Working of a doctor and nurses is not free from risk to themselves which can be verbal, physical as well as legal assaults. Everyday globally, the doctors and the nurses greet the new day and return to their work of taking care of their patients, knowing well the risk involved. None of the doctors can guess which one fine morning becomes a harbinger to their doomsday, especially when serving an anarchic and hostile society. No doctor can anticipate which one patient can cause deadly harm to health care workers, while trying to save the one. Unfortunate incident of PPH (Post-partum Bleeding – a natural complication of pregnancy) and subsequent agitation by mob and over-reactive FIR by hostile Police was enough for a brilliant Obstetrician to commit suicide in Jaipur. Possibly doctors are not assured of getting justice anymore from our system.
Jaipur- A woman doctor booked for death of a pregnant woman in Rajasthan committed suicide
Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. According to police, the pregnant woman died at the hospital run by Dr Archana Sharma and her husband on Tuesday. An FIR was registered against Archana at the Lalsot Police Station after family members of the pregnant woman held a demonstration outside the hospital and demanded immediate action against the erring doctor. Stressed over the FIR, Archana hanged herself to death, police said. “The doctor was booked for the death of the pregnant woman due to negligence in treatment. Today afternoon, the doctor hanged herself to death at her residence above the hospital,” Additional SP (Dausa) Lal Chand Kayal said.
The risk is generally underestimated, although often it may be major risk to life. Majority of people, society and governing bodies and even doctors themselves do not perceive or acknowledge the possible harms to health care workers in present era. But since these risks are increasing exponentially, they should be known to students, who want to take medicine as a profession. There are lesser set procedures, lack of awareness, not protective equipment or hostile society, lack of governance and laws and doctors continue to work in dangerous environment.
Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.
Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project single stray incident as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors need to be careful and remain careful about saving themselves from verbal, physical as well as legal assaults.
Doctor- ‘save the patient but to save themselves also’.
In present era, most of the time, a lenient view is taken against assault of doctors on the grounds of emotional circumstances of relatives and sympathy towards patients, even in cases of blatant injustice imparted towards doctors and nurses. Not infrequently, assaults of doctors are taken as routine incidents committed under disguise of perceived negligence and sympathy towards patients. The culprits are able to commonly get away with it.
But this businessman who abused a lady doctor has not been proved to be lucky, at least till this time. He was handed over a jail term of 6 months. Rightly so, courts need to aim at imparting justice and not judge on the basis of projected disturbed emotional state.
Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.
Man gets six-month jail for abusing lady doctor
Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project single stray incident as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors need to be careful and remain careful about saving themselves from verbal, physical as well as legal assaults.
The incident had taken place on 23 Nov 2017 when Rohinton Umarigar, who was at the Parsi General Hospital for his mother’s treatment used abusive language with the woman doctor who was in charge of the ICU
A Girgaum magistrate court refused leniency to a 52-year-old who used foul language with a woman doctor in 2017 and sentenced him to six months of simple imprisonment. It stated that unwarranted leniency to him would send a wrong signal to society and that he had used unparliamentary language to insult the dignity of a woman.
The incident had taken place on November 23, 2017, when the man, Rohington Umarigar, was at the Parsi General Hospital where his mother was undergoing treatment. He used abusive language with the woman doctor who was in charge of the ICU.
The Nepean Sea Road resident had sought leniency and requested that the court release him by imposing a minimum fine and on a bond of good behaviour. He told the court that he was the only breadwinner of his family. Umarigar’s advocate told the court that the incident occurred at the spur of the moment when his mother was ill. The court said the punishment under Sec 509 of the IPC (word, gesture, act intended to outrage modesty of a woman) was enhanced by the legislation in 2013 looking at the time and seriousness of offences committed against the modesty of women. The court noted that Umarigar had misbehaved a second time with the doctor, which means it was intentional.
“Whenever such type of offence is committed against women, it is against their right to sexual integrity, dignity. It is linked to their right to privacy…in the present matter also, the accused has used unparliamentary words to insult the dignity of woman. He is in his 50s and knows the consequences of his act,” Magistrate Nadeem A Patel said. The court further said that while enhancing the punishment, it was the intention of the legislature to penalize the offence of outraging a woman’s dignity, either physically or verbally. Therefore, in such cases, unwarranted leniency shown will send a wrong message to society. It also imposed a fine of Rs 1,000 on the man.
The man had claimed that he had made a complaint to the hospital management against the doctor for negligence and that this was a counter-complaint. The court refused to accept this defence. It said that even for the sake of argument if it were to be assumed that she had been negligent in her own duty, it did not give him the right to abuse a lady doctor. It relied on the testimony of the victim, as well as her three colleagues at the hospital who testified about the incident.
Doctors are just as offshoots of a tree called as society. They essentially are the same as rest of the society. It is a specialized branch of tree which helps other offshoots of tree to save others. As part of same tree, they resemble the parent society, of which they are part. Society needs to choose and nurture a force of doctors carefully with an aim to combat for safety of its own people.
Apple tree will have apples and musk melons plant will grow muskmelons only. One should not expect apples to grow on muskmelon stem. If society has failed to demand for a good and robust system, failed to save them, it should not rue scarcity of good doctors. Merit based cheap good medical education system is the need of the society. This is in interest of society to nurture good doctors for its own safety.
Therefore the quality of doctors who survive and flourish in such system will be a natural consequence of how society chooses and nurtures the best for themselves.
Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college. Even an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 15-20 % marks also becomes eligible to become a doctor. What is the need to dilute and shortlist around half a million for few thousand seats? Answer to that is simple. To select and find only those students from millions, who can pay millions to become doctors?
If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way forward. So children have to be careful while choosing medical careers from the beginning.
MUMBAI: MBBS aspirants who missed out in the initial rounds of seat allotment and pinned their hopes on vacant NRI quota seats have been bested by students at the tail end of the NEET qualifying list helped by NRI sponsors. Overnight, close to 152 aspirants, many of them with ranks in six digits, have submitted documents, including a certificate from the consulate concerned, to prove that their education will be sponsored by an Indian based abroad. Aspirants with much higher scores, who were banking on the addition of vacant NRI seats to the relatively cheaper management quota — the fee differential can be as much as Rs 25 lakh-35 lakh — have been done in by a minor clause in the fingerprint. A medical college in Maharashtra has, in fact, already allotted a seat to a NEET qualifier placed 267th from the bottom in a list stretching into several lakhs. When registration for the all-India mop-up round began on March 10, several Indian candidates had applied to convert to NRI status. The medical counselling committee gave such students time from noon on March 11 to 6pm the next day to change their nationality from Indian to NRI. However, candidates wrote to the NMC asking for their nationality to be converted in the last leg of the admission process, presumably after all other options to secure a seat had been exhausted. “The NMC was forced to open that window. According to a 2017 Supreme Court judgment, a candidate can change his or her nationality at any point,” said Dr Pravin Shingare, former head of the Directorate of Medical Education and Research. NRI seats, which cost Rs 40 lakh-60 lakh per year — 4-5 times more than those in the management quota — and had no takers until last week, were now suddenly in demand and filled by candidates with rock-bottom scores. At Pravara Institute of Medical Sciences, Loni (Maharashtra), the last management seat was filled by rank 83,817 while the last NRI seat went to rank 8,72,911. At Sri Devaraj Urs Medical College, Kolar, the last management seat was allotted to rank 86,416 and its last NRI seat to rank 8,76,357. This scenario has played out in medical institutes across the country. Rank holder 71,474 had named MGM College as his first choice in the mop-up round. He didn’t get a seat, but a candidate more than 8 lakh ranks below at 8,73,286 has got lucky, thanks to the clause which allows a student to abruptly change his/her nationality in the midst of the admission process. Hence, of the 19 vacant NRI seats at MGM that should have been converted to the general category, according to the NMC notification, not a single one eventually remained vacant.
Our society fails to develops a robust system of choosing and nurturing good doctors and therefore itself responsible for decline in standards of medical profession. A famous axiom “as you sow so shall you reap” has an application to health system, Government and Public as well in this scenario, so people should not rue scarcity of good doctors.
Overplayed narrative of fewer doctors in the country, rather than a system for proper utilization is an effort to increase numbers of doctors. But this goal needs to be achieved with preserving quality of medical education. Almost all efforts to increase the number of doctors are associated on dilution of merit. Selling the medical seats is heading towards bubble burst, when despite declining demand for poor quality and expensive medical education, new private colleges being approved along with lowering merit to a dismal percentage.
Future doctors getting admissions by scoring just 10-20 percent of marks, poor teacher student ratio, seats being awarded to highest bidder are few pointers to the poor quality of medical education. Few years back NEET percent system was changed to percentile and now the bar is lowered further, just to accommodate more ‘bidders’ with less marks, to be able to buy medical seats.
This potpourri portends to be a travesty of quality, not just of medical education but more seriously, of the quality of doctors. Allotment of medical seats is being left to the vagaries of populism and commercialism, through a false sense ‘the illusion of merit’ secured via NEET. Admission criteria whittled down to mere 10-20 percent, will result in an irreversible and regressive compromise with quality of doctors. Will patients approve such dizzying choice and at what cost?
Going by selection of candidates as doctors, if given a choice, by which a patient will like to get treated? A candidate who scored 20 % marks or a person getting 60% or 80% marks. NEET eligibility getting lower and a candidate getting around 20 % of marks may be able to secure a degree to treat patients. What will be the deciding factor? The criteria as to why a person with 60% marks not getting a seat and another with 20% marks will be able to secure. It will depend upon, whether a candidate is able to pay the exorbitant fee or not. Present system and mechanism of admission permit and accept such huge variation! That strange equation is acceptable in lieu of money paid!
In a move that is likely to boost uptake in vacant post-graduate medical seats and also improve availability of specialists in future, the health ministry has slashed the cutoff for NEET-PG 2021 by 15 percentile across all categories. The ministry issued a letter to the National Medical Commission on Saturday giving a go-ahead to the proposal. The revised qualifying cutoff now stands at 35 percentile for the general category, 30 percentile for persons with disabilities (PwD) general, 25 for SC/ST and OBC and 25 for PwD (SC/ST/OBC), the letter said. The reduction in the cut off percentile is expected to allow more MBBS passouts to apply for post-graduate courses, an official said. “The move aims to prevent seat wastage. With this reduction in percentile, approximately 25,000 fresh candidates can participate in the mop-up round of the ongoing counselling,” a ministry official said. Nearly 8,000 post-graduate seats are still vacant despite two rounds each of all India and state counselling. “After due discussion and deliberations, it has been decided by the health ministry in consultation with NMC to reduce the cut off by 15 percentile across all categories…” medical counselling committee member-secretary wrote in a letter to National Board of Examinations executive director . TOI has reviewed the letters. The move is also expected to fill a serious gap in the availability of specialists. There remains a severe shortfall of over 76% in terms of specialists like surgeons, gynaecologists, physicians and paediatricians at community health centres. Against the requirement for existing infrastructure, there is a shortfall of 78.9% surgeons, 69.7% obstetricians & gynaecologists, 78.2% physicians and 78.2% paediatricians. The Centre has further directed NBE to declare the revised results and send data of the newly eligible candidates to the counselling committee
Microsoft Corp. said Zain Nadella, son of Chief Executive Officer Satya and his wife Anu, died Monday morning. He was 26 years old and had been born with cerebral palsy. The software maker told its executive staff in an email that Zain had passed away. The message asked executives to hold the family in their thoughts and prayers while giving them space to grieve privately.
Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It’s caused by damage that occurs to the immature, developing brain, most often before birth.
Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with exaggerated reflexes, floppiness or spasticity of the limbs and trunk, unusual posture, involuntary movements, unsteady walking, or some combination of these.
People with cerebral palsy can have problems swallowing and commonly have eye muscle imbalance, in which the eyes don’t focus on the same object. They also might have reduced range of motion at various joints of their bodies due to muscle stiffness.
The cause of cerebral palsy and its effect on function vary greatly. Some people with cerebral palsy can walk; others need assistance. Some people have intellectual disabilities, but others do not. Epilepsy, blindness or deafness also might be present. Cerebral palsy is a lifelong disorder. There is no cure, but treatments can help improve function.
Signs and symptoms of cerebral palsy can vary greatly from person to person. Cerebral palsy can affect the whole body, or it might be limited primarily to one or two limbs, or one side of the body. Generally, signs and symptoms include problems with movement and coordination, speech and eating, development, and other problems.
Movement and coordination
Stiff muscles and exaggerated reflexes (spasticity), the most common movement disorder
Variations in muscle tone, such as being either too stiff or too floppy
Stiff muscles with normal reflexes (rigidity)
Lack of balance and muscle coordination (ataxia)
Tremors or jerky involuntary movements
Slow, writhing movements
Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling
Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
Difficulty with fine motor skills, such as buttoning clothes or picking up utensils
Speech and eating
Delays in speech development
Difficulty speaking
Difficulty with sucking, chewing or eating
Excessive drooling or problems with swallowing
Development
Delays in reaching motor skills milestones, such as sitting up or crawling
Learning difficulties
Intellectual disabilities
Delayed growth, resulting in smaller size than would be expected
Other problems
Damage to the brain can contribute to other neurological problems, such as:
Seizures (epilepsy)
Difficulty hearing
Problems with vision and abnormal eye movements
Abnormal touch or pain sensations
Bladder and bowel problems, including constipation and urinary incontinence
Mental health conditions, such as emotional disorders and behavioral problems
The brain disorder causing cerebral palsy doesn’t change with time, so the symptoms usually don’t worsen with age. However, as the child gets older, some symptoms might become more or less apparent. And muscle shortening and muscle rigidity can worsen if not treated aggressively.
When to see a doctor
It’s important to get a prompt diagnosis for a movement disorder or delays in your child’s development. See your child’s doctor if you have concerns about episodes of loss of awareness of surroundings or of unusual bodily movements or muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance, or other developmental issues.
Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn’t known. Many factors can lead to problems with brain development. Some include:
Gene mutations that result in genetic disorders or differences in brain development
Maternal infections that affect the developing fetus
Fetal stroke, a disruption of blood supply to the developing brain
Bleeding into the brain in the womb or as a newborn
Infant infections that cause inflammation in or around the brain
Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse
Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought
Risk factors
A number of factors are associated with an increased risk of cerebral palsy.
Maternal health
Certain infections or toxic exposures during pregnancy can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby’s developing brain.
Cytomegalovirus. This common virus causes flu-like symptoms and can lead to birth defects if a mother has her first active infection during pregnancy.
German measles (rubella). This viral infection can be prevented with a vaccine.
Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
Syphilis. This is a sexually transmitted bacterial infection.
Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
Zika virus infection. This infection is spread through mosquito bites and can affect fetal brain development.
Intrauterine infections. This includes infections of the placenta or fetal membranes.
Exposure to toxins. One example is exposure to methyl mercury.
Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid problems, preeclampsia or seizures.
Infant illness
Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:
Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of “used” blood cells aren’t filtered from the bloodstream.
Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.
Factors of pregnancy and birth
While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:
Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors’ risk of cerebral palsy increases.
Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
Delivery complications. Problems during labor and delivery may increase the risk of cerebral palsy.
Complications
Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or in adulthood, including:
Contracture. Contracture is muscle tissue shortening due to severe muscle tightening that can be the result of spasticity. Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation. These can include hip dislocation, curvature of the spine (scoliosis) and other orthopedic deformities.
Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavioral problems can also occur.
Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing disorders. Problems with swallowing can result in respiratory problems, such as aspiration pneumonia.
Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of this painful degenerative bone disease.
Osteoporosis. Fractures due to low bone density can result from several factors such as lack of mobility, inadequate nutrition and anti-epileptic drug use.
Other complications. These can include sleep disorders, chronic pain, skin breakdown, intestinal problems and issues with oral health.
Prevention
Most cases of cerebral palsy can’t be prevented, but you can reduce risks. If you’re pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:
Make sure you’re vaccinated. Getting vaccinated against diseases such as rubella, preferably before getting pregnant, might prevent an infection that could cause fetal brain damage.
Take care of yourself. The healthier you are heading into a pregnancy, the less likely you’ll be to develop an infection that results in cerebral palsy.
Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.
Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.
The ongoing Russia- Ukraine conflict has generated a discussion about a sub-plot, which links to India’s medical education. There have been reports that there are 18000 Indian medical students in Ukraine. People are wondering why Medical Students from India need to go to Ukraine for studying medicine. Answer is quite simple and does not need an Einstein Brain. It is the steep fee that private medical colleges charge from students which is unjustified and beyond any logic. It just needs a sincere ‘Government Will’ to implement the justified fee for MBBS seats in private medical colleges in India. Medical colleges in Ukraine, Georgia, Kyrgyzstan, Bangladesh, Philippines and China have been benefitted because of the severe exploitation of medical students in India.
It needs a sincere and honest assessment of the fee and expenditure of medical college and education rather than a permission for heavy profiteering. If honest calculations are carried out, the fee should not be more than one fifth of present rates, taking into account the hospital services expenditure.
Why do Indian students go to Ukraine to pursue courses, especially MBBS? Because of affordability, says Manjula Naidu, proprietor of a firm that helps send students to Ukraine’s Bukovinian State Medical University. Usha Rani, an Anekal resident whose son is in first-year MBBS at Zaporizhzhia State Medical University, said she wouldn’t have sent him to Ukraine had she been able to pay nearly Rs 80 lakh for an MBBS course in Karnataka. Though Karnataka has more than 9,000 MBBS seats, government quota seats account for not even 40%, forcing many aspirants to opt for countries like Ukraine, Georgia and Kyrgyzstan. What students and their parents find attractive is the Rs 25-30 lakh package for the entire course. Besides there are consulting agencies to help them with loans and the medium of instruction is English. On the other hand, the first fee slab for an MBBS seat in a government college is Rs 59,000 per year, followed by the second slab of government quota seats in private colleges (Rs 1.4 lakh per annum). The next fee slab is of private seats (management quota) in private colleges that varies from Rs 10 lakh to Rs 25 lakh a year. Even more expensive are the NRI quota seats and those in deemed universities.
With the evolving medical science and health care getting intertwined with business, braided changes in medical regulation and law are not an unexpected development. New models of medical regulation, business and law in health care have emerged and progressed in last few decades. Despite a wish to govern and regulate medical profession strictly, the laws and regulations still have to go a long way to provide real justice to everyone. 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 sorrow and other uncountable emotions, all intertwined with financial aspects.But the wish of administrators to govern medical profession strictly with punishments is not new. Hammurabi (5000 years back) at the start of civilization believed that doctors needed to be punished in case there was a poor outcome. Strangely it was at a time, when no one understood the complexity of human body and the limitations of medical science; even basic anatomy and physiology of body was not discovered.
Considering the limitations of medical science along with uncertainties and complexities of human body, regulation of medical profession and system of punishments still remains somewhat unfair to doctors, even after 5000 years. It is still based on principles of revenge and retributions rather than developing a robust system by learning from mistakes. By application of an average wisdom, doctors can be easily blamed for poor outcomes, as they are always and universal a common visible link between treatment and poor outcome.
One of the examples of easy punishments for doctors is Medical consumer protection act that was implemented in 1995 for medical services. Patients were defined as consumers and hence doctors were converted to service providers in lieu of some money. Consequently the changed definitions altered the doctor-patient relationship in an irreversible way.
The reality is that neither doctors, nor patients are ready for such a legal relationship. More-over the system is not robust enough for such a change. To work with weak infrastructure, non-uniform medical education, poor numbers of support staff, inept health system along with legal complexities has pushed doctors into a shell and predisposed them to harassment.
Rather than developing a system to promote good doctor-patient relationship, Medical Consumer Protection Act has created a situation of ‘us versus them syndrome’. It caused erosion of doctor-patient relationship and escalated cost of care. Propagation of stray and occasional incidents about negligence case in court or their outcomes are given disproportionate wide publicity in media. The patients are unable to understand the correct application of such stray incidents to themselves. Such cases may be frivolous, just one in million or a rarity, but people always try to imagine themselves being in the hospital chaos due to the scenario projected. It gives a negative projection about medical services and enhances patients’ fear to seek treatment at right time.
There is a growing mutual mistrust; doctors too have started looking at every patient as a potential litigant. Especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients.
With the mandate to practise evidence based medicine, doctors need to document everything and to offer everything possible, leading to skyrocketing medical costs. To save themselves, doctors have to do mammoth paper work, leading to consumption of time that was meant for real deliberations for the benefit of patients.
Consequently insurance companies, medical industry and lawyers have become indispensable and have positioned themselves in between doctor and patients. Besides creating a rift between doctor and patient, they charge heavily from both sides; from patients (medical insurance, lawyer fee) and doctors (indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall inflated cost of health care.
Not uncommonly doctors are used as scape goats to have a concession on the patient’s treatment from administrators.
Medical consumer protection act has increased the anxiety and insecurity among medical professionals. Doctors can be dragged to courts for trivial reasons, for example the sense of revenge, simply for non-satisfaction, to extract money or simply for avoiding paying 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 doctors does not exist. These money-making ideas are further stoked by the much publicized incidents of high compensations granted by courts.
Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on their confidence and belief, which takes a lifetime to build.
Whenever there is adverse outcome in any patient, all the doctors involved start looking for whom to blame among themselves. Due to legal pressure they try to pinpoint each other’s mistakes. Mutual understanding takes 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 among medical professionals.
The ease with which doctors can be harassed has led to rampant misuse of medical consumer protection act and it has instilled a sense of deep fear and insecurity in the mind of medical professionals. The act has been used as a whip against the doctors by all, including medical industry, law industry and administrators. Only doctors are visible as those who deliver care, so they remain at receiving end for poor outcomes and all these industries remain invisible. The industry has used the protective systems against medicolegal cases to gain maximum benefits out of doctors’ hard work.
In court cases, a certain element of doubt always remains in mind of a doctor whether he will get justice in the long run, or will end up being a victim of sympathy towards patient or clever lawyering. So taking medical decisions in critical situations is becoming more difficult in view of the future uncertainty of disease.
Windfall profits for lawyers is a strong incentive for law industry to promote instigation of patients by against doctors . 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 on ‘sharing and commission basis’. There is no dearth of such relatives and lawyers who are ready to try their luck sometimes in vengeance and sometimes for the lure of money received in compensations.
Consequently doctors are now an easily punishable human link for poor outcomes. Medical professionals work with continuous negative publicity, poor infrastructure, and preoccupied negative beliefs of society and burden of mistrust.
Strangely Medical Consumer Protection Act applies only to doctors, that too selectively. All other professions and services are out of it, not even other constituents of health services. Selective application is what is demoralizing the doctors. Considering the uncertainty and kind of work done by medical professionals, actually it should be other way around.Mistakes are always easy to be picked with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
Nothing else has ever distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Decision making also becomes difficult by uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight with luxury of time and fault-finding approach. The possibility of complex medico-legal situations in doctor’s mind are enough to distract doctors from their primary point of intentions ‘the treatment’.
Therefore increasingly, financially secure doctors are staying away from the riskier jobs. No wise person will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the entire life.
Patients can have poor outcomes for many reasons. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. Whatever court decides, while consuming years, the harassment of doctor is full and permanent. Even if court decides in favour of the doctor, there is no compensation possible for the sufferings and agony spanning over years. Therefore, a single mistake can undo all the good work of past, and the illustrious future work that could have been accomplished.
If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career at risk, why would anyone put himself in that difficult position?
Medical Consumer Protection Act has become a tool to harass doctors and money making tool for lawyers, medical industry or administrators. But it would be naïve to assume that by whipping doctors and regulating them in such a harsh manner will be helpful to patients in long run. The consequent insecurity among doctors, practise of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment) are few of the side effects, which will definitely be passed on to the patients inadvertently. After all doctors have to save themselves as well. As a result, now the battle of life and death will be fought with less zeal, with subdued and demoralized soldiers.
Patients are unable to realize their loss for punishing their saviours. For doctors, no rewards if you win, but sword hanging if one loses. Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Consequently being consumer may be overall a loss making deal for the patients.
Many have woken up to India’s plastic waste generation problem after worrying data was presented in Parliament. But alarm bells have been ringing for a long time. According to the Centre, plastic waste generation has more than doubled in the last five years, with an average annual increase of 21.8%. A 2018-2019 Central Pollution Control Board (CPCB) report puts India’s annual plastic waste generation at 3.3 million metric tonnes. This, according to experts, is an underestimation. Seven states — Maharashtra, Delhi, Karnataka, Uttar Pradesh, Gujarat, West Bengal, and Tamil Nadu — contribute to 66% of the country’s total plastic generation. And, Goa and Delhi’s per capita plastic use is six times higher than the national average. A 2018 study by IIT Kharagpur found that 49% of waste in Delhi drains was plastic.
There is need for robust national plan, ensure transparency and to involve every stakeholder- from Government and industries to every last citizen.
New Delhi [India], February 18 (ANI): Taking forward the commitment to eliminate single-use plastics, the Environment Ministry has notified comprehensive guidelines on Extended Producer Responsibility (EPR) for plastic packaging under Plastic Waste Management Rules, 2016.
According to the Ministry of Environment, Forest and Climate Change, the guidelines on extended producer responsibility coupled with the prohibition of identified single-use plastic items, which have low utility and high littering potential, with effect from July 1, 2022, are important steps for reducing pollution caused by littered plastic waste in the country.
The minister said that the guidelines provide a framework to strengthen the circular economy of plastic packaging waste, promote the development of new alternatives to plastics and provide further next steps for moving towards sustainable plastic packaging by businesses. “Reuse of rigid plastic packaging material has been mandated in the guidelines to reduce the use of fresh plastic material for packaging,” Yadav said.
The Ministry said that the enforceable prescription of a minimum level of recycling of plastic packaging waste collected under EPR along with the use of recycled plastic content will further reduce plastic consumption and support the recycling of plastic packaging waste.
The EPR guidelines will give a boost for formalization and further development of the plastic waste management sector. As a significant first, the guidelines allow for the sale and purchase of surplus extended producer responsibility certificates, thus setting up a market mechanism for plastic waste management.
“The implementation of EPR will be done through a customized online platform which will act as the digital backbone of the system. The online platform will allow tracking and monitoring of EPR obligations and reduce the compliance burden for companies through online registration and filing of annual returns. In order to ensure monitoring on fulfilment of EPR obligations, the guidelines have prescribed a system of verification and audit of enterprises,” it said.
The guidelines prescribe a framework for the levy of environmental compensation based upon the polluter pays principle, with respect to non-fulfilment of extended producer responsibility targets by producers, importers and brand owners, for the purpose of protecting and improving the quality of the environment and preventing, controlling and abating environment pollution, the Ministry added.
It further said that the funds collected shall be utilized for collection, recycling and end of life disposal of uncollected plastic waste in an environmentally sound manner.
Under these producers, importers and brand owners may operate schemes such as deposit-refund system or buy-back or any other model in order to prevent the mixing of plastic packaging waste with solid waste. (ANI)
In an era when doctors are being punished for small mistakes or merely perceived negligence, the blunders committed by administrators are not even noticed. Doctors are not paid for four months and for protesting the same, they were given termination letters. It seems that doctors need to live with blatant injustice all their lives.
Any punishment for the administrators for mismanagement? Looks impossible but punishment to the sufferers is on the cards.
Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world.
Doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.
It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.
The indifferent behaviour has also unveiled the approach of tokenism such as ‘mere lip service’ showing respect to corona warriors.
The strong political and legal will is absent to solve Doctors’ problems.
New Delhi: Doctors, nurses and paramedical staff of East Delhi Municipal Corporation-run hospitals continued their protest on Thursday as well over non-payment of salaries for four months. Meanwhile, an order issued by the medical superintendent of Swami Dayanand Hospital, Dr Rajni Khedwal, stated that services of all senior and junior resident doctors would be considered terminated from February 4 and fresh interviews would be conducted accordingly. The order also stated that all Diplomate of National Board (DNB) residents and contractual doctors would be marked absent.
“We all were there in the protest, none of us went for our duties. We have also asked the administration to speak on our behalf because they are too part of the hospital. Maybe the matter will be resolved tomorrow. Unless we get a concrete statement regarding salary, we will continue the protest,” said Dr Atul Jain, president of the hospital’s resident doctors’ association.
Meanwhile, EDMC commissioner Vikas Anand said that no order had been issued regarding the termination/suspension of the striking doctors’ services so far. The termination order is only for the DNB workers and for the rest of the medical staff, it is based on ‘no work no pay’ as per the SC rule, he clarified.
“The salaries will be provided at the earliest. We have a very good team of doctors at Swami Dayanand Hospital. The only request is that they should join back and resume services,” said the commissioner.
Anand also said that the salaries for the months of February and March would be paid on time. “EDMC is going through a financial crisis and even in such difficult times, the corporation is sensitive towards the interests of its employees. Their due arrears will be paid in the month of May as per the availability of the funds,” he added.
In an era, when even licensed and qualified doctors are finding it difficult to practice medicine, it is strange that unqualified and unlicensed are having a field day. Why strict regulations do not apply to them, is beyond any reasoning and logic. If a medical facility or clinic is functional, it is difficult for the patient, especially in emergency, to check or even doubt its credentials. How such facilities are open, functional and thriving. Sadly our regulation is trying to regulate, who are already regulated. It is trying to punish those who are qualified and licensed, but turns a blind eye towards unlicensed and unqualified doctors.
Such fake doctors own medical set ups, may conduct surgeries, sometimes run hospitals with little help from qualified doctors and do procedures. Another problem is that they promote fake rumours about genuinely qualified doctors and create a mist of mistrust to propagate their fake medical business.
The glans of an infant’s penis shrivelled and fell off after a quack tied a horse’s hair around it ‘to prevent bleeding’ after a ritual of circumcision. The child was rushed to hospital, where a surgery was performed to ensure that the baby will be able to urinate normally, but the boy has lost his glans.. A quack had conducted the religious ritual of circumcision on November 22, 2021, and tied a horse hair to the child’s penis. He then bandaged it and told the family to go home.
The child was born in October 2021. Ten days later, the family members noticed that the glans had come off along with the dressing. Families choose to get their male infants circumcised by neighbourhood quacks. This is not just unhygienic, but can lead to major complications as well. Other unhealthy practices like sprinkling ash on the wound after circumcision are also prevalent.
A toddler has died and his baby brother has required life-saving surgery in hospital after a medical procedure, understood to have been a circumcision, went horribly wrong in Perth’s south-east. The brothers were rushed to hospital in Armadale by family Tuesday evening following the surgeries. The West Australian reports a two-year-old boy was pronounced dead at the hospital’s emergency department. His infant brother – aged between seven and eight months – was rushed to Perth Children’s Hospital for emergency surgery.7NEWS reports he has since been discharged from hospital. WA Police have confirmed the toddler’s death is not being treated as suspicious. “It can be confirmed the boy underwent a medical procedure at a registered medical centre prior to his death,” a police spokeswoman said.
Circumcisionis one of the oldest surgical procedures and one of the most commonly performed surgical procedures in practice today. Descriptions of ritual circumcision span across cultures, and have been described in ancient Egyptian texts as well as the Old Testament. In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by paediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.
Evolution of Medical profession-Extinction of good doctors 