If 2020 was consumed by Covid Virus , the next year 2021 will be for Covid vaccination.
All over the world, billions of people are going to get vaccine.
Corona vaccination is one of the most anticipated events in every country. in coming weeks, multiple vaccines are likely to get regulatory approval.
However, while making a good vaccine was the difficult part, earning trust of public in vaccine is going to be another one. Especially the hurried development at Pandemic speed and lack of awareness about safety issues will be areas of concern.
The adverse events, which are unexpected medial problems that occur with drug treatments, are unavoidable part of any treatment, including vaccine science.
The system need to be in place to identify the causal relationship between vaccine agent and the adverse event. The objective criteria have to be in place to identify and treat, as the population to be vaccinated is also very large.
The main hurdles equally challenging will be sourcing, distributing and giving the actual vaccination doses.
The preparation for mammoth exercise will also be a herculean task. It may take months to get ready to supply and build the chains and preparation for this need to begin now.
A systematic approach needs to be ready, so that the process of vaccination gets on smoothly and quickly, as soon as the doses are available. For example, the need for transport vehicles and the storage facilities for billions of doses at distant places will be one of challenges.
It will take mammoth number of healthcare workers, who will vaccinate people at different towns and cities.
This exercise, if not done in a well-planned manner, could result in chaos. The failure to set up a system will not only result in suboptimal vaccination but also non uniform supplies. Maintaining the cold chain will be crucial for effectiveness.
People should get it based on needs rather than black marketing or money power. The issues which look insignificant like the financial complexity among various stake holders or customer clearances need to be settled first, as they may become significant hurdles for smooth distribution.
Most important would be to safeguard citizen’s faith in vaccine and clinical trials. As for the future science to develop, would require people’s co-operation, faith and participation.
Government regulators and Vaccine makers need to recognize the utmost importance of the communication about the true results of trials and effective communication with the public. The misinformation and distrust should not undermine the good work of medical science and advancements.
There are two important aspect of a successful vaccine,
1. Efficacy for the prevention
Given that the Covid vaccine is needed urgently and will be developed within a years’ time, some doubts about the safety aspect are natural. But safety can be assured, if the data about side effects is made public.
All the companies in a bid to rush their vaccine into the market, are eager to create an hype. But a caution need to be exercised against such hyping, especially when long term safety data is not available.
Even the sparse details of the severe side effect, that leak into the public domain, may be just tip of the iceberg, as far as long term safety data of a vaccine is concerned.
All the side effects, mild or severe, need to be made known and in public domain, rather than exposed later after the use.
More than a month and a half after an adverse event occurred in a clinical trial in India of the AstraZeneca vaccine, the Central Drug Standard Control Organisation (CDSCO), the regulator for vaccine trials, has not issued any statement on the occurrence. It also did not respond to queries about whether it has completed its investigation to determine if the trial participant’s illness was related to the vaccine. Serum Institute, which is partnering the pharma MNC and Oxford University for producing the vaccine in India, has also refused to comment. This is in sharp contrast to AstraZeneca and Oxford University going public when one of the trial participants in the vaccine trial in the UK fell ill and halting the trial till an independent safety monitoring board and UK’s regulatory authority gave safety clearance. Information about the occurrence of the serious adverse event (SAE) during the vaccine trial in India came from the family of the trial participant, which has sent the company and the regulators a legal notice. Serum Institute merely stated that it would issue an official statement next week. AstraZeneca had issued a statement within days of the trial participant in UK falling ill and halted the trials across the world in the UK, Brazil and South Africa. The trial was resumed within a week after the independent safety review committee and national regulators gave clearance. The Indian Council of Medical Research is a co-sponsor of the trial along with Serum Institute.
According to the ICMR, it is for the DCGI to take a call on whether or not to halt the trial. The DCGI heads the CDSCO.
The 40-year-old trial participant, a business consultant with an MBA from New Zealand who says he took part in the trial deeming it his duty to help such an important venture, was administered the vaccine at SRMC on October 1. Eleven days later, he woke up with a severe headache, and progressively lost his memory, showed behaviour changes, became disoriented and was unable to talk or recognise his family members, according to the legal notice. As soon as he fell ill he was admitted to the ICU in SRMC.
“Though the legal notice we have served talks of a compensation of Rs 5 crore, our focus is not on monetary compensation. It was sent just last week, more than a month after the occurrence when we saw that none of the authorities was making the adverse event public. They ought to have warned other participants so that they could watch out for similar symptoms. We want to know why the occurrence of the adverse event has been kept under wraps and why the trial was not halted like it was done in the UK. Is an Indian life of less value than that of an UK citizen?” asked a close family friend who has been helping the family cope with the illness.
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.
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.
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.
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.
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.
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.
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.
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.
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 work: excessive 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 industry; Windfall 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.
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.
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.
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.
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.
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.
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 realsufferers 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.