Millions of preventable disease deaths: whose moral burden is it?


Diseases can be  preventable or unpreventable, have  good  or  bad prognosis. But once patient  enters hospital,  what ever may be the reason or genesis of ailment, it becomes a moral responsibility of doctors.  Health care professionals  can be trash-talked   or ridiculed by media and anyone, even for worst prognostic cases.   But  large numbers of deaths   happen  due to preventable causes like accidents , drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. In fact the burden of   negligence here is massive and  these deaths are unpardonable.   Who ultimately carries the moral burden of millions of  preventable deaths?

Common causes of  such  disease, sufferings  and death , specially in developing and poor countries:

  1. Dietary risks and diseases spread by  water sanitation and hygiene.   These  have  direct  linked with bad sanitation and poor hygiene practices. Poor sanitation is the leading cause of diarrhea, malnutrition, cholera, jaundice ( hepatitis A and E) , worm infestations, typhoid and other enteric fevers, which lead to chronic malnutrition and lowered immunity that further feed the infectious disease cycle.  Apart from infectious disease like diarrhea, but also pneumonia and tuberculosis, which are leading killers across all age groups.
  2. Undernourishment in   children  will cause them to be  underweight, stunted and wasted, and makes them  more vulnerable to infections. They are at higher risk of dying of childhood infections.

Working sewage-disposal systems, waste disposal management, protection of water supply from contamination and hand-washing practices are essential components to reduce preventable deaths.

  1. Poor sanitation, unsafe water and low public health also increase drug-resistant infections in low-income and middle-income countries. Lowering of antibiotic consumption  can not be achieved  because superbugs ,  and antibiotic resistance  are already in the environment and continue to spread through contaminated food, water and hospital equipment.

Antibiotics overuse is rampant as they are  used to treat diarrhea and upper respiratory tract infections. Improving sanitation, providing clean water, adopting personal hygiene and getting vaccinated can reduce infections.

  1. Air pollution : air pollution is a public health crisis.  Masses are forced to breathe in air which  contains pollutants  in  unsafe limits, some are carcinogenic. It  is a cause of  millions of deaths  It is besides many fold of this number live their life with morbidity. Polluting vehicles, industry, lesser trees and plantations, poor practices and not enough governance and policies have resulted in poisonous air to breathe. Diseases like COPD, asthma and lung cancer are few common ailments.
  2. A::Dog bite (rabies ), Animal poop and Human – animal interface:   Not properly disposed  animal poop is a  cause of generation of infections and diseases, requiring heavy use of antibiotics and consequently leads to emergence of further antibiotic resistance bacteria. This cycle of production of infections and use of antibiotics perpetuates a vicious cycle.  Stray animals still defecate at every place.  Poop of Stray dogs, cattle and pigs stays in environment and causes life threatening infections. Hundreds of diseases are described due to poor control of human animal interface.

But stray animals and dogs are everywhere. Owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

         B::   Life threatening infections : dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. Many diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like  Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms,    Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

               C:: Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources.  This can lead to a widespread source of waterborne illnesses. Dry  poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment.

6.     Mosquito borne diseases: millions die because of vector borne disease , as mosquito control  has been inadequate.  Malaria, dengue,  chickengunya  and many other lethal  diseases spread  due to mosquitoes.

 

7.      Preventable natural disasters exacerbated by human activity: floods, famine, disease outbreaks.

8.      Road, rail  accidents and other accidents: are mostly  preventable errors.

         The role of health care professionals in present day circumstances remains misunderstood and underappreciated, as they assume the responsibility for continuous care of the sick or injured. People who have never treated a patient  in their life time influence health policies, which effects  millions. Excessive preventable deaths are  just a symptoms of a larger problem.  Who  is the one who feels moral burden of millions of preventable deaths?

     .

 

Work-life imbalance for doctors/nurses & consequences


 

For doctor and nurses, time of work and action is determined by need of the patient. Whereas in most of other professions, time of  work  can be carried out at any convenient time. As a routine, most of the  human being  work  during day time, by  convention that is 9 AM to 5 PM . whereas, It is not uncommon for medical and nursing professionals to have more heavier  and challenging night shifts.  Most of clinical branches, doctor and nurses  remain busy through out night.

Across the globe, in the  medical systems, specially  not so well organized, it is  a common routine  for the  doctor to get night calls  everyday and  lots of them  rarely gets undisturbed normal sleep.

Needless to say that doctors and nurses do a herculean task to stream line their family and professional life. Kudos to those, who can nurture their hobbies, along with difficult clinical branches. Maintaining a work-life balance remains a distant dream for most of successful clinicians. This balance can be defined as a satisfaction gained by spending time on activities according to one’s wishes, which are besides their clinical work.

Areas of life other than work–life may  include  personal interests, family, social or leisure activities or hobbies.

Work–life  imbalance is the lack of  proper alignment  between work and other important life roles. It is a kind of balanced  state of time, achieved by spending time  on  demands of personal life, professional life and family life, that  is satisfying.  Work-life balance  is not limited to flexible work arrangements  to carry out other life programs and practices.  Work-life balance is a term commonly used to describe the balance that a working individual needs between time allocated for work and other aspects of satisfying life.

The thing that strikes as a  surprise  to most of doctors  of  starting a family  is simply how difficult it is. The learning curve of taking care of family  along with professional responsibilities is  so steep,   While working as doctor  in learning or training  phase, parenting requires  an abundance of energy, time, and grit

And when the responsibilities of being a parent are compounded with the realities of being a trainee doctor, it starts to be too much. It never feels like enough time for anything and  it really becomes utterly exhausting. There is always a struggle constantly with the balance of spending quality time with  family,  trying to study and perform well.  There is little time for hobbies or doing things  to  maintain  sanity of mind.

The environment of work today for doctors has become  more intense with legal issues,  burdening much more   than it was few  decades ago. Burdens beyond clinical work and associated stress  have   created  the need for a better  balance between work and life. Doctors have started thinking to devise or alter  the working in an effort to have a better balance. Experience of  being over-worked, long working hours and an extreme work environment has proven to affect the overall physical and psychological health of  doctors  and deteriorate family-life.

Although there are no structured studies on the issue, but doctors have started feeling difficulty balancing work and family. But the effects are already evident like alcohol and drug abuse, increased rates of divorce and suicides. Increased feeling of stress and  early burnout is an  natural outcome. Doctors,  who have attained  stage of financial security tend to have an early retirement, or reduce working hours.

Consequences of work–life imbalance

Problems caused by imbalance and consequent stress  has become a source of major concern for doctors and nurses.  Symptoms of stress can  result in  both physiologically and psychologically changes. Profession suffers as the workplace becomes the  greatest source of stress.

Persistent stress can result in cardiovascular disease, sexual health problems, a weaker immune system and frequent headaches. It can also result in poor coping skills, irritability, jumpiness, insecurity, exhaustion, and difficulty concentrating. Stress may also perpetuate or lead to binge eating, smoking, and alcohol consumption.

In medical profession,  simply working hard is not enough anymore. To get ahead, a rigorous trainings, prolonged working hours are  new standards. There is very  little time left to be divided   among relationships, kids, and sleep.

This ordeal is prolonged over years  results in  less time spent with family, friends, and community as well as pursuing activities that one enjoys and taking the time to grow personally. Even close friends and  relatives slowly start  becoming distant.

Extending family and becoming new parents  causes  extreme stress  in doctor’s life.  It can have  negative effects.  Between trying to balance a new schedule, managing additional responsibilities, and lacking flexibility and support, they can only increase stress.

Consequently, the evolving system of  health care have made doctors more prone to burnouts. Their  quest to be the  ideal, hard-working, perfectionist ultimately  turns them loner, the grim and stressed individuals.

related article: women doctors  and nurses prone to work- life imbalance

21 occupational Risks to doctors and nurses, while performing their duties


 

Doctor save the patient, but save yourself also.

Working of a doctor and nurses is not free from risk to themselves. The risk is generally underestimated, although it often involves major  risk  to life and may be frightening. Problem is that  majority of people, society and governing bodies  and even doctors themselves do not perceive or acknowledge it many times  the risks seriously.  But since  these risks are increasing exponentially everyday, because of changing scenario, they should be known to students, who want to take medicine as a profession. They need to take an informed decision. There are lesser set procedures, lack of awareness, not protective equipment or supportive society, governance and  laws, at most of  the places globally, and  doctors continue to work  in danger zones. These risks can be of varied types. Contracting the diseases is just one of them.

Even when doctors and nurses contact the diseases, there may or may not be proper support for further treatment, compensation and rehabilitation. Most of the time, they  have to fend for themselves. Because quite many of them , in government and private sector work on adhoc basis, temporary posts and on contract. Doctors  may have following risks, readers can add, if I have missed few:

Occupational health hazards

1.Tuberculosis: Common among health care  workers

2.Hepatitis B, Hepatitis C

3.HIV

  1. Influenza, Swine flu and other viruses of similar type.

5.Chicken pox

6.Rabies

7.Patients some times comes with unknown viral illnesses, which can not be tested. At the time, when treatment is going on, even diagnosis is not known. Doctor can contract these bacteria or viruses. There can be many more.

 

Risks related to stress and overwork

8.Depression, suicide, hopelessness

  1. Burnout.

10.Restricted social life

11.prone to alcohol/ drug abuse/ drug exposure.

Stress of balancing Family life: Kind of work and night duties effect family life very adversely. 12. Specially  female doctors. Completing  family will effect their careers, most of time.

13.High rates of divorces

14.Stress related diseases

 

15.Life style diseases: mainly sedentary work and long hours of working, makes them prone to life style diseases like ischemic heart disease , hypertension etc.

16.Exposure to radiations: specially in radiology and oncology. female doctors are more affected.

17.Lack of exposure to sunlight: effects bones , deficiency of vit D and predisposes to depression

 

  1.   Risk of catching resistant infections and sometimes there is risk that they carry these deadly bacteria to their homes. So their family members and children are at risk.
  2.   Risk of  working in disaster area and transport of sick , floods, earthquakes. Accidents of    ambulances .
  3.   Change in natural bio flora  of doctors and nurses. It is replaced by hospital bio flora. If they get infection, it is difficult to treat.
  4.  Risks because of legal problems and violent patients:  adds to stress Patients may not have favourable prognosis. But it is common for doctors to be blamed  even for naturally poor prognosis of the  disease. Legal trouble adds to further stress.

    –verbal abuse and threatening is very common. So spoiled mood unnecessarily.

– fear of  physical   assault can really harm doctors and family members.

– excessive and unilateral regulation puts doctors at the receiving end of the discontent.

Worst part is that our systems are not defined to prevent, treat or compensate or even acknowledge for these big disasters, if it happens to healers. These problems are not known to students, when they decide to take medicine, nor they are taught in medical school. Most of the time they have to fend for themselves, if problems occur.

Administrators and regulators refrain to study data that would establish and quantify the occupational hazards of being a doctor and nurses. Some of these hazards may be known, but there is no comprehensive analysis of workplace risk for physicians and nurses, like those that have been done for other professions. As physicians, we have a sense of the risk, and yet we remain engaged, continuing to care for our patients as we know  “these things” happen. Perhaps society prefers to remain blissfully ignorant of the sacrifice and risk their doctors take on, comforted by the fantasy of the serene  hospital. Perhaps we  all despise to let reality and data shatter the illusion.

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.

Maybe it is time that we are little more aware  and acknowledge that even doing everything in best manner and honestly , we are in a  conflict zone and  we are all in harm’s way. Just be careful and be mindful that  doctors, nurses, and healthcare workers,  may get  sickened, injured, disabled, or can be dragged to court or harassed even  as they care for their patients in best manner.

Doctor save the patient, but save yourself also.

Ancient Medicine: Introduction of woman as nurses and doctors


 

Introduction of Woman Nurses and Doctors in 19th century Modern medicine 

Women as physicians

It was very difficult for women to become doctors in any field before the 1970s. Elizabeth Blackwell (1821–1910) became the first woman to formally study and practice medicine in the United States. She was a leader in women’s medical education. While Blackwell viewed medicine as a means for social and moral reform, her student Mary Putnam Jacobi (1842–1906) focused on curing disease. At a deeper level of disagreement, Blackwell felt that women would succeed in medicine because of their humane female values, but Jacobi believed that women should participate as the equals of men in all medical specialties using identical methods, values and insights. In the Soviet Union although the majority of medical doctors were women, they were paid less than the mostly male factory workers.

Women as nurses

Florence Nightingale triggered the professionalization of nursing.

Women had always served in ancillary roles, and as midwives and healers. The professionalization of medicine forced them increasingly to the sidelines. As hospitals multiplied they relied in Europe on orders of Roman Catholic nun-nurses, and German Protestant and Anglican deaconesses in the early 19th century. They were trained in traditional methods of physical care that involved little knowledge of medicine. The breakthrough to professionalization based on knowledge of advanced medicine was led by Florence Nightingale in England. She resolved to provide more advanced training than she saw on the Continent. Britain’s male doctors preferred the old system, but Nightingale won out and her Nightingale Training School opened in 1860 and became a model. The Nightingale solution depended on the patronage of upper class women, and they proved eager to serve. Royalty became involved. In 1902 the wife of the British king took control of the nursing unit of the British army, became its president, and renamed it after herself as the Queen Alexandra’s Royal Army Nursing Corps, when she died the next queen became president.

           In the United States, upper middle class women who already supported hospitals promoted nursing. The new profession proved highly attractive to women of all backgrounds, and schools of nursing opened in the late 19th century. They soon a function of large hospitals, where they provided a steady stream of low-paid idealistic workers. The International Red Cross began operations in numerous countries in the late 19th century, promoting nursing as an ideal profession for middle class women.

The Nightingale model was widely copied. Linda Richards (1841 – 1930) studied in London and became the first professionally trained American nurse. She established nursing training programs in the United States and Japan, and created the first system for keeping individual medical records for hospitalized patients. The Russian Orthodox Church sponsored seven orders of nursing sisters in the late 19th century. They ran hospitals, clinics, almshouses, pharmacies, and shelters as well as training schools for nurses. In the Soviet era (1917–1991), with the aristocratic sponsors gone, nursing became a low-prestige occupation based in poorly maintained hospitals.

 

Woman : Renaissance to Early Modern period 16th-18th century

Catholic women played large roles in health and healing in medieval and early modern Europe. A life as a nun was a prestigious role. Wealthy families provided dowries for their daughters, and these funded the convents, while the nuns provided free nursing care for the poor.

The Catholic elites provided hospital services because of their theology of salvation that good works were the route to heaven. The Protestant reformers rejected the notion that rich men could gain God’s grace through good works, and thereby escape purgatory, by providing cash endowments to charitable institutions. They also rejected the Catholic idea that the poor patients earned grace and salvation through their suffering.  Protestants generally closed all the convents and most of the hospitals, sending women home to become housewives, often against their will. On the other hand, local officials recognized the public value of hospitals, and some were continued in Protestant lands, but without monks or nuns and in the control of local governments.

In London, the crown allowed two hospitals to continue their charitable work, under nonreligious control of city officials. The convents were all shut down but Harkness finds that women, some of them former nuns, were part of a new system that delivered essential medical services to people outside their family. They were employed by parishes and hospitals, as well as by private families, and provided nursing care as well as some medical, pharmaceutical, and surgical services.

Meanwhile, in Catholic lands such as France, rich families continued to fund convents and monasteries, and enrolled their daughters as nuns who provided free health services to the poor. Nursing was a religious role for the nurse, and there was little call for science. 

 

 

 

        Permanent link: https://en.wikipedia.org/w/index.php?title=History_of_medicine&oldid=783167827

            Link    https://en.wikipedia.org/wiki/History_of_medicine

Evolution of medical science


 

The   practice of medicine  by trained professionals has been ever evolving  in its approach to   illness and disease, from ancient times to the present.

Early medical traditions evolved in  Babylon, China, Egypt, and India. The Greeks  pioneered the art of   medical diagnosis, prognosis, and advanced medical ethics. The Hippocratic Oath, still taken  by doctors up to today, was written in Greece in the 5th century BCE. In the medieval age, advances in  surgical practices were made and  systematized in Rogerius’s,  The Practice of Surgery. Systematic training of physicians was  started in universities around the years 1220 in Italy.  During the Renaissance,  significant advances were made with invention of microscope and  better understanding of anatomy.   The germ theory of disease in the 19th century led to cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Systematic sanitary measures and public health measures  made significant improvement . Advanced research centers opened in the early 20th century, often connected with major hospitals.  Discovery of antibiotics  was major invention in the mid-20th century.. These advancements, along with developments in chemistry, genetics, and lab technology such as the X-ray, was recognized as   modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses from the 1870s.

 

Link    https://en.wikipedia.org/wiki/History_of_medicine

 

Evolution of medical science:


 

The   practice of medicine  by trained professionals has been ever evolving  in its approach to illness and disease, from ancient times to the present.

Early medical traditions evolved in  Babylon, China, Egypt, and India. The Greeks  pioneered the art of   medical diagnosis, prognosis, and advanced medical ethics. The Hippocratic Oath, still taken  by doctors up to today, was written in Greece in the 5th century BCE. In the medieval age, advances in  surgical practices were made and  systematized in Rogerius’s,  The Practice of Surgery. Systematic training of physicians was  started in universities around the years 1220 in Italy.  During the Renaissance,  significant advances were made with invention of microscope and  better understanding of anatomy.   The germ theory of disease in the 19th century led to cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Systematic sanitary measures and public health measures  made significant improvement . Advanced research centers opened in the early 20th century, often connected with major hospitals.  Discovery of antibiotics  was major invention in the mid-20th century.. These advancements, along with developments in chemistry, genetics, and lab technology such as the X-ray, was recognized as   modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses (from the 1870s).

 

Link:

Unfair prejudice against doctors distressing : shortage of docs and still delivering best, but punished and assaulted


Shortage of docs ails AIIMS emergency only one technician each for ventilator, ECG (link)

http://timesofindia.indiatimes.com/city/delhi/shortage-of-docs-ails-aiims-emergency/articleshow/58831115.cms

Times of India yesterday carried a news article which highlighted the problem of shortage of doctors and trained staff in AIIMS hospital emergency.  The number of doctors  available are less than half of those required. And if this is the scenario in a premier Institute, it does not need an Einstein brain to figure out how the problem at other places in remote areas would be.

Everybody desires to have themselves treated within few minutes of their arrival in a hospital to the best of standards, but there are many obstacles to it in the form of large patient overload and shortage of doctors. Despite shortage of staff, each and every doctor tries his best to see as many patients as possible while sacrificing his own personal life. In any civilized society, this kind of work should bring in appreciation and respect for those who deliver. But for some strange reason, possibly due to vicious campaign against doctors by media and even celebrities, the respect and appreciation for this profession is sadly lacking. Possibly it is due to inadequate root cause analysis of the real issues. News items like these will probably help public realize the problems doctors face.

Despite working in such conditions, they are still abused, assaulted, beaten and taken to court for reasons, which are not justifiable in a civilized society. With all such problems and heavy hearts, this wonderful community still continues doing their noble work day and night to give each patient the best possible treatment within a reasonable time frame.  As compared to other professions the amount of work is more and appreciation much less.

Let’s take an example of courts where people spend lot of money and time and their cases still drag on for years. Crores of cases are pending in courts and thousands die without getting justice in their life time.  In contrast, even if there is shortage of doctors, relief to uncountable patients is provided and the quality of work is much better than other professions. As nature of work of this saviour is very high in moral hierarchy as compared to any other profession, it is time our society realized about the constraints doctors face before blaming them for the loss of optimal health care provision. Surely society owes much more to this wonderful community, but sadly this realization is unlikely in present era.

Ray of hope for doctors :Honourable President and Delhi high court show concern about violence against doctors


At last, Delhi high court has expressed concern  over growing instances of attacks on doctors by irate patients. It also identified lack of adequate number of medical experts in government hospitals, as a possible cause. It also made a note of  government’s  failure to increase the number of doctors despite multifold increase in patient load. And the next date for hearing is fixed for 10 days later, on 29th May.

Our Honourable President Mr Pranab Mukherjee too, has disapproved of the violence against doctors, thus giving hope to  doctors that their fundamental right  of safe working environment may be restored in near future.

Although good working conditions still remain a distant dream for doctors but this raises hope of getting atleast a safer environment which is absolute  necessary for a doctor to practise.

Although points raised by courts are well known and basic but are very important to begin with. But still until now, none of the government authorities had extended help to the doctor’s community. Isn’t it ironical that in 21st century, when sky is the limit for advances in majority of the professions, the most educated and a hard working community of the country is fighting for its basic and fundamental right of a safer workplace? It is just unthinkable that doctors still have to struggle for their basic  right in present era.

 

Honourable President Mr Pranab Mukherjee too, has disapproved of the violence against doctors(link)

Attacks on doctors by relatives of patients unacceptable: President Pranab Mukherjee

Delhi high court has expressed concern  over growing instances of attacks on doctors by irate patients.(Link)

http://timesofindia.indiatimes.com/city/delhi/hc-seeks-report-on-docs-safety/articleshow/58504721.cms

 

Enslavement of Doctors, Nurses and medical profession: specially junior doctors equivalent to modern day slaves?


When I was doing house job, once I had to do continuous 72 hours duty because there was no other house surgeon. I had to leave the ward without rounds which hadn’t started on time that day. And I was marked absent and had to apologise for leaving without rounds!!! Amongst many queries in my mind came the question “ Am I an animal?” but I guess even animals have better rights. Courts and animal right lovers show their concern for them all the time. Then “Who am I?” I was forced to think………some species who is being treated worse than animals. My seniors told me “You are a “doctor” and have to work like this only”.
Can this happen the same way with someone in any other profession? That too a profession wherein a young brilliant child, after 10-15 years of most tough studies ,exams, difficult training throughout the golden years of his youth, starts earning pittance. And in a job that also requires doing duties day and night, sometimes for 24 to 48 hours at a stretch without proper meals and sleep. Most of the hospitals don’t even ensure tea and food on these duties for doctors .But these young hardworking people do it gladly and enthusiastically, doing a most noble work saving innumerable lives or relieving countless people of their pain. No rights have ever been defined for these young brilliant children.
This great work is not even acknowledged in any way. These duties are merely systematic exploitation of doctors because of:
– sometimes in the name of Hippocratic oath,
– sometimes in the name of morality
– because of the kindness in their hearts
– in the name of suffering and dying patients
– in name of shortage of doctors and staff.
– for fear of courts and medico-legal cases
– for fear of assaults since the number of doctors is less per patient.
– by some administrative systems who use pressure tactics and sometimes
bullying to get work done
– by similar widely prevalent culture in most hospitals
– for sake of their career and higher degrees
for sake of employment
– in the name of training , and in many more ways.
And these innocent, brilliant and enthusiastic young doctor with stars in their eyes, go on doing it for years along with never ending studies. There is no count of hours, no money or compensation in most of healthcare systems of world for these inhuman duties, exploited young energy and lives. And then comes the most painful part when they do not get the due respect in the society. Their selfless hard work goes unnoticed and unappreciated most of the time. Most people take this slave like working as guaranteed and do not feel it as any injustice to these young doctors. These brilliant children while on duty, may be verbally abused, routinely threatened, assaulted or dragged to courts for trivial issues and that too for no faults of theirs. They just become punching bags for the inept healthcare system and invisible medical industry though lives saved by these young men are uncountable and people relieved of pain and agony innumerable.
Though some western countries of European union and NHS medical systems have realized the inhuman duties and are now following a fixed hours duty schedule, but still most of countries and health systems have kept their eyes closed regarding these slave like duty hours and poor work conditions.
I have enumerated just a few of the problems and the actual burden on the doctor is substantially more and that is further compounded by the behaviour of the society. All these factors put together threaten the very core of the healthcare system, the doctors, who are then not able to work to their full efficiency.
I wonder if this is perceived as normal and routine then what else does slavery constitute ?

nurses and doctors, altruistic professions not treasured in present era

fading charm of medical profession

choosing medical profession a disadvantage  to doctors and nurses

 

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