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Ayurvedic Surgery: 10 Technical Questions? About safety concerns


      If there are certain doubts about the safety of the patient, the apprehension needs to be addressed.

      The government has issued a notification which authorises post-graduate practitioners in specified streams of Ayurveda to be trained to perform surgical procedures such as excisions of benign tumours, amputation of gangrene, nasal and cataract surgeries.

    The notification by the Central Council of Indian Medicine, a statutory body under the AYUSH Ministry to regulate the Indian systems of medicine, listed 39 general surgery procedures and around 19 procedures involving the eye, ear, nose and throat by amending the Indian Medicine Central Council (Post Graduate Ayurveda Education) Regulations, 2016.

     Any  Surgery, how-so-ever simple it may look to the people sitting on fence, carries some  risk and needs  some kind of precautions and regulations to make it risk free.  Therefore if there are certain doubts about the safety of the patient, the apprehension needs to be addressed. If the service of surgery by Ayurveda surgeon has to be availed by public, a certain confidence needs to be generated about the safety and quality assurance. Mere push by an enforced law will not lead to genesis of trust and confidence. So there needs to be technical analysis of some kind, whether  it is a genuine original  strategy or merely  an imposed law.

     If it was an accepted practice till now, there was no need for such notification. So apparently,  if the need was felt  to be said in a forceful manner, there has to be something unusual about the practice.

      No doubt, ancient Ayurvedic text referred to surgical practices. But  in present era of consumerism, patients need to know, how it was being practiced for last 200 to 300 years. What are the results and data about complications.

  There are two main categories for the purpose of discussion.

A. Existence of a robust system

B. Individual competencies.

    Firstly, there should be basic robust system  that will generate Ayurvedic surgeons.

To start with, the  CCIM need to  satisfy on following questions. Following are the basic requirements of surgery.

1. What  kind of Anaesthesia  will be used in surgeries by Ayurveda surgeons? Who will be the anaesthesiologist?

2. What are post op pain killers be used in surgeries by Ayurveda surgeons?

3. What antibiotics  will be  used;. Allopathic or ayurvedic?

4. What are principles of pre-op evaluation?

5. How surgical techniques are different. Are they same used in allopathic surgery or different ones described in Ayurveda?

6. How the post op complications are being managed. Is it by using allopathic medications and investigations?

7.  Data of surgeries done in last decade or two in all of  Ayurvedic medical colleges, especially those done by Ayurvedic surgeons.

8. Who is teaching Ayurveda doctors about the  surgeries? Are there ayurvedic teachers  or being taught by allopathic surgeons?

9. Will  the people in higher positions and government  officials be availing such facilities or it is only for the  poor people? 

10. Will the patients be given enough information or an informed consent about such Ayurvedic surgeons before  surgery?

         More than a law, the whole exercise   will require a trust building   in public  along with quality assurance and something unique to make such surgeries practically happen.

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Neanderthal gene makes Covid more severe


What is Neanderthal gene

    Neanderthal-inherited genetic material is found in all non-African populations and was initially reported to comprise 1 to 4 percent of the genome. This fraction was later refined to 1.5 to 2.1 percent. It is estimated that 20 percent of Neanderthal DNA currently survives in modern humans.

Relation to severity of Covid

    Response to Covid infection varies from person to person. Some have severe covid infection, need ventilator and some remain unaffected. There is interest in the individual factors which influence the outcome of Covid infection. One such factor is the genetic predisposition.

     Covid-19 patients with a snippet of Neanderthal DNA that crossed into the human genome some 60,000 years ago run a higher risk of severe complications from the disease, researchers have reported.

People infected with the new coronavirus, for example, who carry the genetic coding bequeathed by our early human cousins are three times more likely to need mechanical ventilation, according to a study published Wednesday in Nature.

There are many reasons why some people with Covid-19 wind up in intensive care and others have only light symptoms, or none at all.

Advanced age, being a man, and pre-existing medical problems can all increase the odds of a serious outcome.

But genetic factors can also play a role, as the new findings makes clear.

“It is striking that the genetic heritage from Neanderthals has such tragic consequences during the current pandemic,” said co-author Svante Paabo, director of the department of genetics at the Max Planck Institute for Evolutionary Anthropology.

Recent research by the Covid-19 Host Genetics Initiative revealed that a genetic variant in a particular region of chromosome 3 — one of 23 chromosomes in the human genome — is associated with more severe forms of the disease.

That same region was known to harbour genetic code of Neanderthal origins, so Paabo and co-author Hugo Zeberg, also from Max Planck, decided to look for a link with Covid-19.

Unevenly distributed

They found that a Neanderthal individual from southern Europe carried an almost identical genetic segment, which spans some 50,000 so-called base pairs, the primary building blocks of DNA.

Tellingly, two Neanderthals found in southern Siberia, along with a specimen from another early human species that also wandered Eurasia, the Denisovans, did not carry the telltale snippet.

Modern humans and Neanderthals could have inherited the gene fragment from a common ancestor some half-million years ago, but it is far more likely to have entered the homo sapiens gene pool through more recent interbreeding, the researchers concluded.

The potentially dangerous string of Neanderthal DNA is not evenly distributed today across the globe, the study showed.

Some 16 percent of Europeans carry it, and about half the population across South Asia, with the highest proportion — 63 percent — found in Bangladesh.

This could help explain why individuals of Bangladeshi descent living in Britain are twice as likely to die from Covid-19 as the general population, the authors speculate.

Indian express-Article

In East Asia and Africa the gene variant is virtually absent.

About two percent of DNA in non-Africans across the globe originate with Neanderthals, earlier studies have shown.

Denisovan remnants are also widespread but more sporadic, comprising less than one percent of the DNA among Asians and Native Americans, and about five percent of aboriginal Australians and the people of Papua New Guinea.

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Covid Patients Remain Infectious for 9 days


Covid-19 patients can shed fragments of the virus that causes the infection for up to 83 days in their respiratory or stool samples but they are unlikely to be infectious for as long. According to a study published in The Lancet Microbe, one of world’s top medical journals, no live virus has been isolated from culture of the respiratory or stool sample beyond day nine of symptoms despite persistently high viral RNA loads. This means that a person affected by Covid-19 is infectious for nine days after developing disease symptoms though tests may find presence of the virus for nearly three months. The study conducted by researchers from UK and Italy involved systemic review and meta-analysis of 79 studies that focused on SARS-CoV-2, the virus which causes Covid-19. “The majority of studies included in our review were performed in patients who were admitted to hospital. Therefore, our findings may not apply to people with milder infection although these results suggest those with milder cases may clear the virus faster from their body. Additionally, the increasing deployment of treatments, such as dexamethasone, remdesivir as well as other antivirals and immunomodulators in clinical trials are likely to influence viral shedding in hospitalised patients. Further studies on viral shedding in this context are needed,” Dr Antonia Ho of MRC-University of Glasgow Centre for Virus Research, UK, who is one of the authors of the study, said.

article- times of india

                The Lancet Microbe study also suggests that people infected with SARS-CoV-2 are mostly likely to be highly infectious from symptom onset and the following five days. Therefore, the researchers said, it is important to self-isolate immediately after symptoms start. Understanding when patients are most likely to be infectious is of critical importance for informing effective public health measures to control the spread of SARS-CoV-2. The Lancet study looked at key factors involved in this: viral load (how the amount of the virus in the body changes throughout infection), viral RNA shedding (the length of time someone sheds viral genetic material (RNA), which does not necessarily indicate a person is infectious, as this is not necessarily able to replicate), and isolation of the live virus (a stronger indicator of a person’s infectiousness, as the live virus is isolated and tested to see if it can successfully replicate in the laboratory). The researchers found that the average length of time of viral RNA shedding into the upper respiratory tract, lower respiratory tract, stool and serum were 17 days, 14.6 days, 17.2 days and 16.6 days, respectively. The longest length of time that RNA shedding lasted was 83, 59, 35 and 60 days, respectively. “These findings suggest that in clinical practice, repeat PCR testing may not be needed to deem that a patient is no longer infectious, as this could remain positive for much longer and does not necessarily indicate they could pass on the virus to others. In patients with non-severe symptoms, their period of infectiousness could instead be counted as 10 days from symptom onset,” Dr Muge Cevik, the lead author of the study, said.

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#Medical-Consumer-Protection-Act: Pros & Cons: Advantages & disadvantages


As in last few decades, patients are defined as  consumers and Medical Consumer Protection Act takes roots, the whole system of medicine and healthcare has changed. All the new changes in regulation, insurance and legal system have resulted in facilitating and exercising an easy control of medical industry over health care, each revision has affected doctors adversely. They have been reduced to just only one small component of the industry, who deliver care and remain at receiving end for poor outcomes. Other important stake holders are patients. How this change has been beneficial for patients?   

     Suppressed professionals can be used to work more, get less paid and can be dragged to courts easily. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario,  act smart and are able to entrench themselves in  changed business and legal milieu.

Disadvantages of medical consumer Protection Act (Negatives, cons)

1 .Promotes Defensive medicine: Every patient with any illness has a potential for  complications. Progression of any disease state can cause death.  If doctors start looking at every patient as a potential litigant, especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients. Worst scenario of excessive fear will be refusal of very sick patients in emergency situations or non-availability of doctors.

2. Erosion of doctor-patient relationship: Stray and occasional Incidents about negligence, the cases in courts or their outcome attract wide publicity in media. People are unable to understand the correct application of such stray incidents to themselves. But they always try to imagine themselves being in the chaos or scenario projected. Because of prejudiced notions, a sense of mistrust gradually creeps in, which then extends into   and involves their own  imagination and  circumstances. This sense of mistrust multiplies manifold whenever there is some adverse or even small unpleasant event. Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.

 3. Increased cost of care:   With the increasing need for defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to increased  medical costs.  Insurance companies, medical industry and lawyers have positioned themselves in between doctor and patients. They charge everyone on both sides, heavily for allaying the fears, both  patients (medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.

             25 factors for rising cost and expensive medical care.

4. Enhanced insecurity in medical profession: Needless to say, consumer protection act has increased the anxiety and insecurity of  the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career, will result in professional hanging or a media trial. There is a real probability of being entangled in these problems in present era in day to day practice.

              Disadvantages  of being a doctor, nurse

5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons,  for example the sense of revenge or to extract money or simply for avoiding  to pay for services.  In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These ideas  are further stoked by the incidents of previous high compensations granted  by courts .

   

6. Increased paper workexcessive documentation and time consumption: crucial and large chunk of time of doctors and nurses,   goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a day more worried about completing paper work as well. Initially it was a symbolic documentation, but now there is requirement of mammoth paper work. It leads to consumption of time that was meant for real discussions for the benefit of patients.

7. Doctors used as scape-goats for revenge: Any unsatisfied patient can vent his anger by putting complaint or case against the doctor.  This is done to some extent for revenge or just finding a human factor which can be punished. Not uncommonly doctors are used as scape- goats to have a concession on the patient treatment by administrators. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.

8. Distraction of doctors from the primary point of intention:  Nothing else ever has distracted doctors more than  medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave  emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight.   Complex  medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intentions ‘the treatment.

9. Early retirement or burn out:  Becoming a doctor and practising has become a tough job. After people have reached a point of financial security or when near point of burn out, doctors tend to leave practice. No wise man will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish  health, wealth and fame that was  earned by  slogging  the doctor’s whole life.

10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career to risk, why should anyone put himself in that difficult  position?  Therefore increasingly, financially secure doctors are staying away from the riskier jobs.

11 .Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight.  All patients, who are unsatisfied or with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.

12. Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking  for,  whom to blame  among themselves. All of them will try to pinpoint each other’s mistake.  Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe,  encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately  a mutual understanding and team work takes a hit.

13. Doctors converted to cheap labour:

Hugely benefitted are medical industry, law industry and administrators; The ease with which doctors can be harassed  has lead to rampant misuse of consumer protection ac and t has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip against the  doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain the maximum out of doctors hard work.  Benefits to law industry and lawyers  are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.

14. Confusion while treating; Right decisions ?  A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering.  What was medically right and judicious decision at that real time situation may be  looked as  wrong later, especially when retrospective analysis  is done over years with fault finding approach. So taking medical decisions is becoming more difficult amid future uncertainty of disease.

15. Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem, but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed. Delay in surgeries or therapies are a common outcome.

16. Instigation by law industryWindfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigations of lawsuit against doctors is a major setback for medical profession.

17. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous training and then suddenly find themselves starting the work in a hostile environment. They find it strange to find themselves  at the receiving end of public wrath, law and media for reasons, they can’t fathom. They work with  continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

18. Doctors have become ‘Sitting ducks’  for  continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes.   Mistakes   are always easy to be  pinpointed with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for  any kind of blackmail.

 19. Demoralization of medical professionals – as selectively applied: strangely it applies   only to doctors. All of other professions are   out of it. Selective application is what demoralizes doctors.  Considering the uncertainty and kind of work of medical profession, actually it should be other way around. 

The consequences are like victimization.

Advantages of Medical Consumer Protection Act: (Positives, Pros)

1.  Redressal of grievances:  patient will get satisfaction, if there is a genuine negligence case

2.  Better quality of care ;  medical systems will improve as they will need to lessens the errors and  court cases. Better systems from abroad are also copied to improve the efficiency.

3. Better introspection by medical profession: although doctors from the beginning are sensitive about their work and always look at how better results can be achieved. But act will make this process more formal and official.

4. Training of medical professionals: it will be difficult to put errors under carpet.  Doctor will like to get trained better as no one want to be in soup.

5. Future  learning from court cases:  each and every court decisions  is viewed carefully by medical fraternity. Improvement in protocol and policy making is a natural consequence.

6.  Eye openers for medical profession: court cases and decisions have acted as eye opener for medical profession. It gives an idea, how law looks at medical treatment. It has made clear that medical science and medical law are a bit different. In real time, things are easier to be said than done.

 7. Better documentation and communication: for doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting much. But now there is lot of stress on documentation.

   Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and  achieve  better results.   The real problem lies in the fact that in this age,  anxiety prevailing more for care givers, a sense of injustice prevails . Stress generated can alter the ways, the patients get treated.  If the core of the health care  (medical hands) are harmed, no one can benefit in the long run.

21 occupational risks to doctors and nurses

Reel Heroes vs Real Heroes

Violence at #NMMC HOSPITAL VASHI Mumbai- shame on law and order agencies


Attacks and assaults on doctors appears to be  one of the indicators of  a lawless and uncivilized society and  poor governance.  Doctors  have become punching bags for all the malaise prevalent in the  health system. A failing and inept system, which is unable to provide health to people and  security to doctors. The system  hides behind their working  doctors and presents them as punching bags. The  impunity with which attendant easily and brutally assault doctors and vandalize hospitals  is really appalling. Similar violent incidents all over  should be  shameful  to law enforcing agencies. Are we a lawless society? More problematic is the government apathy and silence of human right commission and similar organizations.

     Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession. Silence of authorities, human right commission is really appalling. 

 Media, celebrities, film stars in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable, where stray incidents were portrayed as generalization, just to earn money and fame.

    Empathy, sympathy, compassion and trust  of the doctor towards the patient, will definitely get a hit after these incidents. Everyday  the news of assaults on doctors, court cases against doctors, negative projection of the medical profession   in the media are viewed  by doctor’s community anxiously..

      Merely taking some token  action and showing  protest will not solve the problem. It does not compensate for the  damage done to medical profession. Sympathy, compassion and trust of the doctors towards patients will definitely reduce. Who will be  the ultimate sufferer, does not need a Einstein brain to predict.

                    This insecurity or fear of the uncertainty tends to affect the thinking process of doctors and the way they practice medicine or deal with the patients. Many will like to be defensive in practice, or try not to treat very sick patients.  Why would someone try complex surgeries, if there is greater  risk involved? Few will limit themselves to follow protocols. Going extra mile  along with risk, which not everyone will like to take. Many will become health managers or do something else than do active clinical work. Who should risk his life while doing routine work?

     Patients might get their revenge for the  naturally occurring disease, but they will lose compassion and trust of doctors in the long run. If that is the way to impart justice in this era, doctors will have to find some way to save themselves.

Patient relatives vandalized NMMC Hospital Vashi, Mumbai

Relatives were booked for vandalising the Navi Mumbai Municipal Corporation (NMMC) hospital in Vashi following the death of a 50-year-old man. Of the seven, the four men were arrested. The patient, Venkatesh Suryavanshi, a resident of Juhu gaon, was shifted from a private hospital in Koparkhairane to the NMMC hospital on Tuesday afternoon. At the time of admission, Suryavanshi, who had tuberculosis, was in a critical condition and had very low oxygen levels. An antigen test had declared him negative for COVID-19.“At the time of admission, after checking his condition, vitals and the history papers, we had said that his chances of survival are very less. He was admitted to the ICU ward,” Prashant Jawade, medical superintendent, NMMC hospital, said.Suryavanshi died during treatment around 3.45 a.m. on Wednesday. After getting to know about the death, his sons Rupesh (22) and Sandesh (20), along with their friends Pankaj Jadhav (22) and Rohit Namwad (32) entered the ICU ward and started vandalising the department. Three women who followed them assaulted security guard Satish Dere.“I was told that they also carried a few sharp weapons with them. The security guard has received injuries. Our engineers are analysing the damage and finding the losses that we incurred,” Mr. Jawade said. Chief Medical Officer Majur Shaikh and a few other hospital staff were also allegedly attacked.

According to the police, the seven had vandalised three ventilators, one dialysis machine, two fans, one table fan, and two nurse stations.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

    21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

TRUMP BLAMES DOCTORS FOR COVID


Unparalleled sacrifice by medical community during pandemic  has not  resulted in any enhancement of  respect or prestige to the medical  profession. It was not enough  to stop physical or verbal assaults, legal or financial  exploitation. It was sufficient  to alter the course of oppression  by administrators or moral blackmail by society.

    Sadly it is getting more worse. Doctors and nurse have been reduced to sacrificial lambs, that are easily slayed, when administrators tend  to put  themselves on high moral  pedestals.

      Financial and legal complexities have been the major side effects of modern medicine, especially for doctors. They are facing  complex  environment,  which are beyond their control. Besides financial and legal complexities, moral dilemmas, facing verbal and physical assaults are creating  complex working conditions. Criticized  by administrators despite their sacrifice, media insults are adding to their disillusionment and possibly  a withdrawal response.

    Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.”

         Media and celebrities usually   have proudly   projected on screen and television that it is right to be disrespectful towards doctors. They have made it appear correct to masses  to be disrespectful to doctors. But such  news is viewed by medical community anxiously and is definitely a poor advertisement for younger generation to take medicine as profession.

     As incidents are widely publicized and masses following their “Reel Heroes” and celebrities  to insult medical profession.

    Disrespect and media insult by celebrities towards a profession as a normal  routine  and perceived as an   easily do-able  adventure  to gather populism.

On the night of October 24th, President Trump addressed his supporters at a Wisconsin rally, located just minutes from a temporary COVID-19 field hospital, making the argument that doctors at the pandemic’s front lines are falsely capturing COVID-19 cases in order to profit from the pandemic. Undermining his own scientific experts was not enough to dispute the severity of the crisis. Now, he desperately suggests — “I don’t know, some people say…” — that America’s most trusted professionals are fabricating the rising coronavirus case numbers of the current “third spike” for personal financial gain.  

Trump’s wrong insinuations

As doctors we are outraged by Trump’s gutless insinuations. We’re not alone. The American Medical Association, American College of Physicians, and the Council of Medical Specialty Societies, leveraging the voices of over 800,000 American physicians, have each castigated Trump for his callous allegations.

The mere implication that health care professionals would be incentivized by profit to alter the true rate of this public health pandemic is reprehensible. Here’s why:

We struggle to contain the losses — and we continue to lose our own. For months, we have worked tirelessly to contain the spread of COVID-19. As we approach a quarter of a million deaths nationwide, we cannot forget the 1,700 of our own health care colleagues among that number. We are the teams that care for everyone, day and night, as we risk our own lives for the benefit of our communities. Unsurprisingly, we are burnt out. These last seven months have been a marathon in resilience, frustration, and fear. 

Here’s the truth: We label patients with COVID-19 because accurate identification of this disease is essential so we can track cases to take the quick action necessary to prevent further spread. If a patient has a history of heart disease or other medical problems, and dies in the hospital with COVID-19, we know that coronavirus exacerbated that underlying condition — and their demise. It is accurate and in line with public health principles to list it as a cause of death.

We face historic furloughs, layoffs and pay cuts. 

Here’s what’s worse: the assertions that doctors are profiting off of the pandemic are completely baseless and could not be further from the truth. Physician practices are not immune to the economic losses Americans are experiencing. One in five American physicians, whether salaried or in independent practice, have experienced pay cuts during the pandemic. Hospitals and physician practices have had to implement furloughs and layoffs to stay afloat, including furloughs at 35% of all primary care offices. More than 16,000 — or 9% — of independent physician practices have had to close entirely. 

More recent estimates suggest that hospitals, thanks to the loss of elective surgeries during pandemic spikes, will face over $300 billion in lost revenue this year alone. And this is all happening while physicians report working more hours this year — amid more uncertainty about the future of their profession.

Doctor: My Sept. 11 fear of flying made a comeback with COVID-19. Was I wrong to worry?

We still work in unsafe conditions, without the equipment needed to protect us — and you. In the spring, the images were indelible: N95 masks being reused for days on end, while nurses were covered in trash bags as a proxy for PPE. Across the country, hospitals, clinics and state agencies bid against each other for what few PPE supplies existed. All the while, President Trump accused health care workers of hoarding PPE and other medical equipment. He blamed health care workers for shortages across the nation, when the root cause of that unfolding tragedy was his administration’s unwillingness to enact a national and comprehensive strategy.

Fast forward to today, where many healthcare workers still do not have adequate PPE and continue to reuse masks, gowns and gloves meant for one-time use. This could have been easily addressed by now, had President Trump fully activated the Defense Production Act to speed up and nationalize PPE production, a request he consistently refused. 

The long road of COVID ahead

We see no end in sight. White House Chief of Staff Mark Meadows made it clear: the Trump administration has given up trying to control this pandemic. While they wave the white flag in hopes of therapeutics and vaccines becoming available in sufficient quantities for all Americans, hundreds of thousands more are projected to die. 

COVID immunity:COVID-19 herd immunity strategy fits Donald Trump’s failures in coronavirus war

The new “medical swamp” narrative emerging from the White House, while deeply disturbing, is not out of character for this administration. Since the first U.S. coronavirus case was reported in January 2020, the president has undermined his own health experts and denied the scientific evidence at every turn. 

The coming weeks and months will be dark as we continue to experience the repercussions of Trump’s callous inaction, but you have the ability to shape how this story ends. We urge all Americans to elect leadership that is morally responsible, unwilling to allow the political manipulation of science. The lives of the American people depend on it.

advantages disadvantages of medical profession

25 factors why health care is expensive

Covid-Warriors or Beggars: Doctors without pay


    Imagine a highly skilled professional community, which can be harassed, assaulted, dragged to courts and subjected to cruelty beyond imagination. Ironically, the despise to this community  comes from the  very people, whom they are trying to save.      

     Even the rightful is denied in a shameless manner, as if their lives don’t matter. During pandemic, doctor and nurses treated as dispensable disposables. A mere lip service to call them Covid-warriors  was performed, but real treatment  to these selfless health workers was akin to sacrificial lambs. 

    The plight of doctors of Hindu Rao Hospital is just an indication of the real thought process and apathy of administrators. If doctors are forced to beg for  basic fundamental rights, their situation is worse than beggars. The current unfortunate situation is enough to  convey  a message to the medical profession, the nation and is  demoralizing the entire doctor community, more so to the aspiring doctors.

Doctors at Hindu Rao Hospital unpaid for months

    Irked over non-payment of salaries, doctors and staff members of North Delhi Municipal Corporation’s Hindu Rao Hospital have decided to sit on indefinite agitation from Monday onwards. The emergency services will, however, operate smoothly.

The doctors and staff members of the hospitals have not been paid since June. Last week, the staffers were on a ‘Pen Down Strike’ from 9 a.m. to 12 p.m. to display their ordeal. According to the civic body, the matter is being looked into.

The letter written by the Resident Doctor Association to the hospital administration stated, “We apologise to announce that we are forced to go for an indefinite agitation w.e.f. October 5, 2020 considering strictly ‘No pay, No work’, while operating the emergency services smoothly.”

It added, “The chronic sufferings of the staff have been too agonizing and intractable where it is distressing to one’s mental and physical well-being, We strongly plea to you for releasing 3 months’ pay and giving us an immediate permanent solution. We also demand a formal notice regarding the same.”

The association rued that despite the High Court Order and repetitive intimations in the past, the salaries of North MCD doctors and staff are long overdue for three months and its ongoing four months.

Besides Hindu Rao hospital, doctors and nurses of other hospitals like Maharishi Valmiki Infectious Diseases, Kasturba Hospital, Girdhari Lal Maternity Hospital and Rajan Babu Institute of Pulmonary Medicine and Tuberculosis have also been protesting over non-payment of dues.

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#NEET: Paying Irrational Fee for Medical College Seat: An Unwise Idea


At a time when medical students and even doctors are uncertain whether opting for medical college along with the vulnerability and risk associated with   becoming a doctor is worth it or not, some are naive enough to pay millions as fee for medical education and for securing a seat of MBBS.

     A famous axiom “as you sow so shall you reap” has an application to health system. One is convinced that industry selling medical college seats has been quite powerful and practically, every technique to sell seats is prevalent to bypass the merit and deny seat to deserving candidates. These meritorious children, who are denied seats could have been   good doctors and   real custodian for the health of people.  But if for some reason, business prevails and government fails to prevent this cruel and corrupt selling of medical seats, an Einstein brain is not required to guess the whole malaise prevalent in health system

         Truth cannot remain hidden for long.  It has to be realized that getting into medical college is a minuscule component of the process of becoming a good doctor.  Once they opt for this profession, the real tough and prolonged battle begins. Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it, especially those who may have invested in heavy fees and in debt.

   Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession

Paying the irrational fee of medical colleges may be an unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way forward or fail to get residency.

The government should regulate these fees and also ensure that if a heavy fee is charged, then it should be spent on medical education of students only. It should not take a form of just any another money minting industry to be used for other purposes.

        Going by selection criteria  of candidates as doctors, if given a choice, by whom a patient will like to get treated? A candidate who scored 20% – 30 % marks or a person getting 60% or 80% marks. NEET eligibility getting lower and  candidates getting around 30 % of marks  may be able to secure a degree to treat patients.  What will be the deciding factor? So in the end, seats remain unfilled and may be a kind of auction, whosoever can pay millions, takes the seat.

    Ironically, that strange equation is acceptable in lieu of money paid!

It is ironical that the medical profession is regulated, but medical business or medical education is not.  Such business of producing doctors based on their paying capacity should be clearly trounced for the benefit of public. Foundations of healthcare should be on touchstone of merit, ethics and character and not based on business deals.

       Therefore meritorious students, especially from average backgrounds, who opt to become doctors feel cheated when they pay massive fee to buy a seat. It is an insult to the very virtue of merit which should have been the sole criteria for these admissions.

     It is the people and society, who will be the real sufferers in future. Therefore resentment to such system should come from the society.  If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors.

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   21 occupational risks to doctors and nurses

   Covid paradox: salary cut for doctors other paid at home

Dr Deben Dutta Mob Lynching & Murder: Lesson for Doctors


Dr Deben Dutta   lynching and murder by mob in Assam last year, was a new low in the current era of deteriorating doctor- patient relationship. In the era, where consumerism was imposed on doctors in most crude form, media and law industry taking advantage of the situation for their benefit.  Complexity of medical science has taken a back seat. The consequences and the brunt of resultant negativism were borne by doctors. Dr Deben Dutta was victim of venomous negativism spread by media against doctors in general.

     Every incidence of verbal, legal, and physical assault is a trust breaker. It is not only erosion of patient’s trust on doctors but the vice versa is also true.  As a rule of nature, as violence increases, compassion decreases. Patients might get their revenge for one stray incident, but they will lose compassion and trust of doctors in the long run. Millions of lives saved everyday by medical professionals were of no consequence.

   GUWAHATI: An Assam court on Tuesday awarded death sentence to a tea garden worker and life imprisonment to 24 others in connection with last year’s lynching of a 73-year-old doctor. Dr. Deben Dutta, a senior medical officer of the Teok Tea Estate hospital in Jorhat district, was lynched by a mob on August 31 last year for his alleged delay in treating a worker, Somra Majhi. Dutta was attacked with sharp weapons and he succumbed to his injuries on the way to a hospital. He had served at the tea garden for over four decades. His killing had triggered widespread outrage.

   The impunity   with which attendant easily and brutally assault doctors is really appalling.  Should  such incidents  be shameful to law enforcing agencies? Are we a lawless society? More problematic is the government apathy and silence of bodies like human right commission.

          In this case, at least the culprits have been brought to book and punished by the court. But still the root cause for such gruesome incident is not addressed. The danger for the medical fraternity is still lurking due to many factors. Risk to the doctor not only comes from the infectious diseases, but can be there because of physical and legal assaults. It can be just consequent  to  venting out  emotions of angry relatives, resulting from a  natural  poor prognosis, but blaming the doctor. Doctors who are universal common link present at the time of death of patients, become victims and punching bag.

       There are lessons to be learnt by doctors from such episodes. As patients are turning into   consumers, health providers cannot remain simply doctors as before. They need to develop skills to anticipate danger and save themselves.  They need to assess their place of work for their own and their family’s safety.

      Aspiring doctors should choose this profession carefully and take a well informed decision.  Such incidents are warning signs for the young generation, who are oblivious   and ignorant to the risks faced by doctors in present era.

   Advantages-Disadvantage of being a doctor

   25 factors- why health care is expensive

   REEL Heroes Vs Real Heroes

   21 occupational risks to doctors and nurses

   Covid paradox: salary cut for doctors other paid at home

Admin Apathy- Kerala Doctors to Protest State’s ‘lack of concern’


         Doctors and nurses are now  getting out of their own self-imposed moral enslavement. Rather they are now forced to do so, as their lives and deteriorating working environment are becoming impossible to be in. One cannot burn himself in a furnace for eternity, for the well-being of others, especially if others are not concerned.

      The incidents at few places are just a tip of the iceberg. Covid has helped doctors to bring forth their plight. Doctors and nurses not paid for months in some Delhi Hospitals.  Doctors openly ridiculed and scolded by Administrators for no fault of theirs. Even a doctor lynched by mob in Assam and many assaulted at other places. Hospitals vandalized indicate that there is danger lurking for doctors everywhere. Most sad part is that, there are no firm administrative hands to deal with the menace.

     Clearly Well being of doctors and nurses is not being taken care of. They are being used as dispensable disposables. Such system, which is based on exploitation of the health workers, is becoming fast unsustainable. If apathy towards their genuine problems continues, negative attitude towards doctor and nurses persists,  it will kill the empathy towards patients as well.

 Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

Government doctors in Kerala to boycott additional duties

    The Kerala Government Medical Officers’ Association (KGMOA) has declared that government doctors will stay away from all additional duties from Thursday, in protest against the government’s apparent lack of concern about the plight of health-care workers who are overworked and fatigued, fighting on the front lines for the past nine months.

  The KGMOA has, however, made it clear that while declaring non-cooperation, COVID-19 care and disease containment activities will not be disrupted.

In a statement issued here, the KGMOA said that apart from ignoring the KGMOA’s repeated demand for deploying additional human resources in COVID-19 care activities, the government’s decision to take away the leave given to health-care workers after continuous COVID-19 duty was something that defied all principles of fairness. This was totally unacceptable, the KGMOA said here.

   Advantages-Disadvantage of being a doctor

   25 factors- why health care is expensive

   REEL Heroes Vs Real Heroes

   21 occupational risks to doctors and nurses

   Covid paradox: salary cut for doctors other paid at home

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