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

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

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

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

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

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

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

This is where the trouble begins.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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May 17, 2022 2

Want to be a Doctor: Expect No Justice

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.

At a time when Political groups, terrorists, drug addicts, celebrities commit crimes and get a priority hearing by courts and speedy relief (whether deserve or not worthy), 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 barbaric response of Police towards peacefully demanding doctors has unmasked the real indifferent attitude of Government and administrators as well as apathy of courts towards medical profession. The cruel 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.

It also shows the scant concern of the Government to provide a real good health care system despite showing a verbal concern for medical services. It also explains why successive Governments irrespective of political moorings have terribly failed to provide healthcare to its people. Why patients fail to get a bed, oxygen, doctors or nurse is consequence to the misplaced priorities of administrators.

Who would be the worst sufferer of the apathetic attitude of the Government? Doctors will suffer initially till they continue to choose medical profession. Once they also become apathetic like administrators, it would be the patients.

Delhi: AIIMS, FAIMA doctors join protest after police crackdown

A day after resident doctors protesting delays in NEET-PG counselling alleged that they were assaulted by the police, doctors from the All India Institute of Medical Sciences (AIIMS) as well as those associated with the Federation of All India Medical Association (FAIMA) have decided to join the stir.

Doctors from AIIMS, one of the only big tertiary-care government medical college hospitals that had stayed away from the protest, in a letter to the Union health minister, said that they would withdraw from all non-emergency work on Tuesday if no concrete steps are taken.

“It’s high time for the government to release a report of what has been done till date, and what are the government’s plans moving forward for expediting NEET-PG counselling. If no adequate response from the government is received within 24 hours, AIIMS RDA shall proceed with a token strike on 29/12/21 including shutdown of all non-emergency services,” the letter read.

This would hamper patient care in the city further. With emergency departments of big hospitals like Safdarjung and Lok Nayak affected by the strike, patients were being referred to the AIIMS for treatment.

In addition, FAIMA called for its resident doctors’ association to withdraw from all work, including emergency services, after Monday’s incident. The protest began with withdrawal from outpatient department (OPD) services in November end by two national organisations – the Federation of Resident Doctors’ Association (FORDA) and FAIMA.

The protest slowly intensified with doctors boycotting even emergency work, following which on the insistence of the government the strike was paused for one week.

The strike resumed on December 17 as FORDA members withdrew from all services.

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December 28, 2021 0

The Book-‘At the Horizon of Life & Death’: Doctors’ struggle with death

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

While doctors are usually blamed for any mishap, be it natural poor prognosis or genuine complications, rarely people get to know their side of the story — how a dying patient affects their psyche, how they deal with these patients and their kith and kin, what are the kinds of abuse and threats made when they are not able to save a life despite their best efforts. Dr Pankaj Kumar, Director Critical Care at a Delhi Hospital, India has come out with an insightful account of these very aspects of a doctor’s life.

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

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

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

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

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

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

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

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

The book is self-published, available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive etc.

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December 13, 2021 1

Doctor treating celebrity (Puneeth Rajkumar): Faces new kind of problem

Previously the death of any patient was thought to be because of natural causes or God’s wish. But in present era of consumerism, first possibility is to blame the doctor and not the disease or natural causes. The doctors treating celebrities are likely to face the ire of fans as they can be easily blamed for the death. Doctors need to be more careful especially about documentation while treating the celebrities. Not only doctors will be at risk of physical assaults or loss of reputation but they should be ready with legal scrutiny as well.

Bengaluru: Late actor Puneeth Rajkumar’s doctor gets police protection

A week after Kannada superstar Puneeth Rajkumar owing to a cardiac arrest in Bengaluru, his family doctor has been provided police protection in the wake of several fans alleging “medical negligence”.According to Bengaluru City Police, a KSRP platoon has been deployed outside the residence and clinic of Dr Ramana Rao at Sadashivanagar. “We are closely monitoring the situation near these areas with intensified patrolling to avoid any untoward incident,” a senior officer confirmed.This comes after the Private Hospitals and Nursing Homes Association (PHANA) sought protection for Dr Ramana Rao and other medical professionals who were involved in the treatment of the late actor. In a letter addressed to Chief Minister Basavaraj Bommai, PHANA president Dr Prasanna H M had expressed concerns about “attempts by fans and well-wishers” to discuss the medical condition of the deceased, which he felt was “a gross violation of the healthcare privacy of an individual or a family”. “We strongly oppose attempts by the public to point fingers at the treating physicians, especially Dr Ramana Rao, who did his best,” Dr Prasanna wrote. The Association has also pointed out that certain TV and social media platforms were running narratives “blaming lack of care by the medical professionals” who offered services to the late actor. “This kind of judgemental and hypercritical media frenzy is creating distrust in society as well as risk to the lives of the medical professionals who served the deceased,” the letter stated.Further, PHANA also requested Bommai to give a public statement in an attempt to boost the morale of the medical fraternity. “After all, we know that the medical profession has limitations, and saving lives is not always possible,” the letter added.

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November 7, 2021 0

REEL HEROES Vs REAL HEROES

The old adage “All that glitters is not Gold” is particularly relevant in current era of media domination where media projection shapes the perception and may defy the reality. Media has dominated our lives and can sway the opinion formation of masses. Written media, television, social media can collectively influence the mass opinion.

Society, in general, needs to be wise enough to realize the importance of getting rid of these blinders in real life . One such factor that causes an illusional mist in the thoughts of masses is projection in films. They create a mirage of illusional glitter wherein there is blurring of real life from the reel life of heroes. The larger-than-life unreal persona of the celebrities on screen looks too charming and sometimes becomes undeniable and dominates mind of masses. The super-human characters played out in films appear to be real. The problem arises when the imaginary characters of the reel life stories are emulated in real life. Individuals as projected character fill in peoples’ imagination and are perceived as real and becomes ingrained in mind. The naivety of masses to perceive the projected character as real one goes beyond a reasonable thought process and imagination.

These roles played in films are not really act of inspiration in real life as the actual purpose accomplished in the end of a movie is entertainment of society and business for themselves. A recent candid admission by the actor Mr Irrfan Khan that film stars should not be role models was impressive (Hindustan times) .

At the best, a particular projected character (and not individual acting star) may be a role model. An actor or super star, is simply doing his work of “acting” in the end. This work of acting may bring an entertainment of few hours at the most.

One cannot stray away from the wisdom to choose between what we consume merely for our entertainment and what we believe or face in real life. One needs to differentiate between rationale truth behind the celebrity gimmicks in the media and exaggerated sensationalism. Sensation created merely for a commercial successful venture should not be allowed to overpower the judgments of real life.

But the problem starts, when these false perceptions created merely by a projected glimmer takes the shimmer away from the real worthy. The real professionals and people who are worthy of glory become invisible behind the glittery mist, a haze, which is unreal and unhelpful in real life.

A soldier contributes to our society much more in real terms. Even a junior doctor saves many lives in a day in emergencies as compared to work of a superstar in films. A teacher, nurse or scientist have contribution which is more fruitful to our generation. Also the scientists, who contribute immensely and bring about the real change in our lives. Their contribution is huge to our society and much more than doing just acting on screen. The reel actor merely imitates the real life lived and actual work done by real heroes like soldier, doctor or teacher. Someone who only acts and behaves like one, is respected and paid thousand times or more than the real one. In reality, people need more than mere entertainment and reel role models and actors in their real lives.

Compare the trivial amount of remuneration, fame and respect the real worker gets as compared to the film stars, who merely imitate their actions. Reel projection for purpose of entertainment is more easier to enact and more profitable than actual performance in real life. It is easier to become a reel hero, as it requires little hard work or just connections to get an opportunity. Some one can be a reel hero just by dynastic factor easily. Hard work is definitely required but that may or may not be prerequisite.

Even good films may raise some social problem, which everyone knows already and offer no practical solution in reality. Therefore what good it brings to the public, beyond entertainment, is any body’s guess. The persona, actors usually project on screen, may actually be far from his or her real personality. In most of cases, what he does in movies and reel life, is actually away from possibility of real life . But strangely in present era, people lose sight of what is mere perception. It is clearly a story, tale, a drama, a myth and is not the real identity of the people, we see on-screen.

In present era, real contributions by people, who are saviours of human life and the real heroes, remain unappreciated. People are so besotted by fame and money that they fail to appreciate the sacrifices made by real heroes. Filmy super hero just imitates a doctor, soldier, dacoit or a street hooligan and just pretends to be one on the screen.

But there are real life heroes that exist around us. Doctors awake at night saving lives every minute or soldier in freezing cold are worthy of more respect and are real heroes. And it is up to the society to look beyond the superficial and reel story, and focus on the real life actors. There has to be an true effort to make, respect and appreciate real heroes.

Point to ponder is that whether society needs people just acting like doctors, soldiers and not the actual and real ones, who saves lives. Does Society need only entertainment, because respect which is paid to someone who is just an actor, is not extended to real doctors, soldiers or other altruistic professions.

A reel hero who acts like a soldier, is famous and richer and than the actual soldier, who dies unnamed and in penury. Children of today’s times will strive to become, who is worshiped and paid respect by society and therefore will prefer to become reel heroes.

A society truly needs the real people, who work and act for them, more than just entertainment. It will need total change in attitude of people to deconstruct the perceptions, which are based on mere projections and are away from reality.

It is time to recreate and worship real heroes, who have become invisible behind the glittery mist.

Society needs to envisage the bigger real picture, and should not be mistaken for another projected story.

The perception of the projection will decide, what does the society actually need- or desire-or deserve , “Reel Heroes or Real Heroes”.

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October 20, 2021 0

Want to be a doctor? Medical Middleman may get you killed

Increasing murderous attacks and assaults on doctors is worrisome, an indicator of a lawless, uncivilized society, poor governance and broken health system.

Think of a profession, where a brilliant student studies hard for 10 to 15 years, does day and night duties, save innumerable lives. Start earning pittance and get conveniently labelled as thug, thief and butcher by Medical Middleman. These brilliant doctors can be abused, assaulted and dragged to courts with impunity. They have become sitting ducks for punishments and physical assaults or can get killed because of instigation created by MEDICAL MIDDLEMEN.

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.

Who are these Medical middlemen? How they have benefited enormously by using one single selective negative narrative?

All those, who with some clever tricks, have placed themselves between doctor and patients. They earn money by promoting mistrust between the two actual stake holders. These Middlemen have no stake, but still want to get benefited by stroking emotions.

One poor outcome out of millions lives saved, is enough for these opportunistic parasites to portray whole medical community as dystopian one.

Most important of these Middlemen are the ‘Reel heroes’ who in a quest to be projected as Real heroes, got placed themselves between doctor and patient by airing vague narratives. By self-appointing themselves as custodian of health of masses, ‘the Reel heroes’ and celebrities gave true meaning to their work of ‘ACTING’ that otherwise was no more than a trifling entertainment.

Media and many celebrities have used fear in public mind to garner accolades and money for themselves, but at the same time created paranoia in minds of people against medical profession. And when masses worshipped ‘the Stars’ as their true well-wishers, they aired advertisements to sell tobacco, soft drinks, junk foods and other sweet poisons to public and children.

Media and celebrities made money and fame by riding on the vulnerability of medical profession. By winning the faith by demonization of doctors, all these middlemen sold their products, news items shows and created a brisk business.

Words used cleverly by such middlemen are ‘Few Doctors’. What majority of other doctors do to save millions was not of much concern and consequence. Public would not know, how to differentiate good or bad ones.

But this was merely a posturing on television; to be a Real hero, actually signified nothing for those unknown ‘Few doctors’, but the denigration of medical profession and attempts to belittle the whole doctors’ community was full and complete. The mistrust generated and demonization of the real well wishers of the patients was irreversible.

These middlemen instigated masses against health care workers by their acidic comments and vitriolic spewed venomous words.

The consequence was the loss of trust on their doctors, the only ones, who were in position to help patients in the emergency situations. The taunts and torment on doctors multiplied manifold in many forms verbal, legal, abuse and physical assaults.

These MEDICAL MIDDLEMEN, with distorted projection earned huge accolades and money, but they promoted feelings of enmity or hatred between doctor and patient.

The aspiring doctors need to know the media role in today’s times. They would carry the image, whatever media projects. A clear understanding in required, before they sacrifice their youth and life without knowing what is in store for them at the end of the long tunnel of study and training.

Students while choosing medical career, should take a well informed decision before entering this profession, which is dangerous to doctor themselves even when discharging their duties in the best manner.

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June 4, 2021 2

Allopathy-Ayurveda debate: Media’s Misplaced priorities

The doctors, nurses and healthcare system have been relentlessly hauled over the coals for last one year and further battered emotionally by the cruel adverse media insinuations and taunts. At the peak of pandemic, when the powerful media should be discussing the core issues to control pandemic; issues like oxygen supply, vaccination and improving the health infrastructure, it has found more interest in a futile Allopathic-Ayurveda debate. Even if someone wants to start this kind of discussion, media should have shown more wisdom not to make it a dominant issue. There are more important, urgent and pressing issues where media can play a vital role.

By many media narratives, an impression is being fostered that doctors have made a mess and forfeited their moral right to treat. Suggestions of ineptitude were gleefully aired, causing demoralization of the warriors, who were immersed in the pool of Covid patients, trying to save them.

Their role should be as facilitators to help doctors to save more lives. One hospital death of out of millions saved, is projected as failure of doctors. They are so distant from the ground reality. To control the health system, media has a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.

Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who were unable to retaliate to the powerful media machinery.

The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.

Media people, who have never treated a patient in their lifetime, sway opinion and treatments of the millions just by game of projection and perception. The news items and the content are guided by idea of creating sensation in a quest to sell news, be it a selective negativity. Such negative and selective projections are causing discouragement and demonization of the medical profession. It is the biggest tragedy to the medical profession in present era.

Normal treatment of the sick patients is being projected as gruesome atrocity, inflicted by doctors. Media could have done better in helping to take off spectacles fogged with bias against doctors and recognizing them as real saviours, just as deserving of justice.

National Media could have helped, had they fueled the right and constructive discussions. The TV channels could have countered the pandemic with better imagination, sobriety, and exemplary performance rather than creating sensation by cynical and futile debates, which are absolutely inappropriate at this time.

Advantages-Disadvantage of being a doctor

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May 30, 2021 0

REEL HEROES VS REAL HEROES in PANDEMIC

There has been frequent attempts by REEL HEROES and celebrities, to projected themselves as Messiah for the cause of patients. By self-appointing themselves as custodian of health of masses, ‘the Reel heroes’ and celebrities gave true meaning to their work of ‘ACTING’ that otherwise is no more than a trifling entertainment.

An anecdotal episode of adverse event or poor prognosis was enough to be used as an illustration to portray whole medical professionals as dystopian community but what remained invisible to all was the fact that every day in hospitals, thousands of lives are salvaged back from the brink of death.

But the actual bargain was an attempt to project Reel heroes as Real heroes and vice versa.

Media and many celebrities have used fear in public mind to garner accolades and money for themselves, but at the same time created paranoia in minds of people against medical profession. And when masses worshiped them as their true well-wishers, they aired advertisements to sell tobacco, soft drinks, junk foods and other sweet poisons to public and children.

There is an eternal, latent vulnerability that intrinsic in the way doctors’ work and has potential to make them sitting ducks for harassment and punishments. It was easy to discern that vulnerability was being exploited and turned more evil, when braided with such insinuations by media and celebrities.

The negative projection to create a generalization in minds of people had been demotivating and demeaning to the entire health care workers. The selective projection had left behind a trail of hopelessness in the mind of people, shattering their trust and instigating against medical profession.

In present era, real contributions by people, who are saviours of human life and the real heroes, remain unappreciated. People are so besotted by their fame and money that they fail to appreciate the sacrifices made by real heroes. Filmy super hero just imitates a doctor, soldier, dacoit or a street hooligan and just pretends to be one on the screen.

Even a junior doctor saves many lives in a day in emergencies as compared to the work of a superstar in films. A teacher, nurse or scientist have a contribution which is more fruitful to our generation. A society truly needs the real people, who work and act for them, more than just entertainment. It will need a total change in the attitude of people to deconstruct their perceptions, which are based on mere projections and are away from reality.

21 occupational risk to doctor and nurses

The naivety of masses to perceive the projected character as real one goes beyond a reasonable thought process and imagination.

At the best, a particular projected character (and not individual acting star) may be a role model. An actor or superstar, is simply doing his work of “acting” in the end. This work of acting may bring an entertainment of few hours at the most.

Point to ponder is that whether society needs people just acting like doctors, soldiers and not the actual and real ones, who saves lives.

Society needs to envisage the bigger real picture, and should not be mistaken for another projected story.

The perception of the projection will decide, what does the society actually need- or desire-or deserve , “Reel Heroes or Real Heroes”.

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

April 27, 2021 2

TRUMP BLAMES DOCTORS FOR COVID

Unparalleled sacrifice by medical community during pandemic has not resulted in any enhancement of respect or prestige to the medical profession. It was not enough to stop physical or verbal assaults, legal or financial exploitation. It was sufficient to alter the course of oppression by administrators or moral blackmail by society.

Sadly it is getting more worse. Doctors and nurse have been reduced to sacrificial lambs, that are easily slayed, when administrators tend to put themselves on high moral pedestals.

Financial and legal complexities have been the major side effects of modern medicine, especially for doctors. They are facing complex environment, which are beyond their control. Besides financial and legal complexities, moral dilemmas, facing verbal and physical assaults are creating complex working conditions. Criticized by administrators despite their sacrifice, media insults are adding to their disillusionment and possibly a withdrawal response.

Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.”

Media and celebrities usually have proudly projected on screen and television that it is right to be disrespectful towards doctors. They have made it appear correct to masses to be disrespectful to doctors. But such news is viewed by medical community anxiously and is definitely a poor advertisement for younger generation to take medicine as profession.

As incidents are widely publicized and masses following their “Reel Heroes” and celebrities to insult medical profession.

Disrespect and media insult by celebrities towards a profession as a normal routine and perceived as an easily do-able adventure to gather populism.

On the night of October 24th, President Trump addressed his supporters at a Wisconsin rally, located just minutes from a temporary COVID-19 field hospital, making the argument that doctors at the pandemic’s front lines are falsely capturing COVID-19 cases in order to profit from the pandemic. Undermining his own scientific experts was not enough to dispute the severity of the crisis. Now, he desperately suggests — “I don’t know, some people say…” — that America’s most trusted professionals are fabricating the rising coronavirus case numbers of the current “third spike” for personal financial gain.

Trump’s wrong insinuations

As doctors we are outraged by Trump’s gutless insinuations. We’re not alone. The American Medical Association, American College of Physicians, and the Council of Medical Specialty Societies, leveraging the voices of over 800,000 American physicians, have each castigated Trump for his callous allegations.

The mere implication that health care professionals would be incentivized by profit to alter the true rate of this public health pandemic is reprehensible. Here’s why:

We struggle to contain the losses — and we continue to lose our own. For months, we have worked tirelessly to contain the spread of COVID-19. As we approach a quarter of a million deaths nationwide, we cannot forget the 1,700 of our own health care colleagues among that number. We are the teams that care for everyone, day and night, as we risk our own lives for the benefit of our communities. Unsurprisingly, we are burnt out. These last seven months have been a marathon in resilience, frustration, and fear.

Here’s the truth: We label patients with COVID-19 because accurate identification of this disease is essential so we can track cases to take the quick action necessary to prevent further spread. If a patient has a history of heart disease or other medical problems, and dies in the hospital with COVID-19, we know that coronavirus exacerbated that underlying condition — and their demise. It is accurate and in line with public health principles to list it as a cause of death.

We face historic furloughs, layoffs and pay cuts.

Here’s what’s worse: the assertions that doctors are profiting off of the pandemic are completely baseless and could not be further from the truth. Physician practices are not immune to the economic losses Americans are experiencing. One in five American physicians, whether salaried or in independent practice, have experienced pay cuts during the pandemic. Hospitals and physician practices have had to implement furloughs and layoffs to stay afloat, including furloughs at 35% of all primary care offices. More than 16,000 — or 9% — of independent physician practices have had to close entirely.

More recent estimates suggest that hospitals, thanks to the loss of elective surgeries during pandemic spikes, will face over $300 billion in lost revenue this year alone. And this is all happening while physicians report working more hours this year — amid more uncertainty about the future of their profession.

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We still work in unsafe conditions, without the equipment needed to protect us — and you. In the spring, the images were indelible: N95 masks being reused for days on end, while nurses were covered in trash bags as a proxy for PPE. Across the country, hospitals, clinics and state agencies bid against each other for what few PPE supplies existed. All the while, President Trump accused health care workers of hoarding PPE and other medical equipment. He blamed health care workers for shortages across the nation, when the root cause of that unfolding tragedy was his administration’s unwillingness to enact a national and comprehensive strategy.

Fast forward to today, where many healthcare workers still do not have adequate PPE and continue to reuse masks, gowns and gloves meant for one-time use. This could have been easily addressed by now, had President Trump fully activated the Defense Production Act to speed up and nationalize PPE production, a request he consistently refused.

The long road of COVID ahead

We see no end in sight. White House Chief of Staff Mark Meadows made it clear: the Trump administration has given up trying to control this pandemic. While they wave the white flag in hopes of therapeutics and vaccines becoming available in sufficient quantities for all Americans, hundreds of thousands more are projected to die.

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The new “medical swamp” narrative emerging from the White House, while deeply disturbing, is not out of character for this administration. Since the first U.S. coronavirus case was reported in January 2020, the president has undermined his own health experts and denied the scientific evidence at every turn.

The coming weeks and months will be dark as we continue to experience the repercussions of Trump’s callous inaction, but you have the ability to shape how this story ends. We urge all Americans to elect leadership that is morally responsible, unwilling to allow the political manipulation of science. The lives of the American people depend on it.

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October 28, 2020 2

Who will treat people in next Pandemic?

Pandemic has unmasked the real risk to doctor and nurses. The occupational risk of being among the diseases, that was known to them, has been unveiled to everyone. That should have generated respect for health workers in a civilized society. What was actually desirable, was the encouragement and psychological support to these warriors. Good administrators were supposed to give some moral boosting and financial support, so that health staff should work willingly and inspire next generation for future catastrophe like this. Instead of armchair preaching to health care staff, there should have been robust rules and guidelines to protect health care staff and health systems as doctors and nurses are working under tremendous psychological pressure.

More importantly, among this chaotic situation, whether rules are being followed or not, how administrators are doing can be at the most a guess work, rather than following a uniform system. The possibility of chaotic management due to economical compulsions or just trying to be projected as an outstanding administrator may be a real possibility rather than exception.

Health care workers can be easily subjected to moral and legal blackmail or pressure to perform their duties in sub-optimal and below par conditions. They can be subject to moral, legal, financial or even pressure of physical assaults. Such pressures can be tremendous in health sector because of financial complexities.

Is the payment made to them is commensurate to the risk to their life and work they do? Who will pay them and how much in case harm or death of health care worker, every one refrains to discuss?

Are they given the real respect, what they deserve and are worthy of?

Every day when doctors and nurses, while going to work have this thought in mind. But still they continue to work amid their own tensions, worries about families. While it is clear to them that administrators refrain to discuss the issues, which matter to them the most.

Times of India carries a report that the interns will be punished, if they become positivefor Covid, while doing duties. Although possibly the circular is withdrawn, but it reflects the deep seated and hidden mental frame of administrators, about the intention, how they wish to behave with doctors. Why such punishments are not for other Government functionaries or officials or even public, who test positive. It is just an example, but there are numerous examples of such kind.

MUMBAI: The department of community medicine at KEM Hospital issued a circular on Thursday asking interns to give a written explanation on how they had been exposed to the Covid-19 infection, after an increasing number of interns went into quarantine. It further said they will be liable to repeat their internship for the duration period of the quarantine if there was any negligence in following “Covid-19 discipline”. The circular was withdrawn within a few hours, after it faced criticism from many. Doctors and students termed the circular “insensitive” and “unwarranted” during a pandemic. Dr Sagar Mundada, psychiatrist and former president of Maharashtra Association of Resident Doctors, called the circular insensitive. “It is a pandemic. Why medical interns should be asked about the source of the infection?” An intern said some of them have been working for three months without stipend while their duty hours have been increased to 12. They collect swabs, blood and insert IV. 6/6/2020 Mumbai: KEM questions interns over quarantine, then backs off – dean Hemant Deshmukh said he had not signed the circular and it will not be implemented. Dr Gajanan Velhal, who signed it, said it was misunderstood. “No such action will be taken against any interns,” he said. Rajvi Bheda, a representative of the Association of State Medical Interns at KEM, said it seemed to be an attempt to ensure interns stay safe. “But it was unfair to the interns too, as it is difficult to identify the source of infection.

As Corona has unmasked the real risk to health workers and society has dealt with heath workers shabbily. Next younger generation of aspiring doctors, who is a witness to the cruelty shown towards health staff, may be forced to think about their decisions to become health workers. Possibly the administrators need to ponder now, who will treat people in next pandemic.

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