Pay millions to be a doctor?: welcome to “ring on fire” #NEET


Being a doctor has become a disadvantage in itself, thanks to our media and celebrities projecting the saviors  in bad light. They are now seen as harbingers of death. Morale of doctors has been at rock bottom and community is devastated.  A society that believes more in fairy tales told by “Reel heroes” has turned prejudiced and preposterous towards “Real  heroes”.  The medical profession reeks of desperation and desolation with apathy from government, indifference from courts and silence of human right commission to salvage them from decrepit state. At the best, they have been reduced to punching bags and scape-goats for inept medical systems or cheap labour to industry.

Problems faced by doctors are not only innumerable but are also so exceedingly complex and diverse that they are difficult to be analysed. It is common to listen doctors discussing these problems whenever one of these crop up. If so many 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. The challenges in this profession are too many and difficult to analyse.
  1.     Medical courses are Comparatively lengthy and expansive study course and difficult training with slave like duties: that I have discussed in one of my previous article on “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, meritorious and bright children who came out of training 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 prejudiced  beliefs of society.

  1. Difficult start of career of doctors: 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 criticized.
    5.The fear and anxiety about the actual treatment,  favorable and unfavorable prognosis of patient, keeps mind of a doctor occupied.
    6. Doctors are blamed for all malaise:The society gets biased because of the media reports and some celebrity talking glib without proper understanding of inept medical system , administrative failure and complexity of medical industry.  These lead to formation of generalized sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
    7.Doctor’s 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.
    8.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 and interventionists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.  21 risks to doctor and nurses
    9.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  is enough to spoil the mood for the day.

10.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” ? Everyday 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. Unfortunately, if 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.
In these court cases, the doctor is at disadvantage since his decision which is now being questioned was taken at that time in good faith using all his wisdom. The decision in retrospect may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight over many years, may label it as faulty if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for punishments and lawsuits. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation will be full and almost permanent. No doctor has time to pursue such things all the time. Even if such events don’t happen to everyone, the very fear of such possible scenarios and their possible complications always lurks in the back of their mind.
11. Physical assault , routine instances of verbal abuse and threat  happen for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. The threat of physical assault is quite real as well. Recently, even female doctors have not been spared by mobs. Silence of prominent social people, celebrities and society icons on this issue is a pointer towards increasingly uncivilized mindset of society.  Even female doctors  are being assaulted.
12. 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.
13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen 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 instigation of lawsuit against doctors is a major disadvantage for medical profession.

14.Overall, a complex scenario for doctors: There is increasing discontentment among 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 disproportionately large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

With so many adversaries, the situation is like sailing a small boat in a tornado.
At present, with this mind-set, the losers are the doctors and medical profession. But the society should be able to foresee its overall loss in the long run if these practices continue.

 

#Expensive-modern-health-care: Reminiscent of an ancient realm of medical regulation #Medical-lawsuits


With the evolution of medical science and medical care intertwined with  medical business, braided changes in  medical  regulation is not an far off expectation. But reticulation of evolution to modern medicine  and health care has not happened  in  isolation. Simultaneously there has been  progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care  has also ushered.  Every one now wishes  to live longer  and  dreams of better quality of life with support of progressive medical care.  Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and corporate invested money into health care, which was unthinkable few decades back in the  past.  This reticulation of business and  health care really took away the profession from control  of doctors. As it is no more simply treating a disease and involves many more issues.  New model of business in  health care is  still  not a mature process. It has emerged and progressed in  just  for few decades, as compared to  medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a  long way to do real justice to every one.   No one really knows how to regulate this difficult area,  which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and  relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is  amalgamation of  intricacies of science with minds of  patient and doctor’s skill in  newly evolved milieu of financial complexities.  Results are not encouraging for the profession.

 An effort to govern or  regulate the medical profession  is not new. Hammurabi  had initiated to  write the rules of the game. This single professional species was managed with cruel regulation 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi,  5000 years ago,  was  not even at the   doorstep of medical science, but he  promulgated some rules. It is difficult to say whether he was naïve or  brilliant  enough to make it more mathematical. He fixed  heavy prize for saving lives and used to  cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly  knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still  remains  somewhat  unfair to doctors.  In other words, it has not attained enough  evolution and maturity.

  Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical  science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to  regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times.  Almost universally, the earlier work or contribution of  a doctor  to society is  not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can  conveniently be  passed on doctors by application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished. Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such  regulatory systems will dissuade  other good people joining the profession, again  resulting in  further inhibition and flourishing of profession for the good.  Obviously,  harsher  penalties will discourage a physician surplus.

Today the global  system of medical regulation, is becoming somewhat  similar, to those ancient regulations in  terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is despite the fact that now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

In an effort to institute  a  well controlled  healthcare, our society is in a way re-entering the realm of an ancient medical regulatory  system. Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the  poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body. Evolution of medical legal system and medical regulation has to evolve and mature, to enjoy  benefits of medical advancement to the fullest. Fear factors and  Impact  of present legal complexities,  on doctors  is  already on a par with that of  Hammurabi  era.

Re-blogged

Working night shifts (#doctor&Nurses) may cause DNA damage, risk of cancer & Heart diseases


        Medical profession getting stressful is nothing new.  There are multiple dimensions to  the multi-pronged stress in present  era.  A new dimension has been discovered. Night shift are integral part of a hospital, doctors and nurses life. But it has shown to be having far reaching consequences. Night shifts have been linked to DNA damage and more serious illnesses.   If these kind of effects prove to be correct in future, it  needs a serious thinking over the issue.

    Researchers found that on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than those who did not work overnight.

Working night shifts can damage a person’s DNA, increasing the risk of cancer as well as cardiovascular, metabolic, and neuro-degenerative diseases, a study has found. For the study published in the journal Anaesthesia, researchers analysed blood samples of 49 healthy full-time doctors taken at different times.

“Although this work is very preliminary, it is clear from the results that even a single night of sleep deprivation can trigger events that may contribute to the development of chronic disease,” said Siu-Wai Choi, of the University of Hong Kong.

Researchers found that on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than those who did not work overnight. In these overnight on-site call doctors, DNA repair gene expression decreased and DNA breaks increased after sleep deprivation.

Damaged DNA increased after only one night of sleep deprivation. This DNA damage may help explain the increased risk for cancer and cardiovascular, metabolic, and neurodegenerative diseases associated with sleep deprivation, researchers said.

Millions of preventable disease deaths: whose moral burden is it?


Diseases can be  preventable or unpreventable, have  good  or  bad prognosis. But once patient  enters hospital,  what ever may be the reason or genesis of ailment, it becomes a moral responsibility of doctors.  Health care professionals  can be trash-talked   or ridiculed by media and anyone, even for worst prognostic cases.   But  large numbers of deaths   happen  due to preventable causes like accidents , drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. In fact the burden of   negligence here is massive and  these deaths are unpardonable.   Who ultimately carries the moral burden of millions of  preventable deaths?

Common causes of  such  disease, sufferings  and death , specially in developing and poor countries:

  1. Dietary risks and diseases spread by  water sanitation and hygiene.   These  have  direct  linked with bad sanitation and poor hygiene practices. Poor sanitation is the leading cause of diarrhea, malnutrition, cholera, jaundice ( hepatitis A and E) , worm infestations, typhoid and other enteric fevers, which lead to chronic malnutrition and lowered immunity that further feed the infectious disease cycle.  Apart from infectious disease like diarrhea, but also pneumonia and tuberculosis, which are leading killers across all age groups.
  2. Undernourishment in   children  will cause them to be  underweight, stunted and wasted, and makes them  more vulnerable to infections. They are at higher risk of dying of childhood infections.

Working sewage-disposal systems, waste disposal management, protection of water supply from contamination and hand-washing practices are essential components to reduce preventable deaths.

  1. Poor sanitation, unsafe water and low public health also increase drug-resistant infections in low-income and middle-income countries. Lowering of antibiotic consumption  can not be achieved  because superbugs ,  and antibiotic resistance  are already in the environment and continue to spread through contaminated food, water and hospital equipment.

Antibiotics overuse is rampant as they are  used to treat diarrhea and upper respiratory tract infections. Improving sanitation, providing clean water, adopting personal hygiene and getting vaccinated can reduce infections.

  1. Air pollution : air pollution is a public health crisis.  Masses are forced to breathe in air which  contains pollutants  in  unsafe limits, some are carcinogenic. It  is a cause of  millions of deaths  It is besides many fold of this number live their life with morbidity. Polluting vehicles, industry, lesser trees and plantations, poor practices and not enough governance and policies have resulted in poisonous air to breathe. Diseases like COPD, asthma and lung cancer are few common ailments.
  2. A::Dog bite (rabies ), Animal poop and Human – animal interface:   Not properly disposed  animal poop is a  cause of generation of infections and diseases, requiring heavy use of antibiotics and consequently leads to emergence of further antibiotic resistance bacteria. This cycle of production of infections and use of antibiotics perpetuates a vicious cycle.  Stray animals still defecate at every place.  Poop of Stray dogs, cattle and pigs stays in environment and causes life threatening infections. Hundreds of diseases are described due to poor control of human animal interface.

But stray animals and dogs are everywhere. Owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

         B::   Life threatening infections : dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. Many diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like  Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms,    Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

               C:: Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources.  This can lead to a widespread source of waterborne illnesses. Dry  poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment.

6.     Mosquito borne diseases: millions die because of vector borne disease , as mosquito control  has been inadequate.  Malaria, dengue,  chickengunya  and many other lethal  diseases spread  due to mosquitoes.

 

7.      Preventable natural disasters exacerbated by human activity: floods, famine, disease outbreaks.

8.      Road, rail  accidents and other accidents: are mostly  preventable errors.

         The role of health care professionals in present day circumstances remains misunderstood and underappreciated, as they assume the responsibility for continuous care of the sick or injured. People who have never treated a patient  in their life time influence health policies, which effects  millions. Excessive preventable deaths are  just a symptoms of a larger problem.  Who  is the one who feels moral burden of millions of preventable deaths?

     .

 

Women doctor and nurses more prone to work–life imbalance


 

Being a health provider  is a tough and stressful job. In any hospital, work goes on during  day and night. Rather many times nights are more heavy and challenging. The systems at odd hours are run by doctors and nurses. Continuous requirement to do odd time shifts, hard training and work demands tend to affect the overall work-life balance of doctors and nurses.

For women, it is particularly more stressful. As at some stage of life, both professional and personal roles become too demanding.  Expectation at both fronts is guided by the idea of perfection. Perception of deviation from the ideal or little imperfection   can lead to sense of aversion, linked to  average performance for them.  If they try to match the ambitions, want more in career, from the partner, children, or themselves, face the real risk of burn out. The cognizance  that perfection cannot be matched or arduous to achieve, in their circumstances, is hard to be realized  at both places.   The quest and  passion of  the women doctors or nurses, to seek perfection at both places, makes them  more prone for  burnout. This  is  a consequence to  a grave exhaustion, in their bid  to balance everything.  Woman doctors and nurses, are specially  more susceptible to stress of a kind,  as most of them face the same ordeal.

Family priority:

Perception of role identity at home  is little different on  being a woman doctor/nurse.  Male doctors are in a better position to  prioritize their work duties over their family duties  in order to  provide financial support for their families. For female doctors , there is a natural tendency to  prioritize their family life.

  Inflexibility or shift working a routine:    

         The  issues will always remain, like spending long hours at work due to inflexibility, or requirement to do shift  duties , need to stay more with patient and training requirements. For females it is very common and  frequently  lead to an imbalance between work and family duties.   More  time spent at work has an direct impact    on family requirements. Sometimes  there are financial requirements of the family, for which they are forced to  negate the effect on family duties.  In such situations they are unable to successfully complete these family duties.

High career ambitions:

Higher  education leads  to ambitions for higher social recognition and better career orientation. These goals are another  reason for taking this dual stress.  In order to correct this  imbalance, many  women doctors  expose themselves to unsolicited job stress. This reflect  in lives as chronic lack of time and  leads to pressure and stress.  The mentioned stresses and strains could lead in the long term to irreversible, physical signs of wear and tear, as well as to negative effects on the human cardiovascular and immune systems.

   Prolonged and odd working hours:

In medical profession,  simply working hard is not enough anymore. To get ahead, a rigorous training, prolonged working hours are  new standards. There is very  little time left to be divided   among relationships, kids, and sleep.

 

Conflict by Perception:

The conflict of work and family is further exacerbated  by perceived deviation from being a  good worker  at  work place and  ideal mother at  home. At work  place, they are looked as less dedicated and similarly at home as well.  Lack of organizational support  for doctors/nurses is main reason for these kind of imbalance.  They are squeezed in between  pressures at work and demands at home.

Extending families:

These day, pressures are so high that  many young women doctors,  want to just stay at home and do housework without having careers. May  give up careers to have children. It strikes to young doctors as a surprise, simply how difficult it is to build a family. The learning curve of taking care of family along with professional  responsibilities is too steep. In such situations, when everything is compounded, with  workload, it becomes utterly exhaustive.

Motherhood:

Breaks taken for family requirements may be taken as red flags, by employers. Delivery and feeding child become  difficult tasks specially in clinical branches, where long duties are routine.

Motherhood needs to be squeezed in between the requirement of profession. Changes in schedule or adjustments made are perceived as “being different”.

While women are increasingly represented in the medical field, they still face challenges balancing work and home life. The frustrations manifest in  burnout and dissatisfaction within a field they once enjoyed.

also read: work-life imbalance for doctors/nurse & consequences

 

Medical Consumer Protection Act: Root of “Us and Them Syndrome”. Effect on medical profession


In present scenario, when patient is no more “patient” and  defined as consumer, doctors is not more than a service provider. With  Medical Consumer Protection Act acquired roots,  the whole system of medical delivery  and healthcare has changed. Most striking is this  entire fiasco is the “Us and Them” syndrome that seems to afflicted  every one. Doctors are pitted against every one, for example,  Doctors vs administrators, doctors vs patients, doctor vs managers. From regulation, insurance and legal system, every change has affected doctors adversely. They have been reduced to just only one component  of the industry, who deliver care and remain at receiving end. Other important stake holder 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 court. So fear of all kinds will make them more  careful. 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 and act smart in  changed business and legal milieu.

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Negatives effect on medical profession: cons or disadvantages of  medical consumer Protection Act

  1. Promotes Defensive medicine: Every patient with any illness has potential to complications. Progression of any disease state can cause death.  If doctors start looking at every patient as a potential litigant, especially those who are dealing with very sick ones,  practice of defensive practice is a natural consequence. This may manifest as excessive investigations, more use of drugs and antibiotics  and even  sometimes even 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 and the cases in courts or  their outcome are given 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 in the scenario applied. Because of prejudiced notions, a sense of mistrust gradually creeps in,  which then extends to and involves their own treating doctor .This sense of mistrust multiplies manifold whenever there is  some adverse or even small unpleasant  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 creeping in of practice of defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to inflated  medical costs.  Insurance  companies and lawyers have positioned themselves in between. They charge everyone 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, 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 in  the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career or will result in professional hanging or a media trial, with these having real probability in today’s day to day practice.
  5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons e.g  for sense of revenge or to extract money or simply for not having 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 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 days 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 scapegoats 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  trying to find some   human factor which can be punished. Not uncommonly doctors are used as  scapegoat to have  a concession on the patient treatment by health organizations. 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 these medico-legal cases and punishments. In many cases, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies and split second life saving and risky  decisions which may later be proved wrong by retrospective analysis, complex  medico-legal situations are endless distractions that have creep in and are enough to distract doctors from primary point of intention.
  9. Early retirement or burn out:  Becoming a doctor and practicing 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 medico-legal complexities in older age. Taken to court for a genuine decision by self  is enough to spoil and tarnish  health, wealth and fame earned by  grilling the whole life.
  10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts ones own life and career to risk, why should one put oneself in that deciding 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 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 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. Hugely benefited are medical industry, law industry and administrators; Rampant misuse of consumer protection act has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip for doctors by all these three stakeholders. Fear of medico-legal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain out of doctors hard work.  Benefits to law industry 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. Right decisions or wisdom of hindsight?; 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 look wrong later  retrospectively, especially when retrospective analysis  is done over years with fault finding approach.
  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 only to repent later.  
  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 instigation of lawsuit against doctors is a major disadvantage for medical profession.

 

  1. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous  training and then suddenly find themselves working in a hostile environment, at the receiving end of public wrath, law and  media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
  2. Subject of 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  pinpoint with retrospective analysis and with lawyers pondering over it for years. In such situations , doctors are sitting ducks for  any kind of

 

 

 Positives, Pros or advantages of medical consumer protection act:

Although there are doubts, whether it will have any positive effect in long term, except monitory benefit to patient’s relatives and lawyers.

  1.     Quick  redressal of grievances:  patient will get satisfaction, if there is a genuine negligence case
  2.  Better quality of care will increase;  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. 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. 7. Better documentation and communication: Doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting. 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 of  anxiety prevailing more for care givers,  do not get enough relief  from stress.

        But sad thing about this kind of learning is that it is at the cost of few, unfortunate doctors, who were in difficult situation, actually suffered, did not know the legal implications  of  their acts or  situation. Most of the time, it is a system failure, but blame can be pinpointed to doctor.

May be The Act has good intention, but its practical application in its present form may cause more harm than good.    If the core of the health care  (medical hands) are harmed, no one can benefit in the long run.

Advantages & disadvantages: pros & cons of medical consumer Protection Act


With patient defined as consumer  and  Medical Consumer Protection Act takes roots,  the whole system of medicine and healthcare has changed. From regulation, insurance and legal system, every change has affected doctors adversely. They have been reduced to just only one component  of the industry, who deliver care and remain at receiving end. Other important stake holder 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 court. So fear of all kinds will make them more  careful. 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 and act smart in  changed business and legal milieu.

Negatives, cons or disadvantages of medical consumer Protection Act

  1. Promotes Defensive medicine: Every patient with any illness has potential to complications. Progression of any disease state can cause death.  If doctors start looking at every patient as a potential litigant, especially those who are dealing with very sick ones,  practice of defensive practice is a natural consequence. This may manifest as excessive investigations, more use of drugs and antibiotics  and even  sometimes even 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 and the cases in courts or  their outcome are given 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 in the scenario applied. Because of prejudiced notions, a sense of mistrust gradually creeps in,  which then extends to and involves their own treating doctor .This sense of mistrust multiplies manifold whenever there is  some adverse or even small unpleasant  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 creeping in of practice of defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to inflated  medical costs.  Insurance  companies and lawyers have positioned themselves in between. They charge everyone 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, 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 in  the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career or will result in professional hanging or a media trial, with these having real probability in today’s day to day practice.
  5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons e.g  for sense of revenge or to extract money or simply for not having 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 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 days 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 after finding  human factor which can be punished. Not uncommonly doctors are used as  scape- goat to have  a concession on the patient treatment by health organizations. 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 these medico-legal cases and punishments. In many cases, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies and split second life saving and risky  decisions which may later be proved wrong by retrospective analysis, complex  medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intention.
  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 by self  is enough to spoil and tarnish  health, wealth and fame earned by  grilling the whole life.
  10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts ones own life and career to risk, why should one put oneself in that deciding 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 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 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. Hugely benefitted are medical industry, law industry and administrators; Rampant misuse of consumer protection act has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip for doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain out of doctors hard work.  Benefits to law industry 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. Right decisions or wisdom of hindsight?; 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 look wrong later  retrospectively, especially when retrospective analysis  is done over years with fault finding approach.
  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 only to repent later.  
  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 disadvantage for medical profession.

 

  1. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous  training and then suddenly find themselves working in a hostile environment, at the receiving end of public wrath, law and  media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
  2. Subject of 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  pinpoint with retrospective analysis and with lawyers pondering over it for years. In such situations , doctors are sitting ducks for  any kind of

 

 

 

 

 

  1. Positives, Pros or advantages of medical consumer protection act:

Although there are doubts, whether it will have any positive effect in long term, except monitory benefit to patient’s relatives and lawyers.

  1.     Quick  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. 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 of  anxiety prevailing more for care givers,  do not get enough relief  from stress.  If the core of the health care  (medical hands) are harmed, no one can benefit in the long run.

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


        

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

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

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


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

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

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

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

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