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what is Mechanical ventilator? A machine critical to save life


A medical ventilator (or simply ventilator in context) is a machine designed to provide mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently.

While modern ventilators are computerized machines, patients can be ventilated with a simple, hand-operated bag valve mask.

Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesiology  (as a component of an  anesthesia machine .

Medical ventilators are sometimes colloquially called “respirators”, a term stemming from commonly used devices in the 1950s (particularly the “Bird Respirator”). However, in modern hospital and medical terminology, these machines are never referred to as respirators, and use of “respirator” in this context is now a deprecated anachronism signaling technical unfamiliarity.

Function                                  

In its simplest form, a modern positive pressure ventilator consists of a compressible air  reservoir or turbine, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable “patient circuit”. The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters. When over pressure is released, the patient will exhale passively due to the lungs’ elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient manifold.

Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters (e.g. pressure, volume, and flow) and ventilator function (e.g. air leakage, power failure, mechanical failure), backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by a computer-controlled  turbo-pump.

Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient’s needs. Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In Canada and the United States and in many parts of world, respiratory therapists are responsible for tuning these settings, while biomedical technologists are responsible for the maintenance.

The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g. inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the circuit may be either noninvasive or invasive.

Noninvasive methods, which are adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive methods require     intubation.  For long-term ventilator dependence will normally be a tracheostomy  cannula, as this is much more comfortable and practical for long-term care than is larynx or nasal intubation.

Life-critical system

Because failure may result in death, mechanical ventilation systems are classified as a life critical-system and precautions must be taken to ensure that they are highly reliable, including their  power supply .

Mechanical ventilators are therefore carefully designed so that no single point of failure can endanger the patient. They may have manual backup mechanisms to enable hand-driven respiration in the absence of power (such as the mechanical ventilator integrated into an  anesthetic machine . They may also have safety valves, which open to atmosphere in the absence of power to act as an anti-suffocation valve for spontaneous breathing of the patient. Some systems are also equipped with compressed-gas tanks, air compressors, and/or backup batteries to provide ventilation in case of power failure or defective gas supplies, and methods to operate or call for help if their mechanisms or software fail.

history of ventilator

source 

History of mechanical ventilator 


                

The history of mechanical ventilation begins with various versions of what was eventually called the iron lung, a form of noninvasive negative pressure ventilator widely used during the polio epidemics of the 20th century after the introduction of the “Drinker respirator” in 1928, improvements introduced by John Haven Emerson in 1931,  and the Both respirator in 1937. Other forms of noninvasive ventilators, also used widely for polio patients, include Biphasic Cuirass Ventilation, the rocking bed, and rather primitive positive pressure machines.

In 1949, John Haven Emerson developed a mechanical assister for anesthesia with the cooperation of the anesthesia department at Harvard University. Mechanical ventilators began to be used increasingly in anesthesia and intensive care during the 1950s. Their development was stimulated both by the need to treat polio patients and the increasing use of muscle relaxants during anesthesia. Relaxant drugs paralyze the patient and improve operating conditions for the surgeon but also paralyze the respiratory muscles.

In the United Kingdom, the East Radcliffe and Beaver models were early examples, the latter using an automotive wiper motor to drive the bellows used to inflate the lungs. Electric motors were, however, a problem in the operating theaters of that time, as their use caused an explosion hazard in the presence of flammable anesthetics such as ether and  cyclopropane .

In 1952, Roger Manley of the Westminster Hospital, London, developed a ventilator which was entirely gas driven, and became the most popular model used in Europe. It was an elegant design, and became a great favorite with European anesthetists for four decades, prior to the introduction of models controlled by electronics. It was independent of electrical power, and caused no explosion hazard. The original Mark I unit was developed to become the Manley Mark II in collaboration with the Blease company, who manufactured many thousands of these units. Its principle of operation was very simple, an incoming gas flow was used to lift a weighted bellows unit, which fell intermittently under gravity, forcing breathing gases into the patient’s lungs. The inflation pressure could be varied by sliding the movable weight on top of the bellows. The volume of gas delivered was adjustable using a curved slider, which restricted bellows excursion. Residual pressure after the completion of expiration was also configurable, using a small weighted arm visible to the lower right of the front panel. This was a robust unit and its availability encouraged the introduction of positive pressure ventilation techniques into mainstream European anesthetic practice.

The 1955 release of Forrest Bird’s “Bird Universal Medical Respirator” in the United States changed the way mechanical ventilation was performed, with the small green box becoming a familiar piece of medical equipment.  The unit was sold as the Bird Mark 7 Respirator and informally called the “Bird”. It was a pneumatic device and therefore required no electrical power source to operate.

Intensive care environments around the world revolutionized in 1971 by the introduction of the first  Servo 900 ventilator Elema – Schonander . It was a small, silent and effective electronic ventilator, with the famous SERVO feedback system controlling what had been set and regulating delivery. For the first time, the machine could deliver the set volume in volume control ventilation.

Ventilators used under increased pressure (hyperbaric) require special precautions and few ventilators can operate under these conditions. In 1979, Sechrist Industries introduced their Model 500A ventilator which was specifically designed for use with hyperbaric chambers.

In 1991 the SERVO 300 ventilator series was introduced. The platform of the SERVO 300 series enabled treatment of all patient categories, from adult to neonate, with one single ventilator. The SERVO 300 series provided a completely new and unique gas delivery system, with rapid flow-triggering response.

In 1999 the LTV (Laptop Ventilator) Series was introduced into the market. The new ventilator was significantly smaller than the ventilators of that time weighing ~14 lbs and around the size of a laptop computer. This new design kept the same functionality of the in hospital ventilators, while now opening up a world of opportunity of mobility for the patients.

A modular concept, meaning that the hospital has one ventilator model throughout the ICU department instead of a fleet with different models and brands for the different user needs, was introduced with SERVO-i in 2001. With this modular concept the ICU departments could choose the modes and options, software and hardware needed for a particular patient category.

mechanical ventilator

Reasons of having excessive thirst:


If some ones  feels  the need to   drink lots of water, most of time  reason is usually  known . For example,   not  drinking enough of it. But some times there can be more sinister mechanisms and need evaluation. There can be number of diseases,  which can  present  by  excessive thirst.   This derangement is  more  other than merely being dehydrated.

If drinking more fluids for several days hasn’t helped, there can be reasons other than dehydration.

Dehydration:

If some ones  feels  the need to   drink lots of water, most of time  reason is usually  known . For example,   not  drinking enough of it. Dehydration occurs if some one  does really hard work  in the ground or  sweating in the sun. The loss of fluids need to be replenished .

Dehydration commonly happens, in cases of food poisoning ,  diarrhoea, vomiting, inability to eat or drink  and loose motions.

Diabetes

One of the most important symptom of diabetes is thirst.  All types of  diabetes will present as increased intake of water and being thirsty.  Frequent urination, another common symptom of diabetes, will bring on thirst.   Therefore  excessive thirst and urination, along with unexplained weight loss, fatigue, or irritability, can be indications of diabetes.

Dry mouth

The abnormal dryness of the mucous membranes in the mouth, due to decreased  flow or change in the composition of saliva.  It is  also known as xerostomia, is often mistaken for excessive thirst.  Causes of dry mouth include smoking tobacco, use of  marijuana, stress, anxiety, or  aging.  But certain drugs (antidepressants) and autoimmune diseases can also cause dry mouth.

One  may think  being thirsty, whereas  actual reason is  having a dry mouth.

Dry mouth can present as :

  • a burning sensation or soreness in your mouth
  • changes in your sense of taste
  • difficulty speaking, eating or swallowing.

Menstrual blood loss

Estrogen and progesterone levels can both affect fluid volume.  If blood flow is more, it can  also cause  more  blood loss.   The blood loss will cause increase in thirst.

 

Thyroid problems

When the thyroid function is deranged , hormone  production is erratic can,  produce increased  or less e hormone. Thyroid dysfunction can   spur a variety of nonspecific symptoms, including abnormally heavy periods, anxiety, feeling hot, and dry mouth. These all can lead to increased thirst.

 Stress

Stress or specially chronic  stress is a cause for  adrenal gland dysfunction specially if  stress is severe.  This can cause dizziness,  depression, anxiety, and  severe  thirst.

 

Diuretic  and food containing diuretics:

    Drugs that produce lot of urine  are diuretics. They  can cause feeling of thirst.

Foods that have a diuretic effect can make you thirsty because they cause you to urinate more. Foods like melons,  ginger, celery, asparagus, beets, lemons.

 

Low-carbohydrate  diets:

        One of  side effect of Keto- diet  is thirst. The eating plan  significantly cuts down on  carbohydrate intake.   Carbohydrates s absorb  more water than protein and fat.

 

Pregnancy:

excessive thirst can happen in pregnancy due to many reasons for example  Increased urination,  nausea and morning sickness

Excessive bleeding:

Ongoing or sudden blood loss,   can  cause  thirst levels  in order to  make up for the fluid loss.

 

Diabetes insipidus:

Diabetes insipidus is a rare disorder that affects water absorption.   It can cause loss of huge  amounts of water  by production of litres of urine.   Cause can be brain or kidney called as central and nephrogenic respectively.

Psychogenic  polydipsia:  this is an urge to drink more water and  patients are unable to control the urge.  Patients may have intake of many litres per day.

 

 

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


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

Re-blog

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

Factors

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

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

UNIT

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

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

 

General practice

 

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

 

**
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**
Internal medicine

 

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

 

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

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***

 

cardiology

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****

 

gastroenterology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

**

 

Neurology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                  3

 

Nephrology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***           3

 

Pulmonary medicine

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***                    3

 

 

Emergency  Medicine

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****                4

 

Anaesthesia

 

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

 

****
       3..   Satisfaction of treating patients

 

**
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****                 4
Endocrinology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**                2
Psychiatry

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                  2

 

 

 

 

paediatrics

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

****                  4

 

Critical care

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****           4

 

Paediatric critical care

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

General Surgery

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

Minimal access surgery

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***                3

 

 

Cardiac surgery- CTVS

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

Urology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                 3

 

Gastro-surgery

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****            4

 

Neurosurgery

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****            4

 

Head and Neck surgery

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***               3

 

Orthopaedics

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                             3

 

Ophthalmology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                           2

 

Radiology

 

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

 

***
       3..   Satisfaction of treating patients

 

*
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                  2
ENT

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                 2

 

Dermatology

 

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

 

**
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

*                1

 

Gynaecology/obstetrics

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****

 

Plastic Surgery

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

*
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**              2

 

 

Oncology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**               2

 

Onco-surgery

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**                    2

 

Anatomy

 

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

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Physiology

 

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

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Biochemistry

 

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

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Microbiology

 

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

 

**
       3..   Satisfaction of treating patients

 

0 to*
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

 

Pathology

 

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

 

**
       3..   Satisfaction of treating patients

 

NIl
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

Medical administrator/Manager

 

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

sometimes multiple

       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

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

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

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


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

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

Factors

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

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

UNIT

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

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

 

General practice

 

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

 

**
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**
Internal medicine

 

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

 

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

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***

 

cardiology

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****

 

gastroenterology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

**

 

Neurology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                  3

 

Nephrology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***           3

 

Pulmonary medicine

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***                    3

 

 

Emergency  Medicine

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****                4

 

Anaesthesia

 

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

 

****
       3..   Satisfaction of treating patients

 

**
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****                 4
Endocrinology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**                2
Psychiatry

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                  2

 

paediatrics

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

****                  4

 

Critical care

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****           4

 

Paediatric critical care

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

General Surgery

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

Minimal access surgery

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

***
      7. Legal complexity and stress

 

***                3

 

 

Cardiac surgery- CTVS

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****               4

 

Urology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                 3

 

Gastro-surgery

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****            4

 

Neurosurgery

 

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

 

****
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****            4

 

Head and Neck surgery

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***               3

 

Orthopaedics

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

***
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

***                             3

 

Ophthalmology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                           2

 

Radiology

 

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

 

***
       3..   Satisfaction of treating patients

 

*
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                  2
ENT

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**                 2

 

Dermatology

 

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

 

**
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

*                1

 

Gynaecology/obstetrics

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

****
       6. Stress of life and death

 

****
      7. Legal complexity and stress

 

****

 

Plastic Surgery

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

*
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

*
      7. Legal complexity and stress

 

**              2

 

 

Oncology

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

***
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**               2

 

Onco-surgery

 

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

 

***
       3..   Satisfaction of treating patients

 

***
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

**
       6. Stress of life and death

 

**
      7. Legal complexity and stress

 

**                    2

 

Anatomy

 

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

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Physiology

 

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

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Biochemistry

 

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

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

Nil
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

Nil

 

Microbiology

 

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

 

**
       3..   Satisfaction of treating patients

 

0 to*
       4.  Satisfaction of making diagnosis

 

**
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

 

Pathology

 

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

 

**
       3..   Satisfaction of treating patients

 

NIl
       4.  Satisfaction of making diagnosis

 

****
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

Medical administrator/Manager

 

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

sometimes multiple

       2..   Prolonged tough training

 

**
       3..   Satisfaction of treating patients

 

Nil
       4.  Satisfaction of making diagnosis

 

Nil
       5. Emergency & odd hour duty

 

*
       6. Stress of life and death

 

Nil
      7. Legal complexity and stress

 

*

 

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

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

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


        

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

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

West Nile virus : first reported death in India ( Kerala): How to prevent?


       A seven-year-old in Kerala, who had tested positive for West Nile Virus (WNV), died in Kozhikode on Monday. It is first reported death in India due to the WNV. West Nile Virus is a disease which spreads from birds to humans with the bite of an infected Culex mosquito. The symptoms include cold, fever, bodyache, fatigue and nausea, with complications leading to meningitis and death.  Birds are natural hosts of the virus.

West Nile virus (WNV) is the leading cause of mosquito-borne disease in the continental United States.  It is most commonly spread to people by the bite of an infected mosquito. Cases of WNV occur during mosquito season, which starts in the summer and continues through fall. There are no vaccines to prevent or medications to treat WNV in people. Fortunately, most people infected with WNV do not feel sick. About 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness. You can reduce your risk of WNV by using insect repellent and wearing long-sleeved shirts and long pants to prevent mosquito bites.

The WNV can cause neurological disease and death in people and is common in Africa, Europe, the Middle East, North America and West Asia.

Here is all about the virus:

What is West Nile virus? West Nile virus (WNV) is an infectious disease spread by infected mosquitoes. It spreads from birds to humans with the bite of an infected Culex mosquito.

What are the symptoms on WNV?

People who get WNV usually have no symptoms or mild symptoms. The symptoms include a fever, headache, body aches, skin rash, and swollen lymph glands. They can last a few days to several weeks, and usually go away on their own.

When is it dangerous?

If West Nile virus enters the brain, it can be life-threatening. It may cause inflammation of the brain, called encephalitis, or inflammation of the tissue that surrounds the brain and spinal cord, called meningitis.

How is WNV diagnosed

A physical exam, medical history, and laboratory tests can diagnose it.

Who are at risk?

Older people, children and those with weakened immune systems are most at risk.

What is the cure?

There are no specific vaccines or treatments for human WNV disease. The best way to avoid WNV is to prevent mosquito bites. Treatment is supportive for patients with neuro-invasive West Nile virus, often involving hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections.

Have there been any outbreaks?

The largest outbreaks occurred in Greece, Israel, Romania, Russia and USA. Outbreak sites are on major birds migratory routes. In its original range, WNV was prevalent throughout Africa, parts of Europe,

Middle East, West Asia, and Australia. Since its introduction in 1999 into USA, the virus has spread and is now widely established from Canada to Venezuela.

In India : Since 2016, 124 cases of the disease have been reported from across the country, but no deaths.

Experts in virology say there is usually no single reason that leads to death in cases of WNV disease.

According to previous research, WNV is not a new disease to India.

In India, the existence of antibodies (protein produced by the human body to fight bacteria and viruses) against WNV in humans was recorded for the first time in 1952, according to a 2006 research paper titled “West Nile Virus isolates from India: evidence for a distinct genetic lineage”.

The research was conducted by experts at the National Institute of Virology in Pune, and published in the Journal of General Virology.

Since WNV is a vector-borne disease, the health ministry has been monitoring the situation closely. A team of experts from health ministry’s National Centre for Disease Control has been assisting state authorities

Prevention

The most effective way to prevent infection from ­­­West Nile virus is to prevent mosquito bites. Mosquitoes bite during the day and night. Use insect repellent, wear long-sleeved shirts and pants, treat clothing and gear, and take steps to control mosquitoes indoors and outdoors.

Take steps to control mosquitoes indoors and outdoors

  • Use screens on windows and doors. Repair holes in screens to keep mosquitoes outdoors.
  • Use air conditioning, if available.
  • Stop mosquitoes from laying eggs in or near water.
    • Once a week, empty and scrub, turn over, cover, or throw out items that hold water, such as tires, buckets, planters, toys, pools, birdbaths, flowerpots, or trash containers.
    • Check indoors and outdoors.

Treatment

There is no specific treatment for WNV disease; clinical management is supportive. Patients with severe meningeal symptoms often require pain control for headaches and antiemetic therapy and rehydration for associated nausea and vomiting. Patients with encephalitis require close monitoring for the development of elevated intracranial pressure and seizures. Patients with encephalitis or poliomyelitis should be monitored for inability to protect their airway. Acute neuromuscular respiratory failure may develop rapidly and prolonged ventilatory support may be required.

WNV Antibody Testing

Laboratory diagnosis is generally accomplished by testing of serum or cerebrospinal fluid (CSF) to detect WNV-specific IgM antibodies. Immunoassays for WNV-specific IgM are available commercially and through state public health laboratories.

WNV-specific IgM antibodies are usually detectable 3 to 8 days after onset of illness and persist for 30 to 90 days, but longer persistence has been documented. Therefore, positive IgM antibodies occasionally may reflect a past infection. If serum is collected within 8 days of illness onset, the absence of detectable virus-specific IgM does not rule out the diagnosis of WNV infection, and the test may need to be repeated on a later sample.

The presence of WNV-specific IgM in blood or CSF provides good evidence of recent infection but may also result from cross-reactive antibodies after infection with other flaviviruses or from non-specific reactivity. According to product inserts for commercially available WNV IgM assays, all positive results obtained with these assays should be confirmed by neutralizing antibody testing of acute- and convalescent-phase serum specimens at a state public health laboratory or CDC.

WNV IgG antibodies generally are detected shortly after IgM antibodies and persist for many years following a symptomatic or asymptomatic infection. Therefore, the presence of IgG antibodies alone is only evidence of previous infection and clinically compatible cases with the presence of IgG, but not IgM, should be evaluated for other etiologic agents.

Plaque-reduction neutralization tests (PRNTs) performed in reference laboratories, including some state public health laboratories and CDC, can help determine the specific infecting flavivirus. PRNTs can also confirm acute infection by demonstrating a fourfold or greater change in WNV-specific neutralizing antibody titer between acute- and convalescent-phase serum samples collected 2 to 3 weeks apart.

Other testing for WNV disease

Viral cultures and tests to detect viral RNA (e.g., reverse transcriptase-polymerase chain reaction [RT-PCR]) can be performed on serum, CSF, and tissue specimens that are collected early in the course of illness and, if results are positive, can confirm an infection. Immunohistochemistry (IHC) can detect WNV antigen in formalin-fixed tissue. Negative results of these tests do not rule out WNV infection. Viral culture, RT-PCR, and IHC can be requested through state public health laboratories or CDC.

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


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

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

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

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

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


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

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

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

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

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

  “Documenting  the communication”

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

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

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

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