ZERO Percentiles Requirement to be a Super Specialist Doctor- a Cruel Joke


          MUMBAI: With hundreds of medical super specialty course seats vacant, the authorities have removed the qualifying mark criterion for aspirants. So, rock-bottom scores or a zero percentile would be acceptable for a course at this level.

            Such decisions appear to be   cruel joke to the life of patients. A wise decision would be to review into reasons for vacant seats for example- policies, fee structure, facilities, demand for the course, and disillusionment of students by existing system or falling percentages to be a super-specialist doctor.  

          Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who   secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college.  Even   an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 15-20 % marks also becomes eligible to become a doctor. That is now further diluted to nearly Zero percentile. Answer to that is simple.  To select and find only those students, who can pay millions to become doctors,  and hence marks and quality of doctors don’t matter?  

   If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, especially those who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way  forward.  

So, rock-bottom scores or a zero percentile would be acceptable for a course at this level.

      Society needs to choose and nurture a force of doctors carefully with an aim to combat for safety of its own people. If society has failed to demand for a good doctors and robust system, it should not rue scarcity of good doctors. Merit based cheap good medical education system is the need of the society. This is in interest of society to nurture good doctors for its own safety.      The quality of doctors who survive and flourish in such system will be a natural consequence of how society chooses and nurtures the best for themselves.

    MUMBAI: With hundreds of medical super specialty course seats vacant, the authorities have removed the qualifying mark criterion for aspirants. So, rock-bottom scores or a zero percentile would be acceptable for a course at this level. “Seats have been going vacant every year. The government felt that as a one-time measure, in the larger context of things, we can even accept students with a zero percentile. This will not have any precedence. It is being taken up as a test case. After all, the entrance test was not conducted to eliminate students, but merely to grade them,” said a senior officer from the health ministry. With 748 super speciality seats unfilled after four rounds of admission this year, the Medical Counselling Committee (MCC) took the drastic step. As a one-time measure, any candidate who had taken the NEET super speciality 2021 exam can participate in the special mop-up admission round irrespective of his/her scores.

When admissions began this year, two rounds conducted by the MCC got a cold response. This led to a special mop-up round with the qualifying bar lowered by 15%. Yet, there weren’t many takers. Now the second mop-up round is open to all aspirants. India has about 4,500 super specialty medical seats. There is more vacancy in the surgical branches than the clinical ones. “Candidates have realised that having a broad speciality gives them a good career and money. Hence, many do not want to spend more time in pursuing a super specialty course,” said Dr Pravin Shingare, former head of the Directorate of Medical Education and Research (DMER). “If you look at Grant Medical College, 80% seats in super specialty have been lying vacant for 10 years. At GS Medical College, 40% seats in the last 4-5 years have been unfilled,” he added. But the trend has extended to the non-surgical branches too in the past three years. The bias in selecting programmes often is dictated by considerations that in the case of a surgical branch, a candidate needs to work with a team, have an operation theatre, but a clinical course allows the doctor to work independently out of a clinic.

Parent representative Sudha Shenoy said the problem also lies with the long bond that candidates need to serve if they join a government college. “Any candidate who joins a super specialty programme would be at least 30 years old. If they have to serve a 10-year bond, when will they start earning? So, government hospitals go off most students’ choice list. And when it comes to private and deemed institutes, the fee is out of bounds for most,” explained Shenoy

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?

Demonize Doctors: New Fad of Administrators- Accepted Norm for Populism? #Dr-Raj-Bahadur-VC-BFUHS Resigns


Dr Raj Bahadur, the vice-chancellor of Baba Farid University of Health Sciences (BFUHS) in the state’s Faridkot district Punjab, submitted his resignation to the Chief Minister’s Office late on the night of Friday, July 29.  He has resigned after state health minister allegedly forced him to lie on a dirty mattress at a hospital.

         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 publically 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.
          Such vulnerability to insult is intrinsic to the doctors’ work, makes them sitting ducks, an easy target for harassment and punishments, if administrators wishes to do so. This vulnerability is exploited by everyone to their advantage. Administrators use this vulnerability to supress them. It is used by media and   celebrities who projected themselves as Messiah for the cause of patients, and sell their news and shows by labelling the whole community of doctors as king of fleece tragedy based on just one stray incident. 

       The painful incident of Dr Raj Bahadur’s   humiliation unmasks the everyday struggle of the doctors in the present era. His resignation  after the public insult  depicts the plight of doctors – being undervalued and demonized by administrators, 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.  The incident has unveiled the despondency, moral burden of mistrust that doctors carry.

  Sadly, the society is unable to realize its loss.

    Bullied by  administrative systems,  indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment.  Is there any punishment for the  administrators for mismanagement or poor infrastructure or lack of funds? Looks impossible but punishment to the sufferers is on the cards.

     Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic  should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world. Role of doctor associations, parent institutes has remained more or less weak, spineless and not encouraging.

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

Faridkot district, submitted his resignation to the Chief Minister’s Office late on the night of Friday, July 29.

 

       New Delhi: The vice-chancellor of a medical college in Punjab has resigned after state health minister allegedly forced him to lie on a dirty mattress at a hospital.

Dr Raj Bahadur, the vice-chancellor of Baba Farid University of Health Sciences (BFUHS) in the state’s Faridkot district, submitted his resignation to the Chief Minister’s Office late on the night of Friday, July 29.

Hours earlier state health minister Chetan Singh Jouramajra had asked him to lie down on a dirty mattress during an inspection of Faridkot’s Guru Gobind Singh Medical College and Hospital, which comes under the BFUHS.

A video clip of the incident that circulated on the social media, showed Jouramajra place a hand on the veteran surgeon’s shoulder as he pointed towards the “damaged and dirty condition” of the mattress inside the hospital’s skin department.

The minister then allegedly forced Bahadur to lie down on the same mattress.

Though the vice-chancellor himself did not confirm his resignation, highly placed sources in the health department confirmed the same to multiple outlets. When approached for comments,  reports that The Tribune Bahadur said, “I have expressed my anguish to the Chief Minister and said I felt humiliated.”

Reports have it that chief minister Bhagwant Mann has expressed his displeasure over the incident and spoken to Jouramajra. Mann has also asked Bahadur to meet him next week.

Speaking to The Indian Express, Bahadur additionally said: “I have worked in 12-13 hospitals so far but have never faced such behaviour from anyone till now. I shouldn’t have been treated this way… it affects this noble profession. It is very painful. He showed his temperament, I showed my humility.”

Bahadur is a specialist in spinal surgery and joint replacement and a former director-principal of Government Medical College and Hospital in Chandigarh. He has also been the head of the orthopaedic department at PGIMER, Chandigarh.

Asked whether new mattresses had been ordered for the hospital, he said: “Two firms sent their quotations and the rate finalisation needs to be done. It is a 1,100-bed hospital and not all mattresses are in bad condition. This mattress shouldn’t have been there but hospital management is the prerogative of the Medical Superintendent.”

Speaking to reporters at the hospital, Jouramajra said: “My intention was not to do any inspection. In fact, I am visiting various hospitals to see what the requirements are so that we can fulfil them.”

Various quarters, including the Indian Medical Association, have criticised Jouramajra.

PCMS Association, a doctors’ body in Punjab, to,  in a statement, strongly condemned the “unceremonious treatment” meted out to Bahadur. PCMSA said the way the V-C was treated was “deplorable”, its reason notwithstanding.

The body expressed its “deep resentment” over the incident and said “public shaming of a senior doctor on systemic issues is strongly condemn-able.”

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?

History & Evolution of Intensive (Critical) Care Units


              The English nurse Florence Nightingale pioneered efforts to use a separate hospital area for critically injured patients. During the Crimean War in the 1850s, she introduced the practice of moving the sickest patients to the beds directly opposite the nursing station on each ward so that they could be monitored more closely.  In 1923, the American neurosurgeon Walter Dandy created a three-bed unit at the Johns Hopkins Hospital. In these units, specially trained nurses cared for critically ill postoperative neurosurgical patients.

           The Danish anaesthesiologist Bjørn Aage Ibsen became involved in the 1952 poliomyelitis epidemic in Copenhagen, where 2722 patients developed the illness in a six-month period, with 316 of those developing some form of respiratory or airway paralysis. Some of these patients had been treated using the few available negative pressure ventilators, but these devices (while helpful) were limited in number and did not protect the patient’s lungs from aspiration of secretions. Ibsen changed the management directly by instituting long-term positive pressure ventilation using tracheal intubation, and he enlisted 200 medical students to manually pump oxygen and air into the patients’ lungs round the clock. At this time, Carl-Gunnar Engström had developed one of the first artificial positive-pressure volume-controlled ventilators, which eventually replaced the medical students. With the change in care, mortality during the epidemic declined from 90% to around 25%. Patients were managed in three special 35-bed areas, which aided charting medications and other management.

        In 1953, Ibsen set up what became the world’s first intensive care unit in a converted student nurse classroom in Copenhagen Municipal Hospital. He provided one of the first accounts of the management of tetanus using neuromuscular-blocking drugs and controlled ventilation.

         The following year, Ibsen was elected head of the department of anaesthesiology at that institution. He jointly authored the first known account of intensive care management principles in the journal Nordisk Medicin, with Tone Dahl Kvittingen from Norway.

      For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources were brought to the room of the patient that needed the additional monitoring, care, and resources. It became rapidly evident, however, that a fixed location where intensive care resources and dedicated personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. In 1962, in the University of Pittsburgh, the first critical care residency was established in the United States. In 1970, the Society of Critical Care Medicine was formed.

How an epidemic led to development of Intensive Care Unit

How an epidemic led to development of Intensive Care Unit

The number of hospital admissions was more than the staff had ever seen. And people kept coming. Dozens each day. They were dying of respiratory failure. Doctors and nurses stood by, unable to help without sufficient equipment.

It was the polio epidemic of August 1952, at Blegdam Hospital in Copenhagen. This little-known event marked the start of intensive-care medicine and the use of mechanical ventilation outside the operating theatre — the very care that is at the heart of abating the COVID-19 crisis.

In 1952, the iron lung was the main way to treat the paralysis that stopped some people with poliovirus from breathing. Copenhagen was an epicentre of one of the worst polio epidemics that the world had ever seen. The hospital admitted 50 infected people daily, and each day, 6–12 of them developed respiratory failure. The whole city had just one iron lung. In the first few weeks of the epidemic, 87% of those with bulbar or bulbospinal polio, in which the virus attacks the brainstem or nerves that control breathing, died. Around half were children.

Desperate for a solution, the chief physician of Blegdam called a meeting. Asked to attend: Bjørn Ibsen, an anaesthesiologist recently returned from training at the Massachusetts General Hospital in Boston. Ibsen had a radical idea. It changed the course of modern medicine.

Student saviours                                    

The iron lung used negative pressure. It created a vacuum around the body, forcing the ribs, and therefore the lungs, to expand; air would then rush into the trachea and lungs to fill the void. The concept of negative-pressure ventilation had been around for hundreds of years, but the device that became widely used — the ‘Drinker respirator’ — was invented in 1928 by Philip Drinker and Louis Agassiz Shaw, professors at the School of Public Health in Boston, Massachusetts. Others went on to refine it, but the basic mechanism remained the same until 1952.

Iron lungs only partially solved the paralysis problem. Many people with polio placed in one still died. Among the most frequent complications was aspiration — saliva or stomach contents would be sucked from the back of the throat into the lungs when a person was too weak to swallow. There was no protection of the airway.

Ibsen suggested the opposite approach. His idea was to blow air directly into the lungs to make them expand, and then allow the body to passively relax and exhale. He proposed the use of a trachaeostomy: an incision in the neck, through which a tube goes into the windpipe and delivers oxygen to the lungs, and the application of positive-pressure ventilation. At the time, this was often done briefly during surgery, but had rarely been used in a hospital ward.

Ibsen was given permission to try the technique the next day. We even know the name of his first patient: Vivi Ebert, a 12-year-old girl on the brink of death from paralytic polio. Ibsen demonstrated that it worked. The trachaeostomy protected her lungs from aspiration, and by squeezing a bag attached to the tube, Ibsen kept her alive. Ebert went on to survive until 1971, when she ultimately died of infection in the same hospital, almost 20 years later.

The plan was hatched to use this technique on all the patients in Blegdam who needed help to breathe. The only problem? There were no ventilators.

Very early versions of positive-pressure ventilators had been around from about 1900, used for surgery and by rescuers during mining accidents. Further technical developments during the Second World War helped pilots to breathe in the decreased pressures at high altitudes. But modern ventilators, to support a person for hours or days, had yet to be invented.

What followed was one of the most remarkable episodes in health-care history: in six-hour shifts, medical and dental students from the University of Copenhagen sat at the bedside of every person with paralysis and ventilated them by hand. The students squeezed a bag connected to the trachaeostomy tube, forcing air into the lungs. They were instructed in how many breaths to administer each minute, and sat there hour after hour. This went on for weeks, and then months, with hundreds of students rotating on and off. By mid-September, the mortality for patients with polio who had respiratory failure had dropped to 31%. It is estimated that the heroic scheme saved 120 people.

Major insights emerged from the Copenhagen polio epidemic. One was a better understanding of why people died of polio. Until then, it was thought that kidney failure was the cause. Ibsen recognized that inadequate ventilation caused carbon dioxide to build up in the blood, making it very acidic — which caused organs to shut down.

Three further lessons are central today. First, Blegdam demonstrated what can be achieved by a medical community coming together, with remarkable focus and stamina. Second, it proved that keeping people alive for weeks, and months, with positive-pressure ventilation was feasible. And third, it showed that by bringing together all the patients struggling to breathe, it was easier to care for them in one place where the doctors and nurses had expertise in respiratory failure and mechanical ventilation.

So, the concept of an intensive-care unit (ICU) was born. After the first one was set up in Copenhagen the following year, ICUs proliferated. And the use of positive pressure, with ventilators instead of students, became the norm.

In the early years, many of the safety features of modern ventilators did not exist. Doctors who worked in the 1950s and 1960s describe caring for patients without any alarms; if the ventilator accidentally disconnected and the nurse’s back was turned, the person would die. Early ventilators forced people to breathe at a set rate, but modern ones sense when a patient wants to breathe, and then help provide a push of air into the lungs in time with the body. The original apparatus also gathered limited information on how stiff or compliant the lungs were, and gave everyone a set amount of air with each breath; modern machines take many measurements of the lungs, and allow for choices regarding how much air to give with each breath. All of these are refinements of the original ventilators, which were essentially automatic bellows and tubing.

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?

Mental Health- Depression


Mental health conditions are increasing worldwide. Mainly because of demographic changes, there has been a 13% rise in mental health conditions and substance use disorders in the last decade (to 2017). Mental health conditions now cause 1 in 5 years lived with disability. Around 20% of the world’s children and adolescents have a mental health condition, with suicide the second leading cause of death among 15-29-year-olds. Approximately one in five people in post-conflict settings have a mental health condition.

Mental health conditions can have a substantial effect on all areas of life, such as school or work performance, relationships with family and friends and ability to participate in the community. Two of the most common mental health conditions, depression and anxiety, cost the global economy US$ 1 trillion each year.

Despite these figures, the global median of government health expenditure that goes to mental health is less than 2%. 

Depression

Depression

Key facts

  • Depression is a common mental disorder. Globally, it is estimated that 5% of adults suffer from depression.
  • Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease.
  • More women are affected by depression than men.
  • Depression can lead to suicide.
  • There is effective treatment for mild, moderate, and severe depression.

Overview

Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years (1). Approximately 280 million people in the world have depression (1). Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when recurrent and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Over 700 000 people die due to suicide every year. Suicide is the fourth leading cause of death in 15-29-year-olds.

Although there are known, effective treatments for mental disorders, more than 75% of people in low- and middle-income countries receive no treatment (2).  Barriers to effective care include a lack of resources, lack of trained health-care providers and social stigma associated with mental disorders. In countries of all income levels, people who experience depression are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.

Symptoms and patterns

During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day, for at least two weeks. Several other symptoms are also present, which may include poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling especially tired or low in energy. 

In some cultural contexts, some people may express their mood changes more readily in the form of bodily symptoms (e.g. pain, fatigue, weakness).  Yet, these physical symptoms are not due to another medical condition. 

During a depressive episode, the person experiences significant difficulty in personal, family, social, educational, occupational, and/or other important areas of functioning. 

A depressive episode can be categorised as mild, moderate, or severe depending on the number and severity of symptoms, as well as the impact on the individual’s functioning. 

There are different patterns of mood disorders including:

  • single episode depressive disorder, meaning the person’s first and only episode);
  • recurrent depressive disorder, meaning the person has a history of at least two depressive episodes; and
  • bipolar disorder, meaning that depressive episodes alternate with periods of manic symptoms, which include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive reckless behaviour.  

Contributing factors and prevention

Depression results from a complex interaction of social, psychological, and biological factors. People who have gone through adverse life events (unemployment, bereavement, traumatic events) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and the depression itself.

There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.

Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive coping in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for older persons can also be effective in depression prevention.

Diagnosis and treatment

There are effective treatments for depression. 

Depending on the severity and pattern of depressive episodes over time, health-care providers may offer psychological treatments such as behavioural activation, cognitive behavioural therapy and interpersonal psychotherapy, and/or antidepressant medication such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Different medications are used for bipolar disorder. Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists. Antidepressants are not the first line of treatment for mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with extra caution.

WHO response

WHO’s Mental Health Action Plan 2013-2030 highlights the steps required to provide appropriate interventions for people with mental disorders including depression. 

Depression is one of the priority conditions covered by WHO’s Mental Health Gap Action Programme (mhGAP). The Programme aims to help countries increase services for people with mental, neurological and substance use disorders through care provided by health workers who are not specialists in mental health. 

WHO has developed brief psychological intervention manuals for depression that may be delivered by lay workers to individuals and groups. An example is the Problem Management Plus manual, which describes the use of behavioural activation, stress management, problem solving treatment and strengthening social support. Moreover, the Group Interpersonal Therapy for Depression manual describes group treatment of depression. Finally, the Thinking Healthy manual covers the use of cognitive-behavioural therapy for perinatal depression.

     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?

Most Unethical Medical Study Ever- Tuskegee Study for Syphilis


One of the ugliest and unethical human studies in the history, Tuskegee Study raised a host of ethical issues such as informed consent, racism, paternalism, unfair subject selection in research, maleficence, truth telling and justice, among others.   It is really unbelievable to understand the heinous nature of the Tuskegee study.

    The Public Health Service started the study in 1932 in collaboration with Tuskegee University (then the Tuskegee Institute), a historically Black college in Alabama. In the study, investigators enrolled a total of 600 impoverished African-American sharecroppers from Macon County, Alabama.

Tuskegee syphilis study

     Tuskegee syphilis study

The goal was to “observe the natural history of untreated syphilis” in black populations. But the subjects were unaware of this and were simply told they were receiving treatment for bad blood. Actually, they received no treatment at all. Even after penicillin was discovered as a safe and reliable cure for syphilis, the majority of men did not receive it.

In 1932, the USPHS, working with the Tuskegee Institute, began a study to record the natural history of syphilis. It was originally called the “Tuskegee Study of Untreated Syphilis in the Negro Male” (now referred to as the “USPHS Syphilis Study at Tuskegee”).

The study initially involved 600 Black men – 399 with syphilis, 201 who did not have the disease. Participants’ informed consent was not collected. Researchers told the men they were being treated for “bad blood,” a local term used to describe several ailments, including syphilis, anemia, and fatigue. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance.

By 1943, penicillin was the treatment of choice for syphilis and becoming widely available, but the participants in the study were not offered treatment.

The purpose of the study was to observe the effects of the disease when untreated, though by the end of the study medical advancements meant it was entirely treatable. The men were not informed of the nature of the experiment, and more than 100 died as a result.

None of the infected men were treated with penicillin despite the fact that, by 1947, the antibiotic was widely available and had become the standard treatment for syphilis.

    .

Of these men, 399 had latent syphilis, with a control group of 201 men who were not infected. As an incentive for participation in the study, the men were promised free medical care. While the men were provided with both medical and mental care that they otherwise would not have received,  they were deceived by the PHS, who never informed them of their syphilis diagnosis and provided disguised placebos, ineffective methods, and diagnostic procedures as treatment for “bad blood”.

The men were initially told that the experiment was only going to last six months, but it was extended to 40 years.  After funding for treatment was lost, the study was continued without informing the men that they would never be treated.

The study continued, under numerous Public Health Service supervisors, until 1972, when a leak to the press resulted in its termination on November 16 of that year.  By then, 28 patients had died directly from syphilis, 100 died from complications related to syphilis, 40 of the patients’ wives were infected with syphilis, and 19 children were born with congenital syphilis.

The 40-year Tuskegee Study was a major violation of ethical standards, and has been cited as “arguably the most infamous biomedical research study in U.S. history.”  Its revelation has also been an important cause of distrust in medical science and the US government amongst African Americans.

Later in 1973, a class-action lawsuit was filed on behalf of the study participants and their families, resulting in a $10 million, out-of-court settlement in 1974.

On May 16, 1997, President Bill Clinton issued a formal Presidential Apology for the study.

On May 16, 1997, President Bill Clinton formally apologized on behalf of the United States to victims of the study, calling it shameful and racist. “What was done cannot be undone, but we can end the silence,” he said. “We can stop turning our heads away. We can look at you in the eye, and finally say, on behalf of the American people, what the United States government did was shameful and I am sorry.”

     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 Family Doctor – A Dear Friend Lost in era of Medical Consumerism


      Until a few decades back, a family physician used to be the right answer for most healthcare situations, right from the toddler in the house to the octogenarians. Medical emergencies always have been an exception.  The family physician could offer expert comprehensive medical care to people of all ages and genders, making them a preferred choice, a dear friend for the common needs of the entire family. He was a great support to all family members at almost all stages of their lives.

Unlike other medical specialists who focus on a specific medical condition, one part of the body or just an organ, a family physician has the expertise and knowledge to provide comprehensive healthcare as well as emotional support to patients of all ages. He was a health guide from infancy to late adulthood and in old age as well. That made him the go-to doctor at any point for the family.

A major role of the family physician was to educate the patients about disease prevention and health maintenance. It included focussing on both physical and emotional health, which may include stress relief, anger management, fertility counselling, weight management and nutritional counselling.  For day-to-day common ailments like flu, ear infection, common allergy, draining small abscess, the family physician was the preferred go-to medical resource for the treatment.

The family doctor could help recognise potential red flags for any emerging conditions that may require prompt attention, such as diabetes, heart disease, or cancer – especially if there was a family history of the condition. If there was any need for specialist medical treatment, the family physician would refer to an appropriate specialist.

But now, with increasing medical commercialisation and consumerism, primary care is at the crossroads. The primary care delivery systems are becoming unsustainable and lack the resiliency to survive in new changing environments.  In an era of specialisation, the primary care has to struggle to remain relevant and viable.

There has been an increasing inclination of patients to have opinions from specialist even for minor issues. In last few years, with greater smartphone ownership, internet connections – a bevy of apps, online medical service aggregators have started operating brazenly, advertised by superstars and celebrities, aggressively pushing for tests and surgeries – have made the ‘family doctor’ look like ‘Dr Minimalist’. There are a number of reasons why more doctors want to become specialists: competitive pressures, greater income potential, higher status among peers, greater prestige in society and patients’ demand. These factors drive the preference for specialisation. The final result is being lot of specialists, who treat an organ but too few “doctors” to treat the human body as a whole. The media insinuation against doctors has created an environment of mistrust against doctors in the community and rift in doctor-patient relationship.

In addition to basic medical services, the family physician used to act as health advisors, guiding anxious patients to the appropriate healthcare facility. In today times, one of the most effective healthcare interventions is to advise the person to “when to see a specialist doctor and when not to go”. But that friendly advice with in comfort of homely atmosphere is getting distant gradually.

The family doctor – a helping hand, a dear friend and an all-time support of is getting far away from patients in this era of medical consumerism.

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?

NMC’s Opaque Policy on Medical College Infrastructure of Disastrous Consequences


        Quality of medical education is a deciding factor for the kind of doctors and hence the character of the treatment that patients are going to get.  Transparency about the infrastructure and faculty of medical college are important and the deciding factors about the credibility of the institute. But the new opaqueness (by National Medical council- NMC) in the system displaying the critical details about medical colleges can have deleterious effects on medical education. The medical students are blind about the claims made by a medical college during inspection for recognition and permission to admit students, which may be not true. There have been many instances and several complaints of ghost faculty in private colleges and mass transfer of faculty during inspection from one government medical college to another.  Not only medical students pay millions to have a seat in private medical colleges, they invest their prime life time in studying medicine. Such opaqueness has a potential to ruin their careers. Medical students will have to work harder to get true information and more careful, about the institute they are getting into.  

NMC’s college infra reports not public, MCI notes taken down too

NMC’s college infra reports not public, MCI notes taken down too

      The National Medical Commission (NMC) does not post college infrastructure assessment reports on its website and has also removed all previous assessment reports posted by the erstwhile Medical Council of India (MCI). So, students or members of the public cannot know what claims were made by a medical college during inspection for recognition and permission to admit students. Why are these assessment reports important? The reports reveal the date of inspection, the names and designation of the inspectors, usually experienced medical faculty from government medical colleges, along with their comments and findings. They reveal what kind of infrastructure existed or was claimed, including inpatient and outpatient load, number of beds and facilities in the teaching hospital and in the college. They reveal the number of faculty shown as employed by the college department-wise. With about 50 new medical colleges opening in 2021, a record for a single year, and especially unusual since it was the peak pandemic year, there were several complaints of ghost faculty in private colleges and mass transfer of faculty during inspection from one government medical college to another. “Not uploading assessment reports shields such substandard colleges with inadequate faculty and infrastructure. They just want to claim more colleges have been opened and that more MBBS seats have been created. It is a numbers game, quality be damned. In the case of private colleges, getting approval without adequate infrastructure or faculty is a windfall as they charge exorbitant fees from students. Usually, approval is given for 100-150 seats. Even at Rs 15 lakh per annum as tuition fees, the college gets to collect Rs 15 crore to Rs 22.5 crore from the first batch,” said a retired professor of a government medical college. “The MCI, which was labelled corrupt and non-functional, used to post the reports of assessments of infrastructure and faculty done according to minimum standard requirements each year,” said Dr Mohammed Khader Meeran, an RTI activist. In response to Dr Meeran’s RTI application seeking college assessment reports of academic years 2020-21 and 2021-22, the NMC said that “the information sought is very voluminous and scattered in various files” and that “it would disproportionately divert the resource of MARB (Medical Assessment & Rating Board) of NMC”.

     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?

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.

     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?

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?

#Doctors-‘Earn Hundreds & Pay Back Millions’ #USG-Lab-Nagpur to Pay 1. 25 Cr Compensation


          Is there any other profession, which has such kind of pathetic arrangement? The sufferers of such pitiable deals are doctors. An average doctors studies for decades and treats hundreds of patients for peanuts (Few hundred rupees). For one alleged mistake or just a legal interpretation is forced to pay millions for an incident, which can be merely procedural or circumstantial mistake.

  Why one should be putting his/her future into such pathetic arrangements? The inspiring doctors need to think.

          Large claims granted by courts are incentives for patients and lawyers for putting medical lawsuits. In an era, where people fight with their parents, brothers and sisters for money and property, it will be naive to think that idea of making money from doctor does not exist.

          Now-a-days medical professionals need to not only be thorough with their medical subjects and the medico-legal implications, but also  need to be careful about how courts may interpret the medical processes. What doctors think is a correct   medical process, but it can be interpreted as negligence, in case of an adverse outcome. Other contributing factors that nail down medical profession are the sympathy to the patient and wisdom of hindsight,   which everyone is flushed with as an after event.  

          Large compensations against medical profession are  the single important factor can increase the cost of  healthcare and demoralize medical profession.   Doctors  are always on the receiving end in case of an adverse outcome.    Medical problems are very complex and sometimes it is difficult to judge  the future course of  disease as well as court  interpretation of  medical science, especially  with retrospective wisdom  by courts.  Summarily doctors have to safeguard themselves from treatment as well as legal and documentation hassles.

         Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors.  

     Strangely  doctor’s fee are quite low but lawyers charges and court compensations are really astronomical amounts, which are beyond any logic.

New Delhi: In a landmark order, the National Consumer Commission (NCDRC) has ordered Nagpur-based Ultrasound Scanning and Imaging Center to pay a compensation of Rs 1.2 crore to a disabled child and his parents in a medical negligence case. The firm has been blamed for misreporting of ultrasound on four occasions during pregnancy, resulting in the birth of a child with congenital anomalies.
Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. The commission held that the ultrasonology center also failed to offer to terminate the pregnancy, failing to diagnose defects at an early stage. The newborn had finger pain (complete absence), right leg below the knee and left leg below the ankle joint.
The clinic – Imaging Point – was run by Radiologist Dr Dilip Ghik in Nagpur. Holding him and his clinic responsible for their failure to detect structural anomalies of the fetus at 17-18 weeks, a two-member NCDRC bench comprising Justices RK Agrawal and SM Kantikar asked them to provide for the child’s welfare, future expenses asked to pay compensation for  the treatment and purchase of limb prostheses.
The order said, “The amount shall be kept as a fixed deposit in any nationalized bank (preferably SBI) in the name of the child till he attains the age of majority. Parents can get periodic interest on the FD for regular health check-up, treatment and welfare of their child. It also directed the radiologists and their clinics to pay Rs 1 lakh towards legal expenses.
As per the commission’s order, in October 2006, the child’s mother, who was pregnant at the time, consulted a gynecologist and obstetrician. The next month the doctor referred the patient to the imaging point for ultrasonography of the pelvis. USG Ghik and reported normally. Three more ultrasounds were done by the Ultrasound Scanning Centre. All USGs were reported as “no obvious congenital anomalies in the abdomen and spine of the fetal head”.
But when the gynecologist performed an elective caesarean section and after the baby was born, the mother and all the attendants were shocked to see a “severely deformed male newborn”. The girl’s parents had alleged that all this happened due to the negligent ultrasound of the radiologist.
He had prayed for a compensation of Rs 10 crore to meet future expenses. But the radiologist denied any negligence in the patient’s USG report.

     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?

Blog at WordPress.com.

Up ↑

%d bloggers like this: