Health Ministry Chief Israel rails at ‘atmosphere that permits blood-shed of healthcare providers’


Nachman Ash rails at ‘atmosphere that permits blood[shed] of healthcare providers’; nurses’ union announces it will join work slowdown

   Violence against doctors has become a serious issue across the globe. 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 benefitted 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.   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, nurses and health care workers seem to be united against this menace and their associations are actively pursuing the issue. More-over the Government also seem to be sensitive to the issue in Israel.

Nachman Ash rails at ‘atmosphere that permits blood[shed] of healthcare providers’; nurses union announces it will join work slowdown

Nachman Ash rails at ‘atmosphere that permits blood[shed] of healthcare providers’; nurses union announces it will join work slowdown

Health Ministry Director-General Nachman Ash on Wednesday sharply criticized the ongoing violence against healthcare providers, a day after a doctor was badly beaten by a patient at a community clinic.“It’s a general atmosphere that permits the blood[shed] of healthcare providers and for no reason,” Ash told the Ynet news site. “A doctor was busy and couldn’t see a patient so he broke into a room with an iron bar and hit her on repeatedly on the head and other parts of her body.

“I talked to the doctor and I understand that it was very fortunate that it ended the way it did [and wasn’t worse],” he said.

“It’s just shocking, and this violent discourse and behavior must be stopped.”

Ash also linked repeated incidents of violence against healthcare providers to anti-vaccine discourse that became prevalent during the coronavirus pandemic. “The connection exists because any discourse that encourages violence ultimately also leads to violence. These are two things that until now we did not want to link,” Ash said. “The violence toward [officials] is one matter and this violence toward healthcare providers is a second issue. But everything is connected.”

A number of top officials and doctors have faced verbal abuse and threats from anti-vaccine activists. Most notably, Dr. Sharon Alroy-Preis, the Health Ministry’s head of public services and a top COVID adviser to the government, has been repeatedly threatened by anti-vaccine activists and conspiracy theorists who view her as the public face of the health system’s inoculation effort. Ash noted that while there were newly announced plans to station police at hospitals, community clinics were more of an issue.

“It really is a much bigger challenge. I want to say that having police in hospitals will not solve everything either. It is impossible to put a police officer in every clinic — that is clear. I believe that punishment is the key, to create deterrence,” AAsh’s comments came as the suspect in Tuesday’s attack on a doctor in the central city of Be’er Yaakov appeared in court on Wednesday for a remand hearing. Police were seeking to charge him with attempted murder.

According to the Kan public broadcaster, the court was told that the suspect is alleged to have attacked the doctor with a meat tenderizer.According to police, the suspect, a resident of the town in his 30s, went to the clinic for medical treatment. While at the clinic he began to behave wildly. He refused to leave when asked by the doctor to do so, and instead grabbed a weapon and hit her on the head.

The doctor was moderately wounded and taken to a nearby hospital for further treatment. The man was apprehended by police shortly afterwards.Tuesday’s attack was the latest in a string of acts of violence in hospitals and clinics in recent months. In the wake of the latest attack, the doctor’s union announced staff at public hospitals and clinics will go on a two-day strike to protest violence against medics, by operating on a weekend schedule with reduced services for all of Thursday and Friday.

“We have made it clear over the past year unequivocally that any case of violence will encounter zero tolerance on our part,” the chairman of the Israel Medical Association, Prof. Zion Hagay, said on Tuesday.

“The most recent strike has led to an important government decision to place police in emergency rooms and allocate the necessary manpower, but we must look solely at how things are implemented on the ground. As long as we do not see real action in the immediate term, we will intensify our actions until someone here wakes up and understands that violence in the health system is a real epidemic,” he said. The nurses union said Wednesday that it will be joining the strike.

The upcoming strike is the second initiated by the doctors’ union in recent weeks. A labor action was called last month after family members of a patient who died at a Jerusalem hospital attacked medical staff and caused significant damage to an intensive care unit after they were informed of his death.

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Osteoarthritis: Painful Joints in Old age- Symptoms, Diagnosis, Treatment


This serious, painful condition is the most common form of arthritis and can affect any joint.

Osteoarthritis is a degenerative joint disease that can affect the many tissues of the joint. It is by far the most common form of arthritis, affecting more than 32.5 million adults in the United States, according to the Centers for Disease Control and Prevention.

Historically, osteoarthritis (OA) was known as a “wear and tear” condition, generally associated with aging. But we know now that it is a disease of the entire joint, including bone, cartilage, ligaments, fat and the tissues lining the joint (the synovium). Osteoarthritis can degrade cartilage, change bone shape and cause inflammation, resulting in pain, stiffness and loss of mobility.

OA can affect any joint, but typically affects hands, knees, hips, lower back and neck. Its signs and symptoms typically show up more often in individuals over age 50, but OA can affect much younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus. It typically develops slowly over time, but after such an injury, it can develop much more rapidly, within just a few years. OA is not an inevitable aging disease; some people never develop it.

There is no cure for OA, but there are ways to manage OA to minimize pain, continue physical activities, maintain a good quality of life and remain mobile.

Causes

Causes

Factors that may contribute to the development of OA include 

  • Age. The risk of developing OA increases with age and symptoms generally, but not always, appear in people over 50. 
  • Joint injury. A bone fracture or cartilage or ligament tear can lead to OA, sometimes more quickly than in cases where there is not an obvious injury.
  • Overuse. Using the same joints over and over in a job or sport can result in OA.. Excess weight adds stress and pressure on a joint, plus fats cells promote inflammation.
  • Musculoskeletal abnormalities. Misalignment of bone or joint structures can contribute to faster development of OA.
  • Obesity
  • Weak muscles. If muscles don’t provide adequate joint support, poor alignment can result, which can lead to OA.
  • Genetics. People with family members who have OA are more likely to develop it.
  • Gender. Women are more likely to develop OA than men.
  • Environmental Factors. Modifiable environmental risk factors include things like someone’s occupation, level of physical activity, quadriceps strength, presence or absence of prior joint injury, obesity, diet, sex hormones, and bone density.

Symptoms

Symptoms tend to build over time rather than show up suddenly. They include

  • Pain or aching in a joint during activity, after long activity or at the end of the day.
  • Joint stiffness usually occurs first thing in the morning or after resting.
  • Limited range of motion that may go away after movement.
  • Clicking or popping sound when a joint bends.
  • Swelling around a joint.
  • Muscle weakness around the joint.
  • Joint instability or buckling (as when a knee gives out).

OA may affect different parts of the body in different ways.

  • Hips. Pain in the groin area or buttocks and sometimes on the inside of the knee or thigh.
  • Knees. A “grating” or “scraping” feeling when moving the knee. 
  • Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become swollen, tender and red, sometimes with pain at the base of the thumb.
  • Feet. Pain and tenderness in the big toe, with possible swelling in the ankles or toes.

Potential Consequences

Pain, reduced mobility, side effects from medications and other factors associated with osteoarthritis can lead to health complications that are not caused by the disease itself.

Obesity, Diabetes and Heart Disease

Painful joints, especially in the feet, ankles, knees, hip or back, make it harder to exercise. But physical activity is not only key to managing OA symptoms; it also can help prevent weight gain, which can lead to obesity. Being overweight or obese can lead to the development of high cholesterol, type 2 diabetes, heart disease and high blood pressure. 

Falls

Research indicates people with OA experience more fall and risk of fracture than those without OA. Although study results vary, some research shows they may have up to 30% more falls and have a 20% greater risk of fracture. Having OA can decrease function, weaken muscles, affect overall balance, and make falls more likely, especially among those with OA in knees or hips. Side effects from pain medications, such as dizziness, can also contribute to falls.

Diagnosis

Medical history, a physical examination and lab test help to make up the OA diagnosis. 

A primary care doctor may be the first person you talk to about joint pain. The doctor will review your medical history, symptoms, how the pain affects activities, as well as your medical problems and medication use. He or she will also look at and move your joints, and may order imaging. These tests help to make the diagnosis:

  • Joint aspiration. After numbing the area, a needle is inserted into the joint to pull out fluid. This test will look for infection or crystals in the fluid to help rule out other medical conditions or other forms of arthritis.
  • X-ray. X-rays can show joint or bone damage or changes related to osteoarthritis.
  • MRI. Magnetic resonance imaging (MRI) gives a better view of cartilage and other parts of the joint.

Treatment

There is no cure for OA, but medication, assistive devices and other therapies that don’t involve drugs can help to ease pain. As a last resort, a damaged joint may be surgically fused or replaced with one made of a combination of metal, plastic and/or ceramic. 

Medications

Pain and anti-inflammatorymedicines for osteoarthritis are available as pills, syrups, patches, gels, creams or injectable. They include:  

  • Analgesics. These are pain relievers and include acetaminophen and opioids. Acetaminophen is available over the counter (OTC); opioids must be prescribed by a doctor.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs to ease inflammation and pain. They include aspirin, ibuprofen, naproxen and celecoxib, available either OTC or by prescription. The OTC versions help with pain but not inflammation.
  • Counterirritants. These OTC products contain ingredients like capsaicin, menthol, lidocaine that irritate nerve endings, so the painful area feels cold, warm or itchy to take focus away from the actual pain. 
  • Corticosteroids. These prescription anti-inflammatory medicines work in a similar way to a hormone called cortisol. The medicine is taken by mouth or injected into the joint at a doctor’s office.
  • Platelet-rich plasma (PRP). Available from a doctor by injection, this product is intended to help ease pain and inflammation. This is not approved by the Food & Drug Administration and evidence is still emerging, so discuss it with your doctor before trying it.
  • Other drugs. The antidepressant duloxetine (Cymbalta) and the anti-seizure pregabalin (Lyrica) are oral medicines that are FDA-approved to treat OA pain.

Nondrug Therapies

Exercise

Movement is an essential part of an OA treatment plan. Getting 150 minutes of moderate-to-vigorous exercise per week should be the goal, according to the U.S. Department of Health and Human Services. A good exercise program to fight OA pain and stiffness has four parts:

  • Strengthening exercises build muscles around painful joints and helps to ease the stress on them. 
  • Range-of-motion exercise or stretching helps to reduce stiffness and keep joints moving.
  • Aerobic or cardio exercises help improve stamina and energy levels and reduce excess weight.
  • Balance exercises help strengthen small muscles around the knees and ankles and help prevent falls.

Talk to a doctor or physical therapist before starting a new exercise program.

Weight Loss

Excess weight puts additional force and stress on weight-bearing joints, including the hips, knees, ankles, feet and back, and fat cells promote inflammation.  Losing extra weight helps reduce pain and slow joint damage. Every pound of weight lost removes four pounds of pressure on lower-body joints.

Physical therapy and Assistive therapy
Physical therapists, occupational therapists and chiropractors can provide:

  • Specific exercises to help stabilize your joints and ease pain.
  • Information about natural treatments and products that can ease pain.
  • Instruction to make movement easier and to protect joints. 
  • Braces, shoe inserts or other assistive devices.

Surgery

Joint surgery can improve pain and function. Joint replacement surgery replaces damaged joints to restore mobility and relieve pain. Hips and knees are the joints most commonly replaced. An orthopedic surgeon can determine the best procedure based on how badly damaged the joint is.

Self-Care

Practicing these habits can slow down OA, keep you healthier overall and delay surgery as long as possible. It is important to pursue a number of different self-care approaches simultaneously. They are listed below.

Maintain a Healthy Weight

Excess weight worsens OA. Combine healthy eating with regular exercise to maintain a healthy weight.

Control Blood Sugar

Many people have diabetes and OA. Having high glucose levels can make cartilage stiffer and more likely to break down. Having diabetes causes inflammation, which also weakens cartilage.

Maintain Range of Motion

Movement is medicine for joints. Make a habit of putting your joints through their full range of motion, but only up to the point where it doesn’t cause more pain. Gentle stretching, raising and lowering legs from a standing or seated position, daily walks and hobbies such as gardening can help. But listen to your body and never push too hard.

Protect Joints

Make sure to warm up and cool down when doing exercise. If you play sports, protects joints with the right gear. Use your largest, strongest joints for lifting, pushing, pulling and carrying. Watch your step to prevent falls. Balance rest and activity throughout the day.  

Relax

Find ways to reduce or avoid stress through meditation, listening to music, connecting with friends and family, doing fun activities, and finding ways to relax and recharge.

Choose a Healthy Lifestyle

Eating healthy food, balanced nutrition, not smoking, drinking in moderation and getting good sleep will help you to feel your best.

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Rheumatoid Arthritis: Painful Joints in Young- Causes, Symptoms, Treatment


Rheumatoid arthritis (RA) causes joint inflammation and pain. It happens when the immune system doesn’t work properly and attacks the lining of the joints, called the synovium. The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body, such as both hands or both knees. But sometimes RA causes problems in other parts of the body as well, such as the eyes, heart and circulatory system and/or the lungs.

For unknown reasons, more women than men get RA, and it usually develops in middle age. Having a family member with RA increases the odds of developing RA.

Causes

In a healthy person, the immune system fights invaders, such as bacteria and viruses. With an autoimmune disease like RA, the immune system mistakes the body’s cells for foreign invaders and releases inflammatory chemicals that attack those cells.  RA, it attacks the synovium, the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender and look red and swollen, and moving the joint may be difficult.

Researchers aren’t sure why people develop RA. They believe these individuals may have certain genes that are activated by a trigger in the environment, such as a virus or bacteria, physical or emotional stress or some other external factor.

Symptoms

Symptoms

In the early stages, people with RA may not see redness or swelling in the joints, but they may experience tenderness and pain.
These symptoms are clues to RA:

  • joint pain, tenderness, swelling or stiffness that lasts for six weeks or longer.
  • Morning stiffness that lasts for 30 minutes or longer.
  • More than one joint is affected.
  • Small joints (wrists, certain joints in the hands and feet) are typically affected first.
  • The same joints on both sides of the body are affected.

Many people with RA get very tired (fatigue) and some may have a low-grade fever. RA symptoms may come and go. Having a lot of inflammation and other symptoms is called a flare. A flare can last for days or months. 
 

Health Effects

  • Eyes. Dryness, pain, inflammation, redness, sensitivity to light and trouble seeing properly.
  • Mouth. Dryness and gum inflammation, irritation or infection. 
  • Skin. Rheumatoid nodules — small lumps under the skin over bony areas. 
  • Lungs. Inflammation and scarring that can lead to shortness of breath and lung disease.
  • Blood vessels. Inflammation of blood vessels that can lead to damage in the nerves, skin and other organs.
  • Blood. A lower than normal number of red blood cells. 
  • Heart. Inflammation can damage the heart muscle and the surrounding areas.
  • Painful joints also make it hard to exercise, leading to weight gain. Being overweight may make people with RA more likely to develop high cholesterol, diabetes, heart disease and high blood pressure.

Diagnosis

Getting an accurate diagnosis as soon as possible is the first step to treating RA effectively. A doctor with specialized training in treating arthritis (called a rheumatologist) is the best person to make a correct diagnosis, using medical history, a physical examination and lab tests.

Medical history. The doctor will ask about joint symptoms (pain, tenderness, stiffness, difficulty moving), when they started, if they come and go, how severe they are, what actions make them better or worse and whether family members have RA or another autoimmune disease. 
Physical examination.  The doctor will look for joint tenderness, swelling, warmth and painful or limited movement, bumps under the skin or a low-grade fever. 
Blood tests- The blood tests look for inflammation and blood proteins (antibodies) that are linked to RA:

  • Erythrocyte sedimentation rate (ESR, or “sed rate”) and C-reactive protein (CRP) levels are markers for inflammation. A high ESR or CRP combined with other clues to RA helps make the diagnosis. 
  • Rheumatoid factor (RF) is an antibody found (eventually) in about 80 percent of people with RA. Antibodies to cyclic citrullinated peptide (CCP) are found in 60 to 70 percent of people with RA. However, they are also found in people without RA. 

Imaging tests- RA can cause the ends of the bones within a joint to wear down (erosions). An X-ray, ultrasound, or MRI (magnetic resonance imaging) scan can look for erosions. But if they don’t show up on the first tests that could mean RA is in an early stage and hasn’t damaged bone yet. Imaging results can also show how well treatment is working.
 

Treatment

The goals of RA treatment are to:

  • Stop inflammation or reduce it to the lowest possible level (put disease in remission).
  • Relieve symptoms.
  • Prevent joint and organ damage.
  • Improve function and overall well-being.
  • Reduce long-term complications.

To meet these goals, the doctor will follow these strategies:

  • Early, aggressive treatment to reduce or stop inflammation as quickly as possible.
  • Targeting remission or another goal (called “treat-to-target”) to work toward few or no signs or symptoms of active inflammation. 
  • Tight control to keep inflammation at the lowest level possible.

Working with your doctor to ensure you get appropriate medical treatment is essential, but you can also take measures on your own to manage your RA and ease pain and fatigue. Diet, exercise, smoking cessation and mental health are all key to good health overall and controlling RA.

Healthy Eating. A balanced, nutritious diet consisting of the recommended amounts of all the food groups helps promote wellness and makes it easier to maintain a healthy weight. 

Daily movement. Even when you don’t have time to exercise, try to make movement part of your everyday routine. Use the stairs instead of taking the elevator. Park in a spot that makes you walk a bit to enter a building. Take the longer way to a meeting in your office. 

Balancing activity with rest. It’s important to try to stay physically active even during a flare, but rest is also especially important when RA is active and joints feel painful, swollen or stiff. Rest helps reduce inflammation and fatigue that can come with a flare. Taking breaks throughout the day protects joints and preserves energy.

Hot and cold treatments. Heat treatments, such as heat pads or warm baths, tend to work best for soothing stiff joints and tired muscles. Cold is best for acute pain and swollen joints. It can numb painful areas and reduce inflammation. 

Topical products. These creams, gels or stick-on patches can ease the pain in a joint or muscle. Some contain the medicine that you can get in a pill, and others use ingredients that irritate your nerves to distract from pain.

Stress Reduction and Complementary Therapies. There are different ways to relax and stop focusing on pain. They include meditation, deep breathing, and thinking about images in your mind that make you feel happy. Massage can help reduce pain, relax sore muscles and ease stress or anxiety. Acupuncture involves inserting fine needles into the body along special points to relieve pain. If you don’t like needles, acupressure uses firm pressure instead. 

Supplements. Studies show that curcumin/turmeric and omega-3 fish oil supplements may help with rheumatoid arthritis pain and morning stiffness. However, talk with a doctor before taking any supplement to discuss side effects and how it may affect other medicines you are taking.

Positive Attitude and Support System. Cultivate a network of friends, family members and co-workers who can help provide emotional support. Take time to do things that you enjoy to lift your mood, which can help relieve pain.

Disclaimer-The above article is for information purposes only and is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional for any questions you may have regarding your health or a medical condition.

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How to Prevent Fall in Elderly


In a young person, usually there are specific ailments for example heart and and nervous system that can cause some one to fall down. But the older age can predispose people to fall for many factors.

Some factors that may contribute to falls include:

  • Loss of muscle mass.
  • Illnesses that impair your mental or physical functioning, such as low blood pressure or dementia.
  • Use of four or more prescription medications.
  • Poor vision.
  • Poor balance.
  • Certain diseases that affect how you walk.
  • Alcohol use.
  • Side effects of some medications, such as:
  • Sedatives or tranquilizers.
  • Sleeping pills.
  • Antidepressants.
  • Anticonvulsants.
  • Muscle relaxants.
  • Heart medicines.
  • Blood pressure pills.
  • Diuretics.

How to prevent Falls in elderly

How to prevent Falls in elderly

Falls can also be caused by factors around you that create unsafe conditions. Here are some tips to help prevent falls outdoors and when you are away from home:

  • Use a cane or walker for added stability.
  • Wear shoes that provide support and have thin nonslip soles. Avoid wearing slippers and athletic shoes with deep treads.
  • Walk on grass when sidewalks are slippery; in winter, put salt or kitty litter on icy sidewalks.
  • Stop at curbs and check their height before stepping up or down.

Some ways to help prevent falls indoors are:

  • Keep rooms free of clutter, especially on floors. Avoid running electrical cords across walking areas.
  • Use plastic or carpet runners on slippery floors.
  • Wear shoes, even when indoors, that provide support and have thin nonslip soles. Avoid wearing slippers and athletic shoes with deep treads.
  • If you have a pet, be mindful of where they are to avoid tripping over them.
  • Do not walk in socks, stockings, or slippers.
  • Be careful on highly polished floors that are slick and dangerous, especially when wet, and walk on plastic or carpet runners when possible.
  • Be sure carpets and area rugs have skid-proof backing or are tacked to the floor. Use double-stick tape to keep rugs from slipping.
  • Be sure stairs are well lit and have rails on both sides.
  • Install grab bars on bathroom walls near the tub, shower, and toilet.
  • Use a rubber bathmat or slip-proof seat in the shower or tub.
  • Improve lighting in your home. Use nightlights or keep a flashlight next to your bed in case you need to get up at night. Install ceiling fixtures or lamps that can be turned on by a switch near the room’s entrance.
  • Use a sturdy stepstool with a handrail and wide steps.
  • Add more lights in rooms.
  • Keep a cordless phone or cell phone with you so that you don’t have to rush to the phone when it rings. In addition, if you fall, you can call for help.
  • Consider having a personal emergency-response system; you can use it to call for help if you fall.

The above article is for information purposes only and is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional for any questions you may have regarding your health or a medical condition.

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Obeisance for Dr Archana Sharma: Bigger Role for Doctors’ Associations


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. Let her sacrifice be a reminder to the whole medical fraternity; either fight against the prevalent injustice or perish, not being able to treat the patients would be a greater disservice to humanity.

Dr Archana Sharma Suicide

      

Dr Archana Sharma Suicide

  It was an incident that was enough to jolt doctors’ and medical associations out of their deep slumber against the everyday sufferings of their members. Protecting and supporting the suffering members against physical and legal assaults should be the need of the hour. But sadly, it was not enough to wake them up. After few days of token protests, everything came  back to routine.  Unfortunately Doctors’ associations have limited their role merely to social gatherings with some token academics.  They have not risen to the real life problems of doctors like goonism, blackmail, physical and legal assaults.  Doctors as individuals remain vulnerable   to these issues and always remain at receiving end of the stick. In this era, doctors’ associations need to play a bigger role especially in cases of medico-legal suits against doctors; to support the sufferers.  As cases of medical negligence may be circumstantial incidents and not real mistakes, courts may not be able to deliver justice to doctors many times. A concern is that in case of poor outcome and case goes to courts, there is an indirect perverse incentive to deliver a guilty verdict against the doctor as a person, who is responsible for life and death.

        Failure of Doctors’ and Medical associations to rise to the occasion even in such a case of blatant cruelty will be a real injustice to DR Archana Sharma.

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Burnout at Workplace: How to Recognize and What to do


Burnout, as it is defined, is not a medical condition — it’s “a manifestation of chronic unmitigated stress.” The World Health Organization describes burnout as a workplace phenomenon characterized by feelings of exhaustion, cynicism and reduced efficacy.

  Dr. Jessi Gold, a psychiatrist at Washington University in St. Louis, knows she’s edging toward burnout when she wakes up, feels instantly angry at her email inbox and doesn’t want to get out of bed. It’s perhaps not surprising that a mental health professional who is trying to stem the rising tide of burnout could burn out sometimes, too. After all, the phenomenon has practically become ubiquitous in our culture.

In a 2021 survey of 1,500 U.S. workers, more than half said they were feeling burned out as a result of their job demands, and a whopping 4.3 million Americans quit their jobs in December in what has come to be known as the “Great Resignation.” When people think of burnout, mental and emotional symptoms such as feelings of helplessness and cynicism often come to mind. But burnout can lead to physical symptoms as well, and experts say it can be wise to look out for the signs and take steps when you notice them.

              Burnout, as it is defined, is not a medical condition — it’s “a manifestation of chronic unmitigated stress,” explained Dr. Lotte Dyrbye, a physician scientist who studies burnout at the Mayo Clinic. The World Health Organization describes burnout as a workplace phenomenon characterized by feelings of exhaustion, cynicism and reduced efficacy.

“You start not functioning as well, you’re missing deadlines, you’re frustrated, you’re maybe irritable with your colleagues,” said Jeanette Bennett, a researcher who studies the effects of stress on health at the University of North Carolina, Charlotte.

But stress can have wear and tear effects on the body, especially when it doesn’t ease up after a while — so it makes sense that it can incite physical symptoms, too, Bennett said. When people are under stress, their bodies undergo changes that include making higher than normal levels of stress hormones such as cortisol, adrenaline, epinephrine and norepinephrine. These changes are helpful in the short term — they give us the energy to power through difficult situations — but over time, they start harming the body.

Our bodies were “not designed for the kinds of stressors that we face today,” said Christina Maslach, a social psychologist at the University of California, Berkeley, who has spent her career studying burnout.

Here’s how to recognize burnout in your body and what to do about it.

What to look out for

Insomnia- One common burnout symptom is insomnia, Dyrbye said. When researchers in Italy surveyed front-line health care workers with burnout during the first peak of the pandemic, they found that 55% reported having difficulty falling asleep, while nearly 40% had nightmares.

Research suggests that chronic stress interferes with the complicated neurological and hormonal system that regulates sleep. It’s a vicious cycle, because not sleeping throws this system even more out of whack. If you’ve noticed that you’re unable to sleep at night, that could be a sign that you’re experiencing burnout, Dyrbye said — and your sleeplessness could exacerbate the problem.

Physical exhaustion is another common sign. Gold said that one of her key symptoms of burnout was fatigue. “I realized I was sleeping every day after work — and I was like, ‘What is wrong with me?’ but it was actually burnout,” she said.

Changes in eating habits — either eating more or less than usual — can also be a sign of burnout: In the study of Italian health care workers, 56% reported changes in food habits. People might eat less because they’re too busy or distracted, or they might find themselves craving “those comfort foods that we all like to go to when we need something to make us feel better,” Bennett said. Research suggests, too, that stress hormones can affect appetite, making people feel less hungry than usual when they’re under a lot of stress, and more hungry than usual when that stress alleviates.

Headaches and stomachaches can also be incited by burnout, Gold said. One study of people in Sweden suffering from exhaustion disorder — a medical condition similar to burnout — found that 67% reported experiencing nausea, gas or indigestion, and that 65% had headaches. It’s also important to note that burnout can develop alongside depression or anxiety, both of which can cause physical symptoms. Depression can cause muscle aches, stomachaches, sleep issues and appetite changes. Anxiety is linked to headaches, nausea and shortness of breath.

What to do

If you’re experiencing physical symptoms that could be indicative of burnout, consider seeing your primary care doctor or a mental health professional to determine whether they are driven by stress or rooted in other physical conditions, Dyrbye said. Don’t just ignore the symptoms and assume they don’t matter.

“It’s really easy to blow off your own symptoms, especially in our culture, where we’re taught to work hard,” Gold said.

If it is burnout, then the best solution is to address the root of the problem. Burnout is typically recognized when it is job-driven, but chronic stress can have a variety of causes — financial problems, relationship woes and caregiving burdens, among other things. Think about “the pebbles in your shoe all the time that you have to deal with,” Maslach said, and brainstorm ways to remove some of them, at least some of the time. Perhaps you can ask your partner to help more with your toddler’s bedtime routine, or get takeout when you’re especially busy so you don’t have to plan dinner, too.

Despite popular culture coverage of the issue, burnout can’t be “fixed” with better self care, Maslach said — in fact, this implication only worsens the problem, because it lays the blame and responsibility on those with burnout and implies that they should do more to feel better, which is not the case, she said. However, some lifestyle choices can make burnout less likely. Social support, for instance, can help, Gold said. This could include talking to a therapist or meeting with friends (even if over Zoom). It may also help to take advantage of mental health or exercise benefits offered by your employer. Sleeping more can help too — so if you’re suffering from insomnia, talk to a doctor about possible treatments, Bennett suggested.

Finally, while you may not want to add more to your plate, try to make a bit of time each day for something you love, Dyrbye said. Her work has found that surgeons who make time for hobbies and recreation — even just 15 to 20 minutes a day — are less likely to experience burnout than surgeons who don’t.

“You have to have something outside of work that helps you de-stress, that helps you focus and helps you relax,” she said.

     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?

#Doctors-‘Earn Hundreds & Pay Back Millions’ #USG-Lab-Nagpur to Pay 1. 25 Cr Compensation


          Is there any other profession, which has such kind of pathetic arrangement? The sufferers of such pitiable deals are doctors. An average doctors studies for decades and treats hundreds of patients for peanuts (Few hundred rupees). For one alleged mistake or just a legal interpretation is forced to pay millions for an incident, which can be merely procedural or circumstantial mistake.

  Why one should be putting his/her future into such pathetic arrangements? The inspiring doctors need to think.

          Large claims granted by courts are incentives for patients and lawyers for putting medical lawsuits. In an era, where people fight with their parents, brothers and sisters for money and property, it will be naive to think that idea of making money from doctor does not exist.

          Now-a-days medical professionals need to not only be thorough with their medical subjects and the medico-legal implications, but also  need to be careful about how courts may interpret the medical processes. What doctors think is a correct   medical process, but it can be interpreted as negligence, in case of an adverse outcome. Other contributing factors that nail down medical profession are the sympathy to the patient and wisdom of hindsight,   which everyone is flushed with as an after event.  

          Large compensations against medical profession are  the single important factor can increase the cost of  healthcare and demoralize medical profession.   Doctors  are always on the receiving end in case of an adverse outcome.    Medical problems are very complex and sometimes it is difficult to judge  the future course of  disease as well as court  interpretation of  medical science, especially  with retrospective wisdom  by courts.  Summarily doctors have to safeguard themselves from treatment as well as legal and documentation hassles.

         Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors.  

     Strangely  doctor’s fee are quite low but lawyers charges and court compensations are really astronomical amounts, which are beyond any logic.

New Delhi: In a landmark order, the National Consumer Commission (NCDRC) has ordered Nagpur-based Ultrasound Scanning and Imaging Center to pay a compensation of Rs 1.2 crore to a disabled child and his parents in a medical negligence case. The firm has been blamed for misreporting of ultrasound on four occasions during pregnancy, resulting in the birth of a child with congenital anomalies.
Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. The commission held that the ultrasonology center also failed to offer to terminate the pregnancy, failing to diagnose defects at an early stage. The newborn had finger pain (complete absence), right leg below the knee and left leg below the ankle joint.
The clinic – Imaging Point – was run by Radiologist Dr Dilip Ghik in Nagpur. Holding him and his clinic responsible for their failure to detect structural anomalies of the fetus at 17-18 weeks, a two-member NCDRC bench comprising Justices RK Agrawal and SM Kantikar asked them to provide for the child’s welfare, future expenses asked to pay compensation for  the treatment and purchase of limb prostheses.
The order said, “The amount shall be kept as a fixed deposit in any nationalized bank (preferably SBI) in the name of the child till he attains the age of majority. Parents can get periodic interest on the FD for regular health check-up, treatment and welfare of their child. It also directed the radiologists and their clinics to pay Rs 1 lakh towards legal expenses.
As per the commission’s order, in October 2006, the child’s mother, who was pregnant at the time, consulted a gynecologist and obstetrician. The next month the doctor referred the patient to the imaging point for ultrasonography of the pelvis. USG Ghik and reported normally. Three more ultrasounds were done by the Ultrasound Scanning Centre. All USGs were reported as “no obvious congenital anomalies in the abdomen and spine of the fetal head”.
But when the gynecologist performed an elective caesarean section and after the baby was born, the mother and all the attendants were shocked to see a “severely deformed male newborn”. The girl’s parents had alleged that all this happened due to the negligent ultrasound of the radiologist.
He had prayed for a compensation of Rs 10 crore to meet future expenses. But the radiologist denied any negligence in the patient’s USG report.

     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?

A Central Law Needed for Violence against Doctors: IMA to NMC


 

Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being.

Unfortunately, abusive and violent behaviour by patients or relatives or those accompanying patients has become one of the attendant risks of the medical profession. It is no surprise then that the medical fraternity has once again called upon the government to enact stringent laws and their proper implementation to curtail this kind of behaviour with the National Medical Commission (NMC) proposing that registered medical practitioners (RMPs) refuse to take on such cases.

The NMC (which replaced the Medical Council of India) is a body that regulates medical education and professionals.

The NMC’s Ethics and Medical Registration Board has issued draft regulations inviting comments from the public, experts, stakeholders and organisations on “National Medical Commission, Registered Medical Practitioner (Professional Conduct) Regulations 2022”.

Comments and suggestions on the draft proposal can be sent by June 22.

A Central Law Needed for violence against doctors: IMA to NMC

“In case of abusive, unruly, and violent patients or relatives, the RMP can document and report the behaviour and refuse to treat the patient. Such patients should be referred for further treatment elsewhere,” the draft proposal says.

 “If a change of RMP is needed (for example, the patient needs a procedure done by another RMP), consent should be obtained from the patient himself or the guardian. The RMP who attends to the patient will be fully accountable for his actions and entitled to the appropriate fees,” it added.

Medical professionals often face a trade-off between the Hippocrates Oath that they take and the necessity of their own well-being. Sahajanand Prasad Singh, president, Indian Medical Association (IMA, a panel that represents doctors and their interests), said a doctor would be ethically wrong if he or she refuses treatment to someone in need. So the need of the hour is to have a central law to check such untoward incidents, said Dr Singh.

“The government passed an Epidemic Diseases (Amendment) Act in 2020 which provided acts of violence against healthcare personnel during any situation akin to current pandemic to be cognizable and nonbailable offences. This law should remain in force forever. If the NMC wants the welfare of doctors, they should work in that direction,” he added.

“The commission or abetment of such acts of violence shall be punished with imprisonment for a term of three months to five years, and with fine of Rs 50,000 to Rs 2,00,000,” says the Epidemic Diseases (Amendment) Act, 2020.

Former IMA president Rajan Sharma, who led a nationwide protest condemning violence against doctors in India, said without a Union home ministry law against attacks on doctors, these proposals would do very little to prevent incidents against healthcare workers.

“There has to be strong laws to deal with the rising cases of violence. The regulations made by NMC should be in tandem with the stringent laws from the Union home ministry,” Dr Sharma said.

On his part, IMA general secretary Jayesh Lele, “It’s only a draft regulation, we are going to submit our important observations to the NMC.”

Anuj Aggarwal, general secretary, Federation of Resident Doctors Association of India, said the RMP Professional Conduct Guidelines offers some breather for resident doctors but has some way to go.

“The guidelines give rightful exceptions to patients with life-threatening conditions, which is justified. However, it is important to consider that most of the events in which a patient’s attendants turn violent are when the patient is very critically ill. So this proposal has no role to play in the majority of such scenarios,” he said.

Dr Aggarwal said that while it is a welcome step to curb the issue of rising violence against doctors, a central law would be a better and more effective deterrent.

The government did propose a central protection act and a draft was put in the public domain in 2019 for feedback but it was put on the back burner.

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?

Dr Manjula Case NHS-UK: Semantics-Regulator’s own Fitness to Practice Doubtful? #GMC-UK


Regulation of the medical profession has become a tool to oppress doctors.

  Dr Manjula Arora case (NHS-UK) unmasks the everyday struggle of the doctors in present era. Being undervalued and demonized, forced to work as sub-servant to administrators and regulators are considered new normal and has become an accepted form of harassment.  Fatigue and burnout are thought to be routine side effects of being a doctor or nurse.   The unhindered over-regulation has left no stone unturned in spreading hatred and creating an environment of mistrust against the medical profession.  Single stray or a trivial incident   is projected    as an example to portray poor image of medical profession as generalization and as a token of the ‘excellent’ work done by administrators and regulators.   Doctors have become soft targets because of their nature of work as they deal with life and death.   Any trivial issues such as semantics used by Dr Manjula Arora (in this case) were blown out of proportion  and   GMC finds this  as an  opportunity  to send a strict message to the whole profession.  Such incidence  show that regulators and administrators  can use the nature of doctors’ work to be  used against medical profession to make saviours as an  easy prey for  punishments   on the pretext of  dishonesty, negligence or semantics being used  as  legal weapons by law-enforcers, even in case of a perceived bias. In the process of such ‘tokenism’ administrators prove their relevance to the system.

       Regulation of the medical profession has become a tool to oppress doctors. Driving the narrative of doctors as “perfect” beings causes more harm to the doctor-patient relationship than not. Constantly seeking to attain perfection is the very approach that leads to burn out, and more mistakes- causing patient harm.

Dr Manjula Arora’s case

Dr Manjula Arora’s case

Dr Arora has been a doctor since 1988 and is of good character. She asked her employer for a laptop. For context, most employees would reasonably expect their employer to provide work-related IT equipment. She was told that none were available, but her interest would be noted for the next roll-out. Many people would interpret this positive response to mean that they would get a laptop in due course. Clearly if her employer did not intend for her to have a laptop, they could simply have said so. Dr Arora spoke to her IT department about getting a laptop and said she had been ‘promised’ one.

And that’s it. That is the entire extent of her ‘misconduct’.

One could regard her statement as a minor exaggeration, or loose terminology, or careless language or verbal shorthand over a trivial subject.  But no one  should consider it to amount to ‘dishonesty’ unless interpret it in biased manner.

The tribunal took a different view. They concluded that ordinary, decent people would consider her use of the single word ‘promised’ as dishonest.  The tribunal further decided that this so-called dishonesty amounted to misconduct.

They also considered that the misconduct was serious.

They decided her fitness to practice was impaired, and that it was necessary to suspend her to send a message to the profession.The regulator has a difficult task. Good regulation protects patients. Poor regulation harms patients, because doctors will run away from a toxic regulatory environment.

Manjula Arora case: the GMC stumbles again? -BMJ

      The case of Manjula Arora, a GP in Manchester, who has been suspended for a month for supposed “dishonesty” about a laptop, was picked up by a few colleagues, and social media did its work of ensuring the pick-up rate increased exponentially.  One always worries about the latest “MedTwitter” controversy. But this one has come on back of seething annoyance among many doctors about our regulator—the General Medical Council (GMC)—and its perceived bias, with cases such as those of Hadiza Bawa-Garba and Omer Karim still fresh in our memories.

Couple this with the recent Medical Workforce Race Equality Standard (MWRES) data confirming a clear association of increased referrals and convictions on the basis of racial background—or indeed country of origin as regards training—and this case lit the touch paper.

If one considers the publicly available details of the whole trial, you have to scratch your head and wonder how it got to this stage?   Would this happen if the name of the individual was, for example, Michael Andrews?  

The relevance of this case stood on two things—any harm to the patient population, which, to me, should be the primary aim of the GMC, and then dishonesty and disrepute brought upon the medical community.

This ruling makes it clear that there is no risk of harm to the public: “The Tribunal considered that no issues in relation to patient safety had been identified in this case. Dr Arora is a competent clinician, and there is no necessity to protect the public.” That should have ended the issue. But the complications started when interpretation about honesty came into the picture.

“The Tribunal attached significant weight to the fact that Dr Arora’s misconduct was a single incident in relation to the use of a single word, with no evidence of any other similar episodes of dishonesty before or after the event.” If you go into the details of the case, it becomes even more murky, as it’s the interpretation of a word—subjective at best— against the background of someone for whom English is not their first language. But it was deemed enough to warrant a month’s suspension according to the tribunal: “this period would send an appropriate message to the medical profession and to the wider public that Dr Arora’s misconduct, albeit relating to a single fleeting moment of dishonesty and not a planned deception.”

This raises a multitude of questions. Firstly, there is the principle that one fleeting moment of dishonesty could result in suspension. If that’s the standard, then the profession is indeed in trouble, with the GMC now making subjective judgements and being an arbiter of what is deemed to be honest or not. Where does the line get drawn? Discussions about patients or conversations about whether Santa exists or not?

Secondly, and more importantly, there is the suspicion of bias in how that law is being applied. Daniel Sokol has written a recent column which discusses the notion of doctors as the “saintly being”; the epitome of perfection at all times. Yet, within all of us exist the same prejudices and flaws as for the rest of the population. Sokol suggests that doctors have to be “scrupulously honest—in and out of work—unless the situation obviously allows for ethical dishonesty.” Yet he makes no mention of the fact that the GMC seems to apply that principle unevenly across the board. I accept that it can be difficult to see the “problem” others are complaining about, but I can assure you there are very few international medical graduates who have read about Arora’s case and not thought “I know why this has happened.”

There is professionalism, but there is humanity too, and I would propose that driving the narrative of doctors as “perfect” beings causes more harm to the doctor-patient relationship than not. What is honesty? Saying to patients that they need to wait for another 16 hours to get a bed, or holding the hand of the elderly frail lady, comforting her and saying “I am sure something will come up shortly”? It brings back the concept that being a doctor is a vocation. Constantly seeking to attain perfection is the very approach that leads to burn out, and more mistakes—causing patient harm.

Finally, if the role of the GMC is to protect the public from “single moments of untruth,” as this destroys the view among the public that doctors are saints (although I am pretty sure the public don’t see doctors like that in modern life), then there needs to be a discussion of that concept, of the overreach into personal lives, and of where the line is drawn as regards the GMC’s intrusion and inordinate application of that principle. I would suggest the role of the regulator should be for the rare circumstances when there is an interest in behaviour not being repeated or where it cannot be dealt with effectively by an employer.

I work with the GMC closely these days, and I find it immensely frustrating to see such cases as they undermine some significant hard work that is being done by individuals who are determined to change the narrative that the GMC is biased. I would encourage all concerned to look into this case, review it, learn from it, and offer support to Arora. There is a lot of work in hand to repair the damage from the Bawa Garba case, and this case could reinforce those sentiments, which we must avoid.

The intention may once have been for doctors to be Superman, but modern times and the foibles of individuals only permit a Batman. It’s worth remembering neither of them work to harm the public.

     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?

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.

     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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