Deaths due to Low Quality Medicine- Pharma Industry Needs Strict Regulation


It is  time to treat Pharmaceutical malaise.

    Take example for cough syrup related  66 deaths at Gambia or  Injection Propofol related deaths at PGI Chandigarh. If deep investigations are not done, poor quality medicines will continue to be marketed and doctors would be held responsible for the adverse reactions and deaths. Strict regulations for quality of pharmaceutical agents is need of the hour.

    Usually every problem related to health is called medical malaise, but that is a misnomer.  In fact health care comprises tens of different industries.  Complex interplay of various industries  like pharmaceutical, consumable industry and other businesses associated with  health care  remain invisible to patients. Various important components for example pharma industry, suppliers, biomedical, equipment, consumables remain largely unregulated. Collective malaise of all these is conveniently projected as medical problems  as blame is conveniently passed on to doctors, as they are only visible component of mammoth health business.  Rest all remain invisible, earn money and  doctors are blamed for the poor outcome of the patient, as doctor is the only universal link that is visible with patient. By an average application of wisdom, it is easier to blame doctors for everything that goes wrong with patient.

      Cough syrup related deaths at Gambia or  Injection Propofol related deaths at PGI Chandigarh – two examples are only a tip of the iceberg.  In routine, if patient gets fake or low quality medicines and does not get well, gets side effects, doctor will face harassment. Whereas people involved and industry will be sitting pretty and  make money.

Therefore strict administration and quality check  is required   to correct Pharma malaise. It may be a complex issue because of complexity involved in implementation and execution of policies. But recognition and beginning to think of the problem is also an important step.

Red alert over deaths after Propofol injection- PGI CHANDIGARH

WHO warns over deaths of 66 children in The Gambia (Indian Pharmaceutical Cough syrup).

WHO warns over deaths of 66 children in The Gambia (Indian Pharmaceutical Cough syrup)

The WHO has issued an alert over four cough and cold syrups made by Maiden Pharmaceuticals in India, warning they could be linked to the deaths of 66 children in The Gambia

The World Health Organization (WHO) on Wednesday issued a warning over four cough and cold syrups made by an Indian company, saying that they could be linked to the deaths of 66 children in The Gambia. The WHO said that the cough and cold syrups, made by Maiden Pharmaceuticals in Haryana, could be the reason for serious kidney injuries. “Please do not use them,” the WHO said in its advisory.

The four cough and cold syrups that have been linked to the deaths of 66 children in The Gambia are Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup. In a release, the WHO has said that the Indian company has not yet provided guarantees on the safety and quality of these products.

“Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” the WHO said in a medical product alert. The WHO also warned that while the products had so far been found in The Gambia, they could have been distributed to other countries.

According to the WHO, diethylene glycol and ethylene glycol are toxic to humans when consumed and can prove fatal. Toxic effects can include abdominal pain, vomiting, diarrhoea, inability to pass urine, headache, altered mental state, and acute kidney injury which may lead to death, the WHO said.

New Delhi-based Maiden Pharmaceuticals declined to comment on the matter.

The World Health Organization also said that it was conducting further investigation with the company and regulatory authorities in India regarding the cough syrup linked to deaths of 66 children.

Last month, Gambia’s government said that it has also been investigating the deaths. The government statement came as a spike in cases of acute kidney injury among children under the age of five was detected in late July.

“While the contaminated products have so far only been detected in the Gambia they may have been distributed to other countries,” WHO Director General Tedros Adhanom Ghebreyesus said at a press conference on Wednesday.

The WHO Director General added that WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients.

Meanwhile, the DSCO has already taken up an urgent investigation into the matter with the regulatory authorities in Haryana.

Red alert  over  deaths after Propofol injection- PGI  CHANDIGARH

CHANDIGARH: Five patients had died after they were sedated before surgeries on a single day last week at PGI, prompting doctors to sound a red alert to Central Drugs Standard Control Organisation (CDSCO)on Propofol injection – an anesthetic given before any major surgery. In this case, the drug was taken from the chemist shop in the hospital emergency. “Following a complaint from PGI doctors, we came with a CDSCO team to collect samples. The samples have been sent to Central Drugs Laboratory, Kolkata,” said Sunil Chaudhary, senior drug control officer, UT. He said, “The suspected batch of drugs has been stopped for supply till reports are received.” Sources said test analysis will take around two-three weeks and final report will be submitted by the CDSCO team. The five patients had to undergo orthopaedic and neurosurgeries. On deliberating the cause of deaths, doctors found Propofol injection as the common thread.

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


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

   Violence against doctors has become a serious issue across the globe. The underlying basic  reason for the omnipresent malaise is the altered doctor-patient equation globally and growing mistrust in the saviours. The mistrust is propagated by opportunist medical industry, media and law industry for their selfish motives as doctors are shown as front men for the failures.  Poor outcomes are projected because of medical errors and mistakes. Every death is thought to be because of negligence rather than a natural complication of the disease.  Because of the instigation and poor law enforcement in favour of doctors, the response of  lay public to these unfortunate incidents has become extremely erratic and out of proportion. As Governments remain more or less indifferent, and doctors have become punching bags for inept health systems.  Law industry has been enormously benefitted financially due to medico-legal cases against doctors. Media has sold their news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations.  An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors.   There is a little token action by police after routine incident of violence against doctors.

    Consequently violence (legal, verbal or physical) against doctor has acquired an epidemic proportion, omnipresent world-wide. As a result, medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.

   But in Israel, doctors, nurses and health care workers seem to be united against this menace and their associations are actively pursuing the issue. More-over the Government also seem to be sensitive to the issue in Israel.

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

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

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

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

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

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

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

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

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

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

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

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

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

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Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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


The painful incident of Dr Archana Sharma’s Suicide unmasks the everyday struggle of the doctors in the present era. Her supreme sacrifice depicts the plight of doctors- being undervalued and demonized, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment.  Her suicide has unveiled the despondency, moral burden of mistrust that doctors carry. Her death is the result of the apathy of fair justice that eludes medical community. Sadly, the society is unable to realize its loss. Let her sacrifice be a reminder to the whole medical fraternity; either fight against the prevalent injustice or perish, not being able to treat the patients would be a greater disservice to humanity.

Dr Archana Sharma Suicide

      

Dr Archana Sharma Suicide

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

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

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   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Burnout at Workplace: How to Recognize and What to do


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

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

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

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

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

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

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

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

What to look out for

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

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

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

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

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

What to do

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

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

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

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

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

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

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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


 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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


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

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

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

Dr Manjula Arora’s case

Dr Manjula Arora’s case

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

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

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

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

They also considered that the misconduct was serious.

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

Manjula Arora case: the GMC stumbles again? -BMJ

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

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

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

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

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

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

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

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

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

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

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

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

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

The Book-‘At the Horizon of Life & Death’:Blackmail of Doctors by opportunist goons, legal industry, Vulture Journalism


      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.  Book describes stories the blackmail doctors face from opportunist goons, legal industry and vulture kind of journalism. Every day blackmail by legal industry, journalist and local goons, similar to what Dr Archana Sharma went through and others doctors are  facing have been described.

         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.

    The 300-page book (English) 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.

         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.

Suicide by Dr Archana Sharma has exposed the blackmail; medical professionals are going through in current era. Doctors have become sitting ducks for punishments complaints, blackmail, and legal complexities besides every day harassment. Negligent police, indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment.  It may not be a good idea to opt for a medical career any more.

More naïve would be to pay millions to be a doctor.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Any Fine Morning can be Harbinger of Doomsday for doctors #lady-doctor-suicide


Working of a doctor and nurses is not free from risk to themselves which can be verbal, physical as well as legal assaults. Everyday globally, the doctors and the nurses greet the new day and return to their work of taking care of their patients, knowing well the risk involved. None of the   doctors can guess which one fine morning becomes a harbinger to their doomsday, especially when serving an anarchic and hostile society. No doctor can anticipate which one patient can cause deadly harm to health care workers, while trying to save the one.  Unfortunate incident of PPH (Post-partum Bleeding – a natural complication of pregnancy) and subsequent agitation by mob and over-reactive FIR by hostile Police was enough for a brilliant Obstetrician to commit suicide in Jaipur.  Possibly doctors are not assured of getting justice anymore from our system.

Jaipur- A woman doctor booked for death of a pregnant woman in Rajasthan committed suicide

Jaipur- A woman doctor booked for death of a pregnant woman in Rajasthan committed suicide

Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. According to police, the pregnant woman died at the hospital run by Dr Archana Sharma and her husband on Tuesday. An FIR was registered against Archana at the Lalsot Police Station after family members of the pregnant woman held a demonstration outside the hospital and demanded immediate action against the erring doctor. Stressed over the FIR, Archana hanged herself to death, police said. “The doctor was booked for the death of the pregnant woman due to negligence in treatment. Today afternoon, the doctor hanged herself to death at her residence above the hospital,” Additional SP (Dausa) Lal Chand Kayal said.

    The risk is generally underestimated, although often it may be major risk to life.  Majority of people, society and governing bodies and even doctors themselves do not perceive or acknowledge the possible harms to health care workers in present era.  But since these risks are increasing exponentially, they should be known to students, who want to take medicine as a profession. There are lesser set procedures, lack of awareness, not protective equipment or hostile society, lack of governance and laws and doctors continue to work in dangerous environment.

         Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.

            Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project   single stray incident   as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors need to be careful and remain careful about saving themselves from verbal, physical as well as legal assaults.

Doctor- ‘save the patient but to save themselves also’.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Man Jailed for Abusing Lady Doctor


         In present era,  most of the time, a lenient view is taken  against assault of doctors on the grounds of  emotional circumstances  of relatives and sympathy towards patients, even in cases of blatant injustice imparted towards doctors and nurses. Not   infrequently, assaults of doctors are taken as routine incidents committed under disguise of perceived negligence and sympathy towards patients. The culprits are able to commonly get away with it.

   But this businessman who abused a lady doctor has not been proved to be lucky, at least till this time. He was handed over a jail term of 6 months. Rightly so, courts need to aim at imparting justice and not judge on the basis of projected disturbed emotional state.

         Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.

Man gets six-month jail for abusing lady doctor

            Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project   single stray incident   as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors need to be careful and remain careful about saving themselves from verbal, physical as well as legal assaults.

  Man gets six-month jail for abusing lady doctor

The incident had taken place on 23 Nov 2017 when Rohinton Umarigar, who was at the Parsi General Hospital for his mother’s treatment used abusive language with the woman doctor who was in charge of the ICU

A Girgaum magistrate court refused leniency to a 52-year-old who used foul language with a woman doctor in 2017 and sentenced him to six months of simple imprisonment. It stated that unwarranted leniency to him would send a wrong signal to society and that he had used unparliamentary language to insult the dignity of a woman.

The incident had taken place on November 23, 2017, when the man, Rohington Umarigar, was at the Parsi General Hospital where his mother was undergoing treatment. He used abusive language with the woman doctor who was in charge of the ICU.

The Nepean Sea Road resident had sought leniency and requested that the court release him by imposing a minimum fine and on a bond of good behaviour. He told the court that he was the only breadwinner of his family. Umarigar’s advocate told the court that the incident occurred at the spur of the moment when his mother was ill. The court said the punishment under Sec 509 of the IPC (word, gesture, act intended to outrage modesty of a woman) was enhanced by the legislation in 2013 looking at the time and seriousness of offences committed against the modesty of women. The court noted that Umarigar had misbehaved a second time with the doctor, which means it was intentional.

“Whenever such type of offence is committed against women, it is against their right to sexual integrity, dignity. It is linked to their right to privacy…in the present matter also, the accused has used unparliamentary words to insult the dignity of woman. He is in his 50s and knows the consequences of his act,” Magistrate Nadeem A Patel said. The court further said that while enhancing the punishment, it was the intention of the legislature to penalize the offence of outraging a woman’s dignity, either physically or verbally. Therefore, in such cases, unwarranted leniency shown will send a wrong message to society. It also imposed a fine of Rs 1,000 on the man.

The man had claimed that he had made a complaint to the hospital management against the doctor for negligence and that this was a counter-complaint. The court refused to accept this defence. It said that even for the sake of argument if it were to be assumed that she had been negligent in her own duty, it did not give him the right to abuse a lady doctor. It relied on the testimony of the victim, as well as her three colleagues at the hospital who testified about the incident.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Lowering NEET Percentile- an Illusion of Merit


Overplayed narrative of fewer doctors in the country, rather than a system  for proper utilization is an effort to increase numbers of doctors. But this goal needs to be achieved with preserving quality of medical education. Almost all efforts to increase the number of doctors are associated on dilution of merit. Selling the medical seats is heading towards bubble burst, when despite declining demand for poor quality and expensive medical education, new private colleges being approved along with lowering merit to a dismal percentage.

     Future doctors getting admissions by scoring just 10-20 percent of marks, poor teacher student ratio, seats being awarded to highest bidder are few pointers to the poor quality of medical education. Few years back NEET percent system was changed to percentile and now the bar is lowered further, just to accommodate more ‘bidders’ with less marks, to be able to buy  medical seats.

    This potpourri portends to be a travesty of quality, not just of medical education but more seriously, of the quality of doctors. Allotment of medical seats is being left to the vagaries of populism and commercialism, through a false sense ‘the illusion of merit’ secured via NEET. Admission criteria whittled down to mere 10-20 percent, will result in an irreversible and regressive compromise with quality of doctors. Will patients approve such dizzying choice and at what cost?

        Going by selection of candidates as doctors, if given a choice, by which a patient will like to get treated? A candidate who scored 20 % marks or a person getting 60% or 80% marks.   NEET eligibility getting lower and a candidate getting around 20 % of marks may be able to secure a degree to treat patients.  What will be the deciding factor? The criteria as to why a person with 60% marks not getting a seat and another with 20% marks will be able to secure. It will depend upon, whether a candidate is able to pay the exorbitant fee or not. Present system and mechanism of admission permit and accept such huge variation! That strange equation is acceptable in lieu of money paid!

Govt cuts NEET-PG cutoff by 15 percentile

Govt cuts NEET-PG cutoff by 15 percentile

 In a move that is likely to boost uptake in vacant post-graduate medical seats and also improve availability of specialists in future, the health ministry has slashed the cutoff for NEET-PG 2021 by 15 percentile across all categories. The ministry issued a letter to the National Medical Commission on Saturday giving a go-ahead to the proposal. The revised qualifying cutoff now stands at 35 percentile for the general category, 30 percentile for persons with disabilities (PwD) general, 25 for SC/ST and OBC and 25 for PwD (SC/ST/OBC), the letter said. The reduction in the cut off percentile is expected to allow more MBBS passouts to apply for post-graduate courses, an official said.  “The move aims to prevent seat wastage. With this reduction in percentile, approximately 25,000 fresh candidates can participate in the mop-up round of the ongoing counselling,” a ministry official said. Nearly 8,000 post-graduate seats are still vacant despite two rounds each of all India and state counselling. “After due discussion and deliberations, it has been decided by the health ministry in consultation with NMC to reduce the cut off by 15 percentile across all categories…” medical counselling committee member-secretary  wrote in a letter to National Board of Examinations executive director . TOI has reviewed the letters. The move is also expected to fill a serious gap in the availability of specialists.  There remains a severe shortfall of over 76% in terms of specialists like surgeons, gynaecologists, physicians and paediatricians at community health centres. Against the requirement for existing infrastructure, there is a shortfall of 78.9% surgeons, 69.7% obstetricians & gynaecologists, 78.2% physicians and 78.2% paediatricians. The Centre has further directed NBE to declare the revised results and send data of the newly eligible candidates to the counselling committee

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

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