwillingness of people to accept the real poor prognosis and political class to flow with populist opinion has done irreparable damage to medical profession. Just a blame game and the word ‘negligence’ are in the air.

    Outcome in these cases is not uncommon or unanticipated by any yardstick in the world. But no one is concerned about that. And in the end, what are the losses?

    Discouraged medical fraternity, low morale of doctors, and talk of leaving this profession have become smaller issues and do not affect anybody in media or Government. 

   But larger issues remain: how to prevent thousands of death due to poor control of communicable and preventable diseases. Proper delivery of health care will not improve by playing the blame game on doctor.  Media bashing of doctors may divert attention from the real issues and  media people   will earn money and fame. Doctors will be punished  as a result of  populist revenge.  But this approach of media is not going to save patients or provide better health care to masses in future.

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.

     

Max Hospital Delhi handed over dead baby : Is “ Lazarus syndrome” a possibility?


 

        There are lot of discussion going on about live  baby handed over to parents by Max Hospital  Delhi, as dead.  Every one including  media has as usual  jumped on to the favorite  topic of  doctor bashing.  Facts are still under investigation. But as a doctor, I can not reach conclusions without scientific discussion, least possible by media  talking superfluously. There can be number of possibilities, which we will  know with time after proper investigation. But whatever the result, doctors bashing had already been done by media , with or without knowing facts.

Life and death are still far beyond the reach of science and obviously  of doctors as well. There are still a lot more unknown than known story about human life. I just wish to draw the attention of my readers about an entity, which is quite mysterious.  Condition is  called     “ Lazarus syndrome”. Also known as auto resuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation.

A little bit about  this rare phenomenon.      

 

Lazarus syndrome, also known as auto resuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation. Its occurrence has been noted in medical literature at least 38 times since 1982. It takes its name from Lazarus who, as described in the New Testament of The Bible, was raised from the dead by Jesus.

Occurrences of the syndrome are extremely rare and the causes are not well understood. One hypothesis for the phenomenon is that a chief factor (though not the only one) is the buildup of pressure in the chest as a result of cardiopulmonary resuscitation (CPR). The relaxation of pressure after resuscitation efforts have ended is thought to allow the heart to expand, triggering the heart’s electrical impulses and restarting the heartbeat. Other possible factors are hyperkalemia or high doses of epinephrine.

Cases

-A 27-year-old man in the UK collapsed after overdosing on heroin and cocaine. Paramedics gave him an injection, and he recovered enough to walk to the ambulance. He went into cardiac arrest in transit. After 25 minutes of resuscitation efforts, the patient was verbally declared dead. About a minute after resuscitation ended, a nurse noticed a rhythm on the heart monitor and resuscitation was resumed. The patient recovered fully.

-A 66-year-old man suffering from a suspected abdominal aneurysm who, during treatment for this condition, suffered cardiac arrest and received chest compressions and defibrillation shocks for 17 minutes. Vital signs did not return; the patient was declared dead and resuscitation efforts ended. Ten minutes later, the surgeon felt a pulse. The aneurysm was successfully treated and the patient fully recovered with no lasting physical or neurological problems.

-According to a 2002 article in the journal Forensic Science International, a 65-year-old  deaf Japanese male was found unconscious in the foster home he lived in. Cardiopulmonary resuscitation was attempted on the scene by home staff, emergency medical personnel and also in the emergency department of the hospital and included appropriate medications and defibrillation. He was declared dead after attempted resuscitation. However, a policeman found the person moving in the mortuary after 20 minutes. The patient survived for 4 more days.

-Judith Johnson, 61, went into cardiac arrest at Beebe Medical Center in Lewes, Delaware, United States, in May 2007. She was given “multiple medicines and synchronized shocks”, but never regained a pulse. She was declared dead at 8:34 p.m. but was discovered in the morgue to be alive and breathing. She sued the medical center where it happened for damages due to physical and neurological problems stemming from the event.

-A 45-year-old woman in Colombia was pronounced dead, as there were no vital signs showing she was alive. Later, a funeral worker noticed the woman moving and alerted his co-worker that the woman should go back to the hospital. A 65-year-old man in Malaysia came back to life two-and-a-half hours after doctors at Seberang Jaya Hospital, Penang, pronounced him dead. He died three weeks later.

-Anthony Yahle, 37, in Bellbrook, Ohio, USA, was breathing abnormally at 4 a.m. on 5 August 2013, and could not be woken. He was given CPR, and first responders shocked him several times and found a heartbeat. That afternoon, he coded for 45 minutes at Kettering Medical Center and was pronounced dead. When his son arrived at the hospital, he noticed a heartbeat on the monitor that was still attached. Resuscitation efforts resumed, and the patient was revived.

-Walter Williams, 78, from Lexington, Mississippi, United States, was at home when his hospice nurse called a coroner who arrived and declared him dead at 9 p.m. on 26 February 2014. Once at a funeral home, he was found to be moving, possibly resuscitated by a defibrillator implanted in his chest. The next day he was well enough to be talking with family, but died fifteen days later.

Implications  The Lazarus phenomenon raises ethical issues for physicians, who must determine when medical death has occurred, resuscitation efforts should end, and postmortem procedures such as autopsies and organ harvesting may take place.

Medical literature has recommended observation of a patient’s vital signs for five to ten minutes after cessation of resuscitation before certifying death.

In Popular Culture

In the TV show Grey’s Anatomy, a patient had a heart attack and after 42 minutes of resuscitation efforts they declared her dead. And 20 minutes after death has been declared, the patient vital signs returned and regained consciousness.

Source

Lazarus syndrome. (2017, September 2). In Wikipedia, The Free Encyclopedia. Retrieved 16:51, December 4, 2017, from https://en.wikipedia.org/w/index.php?title=Lazarus_syndrome&oldid=798456668

https://en.wikipedia.org/w/index.php?title=Lazarus_syndrome&oldid=798456668

Silence of lords is a death sentence to the medical profession:#Doctor’s assaults


 

      Every one when sick, always seeks help of a doctor and invariably help is provided. But strangely, when a doctor needs help, there is no one. Even those people, whose life had been saved, have not returned the favor.  A   strange phenomenon has happened in few years of accusing the doctors for all the ills in society and holding them responsible, without even looking at the root cause.  Everyone has found an easy scapegoat to blame.   Human rights of medical community has been grossly violated by physical assaults. More painful is to see the authorities  who are  supposed to take action have maintained a silence in all these years about this issue.  There has been countless incidences, recent being in Kalyan and Jaipur.

 

If this trend is not checked in an effective manner, it will be difficult to even treat a single patient in coming times. The way media and prominent people have put all doctors in bad light, it seems that a normal and good advice is also not taken in a correct perspective. Even patients do not understand, that this advice is for the  their betterment only.  It is because of prejudiced minds against doctors. Our films and film stars have shown in films that it is okay to assault and bully the doctor to get treatment  in an effort  to impress the gullible masses and make some money. They may be successful in making some money, but by creating mistrust they have put the lives of gullible people on risk. The media should have a more sensible approach and do some basic research before highlighting sensational news against doctors, hospitals and healthcare professionals.

Just imagine, what that gynecologist did to the patient to  earn a slap, for no reason. In this  manner, forget about serious patients and surgeries, doctors will be afraid to do even routine surgeries as well. Here the situation is that even before surgery, doctor was slapped. Imagine, if a complication happens during or after surgery, doctor would have been killed. But strangely our government, human right commissions, police and courts have behaved as if they do not exist to help the doctor, but they expect the doctor to help everyone. This kind of inaction and  silence of  authorities is appalling.

       Obviously good doctors will try to shun the system. Government, human right commissions, police and courts, media have done their contribution to kill a profession, which was of great help to them.  I am sure we are civilized and wisened up enough to recognize these flaws in the society and have some corrective measures before it is too late………….too late to change the perceptions which will settle in the young impressionable minds of the children who till now think of it as their dream career. Otherwise no brilliant child would ever like to enter this profession out of their fear. Nor the parents would like their children to be working for uncivilized society.  The government needs to enact reasonable laws to use  healthcare systems,  to the best interest of people  instead of  unfairly victimize the doctors, just to impress the gullible masses.

It is not a doctor, which was assaulted. Silence of lords is a death sentence to the medical  profession as a whole. One person may realize the folly, but if we wait for realization to come to  whole civilization, it may be too late.

Again I will request the people to introspect, who rue the scarcity of good doctors “ do they deserve to have good doctors?”

 

 

Misplaced priorities of media in Dengue death: negligence in prevention of thousands OR complications in treatment of one very sick?


Prevention is better than cure.  There is lot of discussions going on about dengue death in newspapers and media. It is all about again, about  ritual of  doctor bashing and ill things said  about treatment  and so on. Although doctors have realized to live with such painful criticism, which is largely unjustified but truth of this era.  But some one with more wisdom and specially media has to realize that they are targeting  a wrong cause. Without proper root cause analysis,  problem will not  be solved, rather they will destroy the possibility of correction as well.

            I just want to draw the attention, that so much of furor  by media is directed to the wrong pole. If media has  thought of in rational way and  invested  same kind of  their energy and zeal  on the root cause of dengue it self,  they could have saved thousands. That is the prevention of dengue fever. Times of India shows on the side of this news, another column on the same page  that is about  8549 dengue cases in Delhi alone . Actual figures may have been higher.   Going by simple common sense,  if we had done something to prevent dengue or mosquito control, the problem of patients visiting hospitals in sick state and unfortunate situation  of so called negligence and treatment related  problem will not arise. A lethal disease was generated and allowed to progress.

 Strangely,  treatment details of a very sick patients, after the disease has already struck and   trying to  find  some thing wrong are of great interest to media and public.  No body is worried about the strategies that should have been adopted  to prevent thousands from the disease,  by timely preventive interventions. Real cure lies in preventing mosquito to bite rather finding problems with treatment protocols of doctors after disease has progressed, who are already hard pressed in such difficult circumstances.

            Public  and media will have to  understand the basic priority, whether they want  the prevention of the root cause of sufferings of thousands of  patients or want  some  scapegoat among  those who were trying to save the patient.   Consequences of negligence  in preventing   of such diseases are   huge and  massively destructive to thousands of lives. Once disease has  struck,  one can  foresee futility of this exercise  of blaming  the doctors. Excessive  and unjustified criticism of  the  saviours is   not doing good to any one. A  good strategy to  prevent  such  common diseases will save more people . But if current trend of blame  game  continues, there will be doctors in future but  no  saviours in real sense.        

        

       

Aberrant Evolution of medical profession: will it help the patient?


With advances in medical science, simultaneously there has been aberrant evolution of medical profession, education, regulation and medical industry. By provoking controversy about doctors for varied reasons, medical industry and law has been positioned between the doctor and  patient and  taken a center stage in health care. Till now, doctor patient interaction was the central point of the health industry, a core around which medical industry revolved. But now   this interaction, treatment and  almost everything is controlled by industry and regulated in some manner. There have been technical advancements to promote better treatment and diagnosis but these, at the same time, increase the cost of treatment, involvement of industry and hence dependence on investors.

 There has been advancements, but are they in right direction?

Discouragement  of medical fraternity:  The adage “To err is human” probably does not apply to the doctors anymore. Doctors are definitely regarded different from rest of the humans and are not supposed to have privileges that other persons of humankind are guaranteed. Hence they are harassed often for any adverse clinical outcome even though it may be because of poor prognosis of patient. They work under continuous fear and stress and are punished for each small or big error.

Commercial evolution of medical education: medical student are now forced to pay exorbitant fee with lower standards of education.  

Evolution in medico legal  procedures:  extensive and complex communication, technical advancements and legal interactions has taken a toll on the doctors. But more importantly, how that has improved the patient care or  doctor patient relationship? I feel, it has created fear in mind of doctors and deterioration of doctor patient relationship.

 Evlution of Doctor patient relationship and Trust :In all the complexity, trust between doctor patient has taken a hit. A good paternistic relationship, now has been converted to more of a legal one. Trust has been replaced by  mutual fear.

Evolution of Complex medical regulation and documentation: There has been overzealous regulation of medical profession. Time and resouces which should have been utilized for treatment of patients,  has to be used for complex documentation.

Evolution of media and social media: Painful retrospective analysis of work of doctor by media, courts and public contuse. Decisions which doctors has to take in moments are analysed retrospectively by everyone with wisdom of hindsight over years, without understanding complexities involved.

Evolution of Insurance sector: increasing cost of treatment and  medicolegal component has made both patients and doctors paying to insurance companies.

            This kind of aberrant evolution of medical profession has increased the problems of doctors and patients and it is not helping anyone. Ultimately it will help everyone except doctor and patient. Ultimately discourage the excellence in medical care.

 

Medical Regulation and Medical Community of Ancient Rome


Medical community

Medical services of the late Roman Republic and early Roman Empire were mainly imports from the civilization of Ancient Greece, and then through Greeks enslaved during the Roman conquest of Greece. Greek knowledge imparted to Roman citizens visiting or being educated in Greece.  A perusal of the names of Roman physicians will show that the majority are wholly or partly Greek and that many of the physicians were of servile origin.

The servility stigma came from the accident of a more medically advanced society being conquered by a lesser. One of the cultural ironies of these circumstances is that free men sometimes found themselves in service to the enslaved professional or dignitary, or the power of the state was entrusted to foreigners who had been conquered in battle and were technically slaves. In Greek society, physicians tended to be regarded as noble.

Public medicine

The medical art in early Rome was the responsibility of the pater familias, or patriarch. The importation of the Aesculapium established medicine in the public domain. There is no record of fees being collected for a stay at one of them, at Rome or elsewhere.  individuals vowed to perform certain actions or contribute a certain amount if certain events happened, some of which were healings. Such a system amounts to gradated contributions by income, as the contributor could only vow what he could provide. The building of a temple and its facilities on the other hand was the responsibility of the magistrates. The funds came from the state treasury or from taxes.

Private medicine  A second signal act marked the start of sponsorship of private medicine by the state as well. In the year 219 BCE, a vulnerarius, or surgeon, Archagathus, visited Rome from the Peloponnesus and was asked to stay. The state conferred citizenship on him and purchased him a taberna, or shop, near the compitium Acilii (a crossroads), which became the first officina medica.

The doctor necessarily had many assistants. Some prepared and vended medicines and tended the herb garden. These numbers, of course, are at best proportional to the true populations, which were many times greater.

Roman doctors of any stature combed the population for persons in any social setting who had an interest in and ability for practicing medicine. On the one hand the doctor used their services unremittingly. On the other they were treated like members of the family; i.e., they came to stay with the doctor and when they left they were themselves doctors. The best doctors were the former apprentices of the Aesculapia, who, in effect, served residencies there.

 

The practice of medicine

The physician

The next step was to secure the cura of a medicus. If the patient was too sick to move one sent for a clinicus, who went to the clinum or couch of the patient.

That the poor paid a minimal fee for the visit of a medicus is indicated by a wisecrack in Plautus. It was less than a nummus. Many anecdotes exist of doctors negotiating fees with wealthy patients and refusing to prescribe a remedy if agreement was not reached. The fees charged were on a sliding scale according to assets. The physicians of the rich were themselves rich. For example, Antonius Musa treated Augustus’ nervous symptoms with cold baths and drugs. He was not only set free but he became Augustus’ physician. He received a salary of 300,000 sesterces. There is no evidence that he was other than a private physician; that is, he was not working for the Roman government.

Legal responsibility Doctors were generally exempt from prosecution for their mistakes. Some writers complain of legal murder. However, holding the powerful up to exorbitant fees ran the risk of retaliation. Pliny reports  that the emperor Claudius fined a physician, Alcon, 180 million sesterces and exiled him to Gaul. By chance a law existed at Rome, the Lex Aquilia  passed about 286 BCE, which allowed the owners of slaves and animals to seek remedies for damage to their property, either malicious or negligent. Litigants used this law to proceed against the negligence of medici, such as the performance of an operation on a slave by an untrained surgeon resulting in death or other damage.

Social position While encouraging and supporting the public and private practice of medicine, the Roman government tended to suppress organizations of medici in society. The constitution provided for the formation of occupational collegia, or guilds. The consuls and the emperors treated these ambivalently. Sometimes they were permitted; more often they were made illegal and were suppressed. The medici formed collegia, which had their own centers, the Scholae Medicorum, but they never amounted to a significant social force. They were regarded as subversive along with all the other collegia.Doctors were nevertheless influential. They liked to write. Compared to the number of books written, not many have survived; for example, Tiberius Claudius Menecrates composed 150 medical works, of which only a few fragments remain. Some that did remain almost in entirety are the works of Galen, Celsus, Hippocrates and the herbal expert, Pedanius Dioscorides who wrote the 5-volume De Materia Medica.

Military medical corps

Republican

 The state of the military medical corps before Augustus is unclear. Corpsmen certainly existed at least for the administration of first aid and were enlisted soldiers rather than civilians. The commander of the legion was held responsible for removing the wounded from the field and insuring that they got sufficient care and time to recover. He could quarter troops in private domiciles if he thought necessary.

Imperial  

The army of the early empire was sharply and qualitatively different. If military careers were now possible, so were careers for military specialists, such as medici. Under Augustus for the first time occupational names of officers and functions began to appear in inscriptions. The term medici ordinarii in the inscriptions must refer to the lowest ranking military physicians. No doctor was in any sense “ordinary”. They were to be feared and respected. During his reign, Augustus finally conferred the dignitas equestris, or social rank of knight, on all physicians, public or private. They were then full citizens and could wear the rings of knights. In the army there was at least one other rank of physician, the medicus duplicarius, “medic at double pay”, and, as the legion had milites sesquiplicarii, “soldiers at 1.5 pay”, perhaps the medics had that pay grade as well.

Practice

Medical corps in battle worked on the battlefield bandaging soldiers. From the aid station the wounded went by horse-drawn ambulance to other locations, ultimately to the camp hospitals in the area. There they were seen by the medici vulnerarii, or surgeons, the main type of military doctor. They were given a bed in the hospital if they needed it and one was available. The larger hospitals could administer 400-500 beds.A base hospital was quadrangular with barracks-like wards surrounding a central courtyard. On the outside of the quadrangle were private rooms for the patients. Although unacquainted with bacteria, Roman medical doctors knew about contagion and did their best to prevent it. Rooms were isolated, running water carried the waste away, and the drinking and washing water was tapped up the slope from the latrines.Within the hospital were operating rooms, kitchens, baths, a dispensary, latrines, a mortuary and herb gardens, as doctors relied heavily on herbs for drugs.. They operated or otherwise treated with scalpels, hooks, levers, drills, probes, forceps, catheters and arrow-extractors on patients anesthetized with morphine. Instruments were boiled before use. Wounds were washed in vinegar and stitched. Broken bones were placed in traction. There is, however, evidence of wider concerns. A vaginal speculum suggests gynecology was practiced, and an anal speculum implies knowledge that the size and condition of internal organs accessible through the orifices was an indication of health. They could extract eye cataracts with a special needle. Operating room amphitheaters indicate that medical education was ongoing. Many have proposed that the knowledge and practices of the medici were not exceeded until the 20th century CE.

Regulation of medicine

By the late empire the state had taken more of a hand in regulating medicine. The law codes of the 4th century CE, such as the Codex Theodosianus, paint a picture of a medical system enforced by the laws and the state apparatus. At the top was the equivalent of a surgeon general of the empire. He was by law a noble, a dux (duke) or a vicarius (vicar) of the emperor. He held the title of comes archiatorum, “count of the chief healers.” The Greek word iatros, “healer”, was higher-status than the Latin medicus.Under the comes were a number of officials called the archiatri, or more popularly the protomedicisupra medicosdomini medicorum or superpositi medicorum. They were paid by the state. It was their function to supervise all the medici in their districts; i.e., they were the chief medical examiners. Their families were exempt from taxes. They could not be prosecuted nor could troops be quartered in their homes.The archiatri were divided into two groups:

Archiatri sancti palatii, who were palace physicians

Archiatri populares. They were required to provide for the poor; presumably, the more prosperous still provided for themselves.

The archiatri settled all medical disputes. Rome had 14 of them; the number in other communities varied from 5 to 10 depending on the population.

 

 

 

21 occupational Risks to doctors and nurses, while performing their duties


 

Doctor save the patient, but save yourself also.

Working of a doctor and nurses is not free from risk to themselves. The risk is generally underestimated, although it often involves major  risk  to life and may be frightening. Problem is that  majority of people, society and governing bodies  and even doctors themselves do not perceive or acknowledge it many times  the risks seriously.  But since  these risks are increasing exponentially everyday, because of changing scenario, they should be known to students, who want to take medicine as a profession. They need to take an informed decision. There are lesser set procedures, lack of awareness, not protective equipment or supportive society, governance and  laws, at most of  the places globally, and  doctors continue to work  in danger zones. These risks can be of varied types. Contracting the diseases is just one of them.

Even when doctors and nurses contact the diseases, there may or may not be proper support for further treatment, compensation and rehabilitation. Most of the time, they  have to fend for themselves. Because quite many of them , in government and private sector work on adhoc basis, temporary posts and on contract. Doctors  may have following risks, readers can add, if I have missed few:

Occupational health hazards

1.Tuberculosis: Common among health care  workers

2.Hepatitis B, Hepatitis C

3.HIV

  1. Influenza, Swine flu and other viruses of similar type.

5.Chicken pox

6.Rabies

7.Patients some times comes with unknown viral illnesses, which can not be tested. At the time, when treatment is going on, even diagnosis is not known. Doctor can contract these bacteria or viruses. There can be many more.

 

Risks related to stress and overwork

8.Depression, suicide, hopelessness

  1. Burnout.

10.Restricted social life

11.prone to alcohol/ drug abuse/ drug exposure.

Stress of balancing Family life: Kind of work and night duties effect family life very adversely. 12. Specially  female doctors. Completing  family will effect their careers, most of time.

13.High rates of divorces

14.Stress related diseases

 

15.Life style diseases: mainly sedentary work and long hours of working, makes them prone to life style diseases like ischemic heart disease , hypertension etc.

16.Exposure to radiations: specially in radiology and oncology. female doctors are more affected.

17.Lack of exposure to sunlight: effects bones , deficiency of vit D and predisposes to depression

 

  1.   Risk of catching resistant infections and sometimes there is risk that they carry these deadly bacteria to their homes. So their family members and children are at risk.
  2.   Risk of  working in disaster area and transport of sick , floods, earthquakes. Accidents of    ambulances .
  3.   Change in natural bio flora  of doctors and nurses. It is replaced by hospital bio flora. If they get infection, it is difficult to treat.
  4.  Risks because of legal problems and violent patients:  adds to stress Patients may not have favourable prognosis. But it is common for doctors to be blamed  even for naturally poor prognosis of the  disease. Legal trouble adds to further stress.

    –verbal abuse and threatening is very common. So spoiled mood unnecessarily.

– fear of  physical   assault can really harm doctors and family members.

– excessive and unilateral regulation puts doctors at the receiving end of the discontent.

Worst part is that our systems are not defined to prevent, treat or compensate or even acknowledge for these big disasters, if it happens to healers. These problems are not known to students, when they decide to take medicine, nor they are taught in medical school. Most of the time they have to fend for themselves, if problems occur.

Administrators and regulators refrain to study data that would establish and quantify the occupational hazards of being a doctor and nurses. Some of these hazards may be known, but there is no comprehensive analysis of workplace risk for physicians and nurses, like those that have been done for other professions. As physicians, we have a sense of the risk, and yet we remain engaged, continuing to care for our patients as we know  “these things” happen. Perhaps society prefers to remain blissfully ignorant of the sacrifice and risk their doctors take on, comforted by the fantasy of the serene  hospital. Perhaps we  all despise to let reality and data shatter the illusion.

Everyday globally, the doctors and the nurses  greet the new day and return to their work of taking care of their patients, knowing well the risk  involved.

Maybe it is time that we are little more aware  and acknowledge that even doing everything in best manner and honestly , we are in a  conflict zone and  we are all in harm’s way. Just be careful and be mindful that  doctors, nurses, and healthcare workers,  may get  sickened, injured, disabled, or can be dragged to court or harassed even  as they care for their patients in best manner.

Doctor save the patient, but save yourself also.

Human Animal Interface of Swachh Bharat, infections and antibiotic resistance


   Patients are always curious and ask “doctor, why have I got infection? From where? I eat good, maintain good health?” there are no ready answers. But there are certain factors in environment, which cause infections. More infections will require more antibiotics to be used and hence make bacteria resistant and difficult to treat. In fact, this one factor can undo all the advancement of medical science and push us back by centuries to pre-antibiotic era. Not uncommonly, response to antibiotics is not good and doctors are blamed for not doing enough. It is hard for the patient to know and understand the complexity of situation.

Antibiotic resistance is the ability of a microorganism to withstand the effects of an antibiotic. Antibiotic resistance evolves naturally or could also be engineered by applying an evolutionary stress on a population. If stress (Antibiotic) is applied on bacteria, a mutation or gene is generated. In other words, evolve into highly resistance bugs because of use of antibiotics. If a bacterium carries several resistance genes, it is called multi resistant or a superbug. Antibiotic resistance is a consequence of evolution of bacteria.

The antibiotic action is an environmental pressure; those bacteria which have a mutation allowing them to survive will live on to reproduce. When these bacteria are cause of infection and severe illness, even the best medical care does not prevent death in every case.

Antimicrobial resistance is a major public health problem globally while all types of AMR are concerning, antibacterial resistance (ABR) is seen as currently posing the most serious health threat. India has some of the highest antibiotic resistance rates among bacteria that commonly cause infections in the community and healthcare facilities, shows the latest Department of Biotechnology (DBT) report. Antibiotic resistance among bacteria high in India, reveals report.

The Scoping Report on Antimicrobial Resistance in India, as it is called, was prepared for DBT and Research Councils United Kingdom (RCUK) by the Center for Disease Dynamics, Economics & Policy, India (CDDEP).The Antimicrobial resistance is spreading is popping up in India, from the fecal matter of animals to groundwater for drinking. This is a concern as microorganisms can spread from animals to people and from the environment to humans.  This contamination is one of the important cause of increased infections and hence use of more antibiotics in community.

Swachh Bharat  if truly applied can actually contribute and  solve problem of antibiotic overuse and hence resistance to antibiotic  to some extent. Garbage and undisposed poop of human and animals cause generation of infections and diseases, hence leading to increased need for antibiotics.  That requires heavy use of antibiotics and consequently leads to emergence of further antibiotic resistance bacteria. This cycle of production of infections and use of antibiotics perpetuates a vicious cycle.  Although as I mentioned    disposal of animal waste remains a challenge for Swachh Bharat as current policies  do not address this issue, which contaminates  air and water sources.

Stray animals still defecate at every place.  Poop of Stray dogs, cattle and pigs stays in environment and causes life threatening infections. Pet owners also do not show responsible behavior towards community in the absence of proper rules. Hundreds of diseases are described due to poor control of human animal interface.  My appeal to higher authorities is to form policies and create awareness in this regards can do wonders for community acquired infections and hence tackle with menace of antibiotic resistance as well. True application of Swachh Bharat  in controlling human animal interface can improve health of millions in the country.

Sign the petition

Swatch Bharat obstacle: declare “open defecation free zone” only if free of infectious, toxic dog & animal poop.

https://www.change.org/p/prime-minister-of-india-swachh-bharat-declare-open-defecation-free-zone-only-if-free-of-infectious-dog-animal-poop?recruiter=821371489&utm_source=share_petition&utm_medium=copylink&utm_campaign=share_petition

 

 

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