LNJP hospital doctor’s assault: Role of Doctor’s Associations and Parent Institutes, human right commissions?


The  impunity with which attendant easily and brutally assault doctors is really appalling, that too in bigger institutes like LNJP Delhi , should be shameful to law enforcing agencies. Are we a lawless society? More problematic is the government apathy and silence of human right commission. Here comes the point that what is the role of our doctor’s organizations and parent hospital and institute, where the incident happens.

         Why  in each and every case of doctor’ s assault, doctor’s bodies and organization do not file a case in the court against the  responsible  authority for security. Non action by Doctor’s Associations, bodies and organizations, not able to take a stand for their children is  most disappointing.

     Another issue is with the parent institute, where such incident happens. Institutes as a unit or a parent  should file cases, rather than few suffering doctors running here and there for help.

 Role of Government, Doctor’s Associations and Parent Institutes is akin to a “father”, who is wining and dining, whereas  his  working and brilliant children are being beaten black and blue.  This is certainly  a poor advertisement, if society wants good doctors.  At least  it should not rue about extinction of good doctors. 

doctor assault CMC Ludhiana

Beti padhao beti bacchao

assault of female doctors

Doctor’s assault (CMC Ludhiana): Every incident hits doctor’s compassion towards patients


Discussion always revolves around the trust of the patients on the doctor. But in reality, situation is getting different gradually. Empathy, sympathy, compassion and trust  of the doctor towards the patient  are important factors during the treatment.  Everyday  the news of assaults on doctors, court cases against doctors, negative projection of the medical profession   in the media are viewed  by doctor’s community anxiously. Recent senseless attack  on doctor in Christian medical college Ludhiana is another example. Merely taking some action after protest will not solve the problem. It does not compensate for the  damage done to medical profession. Also it erodes the trust and compassion of doctors towards patients.

          Formal and informal discussions among medical professional at various forums  have taken a center stage about the changing scenario. It  gives a perception that patients are loosing faith in doctors. That perception is not incorrect. But what remains hidden is that every incidence of verbal, legal, and physical assault  brings some kind of feeling of insecurity in minds of all doctors, who deal with patients.

                    This insecurity or fear of the uncertainty tends to affect the thinking process of doctors and the way they practice medicine or deal with the patients. Many will like to be defensive in practice, or try not to treat very sick patients.  Why would someone try complex surgeries with risk involved? Few will limit themselves to follow protocols. Going extra mile with risk, which not everyone will like to take. Many will become health managers or  do something else than do active clinical work. Who should risk his life while doing routine work? Brilliant students  will not be inspired to be doctors.

  Every incidence of verbal, legal, and physical assault is a trust breaker. It is not only erosion of patient’s trust on doctors but the vice versa is also true.  As  a rule of nature, as violence increases, compassion decreases. Patients might get their revenge for the disease, but they will lose compassion and trust of doctors in the long run.

 

Cervical cancer: myths and facts


Of all the cancers affecting  women, cervical cancer has emerged as one of most common cause of cancer.

Women between 15 and 44 years of age are particularly at risk.

Cervical cancer is mostly caused by the Human Papilloma Virus or HPV. It is a condition that affects lining of the cervix, or the lower part of the uterus. This cancer develops gradually and becomes full-blown over time.

HPV infection can spread through sexual or skin-to-skin contact. Though this infection usually goes away on its own over time in most women, in others, it can persist and cause precancerous changes in the cells of the cervix.

Some symptoms of this cancer include abnormal vaginal bleeding, vaginal bleeding after menopause or sex, bleeding or spotting between periods, longer or heavier menstrual periods than usual, other abnormal vaginal discharge, and pain during sexual intercourse

As with any other disease, there are certain myths associated with cervical cancer as well.

Myth 1: Women without a family history of cervical cancer do not need to get screened.

Those without a family history of this condition may also be at risk. This is because the HPV infection can spread through sexual contact. It is, thus, important to get take preventive measures and get Pap tests done.

Myth 2: Pap tests should be done every year

There is no need to get a Pap test every year if this test and the one for HPV are normal. The recommended schedule is once in three years in women between 21 and 29; and once every five years in women between 30 and 64. Those above the age of 64 should follow their doctor’s advice.

Myth 3: It is not possible to prevent cervical cancer

Cervical cancer is one of the most preventable cancers. A Pap test can help determine any kind of changes in the cells of the cervix. Once any such change is detected, it is possible to start treatment early and prevent the cancer from developing. Pap test is imperative for anyone who has been sexually active or in women who have HPV and are smokers.

Myth 4: Women with no symptoms need not get tested

HPV infections do not show any symptoms in most cases. While there are different types of HPV, some high-risk types are associated with cervical cancer and can go undetected until the development of abnormal cells. This makes it important for women to get tested on a regular basis.

Myth 5: Women who have had a hysterectomy do not need to get tested

It is imperative to undergo a screening for cervical cancer irrespective of whether a woman has had a hysterectomy. Only those who have undergone a total hysterectomy (a process where both cervix and uterus are removed) need not get screened.

Myth 6: Pap test is similar to a pelvic exam

Pelvic exam is a physical examination of the pelvis, vagina, and pelvic floor (the area encompassed by the hip bones), whereas, in a Pap test, cells from the cervix are gently scraped away and examined for abnormal growth.

Myth 7: Condoms can prevent HPV

Condoms can help prevent certain sexually transmitted infections (STI). However, this may not be true for HPV as the virus can inhabit areas that condoms do not cover.

Myth 8: Cervical cancer treatment can cause infertility

Advances in medicine and surgery have ensured that cervical cancer treatment does not affect fertility in a woman. These surgical treatments can help a woman conceive by removing only the cervix and not the uterus.

Timely screening and detection are two very important aspects of combating cervical cancer, as it is a completely treatable condition. Apart from this, women should make some basic lifestyle changes to avoid contracting an infection. These include avoiding sexual contact with multiple partners; getting screened on a timely basis; quitting smoking; consuming a healthy diet rich in fruits, vegetables, and whole grains; and maintaining a healthy weight. All these can go a long way in preventing cervical cancer.

source;

https://www.deccanchronicle.com/lifestyle/health-and-wellbeing/010218/8-myths-and-facts-about-cervical-cancer.html

 

Medical lawsuit:bad lottery for doctor, Will ever there be justice for doctors?


Court’ s decisions, delivered with retrospective analysis and wisdom of hindsight puts the doctors  in  disadvantageous position, who have to decide  in the circumstances of  future uncertainties of diseases. Patients  will   always be unhappy due to disease and tend to blame the doctor. Doctors can bear  with the level of understanding of patients, ignorance of patients towards medical science, but it is  hard to digest the court’s  judgments of these types. Every drug, howsoever innocuous it may be, has different reaction in different humans. It is impossible to predict which patient will  have allergic or idiosyncratic reactions.

Here a neurologist has been punished because of rare side effect of the drug, which can happen to any one and with any drug.  If content of the newspaper are correct and this is the judgement, it is really unfortunate for the doctor and medical community as a whole.

So if doctors are being punished for uncertainity of medical science and there is  ignorance of courts towards the same, it will become impossible  for doctors to work.  It seems that in future it will be difficult to treat even a single patient because patients, courts and everyone either  do not accept genuine and routine complications of the disease or the outcome and  blame  the doctors  knowingly.

These kind of  judgments  are setting up   precedent for cases of negligence against medical professionals, for no fault of theirs. Thereby instilling a sense of fear in the minds of doctors, besides decreasing the faith in judiciary as well. Doctors are helping everyone, but getting zero justice themselves from all quarters including courts, have made medical professionals  sitting ducks  for harassment  by all possible means.

Now the neurologist will spend more money on lawyers in defending himself. He will waste his time in courts rather than treating patients. Above all, damage to his professional soul and morale of medical professionals as a community will get a jolt. Even if wisdom prevails and higher court does the justice later, the irreparable damage is already  done to medical profession.

The atmosphere of falsely created vigilantism is pervading everywhere against doctors, with the result that wisdom, judgment, intellectual debate, and basic common sense is being abandoned for the sake of populist judgments. The perception thus created against doctors by media and celebrities has done immense damage to profession, resulting in bringing the doctors  to their knees. Whether there is any substance to the allegations, unfortunately, does not seem to matter.

If doctors are going to be penalized despite  doing their job correctly, then God save the people and medics. If this is the  justice imparted to doctors, good doctors will choose for safer options. As society is unable or unwilling to do justice to doctors, should it expect good doctors to treat their patients? Or actually does the society deserves to have good doctors?

 

Hammurabi’s medical regulation code (1750 BC): Noble profession has always been regulated cruelly ?


Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times. the ancient rulers always blamed the physician for the poor patient outcome and also made regulations to regulate medical profession, and this was when the medical science was not even developed enough to deal with most diseases.

A great military commander, Hammurabi consolidated small states in the vicinity after ascending to the throne on the death of his father. Sometime around 1780-50 B.C., the Babylonian king Hammurabi promulgated the now famous  Code of Hammurabi, covering both civil and criminal law.

Hammurabi’s Code of Laws was considered the first documented Code ever used by human civilization in Mesopotamia, the cradle of civilization, the land of Assyro-Babylonian culture. This era first saw the interface between medicine and law in the dawn of civilization.

Among the 282 laws in Hammurabi’s Code, nine (215-223) pertain to medical practice:

 

HAMMURABI’S CODE OF LAWS :

  1. If a physician performs eye surgery and saves the eye, he shall receive ten shekels in money.
  2. If the patient be a freed man, he receives five shekels.
  3. If he be the slave of some one, his owner shall give the physician two shekels.
  4. If a physician performs an operation and kills someone or cuts out his eye, the doctor’s hands shall be cut off.
  5. If a physician performs an operation on the slave of a freed man and kills him, the doctor shall replace the slave with another slave.
  6. If he had opened a tumor with the operating knife, and put out his eye, he shall pay half his value.
  7. If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
  8. If he were a freed man he shall pay three shekels.
  9. If he were a slave his owner shall pay the physician two shekels.

 

As we can see, it did  not take into account  the earlier works or contribution of doctors to society. It also did not take into account the  uncertainty of medical science and uncertainties of the outcome.  The regulatory system was based on  principle of revenge and punishments.

Deselection of providers: Hammurabi’s Codex specified the harshest form of deselection possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. This severe punishment for negligence supposedly weeded out physicians incapable of delivering adequate care. In addition, it prevented these physicians from practicing in a different locality. Obviously, such a penalty discouraged a physician surplus.

Since ancient civilization, medical regulation has been always cruel to doctors.   Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical profession.

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

In an effort to institute managed healthcare, our society is in a way re-entering the realm of an ancient medical care system. Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the  poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body.

 

 

https://en.wikipedia.org/wiki/Code_of_Hammurabi

Code of Hammurabi. (2017, December 18). In Wikipedia, The Free Encyclopedia. Retrieved 16:58, December 23, 2017, from https://en.wikipedia.org/w/index.php?title=Code_of_Hammurabi&oldid=816023447

 

 

Doctor’s predicament: How to treat prejudiced minds of patients?


“Medical negligence” is the word in the air. Routine complications of treatment, poor prognosis of severe diseases and death of sick patients are blown out of proportion and projected as negligence of doctors. All these insinuations are creating fear in the minds of gullible masses, who do not have any idea about the complexity of medical profession and treatment of diseases.

Thing have become so difficult that it will become difficult to treat even simple diseases in future. Non acceptance of natural progression of disease or genuine complications of surgeries by a patients has created fear among doctors. This is due to vicious campaign by media and has done irreversible damage to doctor patient relationship.

Instead of trying to improve the health care system as a whole, focus has settled on blaming the doctor only. Less number of doctors, poor health care system and insufficient resources are nowhere in focus.

Being a doctor is a tough journey. Nature of work that provides relief to human beings, while sacrificing his own personal life should be respected by civilized society. But sadly, doctors are projected in a bad light due to vicious campaign by media and celebrities. The due respect and appreciation is sadly lacking. This kind of malicious allegation against a profession community has created a sense of mistrust against the doctors in the mind of patients. Situation has become so bad that a patient, while interacting with his doctor, is not trusting the correct advice and decisions taken by a doctor in good faith. Patient will question the advice and most of the time delay his own treatment. Not uncommonly the treatment is delayed and crucial time is wasted for unnecessary reasons.

Hostile environment, risk to doctor himself, unrealistic expectations of society, retrospective analysis, physical and verbal assaults, medical industry and medico–legal issues have created a complex environment for doctors.

Although doctors have learnt to live with this pain of mistrust thrust upon them and they are suffering. But it does not require an Einstein brain to anticipate that who will be suffering ultimately due to this kind of mistrust. Society seems to be going to self destructive mode. At present, doctors and patients both are sufferers. May be media and celebrities will earn some money and fame by creating and propagating this mistrust.

‘A doctor who always operated on ear, irrespective of problem’: Role of media in Fortis and Max hospital Delhi incidents


        During my  days as medical student, we laughed at a story wherein a doctor always operated on patient’s  ear for all their ailments. Whatever may be the problem in the body, it was only the ear which received the cut always.  Similar treatment is being given to doctors by media.  Now-a days, for every progression of the disease and for genuine poor prognosis or death of the patient, media  is prompt to start the  blame game of doctor- doctor. Media even does not try to verify the facts. The real medical issues in treatment of these cases are still not emphasized by media, like whether these cases were salvageable or not.  For example why so many preventable disease like dengue, malaria happen every year   to thousands of people every year and are still progressing?  Take the case of foetus at 22 weeks…… how many have survived in India or in  the  world? In this case and that of  the complicated dengue case, the survival chances were quite dismal, even in developed world medicine.  Inability of media people to analyze the difficulty on scientific parameters, unwillingness of people to accept the real poor prognosis and political class to flow with populist opinion has done irreparable damage to medical profession. Just a blame game and the word ‘negligence’ are in the air.

    Outcome in these cases is not uncommon or unanticipated by any yardstick in the world. But no one is concerned about that. And in the end, what are the losses?

    Discouraged medical fraternity, low morale of doctors, and talk of leaving this profession have become smaller issues and do not affect anybody in media or Government. 

   But larger issues remain: how to prevent thousands of death due to poor control of communicable and preventable diseases. Proper delivery of health care will not improve by playing the blame game on doctor.  Media bashing of doctors may divert attention from the real issues and  media people   will earn money and fame. Doctors will be punished  as a result of  populist revenge.  But this approach of media is not going to save patients or provide better health care to masses in future.

Save the doctor to save yourself: An era when genesis of diseases is not punished, but treatment is.


            “Young girl killed by doctors at Fortis Gurugram” and “alive baby declared dead by doctors at Max Hospital Delhi”. These two news items  have recently jolted everyone in medical fraternity. Doctors have  yet  to come to terms with harsh reality  in order to   realize about the  harm   that can happen to themselves, when they just  say yes to treat the complex cases. A worst form of dengue already complicated, or a premature delivery at 22 weeks. I am sure doctors will know, how many patients and pregnancies have survived at this stage in the world, in both of these conditions.

     We have all kind of preventable diseases happening around us. Thousands of people suffering and many loose life, just because of worthless causes. Even healthy people are killed because of preventable calamities like open pot holes, floods, heat or preventable fires, accidents and so on. But strangely when disease happens and gets complicated in one patient, death due to these complications in the hospital is taken very severely. Although it may  have been  just untreatable at some point, but whole burden of death and punishments are  passed  over to doctors very conveniently.

   In both these complex cases, there are no clear cut guidelines by government. In whatever way doctor will act, he can be blamed easily on some pretext or another. By such yardsticks,  all complicated cases and subsequent  deaths happening in hospital settings can be termed as ‘ negligence’ by a fault finding retrospective approach. Now doctors have become scared  to treat complex cases.  

   It is sad to see that our leaders, media and all stakeholders have no knowledge of complex medical issues. I do not see any solution to these kind of exploitation and extortion of medics in near future.  But   are all complicated cases and deaths in hospital are Negligence?  This is going to be tough time for doctors but subsequently for patients.  These are worst days for doctors, where genesis of disease is overlooked and unnatural death of hundreds is not taken care of. But doctor who is working with intentions to treat the complex situation is being punished.  But society should be able to count its losses after few years, if such trend continues.  Good doctors will easily quit or shift to safe positions. Society has to save doctors, if it wants to save it’s people.

     

Max Hospital Delhi handed over dead baby : Is “ Lazarus syndrome” a possibility?


 

        There are lot of discussion going on about live  baby handed over to parents by Max Hospital  Delhi, as dead.  Every one including  media has as usual  jumped on to the favorite  topic of  doctor bashing.  Facts are still under investigation. But as a doctor, I can not reach conclusions without scientific discussion, least possible by media  talking superfluously. There can be number of possibilities, which we will  know with time after proper investigation. But whatever the result, doctors bashing had already been done by media , with or without knowing facts.

Life and death are still far beyond the reach of science and obviously  of doctors as well. There are still a lot more unknown than known story about human life. I just wish to draw the attention of my readers about an entity, which is quite mysterious.  Condition is  called     “ Lazarus syndrome”. Also known as auto resuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation.

A little bit about  this rare phenomenon.      

 

Lazarus syndrome, also known as auto resuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation. Its occurrence has been noted in medical literature at least 38 times since 1982. It takes its name from Lazarus who, as described in the New Testament of The Bible, was raised from the dead by Jesus.

Occurrences of the syndrome are extremely rare and the causes are not well understood. One hypothesis for the phenomenon is that a chief factor (though not the only one) is the buildup of pressure in the chest as a result of cardiopulmonary resuscitation (CPR). The relaxation of pressure after resuscitation efforts have ended is thought to allow the heart to expand, triggering the heart’s electrical impulses and restarting the heartbeat. Other possible factors are hyperkalemia or high doses of epinephrine.

Cases

-A 27-year-old man in the UK collapsed after overdosing on heroin and cocaine. Paramedics gave him an injection, and he recovered enough to walk to the ambulance. He went into cardiac arrest in transit. After 25 minutes of resuscitation efforts, the patient was verbally declared dead. About a minute after resuscitation ended, a nurse noticed a rhythm on the heart monitor and resuscitation was resumed. The patient recovered fully.

-A 66-year-old man suffering from a suspected abdominal aneurysm who, during treatment for this condition, suffered cardiac arrest and received chest compressions and defibrillation shocks for 17 minutes. Vital signs did not return; the patient was declared dead and resuscitation efforts ended. Ten minutes later, the surgeon felt a pulse. The aneurysm was successfully treated and the patient fully recovered with no lasting physical or neurological problems.

-According to a 2002 article in the journal Forensic Science International, a 65-year-old  deaf Japanese male was found unconscious in the foster home he lived in. Cardiopulmonary resuscitation was attempted on the scene by home staff, emergency medical personnel and also in the emergency department of the hospital and included appropriate medications and defibrillation. He was declared dead after attempted resuscitation. However, a policeman found the person moving in the mortuary after 20 minutes. The patient survived for 4 more days.

-Judith Johnson, 61, went into cardiac arrest at Beebe Medical Center in Lewes, Delaware, United States, in May 2007. She was given “multiple medicines and synchronized shocks”, but never regained a pulse. She was declared dead at 8:34 p.m. but was discovered in the morgue to be alive and breathing. She sued the medical center where it happened for damages due to physical and neurological problems stemming from the event.

-A 45-year-old woman in Colombia was pronounced dead, as there were no vital signs showing she was alive. Later, a funeral worker noticed the woman moving and alerted his co-worker that the woman should go back to the hospital. A 65-year-old man in Malaysia came back to life two-and-a-half hours after doctors at Seberang Jaya Hospital, Penang, pronounced him dead. He died three weeks later.

-Anthony Yahle, 37, in Bellbrook, Ohio, USA, was breathing abnormally at 4 a.m. on 5 August 2013, and could not be woken. He was given CPR, and first responders shocked him several times and found a heartbeat. That afternoon, he coded for 45 minutes at Kettering Medical Center and was pronounced dead. When his son arrived at the hospital, he noticed a heartbeat on the monitor that was still attached. Resuscitation efforts resumed, and the patient was revived.

-Walter Williams, 78, from Lexington, Mississippi, United States, was at home when his hospice nurse called a coroner who arrived and declared him dead at 9 p.m. on 26 February 2014. Once at a funeral home, he was found to be moving, possibly resuscitated by a defibrillator implanted in his chest. The next day he was well enough to be talking with family, but died fifteen days later.

Implications  The Lazarus phenomenon raises ethical issues for physicians, who must determine when medical death has occurred, resuscitation efforts should end, and postmortem procedures such as autopsies and organ harvesting may take place.

Medical literature has recommended observation of a patient’s vital signs for five to ten minutes after cessation of resuscitation before certifying death.

In Popular Culture

In the TV show Grey’s Anatomy, a patient had a heart attack and after 42 minutes of resuscitation efforts they declared her dead. And 20 minutes after death has been declared, the patient vital signs returned and regained consciousness.

Source

Lazarus syndrome. (2017, September 2). In Wikipedia, The Free Encyclopedia. Retrieved 16:51, December 4, 2017, from https://en.wikipedia.org/w/index.php?title=Lazarus_syndrome&oldid=798456668

https://en.wikipedia.org/w/index.php?title=Lazarus_syndrome&oldid=798456668

Misplaced priorities of media in Dengue death: negligence in prevention of thousands OR complications in treatment of one very sick?


Prevention is better than cure.  There is lot of discussions going on about dengue death in newspapers and media. It is all about again, about  ritual of  doctor bashing and ill things said  about treatment  and so on. Although doctors have realized to live with such painful criticism, which is largely unjustified but truth of this era.  But some one with more wisdom and specially media has to realize that they are targeting  a wrong cause. Without proper root cause analysis,  problem will not  be solved, rather they will destroy the possibility of correction as well.

            I just want to draw the attention, that so much of furor  by media is directed to the wrong pole. If media has  thought of in rational way and  invested  same kind of  their energy and zeal  on the root cause of dengue it self,  they could have saved thousands. That is the prevention of dengue fever. Times of India shows on the side of this news, another column on the same page  that is about  8549 dengue cases in Delhi alone . Actual figures may have been higher.   Going by simple common sense,  if we had done something to prevent dengue or mosquito control, the problem of patients visiting hospitals in sick state and unfortunate situation  of so called negligence and treatment related  problem will not arise. A lethal disease was generated and allowed to progress.

 Strangely,  treatment details of a very sick patients, after the disease has already struck and   trying to  find  some thing wrong are of great interest to media and public.  No body is worried about the strategies that should have been adopted  to prevent thousands from the disease,  by timely preventive interventions. Real cure lies in preventing mosquito to bite rather finding problems with treatment protocols of doctors after disease has progressed, who are already hard pressed in such difficult circumstances.

            Public  and media will have to  understand the basic priority, whether they want  the prevention of the root cause of sufferings of thousands of  patients or want  some  scapegoat among  those who were trying to save the patient.   Consequences of negligence  in preventing   of such diseases are   huge and  massively destructive to thousands of lives. Once disease has  struck,  one can  foresee futility of this exercise  of blaming  the doctors. Excessive  and unjustified criticism of  the  saviours is   not doing good to any one. A  good strategy to  prevent  such  common diseases will save more people . But if current trend of blame  game  continues, there will be doctors in future but  no  saviours in real sense.        

        

       

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