Fish Bile ‘Treatment’ Lands Woman in Hospital- Folly of Fringe Theories in medicine


    It has become a common practice to advertise health products or therapies that claim to be panacea for all ailments enhance immunity, to increase power and health by creating an impression on minds on various platforms. Instead of producing scientific evidence, such products and therapies are sold under disguise of natural therapies or alternate medicines. Needless to say, the objective evidence or global neutral trial for the claimed efficacy or about real side effects is always missing.

    Companies have created huge fortunes based on circulation of such pedagogic narratives and social knowledge. But in real sense, these are actually chemical and have biological actions and reactions. Chemical derived from natural sources can have side effects and contain impurities.  Global neutral trials to validate effects and side effects remain an urgent need of the hour for all health products.

   Suffering for the common public is immense. Doctors’  sincere warning had no effect rather they were called as medicine mafia.   Unfortunately  false beliefs  like local religious figures can cure cancer and kidney diseases  cause they could communicate with invisible spirits  and gain knowledge. Unsurprisingly the cranks  have been  wrong and innocent patients suffer.   Doctors objecting to  elevation of  crank theories were painted as  western medicine agents,  or nattering nabobs of negativity.

 Here is an example of the folly of following fringe  theories.

Fish bile ‘treatment’ lands woman in hospital

Fish bile ‘treatment’ lands woman in hospital

 A 52-year-old homemaker from Dum Dum had to undergo a few rounds of dialysis and was put under intense critical care for a renal failure, triggered by ‘fish bile poisoning’. The patient had ingested raw fish bile for four consecutive days as a treatment to cure her diabetes prior to being rushed to Manipal Hospitals Kolkata with acute abdominal pain. Doctors at the Salt Lake hospital found the patient had low blood pressure and was in a state of shock. Initial reports showed a significant derangement of liver and kidney functions. It led doctors to treat common causes of liver and kidney injuries or drug induced organ damage. When further tests didn’t match with these diagnoses, the team started looking for a possible cause. The patient then revealed she had ingested bile of Rohu fish for four days to control her diabetes. “Consuming fish bile causes acute kidney and liver injury with the need to go for long term dialysis. This patient had to be put under dialysis within 72 hours of admission,” said internal medicine and critical care consultant. She was discharged from hospital after a month.

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Doctors in Israel Protest Violence against Medics


          Violence against doctors has become a serious issue in India. But problem is a global one to some extent. The underlying basic  reason for the omnipresent malaise is the altered doctor-patient equation globally and growing mistrust in the saviours. The mistrust is propagated by opportunist medical industry, media and law industry for their selfish motives as doctors are shown as front men for the failures.  Poor outcomes are projected because of medical errors and mistakes. Every death is thought to be because of negligence rather than a natural complication of the disease.  Because of the instigation and poor law enforcement in favour of doctors, the response of  lay public to these unfortunate incidents has become extremely erratic and out of proportion. As Governments remain more or less indifferent, and doctors have become punching bags for inept health systems.  Law industry has been enormously benefited financially due to medico-legal cases against doctors. Media has sold their news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations.  An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors.  Local goons have blackmailed doctors over genuine complications and the natural deaths occurring in hospitals.    There is a little token action by police after routine incident of violence against doctors.

  Consequently violence (legal, verbal or physical) against doctor has acquired an epidemic proportion, omnipresent world-wide. As a result, medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.

   But in Israel, doctors seem to be united against this menace and their associations are actively pursuing the issue.

          Doctors in Israel to Protest Violence against Medics 

The strike was called after family members of a patient who died at a Jerusalem hospital on Monday attacked medical staff and caused significant damage to the intensive care unit after they were informed of his death.

The union said the hospitals and clinics would operate on a weekend schedule for 24 hours on Thursday, offering reduced services.

 

 

Union calls for attacks on medical staff to be treated as severely as attacks on police; action comes after patient’s relatives ran amok in Jerusalem hospital

Staff at public hospitals and clinics will strike on Thursday to protest violence against medics, the doctor’s union announced Tuesday.

The Israel Medical Association, announcing the strike, called for a police presence in every emergency room, and said hospitals and community clinics needed improved security systems. The association also urged a change in legislation so that an attack on medical staff would be viewed with the same severity as an attack on a uniformed police officer. The chairman of the Israel Medical Association, Prof. Zion Hagay, said that Thursday’s strike would be just the start of action taken by the medical establishment if changes were not made to protect workers.

“We have long announced that we will not accept any more incidents of violence in the health system, and it has unfortunately become a real epidemic,” Hagay said at the start of the association’s meeting on Tuesday evening. “The lives of doctors must not be abandoned, and this initial strike is only a warning.”

“As long as the Israeli government does not immediately take the necessary steps to increase the personal security of medical staff, we will not hesitate to increase  it.There has been no announcement from the nurses’ union on whether they will be joining the strike.

The strike comes in the wake of violence at the Hadassah Medical Center in Jerusalem after a patient died there on Monday.

An initial investigation found the patient died after taking an overdose, police said, without giving further details.

Relatives of the man arrived at the hospital and were notified of the patient’s death.

After they were given the news, a number of the patient’s relatives broke doors and windows in the unit, damaged the nurse’s station, computers, and equipment, and attacked staff. Two members of staff were lightly injured, requiring medical treatment.

Police said they arrested an East Jerusalem resident in his twenties on suspicion of being involved in the violent clash at the medical center.

Recent months have seen an increased wave of attacks against medical teams and facilities across the country.

In November, nurses at Haifa’s Rambam Medical Center held a strike for several hours in protest of a violent incident in which staff members were beaten and threatened by the family of a dying cancer patient.

Earlier the same month Rambam said it had to forcibly remove dozens of people who gathered outside the facility after a victim of violence was brought there for treatment. According to hospital officials, riot police were called to the scene to prevent the crowd from entering the hospital.

And in Beersheba, four people were hurt and 19 were arrested in a massive brawl outside Soroka Medical Center that included gunfire.

In 2017, in one of the most severe cases in recent years, a man burned 55-year-old nurse Tova Kararo to death at the Holon clinic at which she worked.

Nurses already held multiple strikes this year and last year over severe staff shortages during Covid, which resulted in additional state funding. 

A doctor and three nurses at Rambam Medical Center in Haifa were assaulted last month by relatives of a cancer patient. Staff were beaten and threatened by the family of the patient, who eventually died, The Times of Israel reported.

Chairwoman of the National Association of Nurses, Ilana Cohen, said at the time that if the government did not take action to fight such violence, “we’ll hold a strike throughout the entire health care system.”

“War has broken out here,” Benny Keller, the head of Rambam’s security, told the Kan public broadcaster Wednesday, according to The Times of Israel

“Two or three times a week, the hospital turns into a battlefield between warring clans.”

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Online Health Service Aggregators- New Commission Agents in Medical Business: Increase Cost


 

India features a mixed-market health system where chronically low investment in public health systems has led to the proliferation of private care providers.  In last few years, a bevy of apps and service aggregators have starting operating brazenly in the country, pushing aggressively for tests and surgeries and delivering drugs, often advertised by Superstars and Celebrities. Patient often zigzags between health providers with unclear referral pathways, and ends up receiving questionable quality of care that may typically neither be safe nor affordable.   

       Online health aggregators are nothing more than sophisticated commission agents. The medical business model thrives on advertisement and commission. Government rules prevent doctors from advertising or soliciting for surgeries, but these companies live on advertising. Any doctor or hospital can get advertised through these companies. In lieu of some money, anyone can be declared as the best and hence misguidance to the patients cannot be ruled out. The flow of patients to a health care facility can be enhanced by financing the advertisements and not by actual quality work and results in increasing medical business manifold.  They do not contribute to much needed medical infrastructure and merely redirect patients to existing facilities. They may at the best be able to  become facilitators of the process that attract patients by advertisements and  result in skyrocketing cost to patients. Any of the Hospitals and doctors can be projected as the best, who tie up with these online aggregators in lieu of some money. Therefore the misguidance as well as increased costs is the two main drawbacks of such a lucrative arrangement of this new medical business.  They charge hospitals and doctors for advertisements ( sending more patients) and patients for channelizing them. In the resulting Zig-Zag path, patients are treated more on the basis of advertisements that are many times aired by our ‘Filmy Superstars’.

The health service aggregators have no skin in the game. Neither do they invest in hospitals nor do they have the responsibility of running a hospital, but they want the money which a patient will spend on their health in a hospital. They have conveniently created online apps and are ranked top on search websites. This whole process is against the values and ethics, which healthcare delivery is supposed to be.

Unregulated operations by unscrupulous online health service aggregators pose grave risk to public health.

   

Unregulated operations by unscrupulous online health service aggregators pose grave risk to public health.

  The damage caused by the unchecked presence of health service aggregators online is snowballing into a major healthcare crisis which the Union and state governments can ill afford to ignore. Instead of becoming a part of the solution, they have added to the problem by pushing aggressively for tests, surgeries and healthcare services without any medical requirement or prescription.

  There are plenty of  such apps which advertise about doctor consultations, quick surgeries and direct-to-consumer laboratory tests.

       This is where the trouble begins.

In one  case, the  healthcare aggregator suggested surgery for constipation. The mention of surgery scared the patient, who then approached a hospital where they advised him to improve his diet.

For a kidney stone issue, a healthcare aggregator suggested a laser surgery  to a patient without consulting a urologist. The laser surgery was done and the stones got stuck in his pelvi-uretery junction of the kidney-uretery track. He  became aware of it two weeks later when he had severe pain in his flank, because of which he walked in to a hospital after the app refused to acknowledge his concerns.

In all of these cases, the apps charged almost double the existing rates for surgeries. For a piles operation, in a general ward, a hospital charges between Rs 50,000-70,000, inclusive of medicines in a patient without co-morbidities. The apps charged between 1.25 lakh to 1.5 lakh, while the national public health insurance scheme Ayushman Bharat rates for such surgeries begin at Rs 10,000.

Ads are being run by online health service aggregators in newspapers and all  kind of  media.

For removal of kidney stones, hospitals charge Rs 50,000, while the apps charge upwards of Rs 1 lakh, while on the government’s Ayushman Bharat scheme, it is Rs 33,000.

Circumcision is priced at Rs 60,000 by the healthcare aggregators, when hospitals charge Rs 10,000 for a surgery such as this and it is Rs 3,000 for those availing it using Ayushman Bharat.

Their modus operandi? The healthcare aggregators have tie-ups with certain departments in certain hospitals, where after the app does the diagnosis, a doctor on their payroll is sent to the hospital to perform the surgery. After the surgery, the doctor walks away without any care and the patient is left at the hospital until he gains consciousness. At which point, if there is any immediate post-operative care, the nurse concerned does it based on the instructions of the doctor who left. Then the patient checks out.

    A fee is paid by these healthcare aggregators to these hospitals for use of the premises for the surgery. In most cases, they approach smaller hospitals where either the top administration turns a blind eye towards these activities.    Sometimes, the  doctor who performed the surgery may not be  on their rolls, but that from a healthcare aggregator.

 “The health service aggregators  have no skin in the game. Neither do they invest in hospitals nor do they have the responsibility of running a hospital, but they want the money which a patient will spend on their health in a hospital. They have conveniently created online apps and are ranked top on search websites. This whole process is against what healthcare delivery is supposed to be,” said Dr Jagadish Hiremath, CEO of ACE Suhas Hospital in Bengaluru.

Government rules prevent hospitals from advertising or soliciting for surgeries, pointed out Hiremath, but these companies live on advertising.

Such health care aggregators are feeding off hospitals and they need to be regulated. “If you remove the advertisements, these companies don’t exist. They have no physical presence except for a few labs or clinics,” he added.

“The problem is getting compounded by these discounts and offers for unnecessary medically and unwarranted testing in the name of wellness/immunity packages. It is a price war to offer maximum number of tests at lowest prices which is totally meaningless,” highlighted Malini Aisola, co-convenor of All India Drug Action Network (AIDAN)

These online health service aggregators have added to issue of illegal pathology laboratories mushrooming all over, pointed out Dr Jagadish Keskar of the Maharashtra Association of Pathologists and Microbiologists

  Almost all of them have roped in big names as brand ambassadors – actor Hrithik Roshan, Amitabh Bachchan, singer Guru Randhawa, Rahul Dravid, actor Sonu Sood, actor Rajat Kapoor,  Neha Dhupia, Yuvraj Singh and Randeep Hooda to talk about specific health issues and MS Dhoni.

   “They have all these famous names as brand ambassadors as if they will perform the surgeries or look at your blood in a lab. This confuses the public, who are already bombarded with too much information,” quipped Hiremath.

     Consumer Drug Advocacy group All India Drug Action Network (AIDAN) argued that the direct-to-consumer advertising has to stop completely. “It is too dangerous in healthcare. Aggregators are inducing demand when people are at their most vulnerable due to the pandemic. They are pushing promotions and offers on tests and surgeries and healthcare services without medical assessment or prescription,” said Aisola.

There is a danger particularly with surgeries, contended Aisola, because this could lead to bypassing medical opinions and identifying alternative treatments. When doctors, hospitals and labs associate themselves with the aggregators, there are ethical issues too, she pointed out.

The practice of doctors associating themselves with these healthcare aggregators have alarmed several doctors’ associations. Association of Minimal Access Surgeons of India (AMASI) wrote to its members stating that any member who has made such a contract with healthcare aggregators should disengage immediately failing which a member found to be in contract thereafter may be liable for disciplinary action by regulatory authorities.

They warned that any litigation arising from such practices will not be defended by the association during legal process by way of expert opinion or otherwise.

“It jeopardizes adequate clinical judgment by a trained person regarding need for surgery and decision as to the type of surgery that would be optimum for the particular patient. The apps are made for the sole purpose of making money,” said the AMASI notification.

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 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

CJI Ramana’s Concern about Violence against Doctors: too Mild a Remedy, Need Concrete Action


            

            While violence against doctors should be a concern to everyone, more so for the public, but sadly everyone in society has preferred to take advantage and reap benefit of the situation at the cost of doctors. Government has remained more or less indifferent, whereas people don’t have minimum basic health amenities and doctors have become punching bags for inept health system.  Law industry has been enormously benefited financially due to medico-legal cases against doctors. Media and celebrities have sold their shows and news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations.  An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors.  Local goons have blackmailed doctors over genuine complications and the natural deaths occurring in hospitals.  There is a little token action by police after routine incident of violence against doctors. Consequently medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.  Actually public needs to be concerned as the society itself is going to suffer in the long run,  not realizing  that people themselves are responsible for their health problems and not the doctors. 

     At this stage, Chief Justice of India N V Ramana on Saturday expressed serious concern over rising violence against upright and hardworking doctors and lodging of false cases against them.  The show of concern is nice gesture, as problem is clearly evident to all, but merely  expressing a concern at this stage is too mild a remedy.  When cancer is in late stages and  needs a radical surgery,  applying an ointment will not work.

Rising violence against doctors saddening, they deserve better: CJI Ramana            

Rising violence against doctors saddening, they deserve better: CJI Ramana

Chief Justice of India N V Ramana on Saturday expressed serious concern over rising violence against upright and hardworking doctors and lodging of false cases against them. The CJI said that he would also like to pay his tribute to the unending spirit of doctors, who work tirelessly round the clock for their patients. Doctors are mentors, guides, friends and counsellors. They should always remain active members of society, and solve problems faced by the people,” he said. The CJI said, “I am extremely saddened to witness rising violence against doctors. Several false cases are being lodged against upright and hardworking doctors. They need a better, and more secure, working environment.  This is where professional medical associations assume great significance. They have to be proactive in highlighting the demands of doctors.”  The CJI also expressed concern about the healthcare system in India and said that more than 70 per cent of the population resides in rural areas where people don’t have minimum basic amenities, forget about the comfort of corporate hospitals.

“Even Primary Health Centres (PHC) are also not properly equipped, if there is a PHC there are no doctors and if there is a doctor, there is no PHC. If both are there, there is no infrastructure. This is the situation in this country and in this scenario this type of affordable technique of detecting cancer through ultrasound at the preliminary stage is very helpful,” the CJI said.

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   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

A comparison of imparting Justice Vs Health: Grave injustice to medical professionals


        Justice is needed for satisfaction of soul and peaceful mind, is of same importance what is to the health of body. Justice delayed gives a sense of hurt and pain to soul. Pendency in courts simply reflects the grave injustice people are living with.

 Pendency in courts casts a ‘pall of gloom’, presents a hopeless situation: AG

          Justice and Health- Both are crucial for happiness of the living beings as well as society as a whole.  Hospitals are full of patients and so are courts with litigants. None of the people go to hospital and courts happily and everyone invariably wants early relief.

   Compare the situation in courts with a hospital.  Once a patient visits hospital, he will be treated almost instantaneously; irrespective how many patients’ doctors might have to examine in a day or night. There is almost nil pendency in hospitals, be it day or night, emergency or routine cases.

     Now can we expect similar treatment at courts? Do the people visiting courts are imparted justice in real sense.  Doctors get few minutes to decide. Most of the time, for the investigations and the treatment few visits are required. But there is no pendency. In Government hospitals, even appointments are not given. A doctor sitting in outdoor will see hundreds of patients. On emergencies night duties, doctor will not be able to count how many he/she has stabilized or numbers treated.

      Even in such chaotic systems, doctor can be punished, dragged to courts or assaulted for unintentional mistakes, that are  almost always secondary to load of patients or inept infrastructure.

     The work at hospital continues day and night, 24 hours and 365 days, despite almost always lesser number of doctors and required manpower. Systems in hospitals  are designed and maintained meticulously   to have no pendency what-so-ever situation is.   Larger number of patients go back home treated well and very few unfortunate patients are unable to recover, but still whatever is required- is done invariably.

Pendency in courts casts a ‘pall of gloom’ , presents a hopeless situation: AG

NEW DELHI: India’s top law officer K K Venugopal on Friday said litigants’ fundamental right to speedy justice lay in tatters and implored country’s top judges to take drastic measures to arrest their waning confidence in justice delivery system caused by monstrous pendency of 4.8 crores cases, many for decades. When we look at the pendency, a pall of gloom settles. We find that we are in a hopeless situation,” Venugopal said, “How has the justice delivery system deteriorated to this extent? If you look at the pendency over the years, we realise that over a lakh of cases are pending for more than 30 years at trial court level and 10-15 years in HCs. How do you believe that so far as litigants are concerned they would have confidence in the justice delivery system?” “But against whom the poor litigant can complain, or an under trial who is incarcerated for a number of years which he would have undergone had he been convicted and punished? Do they file a case for enforcement of their fundamental right? But against whom?

44 million pending court cases: How did we get here?

       There are about 73,000 cases pending before the Supreme Court and about 44 million in all the courts of India, up 19% since last year.

According to a 2018 Niti Aayog strategy paper, at the then-prevailing rate of disposal of cases in our courts, it would take more than 324 years to clear the backlog.

Grave injustice for medical professions:

  1.  A doctor making wrong diagnosis (gets few minutes to decide) can be prosecuted, but courts giving wrong verdicts (get years to decide) are immune?

     2. Compare the remuneration of lawyers to doctors. Doctors gets few hundreds to save a life (often with abuses) and lawyers can get paid in millions (happily).

      3. Doctors treat the body and larger is still not fully known about mechanisms. Still doctors can be blamed for unanticipated events. Whereas  law is a completely known and written subject.

   4. If health is citizen’s right so should be a timely justice.

         Despite doing so much for patients, still people’s behaviour to doctors and hospitals is not respectful. Doctors are punished for slight delays and people and courts remain intolerant to unintentional mistakes. But people can’t behave in the same manner to courts and legal system and keep on tolerating the blatant injustice for years. 

     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

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

   

Myocardial ischemia-Complications-Prevention-Treatment 


Myocardial ischemia occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen. The reduced blood flow is usually the result of a partial or complete blockage of your heart’s arteries (coronary arteries).

Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle’s ability to pump blood. A sudden, severe blockage of one of the heart’s artery can lead to a heart attack. Myocardial ischemia might also cause serious abnormal heart rhythms.

Treatment for myocardial ischemia involves improving blood flow to the heart muscle. Treatment may include medications, a procedure to open blocked arteries (angioplasty) or bypass surgery.

Making heart-healthy lifestyle choices is important in treating and preventing myocardial ischemia.

Symptoms

Some people who have myocardial ischemia don’t have any signs or symptoms (silent ischemia).

When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris). Other signs and symptoms — which might be experienced more commonly by women, older people and people with diabetes — include:

  • Neck or jaw pain
  • Shoulder or arm pain
  • A fast heartbeat
  • Shortness of breath when you are physically active
  • Nausea and vomiting
  • Sweating
  • Fatigue

When to see a doctor

Get emergency help if you have severe chest pain or chest pain that doesn’t go away.

Causes

Myocardial ischemia occurs when the blood flow through one or more of your coronary arteries is decreased. The low blood flow decreases the amount of oxygen your heart muscle receives. Myocardial ischemia can develop slowly as arteries become blocked over time. Or it can occur quickly when an artery becomes blocked suddenly. Conditions that can cause myocardial ischemia include:

Coronary artery disease (atherosclerosis). Plaques made up mostly of cholesterol build up on your artery walls and restrict blood flow. Atherosclerosis is the most common cause of myocardial ischemia.

Blood clot. The plaques that develop in atherosclerosis can rupture, causing a blood clot. The clot might block an artery and lead to sudden, severe myocardial ischemia, resulting in a heart attack. Rarely, a blood clot might travel to the coronary artery from elsewhere in the body.

Coronary artery spasm. This temporary tightening of the muscles in the artery wall can briefly decrease or even prevent blood flow to part of the heart muscle. Coronary artery spasm is an uncommon cause of myocardial ischemia. Chest pain associated with myocardial ischemia can be triggered by: Physical exertionEmotional stressCold temperaturesCocaine useEating a heavy or large mealSexual intercourse Risk factors Factors that can increase your risk of developing myocardial ischemia include: Tobacco. Smoking and long-term exposure to secondhand smoke can damage the inside walls of arteries. The damage can allow deposits of cholesterol and other substances to collect and slow blood flow in the coronary arteries. Smoking causes the coronary arteries to spasm and may also increase the risk of blood clots.

Diabetes. Type 1 and type 2 diabetes are linked to an increased risk of myocardial ischemia, heart attack and other heart problems.

High blood pressure. Over time, high blood pressure can accelerate atherosclerosis, resulting in damage to the coronary arteries.

High blood cholesterol level. Cholesterol is a major part of the deposits that can narrow your coronary arteries. A high level of “bad” (low-density lipoprotein, or LDL) cholesterol in your blood may be due to an inherited condition or a diet high in saturated fats and cholesterol.

High blood triglyceride level. Triglycerides, another type of blood fat, also may contribute to atherosclerosis.

Obesity. Obesity is associated with diabetes, high blood pressure and high blood cholesterol levels.

Waist circumference. A waist measurement of more than 35 inches (89 centimeters) for women and 40 inches (102 cm) in men increases the risk of high blood pressure, diabetes, and heart disease.

Lack of physical activity. Not getting enough exercise contributes to obesity and is linked to higher cholesterol and triglyceride levels. People who get regular aerobic exercise have better heart health, which is associated with a lower risk of myocardial ischemia and heart attack. Exercise also reduces blood pressure.

Complications

Myocardial ischemia can lead to serious complications, including:

Heart attack. If a coronary artery becomes completely blocked, the lack of blood and oxygen can lead to a heart attack that destroys part of the heart muscle. The damage can be serious and sometimes fatal.

Irregular heart rhythm (arrhythmia). An abnormal heart rhythm can weaken your heart and may be life-threatening.

Heart failure. Over time, repeated episodes of ischemia may lead to heart failure. Prevention The same lifestyle habits that can help treat myocardial ischemia can also help prevent it from developing in the first place. Leading a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow.

Diagnosis

Your doctor will start by asking questions about your medical history and with a physical exam. After that, your doctor might recommend:

Electrocardiogram (ECG). Electrodes attached to your skin record the electrical activity of your heart. Certain changes in your heart’s electrical activity may be a sign of heart damage.

Stress test. Your heart rhythm, blood pressure and breathing are monitored while you walk on a treadmill or ride a stationary bike. Exercise makes your heart pump harder and faster than usual, so a stress test can detect heart problems that might not be noticeable otherwise.

Echocardiogram. Sound waves directed at your heart from a wand-like device held to your chest produce video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn’t pumping normally.

Stress echocardiogram. A stress echocardiogram is similar to a regular echocardiogram, except the test is done after you exercise in the doctor’s office on a treadmill or stationary bike.

Nuclear stress test. Small amounts of radioactive material are injected into your bloodstream. While you exercise, your doctor can watch as it flows through your heart and lungs — allowing blood-flow problems to be identified.

Coronary angiography. A dye is injected into the blood vessels of your heart. Then a series of X-ray images (angiograms) are taken, showing the dye’s path. This test gives your doctor a detailed look at the inside of your blood vessels.

Cardiac CT scan. This test can determine if you have a buildup of calcium in your coronary arteries — a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (coronary CT angiogram).

Treatment

The goal of myocardial ischemia treatment is to improve blood flow to the heart muscle. Depending on the severity of your condition, your doctor may recommend medications, surgery or both. Medications Medications to treat myocardial ischemia include:

Aspirin. A daily aspirin or other blood thinner can reduce your risk of blood clots, which might help prevent blockage of your coronary arteries. Ask your doctor before starting to take aspirin because it might not be appropriate if you have a bleeding disorder or if you’re already taking another blood thinner.

Nitrates. These medications widen arteries, improving blood flow to and from your heart. Better blood flow means your heart doesn’t have to work as hard.

Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure so blood can flow to your heart more easily.

Calcium channel blockers. These medications relax and widen blood vessels, increasing blood flow in your heart. Calcium channel blockers also slow your pulse and reduce the workload on your heart.

Cholesterol-lowering medications. These medications decrease the primary material that deposits on the coronary arteries.

Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels and lower blood pressure. Your doctor might recommend an ACE inhibitor if you have high blood pressure or diabetes in addition to myocardial ischemia. ACE inhibitors may also be used if you have heart failure or if your heart doesn’t pump blood effectively.

Ranolazine (Ranexa). This medication helps relax your coronary arteries to ease angina. Ranolazine may be prescribed with other angina medications, such as calcium channel blockers, beta blockers or nitrates.

Procedures to improve blood flow

Sometimes, more-aggressive treatment is needed to improve blood flow. Procedures that may help include:

Angioplasty and stenting. A long, thin tube (catheter) is inserted into the narrowed part of your artery. A wire with a tiny balloon is threaded into the narrowed area and inflated to widen the artery. A small wire mesh coil (stent) is usually inserted to keep the artery open.

Coronary artery bypass surgery. A surgeon uses a vessel from another part of your body to create a graft that allows blood to flow around the blocked or narrowed coronary artery. This type of open-heart surgery is usually used only for people who have several narrowed coronary arteries.

Enhanced external counterpulsation. This noninvasive outpatient treatment might be recommended if other treatments haven’t worked. Cuffs that have been wrapped around your legs are gently inflated with air then deflated. The resulting pressure on your blood vessels can improve blood flow to the heart. Lifestyle and home remedies

Lifestyle changes are an important part of treatment. To follow a heart-healthy lifestyle:

Quit smoking. Talk to your doctor about smoking cessation strategies. Also try to avoid secondhand smoke.

Manage underlying health conditions. Treat diseases or conditions that can increase your risk of myocardial ischemia, such as diabetes, high blood pressure and high blood cholesterol.

Eat a healthy diet. Limit saturated fat and eat lots of whole grains, fruits and vegetables. Know your cholesterol numbers and ask your doctor if you’ve reduced them to the recommended level.

Exercise. Talk to your doctor about starting a safe exercise plan to improve blood flow to your heart.

Maintain a healthy weight. If you’re overweight, talk to your doctor about weight-loss options.

Decrease stress. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. It’s important to have regular medical checkups. Some of the main risk factors for myocardial ischemia — high cholesterol, high blood pressure and diabetes — have no symptoms in the early stages. Early detection and treatment can set the stage for a lifetime of better heart health.  

     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

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Why buying a medical college seat & paying millions may be a blunder?


    The painful incident of Dr Archana Sharma’s Suicide unmasks the everyday struggle of the doctors in the present era. Her supreme sacrifice depicts the plight of doctors- being undervalued and demonized, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment.  Her suicide has unveiled the despondency, moral burden of mistrust that doctors carry. Her death is the result of the apathy of fair justice that eludes medical community. Sadly, the society is unable to realize its loss.

    Negligent police, indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment.  It may not be a good idea to opt for a medical career any more. In the present circumstances, when doctors themselves are doubtful about the advice for choosing medical career, some people are naïve enough to spend millions on securing an expensive medical college seat.  Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted   about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.

Disadvantages of being a doctor, Drawbacks of Medical profession: 

Choosing medical career  or being a medical professional  a disadvantage to doctor in comparison to other professions?

  1. Medical courses are comparatively lengthy and expansive study course and difficult training with slave like duties. “enslavement of doctors”.
  2. Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.  They have to just flow with system ultimately.

3.Hostile environment for doctors to begin: Suddenly young and bright children complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

  • Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
  • The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
  • Blamed for all malaise: The society gets biased because of the   media reports and some celebrity talking glib against medical profession. The blame for inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
  • Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
  • Risk to doctor himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include   tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.
  • Unrealistic expectations of society:  Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.
  • Retrospective analysis of doctor’s every action continues all the life: It could be by patients and relatives every day in the form of “Why this was not done before?” Every day irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

The decision taken in split seconds will be questioned, which  in retrospect  may not turn out to be the best one. But later retrospective analysis along with wisdom of hindsight with luxury of time  (in courts) may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with patients makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

  1. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.
  2. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
  3. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession:  It is heart-breaking to watch  zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure 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 disadvantage for medical profession.
  4. 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, which use pressure tactics to get their own way.

       It may be a  naïve idea  or just a blunder to pay millions to be a doctor.

     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

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

‘Doctor- Save Yourself’: Court Convicts Doctors For Operating Woman Without Ventilator


A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other lifesaving equipment.  This was despite the fact that  the committee constituted by the District Surgeon to verify the allegation of medical negligence in its final report has said there is no negligence on the part of the accused during the performance of the LAVH surgery and also shows  *how the accused have tried to save the deceased.”*

What is worrying for the doctors is that every death during medical treatment can be a blame against the doctors. If the courts were to impose criminal liability on the hospital and doctors for everything that goes wrong, the doctors now should be more worried about their own safety than giving all the best treatment to their patients.     Both Government and Private  small hospitals carry out  thousands of routine surgeries every day. Occasionally complications may arise  in simplest looking procedures – for example even in   normal deliveries; what to say about routine surgeries.         How many hospitals (Government and private) in districts, town in peripheries are equipped with a ventilatory support system?  Perhaps  they are too less, although an honest count would  be some  interesting data.  Still, surgeries of the type mentioned are conducted  routinely  in almost all of these small centres.

So based on one incident of this kind, the thousands of surgeries done in such areas are going to be affected. In other words, doctors will not dare to conduct surgeries in peripheries.       As per the verdict of the court, many of the surgical speciality’s doctors in periphery are indulging in blameworthy activities every day in their routine work. Why should they risk their lives and profession in such circumstances?   That raises  another question , as many  Government  Hospitals are also without ventilators in the periphery. Should Govt doctors also  refuse surgeries without an ICU setup?  Any Surgery or even normal delivery in rare circumstances can get complicated and  the patient may require ventilator. Usually anaesthetist use Ambu-bag for an emergency situation and transport the  patient to other facility. So absence of a  ventilator is not life threatening in a real sense.     In peripheries, a large number of  deliveries are conducted  by ANMs, and nurses, and complications may arise occasionally.  So what are the facilities expected and available at a sub-centre? In reality   almost nothing is available.      Merely having a ventilator  does not solve the problem and  is not enough . The hospital  requires much more  arrangements to keep a patient  on ventilator.  Do all Govt hospitals where surgeries are  being done have ventilator and trained doctors  and support staff to operate those ventilators? It needs round the clock trained  doctors  and nurses, ABG  machine, portable X-ray , bed side Echo dialysis etc. Doctors in ill-equipped Govt   centres  are forced to conduct deliveries.  What should be the SOP in such circumstances? A real and honest data would be an eye opener and interesting.

Doctor need to  ponder over the issue of saving themselves before they save the patient.

 

 

Medical Negligence: Karnataka Court Convicts Three Doctors For Death Of Woman Operated Without Ventilator Facility & Other Life Saving Equipment* “A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other life saving equipment. BIDAR: Four people, including three doctors, have been handed jail terms and slapped with fines by a local court for a botched surgery which claimed the life of a woman.The II Civil (senior) and JMFC Court judge Abdul Khadar sentenced well-known medical practitioners Dr Rajshree Biradar and Dr Vaijinath Biradar, and Saibanna, to two years imprisonment and fined them Rs 10,000 each. If they fail to pay the fine, they will have to serve an additional six months in prison. Dr Rajshekar Patil was sentenced to six months imprisonment and fined Rs 5,000. He will have to serve additional imprisonment of one month if he fails to pay the fine.The case dates back to October 12, 2014, when Sampavati, wife of Ghaleppa Auradakar, got herself admitted to Sushrut Nursing Home in the city for a hysterectomy procedure. But after a five-hour surgery, she died due to alleged medical negligence.However, without disclosing her condition to the family, she was shifted to Dr Rajshekhar Patil’s Shree Hospital in an ambulance. Dr Patil continued the treatment without disclosing her condition, it was alleged in the chargesheet.

Nursing home was negligent in not having ventilator: Court

Later, it was revealed that Sampavati had died at Sushrut Nursing Home itself due to the lack of ventilator facility. The court, while convicting the accused, observed that the nursing home authorities were negligent in not having a ventilator facility for such a risky procedure.

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

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Typical Story of Blackmail by Goons &Vulture journalism #Dr-Archana-Sharma-Suicide


       Painful story of Dr Archana Sharma Suicide unmasks the everyday struggle of the doctors in present era. Although not ideal but being undervalued, dis-empowered and demonized, forced to work as sub-servant to bureaucrats are considered new normal and is an accepted form of harassment.  Fatigue and burnout are thought to be routine side effects of being a doctor or nurse. Venomous media, celebrities, film stars and prominent personalities have left no stone unturned in spreading hatred and creating an environment of mistrust against the medical profession.  They project   single stray incident   as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors have become prone to the verbal, physical as well as legal assaults.  Dr Archana Suicide unmasked an organised crime and propagators were local goons, politicians and vulture journalist, who usually managed an orchestrated racket to blackmail the doctors and extort money. Doctors being soft targets because of their nature of work as they deal with life and death.   Any death gives them opportunity to all to blackmail the doctors on the pretext of negligence, a legal weapon used by law-enforcers.

          Dead doctor’s husband demands action against ‘vultures’ and ‘blackmailers’

          Dead doctor’s husband demands action against ‘vultures’ and ‘blackmailers’

       JAIPUR: The husband of gynaecologist Dr Archana Sharma, who committed suicide on Tuesday, lodged an FIR against one Shiv Shankar Ballya Joshi for exerting pressure on the doctor and organising protests in her hospital. Hours before his transfer, Dausa SP Anil Kumar said police have seen the CCTV footage wherein Joshi was belting out abusive slogans against the doctor in the hospital. Police said they were investigating Joshi’s role in the case. The entire incident began when a 22-year-old woman was brought to Sharma’s Anand Hospital on Sunday night with labour pain. Though she was taken to the labour room, her condition deteriorated allegedly due to excessive bleeding and she died on Monday. On the same day, Dausa police registered an FIR under Section 302 (Murder) of the IPC which names Dr Archana Sharma and her husband Dr Suneet Upadhyay. The FIR put Rajasthan police in a tight spot because several doctors alleged that cops could have filed the FIR under Section 304A (causing death by negligence) of the IPC, instead of slapping murder charges on doctors. 4/1/22, 3:20 PM Rajasthan: Dead doctor’s husband demands action against ‘vultures’ and ‘blackmailers’.  Kumar, however, said the police only registered the FIR on the basis of the complaint filed by the patient’s family. In an emotional video message, Dr Upadhyay alleged that Joshi had promised the family a hefty compensation and brought them back with the body to the hospital. “Joshi called other BJP leaders to the hospital too. Joshi has been trying extortion and blackmailing in the hospital,” he said, adding that the police have been shielding Joshi due to a senior BJP leader of Dausa. Sharma’s husband Dr Suneet Upadhyay in his FIR said that some “vultures” played politics on the patient’s body as they gheraoed the hospital and forced the local administration to file a case of murder against the doctor. Upadhyay alleged that Joshi played a key role in this entire affair. He has been accused in the FIR of threatening the hospital multiple times in the past. As per the FIR, many complaints were filed against Joshi at the police station, but cops took no action against him, which further emboldened the accused. Upadhyay said Joshi was hurling invectives during the protest at the hospital and his wife could not tolerate such insults because she was a reputed surgeon who had saved the lives of several women and children. He said she was stalked by fears that Joshi could send her to jail even though she was innocent. The complaint also mentions that Sharma read a report of the incident in a local newspaper, but there was no mention of the hospital’s version there.

          According to Upadhyay, the family members of the deceased patient had returned from the hospital with complete satisfaction because they had witnessed the doctors struggling for nearly two hours to save her life. He said the family of the deceased patient were preparing for her last rites when Joshi stepped in and brought the body back to the hospital. Joshi allegedly called up people over the phone and gathered a large crowd at the hospital. He wanted to file a case of murder against the doctor even though the family of the patient had not given any complaint. The FIR states that vultures like them have made the lives of doctors in the country very difficult and told cops to act against such blackmailers. Dausa police said they have booked Joshi under Section 306 (abetment of suicide), 304 (extortion) and 384 (extortion by threat of accusation of an offence punishable with death or imprisonment for life, etc) of the IPC. Police said Joshi is a local leader, whereas, they are probing the journalist’s involvement.

     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

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

The Book-‘At the Horizon of Life & Death’:Blackmail of Doctors by opportunist goons, legal industry, Vulture Journalism


      While doctors are usually blamed for any mishap, be it natural poor prognosis or genuine complications, rarely people get to know their side of the story — how a dying patient affects their psyche, how they deal with these patients and their kith and kin, what are the kinds of abuse and threats made when they are not able to save a life despite their best efforts.  Book describes stories the blackmail doctors face from opportunist goons, legal industry and vulture kind of journalism. Every day blackmail by legal industry, journalist and local goons, similar to what Dr Archana Sharma went through and others doctors are  facing have been described.

         Dr Pankaj Kumar, Director Critical Care at a Delhi Hospital, India has come out with an insightful account of these very aspects of a doctor’s life.

    The 300-page book (English) contains 20 stories divided into three parts viz – Larva & Pupa Syndrome, Hope & Fear & Medical Lawsuits. The book is available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive  etc.

         His book ‘At the Horizon of Life & Death’ is a Reality Fiction that reflects the sensitivity involved in dealing with patients facing death.

     Through the eyes of its protagonist Dr Anand, the book captures significant moments in the treatment trajectory of critical patients. The book tries to create awareness regarding pertinent issues faced by the medical professionals like demoralisation, expensive medical education, the extreme pressure and suicidal ideation, the plight of the nurses and support staff, assaults and violence and the medico-legal intricacies involved in day-to-day practice among others. The author has also taken care to guide aspiring doctors to make well-informed career decisions.

     Part One (Larva & Pupa Syndrome)-  talks about the expensive medical education, and the issues students face in medical college.

    Part Two (Hope & Fears) talks about the beginning of doctors’ professional journey, the disease demons they face while dealing with critical patients, dilemmas of doctors and patients near death situations.

    Part Three (Medical Lawsuits) is about how doctors are always working under the threat of medico-legal lawsuits.

        While stories are fictional, the scenarios and the problems in them are very real — things that he faced or saw his colleagues facing.

     Medical profession has become victim of mistrust generation and blame culture. Everyone keeps harping about the few black sheep in the community, while larger good work of doctors is not highlighted enough.

    The stories span from Dr Anand’s initial days in the emergency room and capture his struggles in complex medico-legal scenarios over the next four decades. This book is an effort to bring back focus on the treatment of the patient as opposed to the mistrust, legal frameworks and policies surrounding the healthcare practice.

Suicide by Dr Archana Sharma has exposed the blackmail; medical professionals are going through in current era. Doctors have become sitting ducks for punishments complaints, blackmail, and legal complexities besides every day harassment. Negligent police, indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment.  It may not be a good idea to opt for a medical career any more.

More naïve would be to pay millions to be a doctor.

     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

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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