Death is the inevitable conclusion of life, a universal destiny that all living creatures share. Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. But the evaluation and compensation of ‘Death’ in this new era of consumerism has become a story of paradox. Compare the situation when someone is admitted in hospital for a serious ailment to a healthy person who is travelling happily in train. It doesn’t require an Einstein’s brain to compare, who is more at risk for death. Although death in both situation is sad but the differential compensation formulas applied by courts and justice systems require a re-look in both the situations.
Accidents can happen everywhere. It can be on roads, trains or in the air and more possible in the hospital, when doctors are trying to save a critically sick patients. Chances are more in hospital as situation is akin to as doctors are trying to fly a defective aeroplane.
Medical accidents are usually interpreted as medical negligence. Ironically, for genuine mistakes or even a natural poor outcome, an impression is created as if the doctors have killed a healthy person and is assumed as a doctor’s fault. Not uncommonly doctors become punching bags as a revenge in case of a hospitalized death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event. But all these issues are variable and depend upon understanding level and wisdom of people. What is surprising is the non-uniformity of courts and justice systems in evaluating and compensation of death. For hospital death alleged due to medical negligence – compensation formula is applied that is not used for other hundreds of healthy deaths.
An unfortunate incident of train accident causing hundreds of untimely deaths happened yesterday. In fact the burden of negligence here (like a train accident- hundreds of deaths) in healthy deaths is massive and these deaths are unpardonable.
It will be interesting to see how courts apply the formula for compensation in hundreds of healthy deaths due to negligence as is applied in cases of medical negligence when someone has poor outcome.
That brings forth a fundamental question. Why compensation to death is not uniform? Why medical profession is handed over a harsher punishment and pays a higher compensation (while trying to treat) for a death which is more natural and consequence to some disease? Why for compensation in hundreds of healthy deaths that was completely unnatural – same formula is not applied?
Such differential evaluation and compensation of death is not only illogical and unreasonable but a grave injustice to medical profession. Point to ponder- if trying to save someone’s life raises a risk of heavy compensations, why should doctors do it?
The painful incident of Dr Archana Sharma’s Suicide (one year back) had unmasked the everyday struggle of the doctors in the present era. Her supreme sacrifice depicted the plight of doctors- being undervalued and demonized, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment. Her suicide has unveiled the despondency, moral burden of mistrust that doctors carry. Her death was the result of the apathy of fair justice that eludes medical community. Sadly, the society still is unable to realize its loss.
Let her sacrifice be a reminder to the whole medical fraternity; either fight against the prevalent injustice or perish, not being able to treat the patients would be a greater disservice to humanity.
Such incidents show that goons, public, regulators and administrators can use the nature of doctors’ work to be used against medical profession to make saviours as an easy prey for punishments on the pretext of dishonesty, negligence or semantics being used as legal weapons by law-enforcers, even in case of a perceived bias. In the process of such ‘tokenism’ goons and administrators prove their relevance to the medical system.
Private health care has become a predominant mode of health care delivery. The failure of public sector is mainly due to poor infrastructure and inept health management. Sadly health is being managed by administrators, who have never treated a patient in life-time. Inadequacy of public sector stems from the government inability to take responsibility of delivering quality accessible healthcare. This has added to the distress and has accelerated privatisation of health care.
Instead of making the process of opening a health care centre or hospital an easier process, it has been made a herculean task. Getting many dozens of licences is not easy. Doctors who try to open hospitals complain about numerous hurdles, but possibly are left with no option. It is still easier for big hospitals with investors’ money but difficult for doctors on their own. Running the hospital is no more an easy task due to bureaucratic and public pressures.
Private health sector especially smaller hospitals feel burdened by government schemes because of unrealistically low reimbursement rates for surgeries or procedures. Not only unreasonably low reimbursement payments are forced upon doctors but are delayed due to many unpleasant factors in government system.
There is no protection to doctors against physical assaults. Local goons and mobs easily get away with abusing and attacking doctors. The health care workers have become scapegoats for the inadequate and inept medical system.
Rather than developing a system to promote good doctor-patient relationship, Medical Consumer Protection Act has been imposed and 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.
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.
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.
In reality it is not only the #RTH, it is the overall unfair, unsupportive and exploitive and punitive ecosystem for doctors, which is painful. Doctors are finding actually difficult to work in such environment.
Possibly it is a last cry before they quit or perish, if still remain unheard.
Administrators’ wish to govern or regulate the medical profession cruelly is not new.Hammurabi 5000 years (King of Babylonia) ago had initiated to write the rules of the game. Although he was not even at the doorstep of medical science, but he promulgated some rules. It is difficult to say whether he was naive or brilliant enough to make it more mathematical. He fixed heavy prize for saving lives of rich people and used to cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.
No one really knows how to regulate this difficult area, which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is amalgamation of intricacies of science with minds of patient and doctor’s skill in newly evolved milieu of financial complexities. Results are not encouraging for the medical profession.
With the evolution of medical science and medical care intertwined with medical business, braided changes in medical regulation is not an far off expectation. But reticulation of evolution to modern medicine and health care has not happened in isolation. Simultaneously there has been progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care has also ushered. Every one now wishes to live longer and dreams of better quality of life with support of progressive medical care. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and investors putting money into health care, which was unthinkable few decades back in the past.
This reticulation of business and health care allowed health care to be controlled in some way by administrators and investors. These people actually controlling health care are away from the health providers, who treated the patients. The rulers are unaware of the limitation of medical science and the uncertainties and complexities of human body, so the regulation remains somewhat unfair to doctors.
Today the global system of medical regulation, is becoming somewhat similar, to those ancient codes in terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects.
Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge, but the law has failed to keep in mind the poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body.
In such unfavourable and hostile circumstances, opting for a medical career is like getting into a trouble zone and getting entrapped into a system of exploitation and may be a self-bought disaster. It looks like as an absurd thought and highly ill advised.
Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.
Doctors have been left with only two ways either to persist, fight or perish. Silently quitting their beloved profession is going on for some time all over the world. Even in developed countries, there has been a fading enthusiasm to be a doctor
Increasing cruelty and unreasonable regulation is leading to doctors’ revolt. For example #NO-TO-RTH-AGITATION is a movement, the result of failure of Government to create public health system, but it has potential to fail the existing private doctors’ system as well. Smaller hospitals are already on verge of closure, will be forced to shut down.
It is a cry for survival for the doctors, if short-sighted bureaucracy can understand the real problem.
Slow or acute revolt is long due globally- no less than mutiny- a struggle for professional dignity.
Has the time come to say ‘no to medical profession’? At least paying millions and becoming a doctor is not worth it.
Movements like #NO-TO-RTH are result of long standing humiliation of medical profession.
Social media and celebrities have rewired the people’s mind against medical profession. It has created a terrifying picture about the harm that doctors do to patients. The turmoil against medical profession in the society is linked to social media that exploits the deep wired craving of patients to know more about the “realities”. This hot emotion, generating a sense of threat to them in hospitals, is exactly what they are designed to provoke. Especial comments- facts or not- produces entirely different reactions. The analytical comments about the possible harm awaken negative thinking, tribal instinct, and hardens opinion one way or other.
Media, celebrities and others are getting away with making disparaging remarks and doctors have no mechanism to retaliate. The hurtful blabber continues at will. By theatrically deriding hard work of doctors, they grabbed eyeballs to be at the centre stage of health care and prove their relevance to the system.
Among millions of patients being treated every day, there are bound to be few handfuls of adverse events, poor outcomes. Media, lawyers and other opportunistic elements sniff those few incidents and discuss it with distorted version that rewards are instantaneous.
Talking about death, negligence in medical care on media is a frightening topic and not without consequences. Ethical lines are crossed frequently. Negative emotions are generated like hate, anger and hurt and usually instigating against the medical profession. By use of few provocative words, the media can be set on metaphorical fire; the populism statistics hit the roof. The negative projection played in a peculiar way rules the internet and television. The media journalist hits an instantaneous stardom.
In the mad game for popularity, cross ethical lines and create rifts. They embellish it with more provocative words and share it with their name hoping to drive more engagement.
With no strong retaliation from doctors’ associations, shrugging and ignoring by individual doctors has made medical profession not only a scapegoat but a medium to gain cheap popularity for everyone who can publically bash the medical community. Doctors’ associations have failed to fight to save dignity and pride of their members.
In such unfavourable and hostile circumstances, medical students paying crores to get medical college seat is like getting into a trouble zone and getting entrapped into a system of exploitation and may be a self-bought disaster. Someone paying for being a doctor in millions and crores is an absurd thought and highly ill advised. For the candidates who are not financially strong, it may be difficult to even recover the money spent, what to say about the time and youth wasted in getting a degree which may or may not be that worth.
The painful aspect is that after a medical student is awarded a degree, he becomes part of the community that is labelled as ‘thief’ or ‘butcher’ or ‘worst’ on various platform openly by media and prominent people. Sadly no action is taken for their public humiliation and passed as a routine issue. Courts and human right commission also remain silent on grave injustice to this educated and hard working community.
Has the time come to say ‘no to medical profession’? At least paying millions and becoming a doctor is not worth it.
#RTH-AGITATION- Rajasthan – Sadly doctors are fighting for their genuine rights and dignity against all. No one is with them – media, judiciary, Government and not even patients whom they have saved.
Aspiring doctors should know the reality and introspect- why they wish to be a doctors in such circumstances?
Smaller hospital and individual doctors’ clinics are backbone of the health care system in India. Their contribution towards public health can’t be ignored. Be it Covid care or treatment of daily ailments, they are actually helpful to the public and indispensable in real sense. Their contribution to society is huge especially in view of broken public health care system.
They provide health care near to public near their residential area at affordable cost. From an another angle, they generate employment to the workers as well as small businesses associated with their small hospitals.
In a populous country like India, strengthening these smaller hospital is a desirable step. To strengthen the health care, Government can actually do well to support these hospitals and achieve health care to all. Supporting them will require a fraction of resources, as compared to the money needed in case Govt has to provide to public itself.
It will be a short-sightedness of the Government policies, if instead of supporting them, Govt wishes to exploit their resources to give free health care to public.
But administrators and bureaucratic system has failed on both fronts. Neither they were able to develop a dependable health care system for public, nor they tried to support smaller health systems. What they tried to do was akin to the ancient story of ‘ the farmer and the Golden goose’. The Greedy farmer wanted all the golden eggs instantly without feeding the bird and therefore killed the duck. Government with its short-sighted bureaucracy is killing its golden health care and not realizing the real potential and benefits.
In the present day, ebbed from all sides, doctors need to earn back the dignity of profession and resist oppression. The phenomenon of oppression of doctors in the name of regulation is a global issue. The populist oppressive schemes in the misleading names like #RTH-Rajasthan (RIGHT TO HEALTH) are prevalent everywhere globally in some form or another. Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.
Acquiring kind of skill , the years of passionate, merciless, excruciating medical learning is placed at the disposal of administrators, who themselves have failed to develop a good health care system in real sense.
#NO-TO-RTH-AGITATION is a movement , the result of failure of Government to create public health system, but it has potential to fail the existing private doctors’ system as well. Smaller hospitals are already on verge of closure, will be forced to shut down. It carries the risk of extinction of neighbourhood friendly doctor and hospitals.
The basic problem is the intentions for the task of developing a good health care system. The agenda of administration is to control the health care workers rather than developing a good health care system for citizens.
What NO-TO-RTH-AGITATION is actually doing? It is a cry for survival of the smaller hospitals- not only for themselves but for Indian Health care system, if short-sighted bureaucracy can understand the real problem.
It is not easy to practice as doctor these days. Media full of doctors bashing, credibility crisis and regulators perpetually hounding doctors, who are forced to work under imposed medicolegal sword. There is no day that passes when system does not perpetuate negativity against medical profession. Doctors, ebbed from all sides, have lost the dignity and independence. Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.
The complex medical skill, the years of passionate, merciless excruciating medical learning is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense. Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived by administrators -by sprouting the fraudulent generalities.
All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry – except the well-being of the doctors and nurses.
Doctors have often wondered at the smugness with which administrators assert their right to enslave them, to control their work, to force their will, to violate their conscience, to stifle their mind. Irony is that while administrators do this, still they depend on the same doctors for saving lives -whose life they have throttled, who resent the treatment meted out to the health care workers.
In todays’ era there has been bullying of doctors by administrative systems, new unreasonable laws, which use pressure tactics on medical professionals to get their own way – no less than enslavement.
Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.
Medical courses are comparatively lengthy and expensive study course and difficult training with slave like duties. “enslavement of doctors”.
Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.
Hostile environment for doctors to begin: Suddenly young and bright children complete training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
Blamed for all malaise: The society gets biased because of the media reports and some celebrity talking glib against medical profession. The blame for inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
Risk doctoring himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.21 occupational risks to doctors and nurses
Unrealistic expectations of society: Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.
Retrospective analysis of doctor’s every action continues all the life. It could be by patients and relatives every day in the form of “ Why this was not done before?” Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.
The decision taken in emergency will be questioned and in retrospect they may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight with luxury of time, may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.
11. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.
12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: zero fee and fixed commission ads on television by lawyers in health systems are a common advertisement to harass doctors. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigation of lawsuit against doctors is a major disadvantage for medical profession.
14. Overall, a complex scenario for doctors: There is increasing discontentment among doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients. They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult.
In this era, a thought is gradually getting prevalent-‘Is choosing medical career or becoming a doctor is a mistake?
In the present era, Doctors are ebbed from all sides, need to earn back the dignity of profession and resist oppression. The phenomenon of oppression in the name of medical- regulation is a global issue. The oppressive schemes in the misleading names like #RTH Rajasthan (RIGHT TO HEALTH) are prevalent everywhere globally in some form or another.
Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.
Doctors in Rajasthan India have shown first of its kind revolt, that is just waiting to happen globally at some stage.
It is not easy to practice as doctor these days. Media full of doctors bashing, credibility crisis and regulators perpetually hounding doctors, who are forced to work under imposed medico-legal sword. There is no day that passes when system does not perpetuate negativity against medical profession.
By certain laws and Acts like RTH, an effort is on to place medicine under State control. Acquiring kind of skill , the years of passionate, merciless excruciating medical learning is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense.
Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived by administrators -by sprouting the fraudulent generalities.
All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry – except the well-being of the doctors and nurses.
Doctors have often wondered at the smugness with which administrators assert their right to enslave them, to control their work, to force their will, to violate their conscience, to stifle their mind. Irony is that while administrators do this, still they depend on the same doctors for saving lives -whose life they have throttled, who resent the treatment meted out to the health care workers. Like the failed medical system, administrators have failed to realize that all the negativity perpetuated against doctors, who are working with the burden of mistrust under medico-legal sword is going to make them less safe.
Administrators, who have never treated a patient in their lifetimes, not only try to control treatment of thousands of patients, but project themselves messiah by demonizing doctors. Lowly educated celebrities and administrators have found a new easy way to project themselves on higher pedestrian by publicly insulting highly educated but vulnerable doctors. The biggest tragedy to the medical profession in the present era is the new fad of administrators to discourage and demonize the medical profession for their popularity gains. Being so distant from the ground reality, their role should not have been more than facilitators, but they have become medical administrators. To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.
Slow or acute revolt is long due. Doctors have only two ways- either to persist, fight or perish. Silently quitting their beloved profession is going on for some time all over the world. Even in developed countries, there has been a fading enthusiasm to be a doctor. But doctors of Rajasthan have shown the way. The way to persist and resist the indignity handed over to medical profession. The have shown that the struggle was not that difficult that it looked to be. They have chosen the correct path of struggle for Independence (Professional). That makes them global leaders without any doubt.
In the new ‘ Right to Health- Bill- Rajasthan’, because of government inability to provide basic and essential services, private hospitals are dictated to render services. As services at Government hospitals are inadequate and have failed to provide facilities to handle the emergencies. Since the patients cannot be left without treatment, provision for emergency services should be made available to country’s population. That is the Government’s duty which the administrators have failed to fulfil. Therefore co-operation from private sector is expected, but it should be sought as help rather than an imposed dictate. This act, though may have a noble intention in mind, should be analysed by all stakeholders in an objective manners.
• Will government render some support in any manner to private health organizations, which they may need genuinely in order to do this difficult task, as the Government itself has been unable to do in so many years?
• In order to provide these essential services especially emergency and lifesaving, is government asking the private players for help for this noble cause or does this act simply dictates its wish onto the private players bulldozing their genuine concerns in doing so?
Will Government increase its’ own responsibility and accountability and shoulder more responsibility towards ‘Health to All’ or it is only for private doctors to provide?
• Will government provide physical and legal protection to doctors and health establishments on the issues arising from the act?
• Although the RTH looks like is a democratic action, but is it democratic to doctors and private health players as well? Are their genuine problems and views addressed and accommodated?
• What are government’s plans in the long term to improve such services? Does it plan to continue forcing the private setups (without ant help to them) or are there any plans to improve the government health facilities in future to a level commiserate with the need of the hour.
Imposing such dictates will definitely force the aspiring doctors to think, whether to choose medical career or not.
The Rajasthan government’s proposed right to health bill has landed in deep controversy due to objections from the private healthcare sector, which is dishonouring as a part of the protests the provision of cashless treatment under existing state-run schemes. The draft bill has been criticised as a hasty job that overlooks ground realities and suffers from lacunae that the Ashok Gehlot government is apparently resisting taking note of.
Chief minister Gehlot, on February 17, urged private hospitals to end their boycott of the Chiranjeevi scheme and the Rajasthan Government Health Scheme (RGHS), which provide mostly cashless treatment to private individuals and government employees, respectively, terming it improper on humanitarian grounds. “The private sector has a role to play in making Rajasthan a model state in healthcare, and we will clarify all doubts of private hospitals about the right to health bill,” Gehlot said. It remains to be seen if his appeal has any impact, given that private doctors’ associations have accused the government of intimidating private hospitals to end the boycott of the bill.
Social activists backing the bill have opened a separate front by criticising private hospitals for opposing the proposed legislation. The moot question is this: Does right to health only include private healthcare, which the bill aims at, or also things like potable water, clean air, unadulterated edibles and quality roads? In short, factors determining a healthy life but excluded from the ambit of the proposed law.
The bill has been in the pipeline for some months now. It was tabled in the state assembly in September 2022 but referred to a select committee subsequently because the Opposition and doctors’ fraternity wanted it be debated thoroughly. On February 15, the select committee deferred its scheduled meeting as private doctors threatened to step up their stir against the bill. Earlier, the state government had expressed its resolve to push ahead with passage of the bill.
A key contentious point in the bill is that no medical facility—whether government or private—can deny a patient ‘emergency’ care. The bill, however, falls short of defining ‘emergency condition’ and how the cost of treatment is to be reimbursed to private hospitals. Private doctors and private medical institutions feel the bill will give extraordinary powers to designated government officials to enter their premises and harass them.
Rajasthan has been witnessing a sharp rise in patient-doctor conflicts, both in government hospitals where doctors are accused of negligence as well as private medical facilities, which are accused of charging patients exorbitantly. Critics of the bill say it fails to address the concerns of doctors. Initially, private doctors had protested against the clause to compulsorily provide ‘emergency’ care to patients. They cited various aspects of their concern, such as someone with even a minor injury demanding emergency treatment at a hospital or a person suffering a heart attack approaching a hospital or nursing home that lacks facilities to deal with such a case.
As details of the draft bill emerged, there was also apprehension in the private healthcare sector that the bill may become a tool to bring ‘inspector raj’ into the medical sector. “Once you give officials open access to enter our premises, it is bound to be misused. The bill is a ploy of bureaucrats to control the private medical sector,” alleges Dr Vijay Kapoor, secretary, Private Hospitals and Nursing Home Societies, Jaipur. Highlighting ‘discrepancies’ in the bill, Kapoor points out that while a person who wheels in an accident victim to a hospital is entitled to a reward of Rs 5,000, the bill is silent on how the hospital would be reimbursed for treating the patient. “The bill
Private hospitals have been the backbone of the Gehlot government’s flagship Chiranjeevi scheme, under which beneficiaries are entitled to free treatment worth up to Rs 25 lakh in government and affiliated private hospitals. The scheme has been hit by the alleged refusal of many private hospitals to admit patients—as a symbol of protest against the right to health bill.
The Chiranjeevi scheme allows private hospitals to bill patients for certain costs incurred so as to partially compensate for the high cost of diagnostics and treatment. Private hospitals expect a similar consideration in the right to health bill, besides widening the scope of factors determining ‘healthy life’.
Some doctors wonder if a separate bill like this was necessary at all since right to health was enshrined as a fundamental right under Article 21 of the Constitution. Moreover, private doctors say they hardly have any representation in the various committees proposed to implement the provisions of the bill, grassroots level up.
Social activists like Nikhil Dey of the Rajasthan Soochna Evam Rozgar Adhikar Abhiyan and Kavita Srivastava of the Peoples Union of Civil Liberties (PUCL) are dismissive of the opposition to the bill. “It cannot be acceptable that the life of a rich individual is saved but not of a poor for want of money,” says Dey. Srivastava adds that while some objections of doctors could be genuine, the bill cannot be rejected outright.
Private doctors claim schemes to provide healthcare through the private sector under insurance coverage by the state government have been marred by corruption. “Hefty bribes are sought for empanelment of hospitals under these schemes, reimbursement of claims and settlement of complaints if any,” alleges Kapoor.
With more and more private hospitals allegedly refusing cashless treatment to private individuals and government employees under state-run health schemes, patients are suffering. Besides, given the accusation that officials demand bribes and some government doctors patronise certain private hospitals, Gehlot’s right to health bill appears caught in rough weather, all the more since it’s perceived as been hastily drafted.
Up to the end of World War II, less than 10% of the general anaesthetics administered were with intravenous barbiturates. The remaining 90% of anaesthetics given in the USA were with diethyl ether. In the United Kingdom and elsewhere, chloroform was also popular. Diethyl ether administration was a relatively safe and simple procedure, often delegated to nurses or junior doctors with little or no specific training in anaesthesia. During the Japanese attack on the US bases at Pearl Harbor, with reduced stocks of diethyl ether available, intravenous Sodium Pentothal(®), a most ‘sophisticated and complex’ drug, was used with devastating effects in many of those hypovolaemic, anaemic and septic patients. The hazards of spinal anaesthesia too were realised very quickly. These effects were compounded by the dearth of trained anaesthetists. The anaesthesia tragedies at Pearl Harbor, and the discovery in the next few years of many other superior drugs that caused medical and other health professionals to realise that anaesthesia needed to be a specialist medical discipline in its own right. Specialist recognition, aided by the foundation of the National Health Service in the UK, the establishment of Faculties of Anaesthesia and appropriate training in pharmacology, physiology and other sciences soon followed. Modern anaesthesiology, as we understand it today, was born and a century or more of ether anaesthesia finally ceased.
The World War II medical tragedies, especially those at Pearl Harbor, were a wake-up call for surgeons and the medical profession generally throughout the world. There was a realisation that it was no longer appropriate for any junior doctors or nurses to administer ‘sophisticated’ anaesthetic drugs for many types of surgeries and to critically ill patients. This had been known for many years in thoracic surgery and neurosurgery, but in the years after the war it was clear that appropriately trained anaesthetists were required, who had the knowledge and skills to use advanced drugs such as thiopentone and the new techniques and equipment which had rapidly developed in the 1940s.
The significance of the results of attempts of nurse and doctor anaesthetists to use thiopentone anaesthesia in military casualties who were hypovolaemic was very clear. Cardiovascular collapse and respiratory arrest with a lack of oxygen supplies, resuscitative skills and knowledge of thiopentone’s pharmacology and dosage, along with the insufficient numbers of skilled anaesthetists, clearly resulted in many tragedies. Some spinal anaesthetics also contributed to the perioperative mortality. So it was not too long during that fateful day in 1941 before surgeons and others reverted to using ‘drip ether’ as the principal anaesthetic technique and restricted the use of the available local anaesthetics, procaine and tetracaine, to infiltration only—mainly in burns patients. Exactly how many anaesthetic deaths resulted from intravenous thiopentone and hexobarbital will probably never be known as there were no defined classifications of such deaths as we have today.
In summary, the greatest significance of the anaesthetic events at Pearl Harbor, and more broadly throughout World War II, was that the surgeons, the medical profession generally and health authorities recognised the need for appropriately trained and skilled specialist practitioners of anaesthesia. Modern anaesthesia, or anaesthesiology as I believe we should refer to it, was born soon after Pearl Harbor and World War II, and the ‘ether century’ began to expire, although ether continued to be used into the 1970s for many simpler surgeries in less developed centres.
In an horrifying and frightening incident, mauled and hunted two siblings, aged 7 & 5, killed in stray dog attack in Delhi’s Vasant Kunj
NEW DELHI: Two siblings, aged seven and five, were killed allegedly in stray dog attack in two separate incidents in the Vasant Kunj area of Delhi. The police said that the 7-year-old boy went missing on March 10 and his body was recovered later with animal bite like injuries.
They needed some shield to protect himself which society, government, courts and so called “dog-lovers” failed to provide.
Courts have also upheld animal rights but failed to formulate and implement policies to ensure safety of humans from these violent strays. Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites.
Danger of stray dogs is increasing every day around us. As the strays population in increasing, now they are grouped and see vulnerable humans as easy prey. Packs of dogs have become dangerous and difficult to control. Protected by Dog lovers and animal right laws, the danger to normal people of being hunted even around their homes is real. Human right of being in a safe environment is being ignored. Is it not hypocritical that you care for a violent stray that is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous apathy towards safety of humans. Such dog lovers most of the time, totally ignore the fact that these dogs are a threat to children and older people. An immediate sense of hatred towards such dog lovers is a consequence and a natural thought.
Animal lovers while pretending of “dog love” have formed NGOs and have donations and accumulate money. But have failed to create shelters for stray dogs. Neither have any steps been taken to save people from dog bites. So consequently, people especially vulnerable are children and older people who are mauled and eaten alive by stray dogs. What responsibility and accountability these animal lovers and NGO bear towards such incidents? Why people who collect money in name of animals do not take care and form shelters for these strays? every single death from such preventable cause raise a question on this issue.
Apathy of these so called dog lovers towards humans is appalling.
SUGGESTION: the Government, NGOs and people who claim to be “animal lovers” should create shelters to save strays “as well as people”. It should be mandatory that all the dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering, save lives and eventually reduce use of antibiotics. A rationale mind will definitely appreciate the danger due to strays, and can initiate proper steps rather criticizing above said facts in the name of animal rights. An animal has no sense of responsibility, so rights should be limited accordingly.
Evolution of Medical profession-Extinction of good doctors 