An Urban Jungle: where animals hunt Humans


Danger of stray dogs is increasing every day around us. As the strays population in increasing, now they are grouped and see vulnerable humans as easy prey. Packs of dogs have become dangerous and difficult to control. Protected by Dog lovers and animal right laws, the danger to normal people of being hunted even around their homes is real. Human right of being in a safe environment is being ignored. Is it not hypocritical that you care for a violent stray who is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous apathy towards safety of humans. Such dog lovers most of the time, totally ignore the fact that these dogs are a threat to children and older people. An immediate sense of hatred towards such dog lovers is a consequence and a natural thought.

Just one of uncountable examples. An 80-year-old woman was attacked by stray dogs while she was going to a temple in Ludhiana city on Tuesday. She was admitted to DMC Hospital for treatment. Residents claimed that a group of 15-20 stray dogs has created terror in the area. The pack of dogs often attacks people including children. The said despite their repeated complaints to the authorities they have not got any kind of relief from this problem.

It is not uncommon dogs chasing children and older people. In a recent incident and a common one , the loud barking sounds were intermixed with cries of a child, who was running and screaming for his life. Two stray dogs were near him, trying to hunt him as a prey. As they got nearer to him, I somehow managed to get some stick from a plant and managed to save the child and shoo away the dogs. The nine year old child just clung to me, almost pale, dizzy and his eyes closed with fear. His football was in his lap, which he was trying to use as shield. A shield which society, government, courts and so called “dog-lovers” failed to provide. This child must be the life for his parents and could have been in a great trouble that day because of apathy of few “Animal Lovers”. For whom animal love is like a hobby to be projected for hollow public applause. I looked around, a gentleman was comfortably sitting with his small dog and reading newspaper. He did not even bother to look at what was happening. He was the person, who used to feed these stray dogs and claimed himself to be a “Dog lover”. He was totally unperturbed by the fact that a child was about to lose his life because of these wolf like dogs roaming freely. Similar apathy has been displayed by government and courts with a result that thousand suffer from dog bite every day.

Apart from the injury part, Rabies is a disease spread by dog bite, which is not treatable. Getting anti-Rabies serum becomes another Herculean task.

Courts have also upheld animal rights. That is right but they did not formulate policies to ensure safety of humans from these violent strays.

Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites.

Animal lovers while pretending of “dog love” have formed NGOs and have donations and accumulate money. But have failed to create shelters for stray dogs. Neither have any steps been taken to save people from dog bites. So consequently, people especially vulnerable are children and older people who are mauled and eaten alive by stray dogs. What responsibility and accountability these animal lovers and NGO bear towards such incidents? Why people who collect money in name of animals do not take care and form shelters for these strays? every single death from such preventable cause raise a question on this issue.

Apathy of these so called dog lovers towards humans is appalling.

Besides dog bite and injuries, animal and dog poop is an health hazard. Following are the diseases which occur in community because of animal poop.

Problem of animal poop with dust : It is all around us. It is actually even a bigger health problem than open defecation by humans. Humans defecate in country side and in open fields. But stray animals and dogs are everywhere. Even 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.

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. A dog’s digestive system can handle just about anything that it eats and this makes its poop very toxic. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. These heavy loads of bacteria increase the risk of infections in the community. But pregnant women, children and people with suppressed immune systems may are more prone to these infections. 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.

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 in our country. 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. This may be an important cause of high rates of community acquired infections among our population.

SUGGESTION: the Government, NGOs and people who claim to be “animal lovers” should create shelters to save strays “as well as people”. It should be mandatory that all the dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering, save lives and eventually reduce use of antibiotics. A rationale mind will definitely appreciate the danger due to strays, and can initiate proper steps rather criticizing above said facts in the name of animal rights. An animal has no sense of responsibility, so rights should be limited accordingly.

dog poop: obstacle to Swatch Bharat

How to implement bridge course, if necessary: A suggestion #NMC


Crosspathy is dangerous to human race and potential global catastrophe because of antibiotic resistance.  All  allopathic medicines are hazardous chemicals in inexperienced hands. Incorrect and massive use of antibiotics will  cause antibiotic resistance, which has global ramifications. From this angle, it is a retrograde step. When all over the world, need is being felt that there has to be better control of antibiotic prescription.  We are entering an era, where antibiotics are getting useless and more so because of rampant misuse of antibiotics.  Rather than exercising a better control, it will be a catastrophic to human race world over by causing antibiotic resistance.

Will  thousands or lac   of alternate medicine graduate will dispense all antibiotics,  anticancer , anti diabetic , cardiac medications? It is hard to think about hundreds of potentially dangerous medicines being given without structured training and  proper exams in this system of crosspathy.

   Although it appears to be an avoidable decision, but still if required can be done by creating “doctors for area of need.

Following steps should be taken before implementation:

 Main Aim; to create doctors  for area of need. (AON doctor)

  1. To identify areas of need; most basic step is to identify the areas of need, where doctors are not available. Government should identify area of need and implement the scheme in selected areas, and with  selected simple drugs. Such areas should be such that which do not have medical facilities or lack doctors. Areas which already have doctors will not accept the diluted  or sub-optimal care, for example urban population.
  2. Limited seats-To identify the number required; let us say start with pilot project of  selecting 500 to1000 such doctors. All the lakhs of alternate doctors  can not be allowed to prescribe allopathic medicines. It will put the community at risk.

Each and every seat of AON and its doctor needs to be identified , earmarked and  trained for the particular seat.

  1. To identify the skills required for the area; for example emergency, for paediatrics or obstretics and gynaecology, trauma.
  2. Willingness to work in area of need- to identify the doctors: have a written competition from all candidates who apply for bridge course. To identify doctors who have given willingness to work in these areas of need. People who perform well should be taken for bridge course  only on limited seats. Bridge course should not  free for all.
  3. To develop a structured bridge course, which should be around one year after comparing the course of MBBS and the course done by the candidate.
  4. Admission and exit in the bridge course should be through exam and limited seats.
  5. Bridge course and allopathic medicines should not be made free for all, that any body can dispense it. We can get benefit only if is specific to needs of people. If everyone is allowed to practice allopathy in all locality, it will be a global hazard besides our community .
  6. These trained doctors will have an undertaking to serve in area of need only. For a period at least 10 to 20 years.
  7. Number should be limited but training should be good.
  8. A special course needs to be designed separately for one year, so that people in area of need do not get substandard care

Without proper planning and implementation and identification of area of need, this bridge course will not benefit anyone, rather it can be disastrous.

 

Black coat vs white coat: medical profession vs law industry


Every medical  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  benefited enormously because of consumer protection act at the cost of doctors. Increasing mistrust and unhappiness in patient’s mind definitely does not  help patients and doctors, but ends up benefiting law industry.

Strangely  doctor’s fee are quite low but lawyers charges them astronomical amounts, which are beyond any logic.

      In a country 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. With court compensations going into crores, doctors  can sense many times that some patient relatives  try to use the opportunity. They have nothing at stake so they try to make some noise on social media and harass the doctor in court or on social platforms. Even for patients, who had poor prognosis at the very onset of treatment, relatives can create problems, many times due to financial reasons. Doctors have no protection from these nuisance. All these factors further enhance insecurity in doctor’s mind.

It is  because of career building of few professions, that medico-legal cases are being fueled. Medical errors and complications are integral part of the treatment . Even simplest of diseases carry some amount of risk.  These  will still remain, even if doctors are hanged to death. Natural complications, poor prognosis can be attributed to errors by clever lawyering and because of benefit derived by other professions.

Many careers  are  shining in name of preventable deaths  and medical errors at the cost of medical profession.  The managers, right activists, media   and lawyers  have made their career and wealth out of it. Ask any doctor really, are these issues really preventable beyond  a point.  The  line separating errors or natural complications is really blurred and arbitrary. People who work in life and death situation know it well that  even natural poor prognosis can be labelled and proved as error by retrospective analysis and wisdom of hindsight and more certainly with luxury of time at disposal for lawyers and courts.

It becomes a unbalanced match specially when the amount of money which was paid to doctor to save a life was peanuts as compared to now being paid to punish him.

 Zero fee advertisements and fixed commission ads on television by lawyers in health systems in certain developed countries is an example of instigation against medical profession. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such   relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigation of lawsuit against doctors has become a major disadvantage for medical profession.

Sense of impending  injustice  is fueling among doctors, giving   a  feeling  of   sitting ducks  for harassment.

what if money is taken out of medico-legal cases

“Silver lining to #Doctor-assault”: for enforcing law – Poor advertisement for #private-expensive-medical-seat


 

Doctor assault is definitely a poor advertisement,  to take note by  medical students, who want to buy a private medical college seat by paying millions. Medical colleges are owned by rich and powerful.  There is possibility of loss of business. Why should one pay millions and also bear  risk of being beaten or killed, while doing such a  stressful duty. People will be fearful to be doctors on a free seat, leave alone on the paid seat. It will be a naïve idea to pay millions and be a doctor.

       So  “loss in business” is something which can force administrators and government to make laws against doctor assault and lawlessness against doctors.  That is the only silver lining  of doctor assaults. If private medical colleges are to survive and attract rich candidates and earn money, a law to protect doctors is a must.

Medical profession reeks of desperation and desolation, with not any one from power corridors to protect them, no courts, no human right commission for them to save the saviors from its decrepit state.

Every doctor knows that some thing is really wrong happening against the profession.  Not only every day minor irritants but there  are recurring episodes of blatant cruelty against doctors. The whole profession is being criticized openly in the garb of stray incidences or in cases of genuine poor prognosis. Each and every doctors  wants  to react.  But no one knows  really “ how to do it”. There is no unity  amid this chaotic problem. The community has been broken  and pushed to behave as single suffering   individuals. whatever way  they choose to react ,  the slightest reaction may  invite the ire of many unknown people, may be mighty and    revengeful.

Doctors  are being treated as  punching bags for venting out emotions of the bereaved relatives. they are just a front man for revenge, for an inept and insufficient system, which has failed to take the real responsibility. Nothing and really nothing can justify this barbaric act. Emotions should not be allowed to take such a demonic form.

Such apathy towards doctors will continue till businesses associated  and dependent on health care take a hit.  Possibly  demoralization of doctors consequent poor health system  will not affect any one, but affecting money generation may  force establishments to act against doctor assault.   One of  such business is private medical education. Killings or assaults of doctors may not be a effective deterrents, but “loss of business”  definitely can play wonders.

 

 

Pay millions to be a doctor?: welcome to “ring on fire” #NEET


Being a doctor has become a disadvantage in itself, thanks to our media and celebrities projecting the saviors  in bad light. They are now seen as harbingers of death. Morale of doctors has been at rock bottom and community is devastated.  A society that believes more in fairy tales told by “Reel heroes” has turned prejudiced and preposterous towards “Real  heroes”.  The medical profession reeks of desperation and desolation with apathy from government, indifference from courts and silence of human right commission to salvage them from decrepit state. At the best, they have been reduced to punching bags and scape-goats for inept medical systems or cheap labour to industry.

Problems faced by doctors are not only innumerable but are also so exceedingly complex and diverse that they are difficult to be analysed. It is common to listen doctors discussing these problems whenever one of these crop up. If so many doctors feel so disgusted about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession. The challenges in this profession are too many and difficult to analyse.
  1.     Medical courses are Comparatively lengthy and expansive study course and difficult training with slave like duties: that I have discussed in one of my previous article on “enslavement of doctors”.
  2. Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice. They have to just flow with system ultimately.
 3. Hostile environment for doctors to begin: Suddenly young, meritorious and bright children who came out of training find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and prejudiced  beliefs of society.

  1. Difficult start of career of doctors: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticized.
    5.The fear and anxiety about the actual treatment,  favorable and unfavorable prognosis of patient, keeps mind of a doctor occupied.
    6. Doctors are blamed for all malaise:The society gets biased because of the media reports and some celebrity talking glib without proper understanding of inept medical system , administrative failure and complexity of medical industry.  These lead to formation of generalized sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
    7.Doctor’s personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
    8.Risk to doctor himself:     Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include tuberculosis and other bacterial and viral illnesses. Radiologists and interventionists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.  21 risks to doctor and nurses
    9.Unrealistic expectations of society: Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative  is enough to spoil the mood for the day.

10.Retrospective analysis of doctor’s every action continues all the life-It could be by patients and relatives every day in the form of “ Why this was not done before” ? Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. Unfortunately, if there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.
In these court cases, the doctor is at disadvantage since his decision which is now being questioned was taken at that time in good faith using all his wisdom. The decision in retrospect may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight over many years, may label it as faulty if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for punishments and lawsuits. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation will be full and almost permanent. No doctor has time to pursue such things all the time. Even if such events don’t happen to everyone, the very fear of such possible scenarios and their possible complications always lurks in the back of their mind.
11. Physical assault , routine instances of verbal abuse and threat  happen for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. The threat of physical assault is quite real as well. Recently, even female doctors have not been spared by mobs. Silence of prominent social people, celebrities and society icons on this issue is a pointer towards increasingly uncivilized mindset of society.  Even female doctors  are being assaulted.
12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community, is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigation of lawsuit against doctors is a major disadvantage for medical profession.

14.Overall, a complex scenario for doctors: There is increasing discontentment among doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients. They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see disproportionately large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

With so many adversaries, the situation is like sailing a small boat in a tornado.
At present, with this mind-set, the losers are the doctors and medical profession. But the society should be able to foresee its overall loss in the long run if these practices continue.

 

Blatant cruelty & #oppression-of-doctors: Re-entering Hammurabi Era (1750BC)


Every doctor knows that some thing is really wrong happening against the profession.  Not only every day minor irritants but there  are recurring episodes of blatant cruelty against doctors. The whole profession is being criticized openly in the garb of stray incidences or in cases of genuine poor prognosis. Each and every doctors  wants  to react.  But no one knows  really “ how to do it”. There is scant  unity  amid this chaotic problem. The community has been broken  and pushed to behave as single suffering   individuals. whatever way  they choose to react ,  the slightest reaction may  invite the ire of many unknown people, may be mighty and revengeful.  

          By showing cruelty and being revengeful towards doctors , our society is in a way re-entering the realm of an ancient medical regulatory  system, Hammurabi Era (1750BC). Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the  poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body.  Fear factors and  Impact  of present legal complexities,  on doctors  is  already on a par with that of  Hammurabi  era.

Then why  doctors  be  made a punching bag for venting out emotions of the bereaved relatives. Nothing and really nothing can justify this barbaric act. Emotions should not be allowed to take such a demonic form.

This is simply jungle raj, goonism and  expression of a most  uncivilized kind of society, which simply cannot be excused by any sort of reasoning. The incident is being  protested by the professional bodies as is the routine and after few day things normalized for everybody else except that terrorized doctor .  

If the courts, the commission for women’s rights, and the human rights commission are maintaining silence, is it because the rights of doctors were never clearly defined and outlined.  The duties of a doctor have always been enumerated but the rights have never been discussed.

           Human rights of doctor and medical community have been grossly violated by physical assaults. It is painful to see that the authorities that are supposed to take action have maintained a silence all these years about this issue.

What is role of human rights commission, if rights of a hard working community like doctors are violated and what is it supposed to do? I really fail to understand what else will it take to shake them out of their stupor ?

NRS Hospital Violence

Hammurabi era

female doctor assault

#Choosing-to-be-doctor in lawless society: A self inflicted disaster #uncivilized-society #Govt-apathy


There is increasing discontentment among doctors because of  present complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

Enslavement of doctors

NRS Hospital doctor assault

Young doctors  complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They  face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

       They face physical assault , routine instances of verbal abuse and threat for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. The threat of physical assault is quite real as well.  Even female doctors have not been spared by mobs. Silence of prominent social people, celebrities, human right commission  and society icons on this issue is a pointer towards increasingly uncivilized mind set of society. 

Being revengeful against doctor is very easy. They have become sitting ducks for revenge. Verbal abuse, physical harm, legal remedies, disciplinary actions, punishments, social mudslinging, court cases and legal harassment are common remedies easily available. In absence of support, lack of law and order enforcement, physical assaults and even murder is also not a distant possibility. Here it was just a treatment failure or may be a poor response to treatment, which resulted in killing of doctor’s family. If trying to treat some one can result in harm to one self, why should the doctors will choose to treat. More over why should one become a doctor at all. Such incidents of extreme violence are not merely disaster for a family, but  are warning signs to whole of profession.

     Many in such unfortunate situations must have a thought in mind “ why should one become a doctor  and serve an uncivilized society?”

 

Deadly doctor assault at #NRS-Hospital-Kolkata: doctors- save yourself


The condition of the intern, who was admitted to a hospital, was stated to be critical . After Death of Patient, Relatives Clash With Junior Doctors in  #NRS-Hospital-Kolkata-west-bengal Hospital Over ‘Negligence’

An intern was injured in the clash and regular services at Nil Ratan Sircar Medical College and Hospital were disrupted as clashes broke out over the death of a 75-year-old patient.

        Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession. Silence of authorities, human right commission is really appalling.  Role of doctor associations, parent institutes have been spineless and not encouraging.  Media, celebrities, film stars in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable, where stray incidents were portrayed as normal routine just to earn money and fame. Ultimately doctors have been left to fend for themselves individually or with friend groups. 

Kolkata: A clash erupted between junior doctors and relatives of a patient at a state-run hospital here late Monday night after the 75-year-old died due to alleged negligence, police said Tuesday. An intern was injured in the clash and regular services at Nil Ratan Sircar Medical College and Hospital were disrupted as the junior doctors began a sit-in, demanding better security, they said.  Family members of Mohammed Shahid, a resident of Tangra, allegedly assaulted some junior doctors at around 11 pm last night after he died. As a result, a clash broke out, virtually turning the hospital premises into a battleground, the police said. Shahid’s family members were also angry over a delay in handing over his body, they added.

A large team of police personnel from Entally police station intervened and restored to lathicharge to bring the situation under control, a senior Kolkata Police officer said. More than 50 doctors shut the gates of the medical institution and began a sit-in on Monday night, demanding “protection”, the police said. The condition of the intern, who was admitted to a hospital, was stated to be critical, they said. Services at the hospital, including the emergency services, were affected on Tuesday as the junior doctors’ continued their protest.
West Bengal Medical Education Department director, Dr Pradip Kumar Mitra, visited the hospital and tried to persuade the doctors to withdraw their protest, but in vain.


    Empathy, sympathy, compassion and trust  of the doctor towards the patient, will definitely get a hit after these incidents. Everyday  the news of assaults on doctors, court cases against doctors, negative projection of the medical profession   in the media are viewed  by doctor’s community anxiously. Recent senseless attack  on doctor  at NRS Hospital Kolkata again a warning to children, who wish to be doctors.

      Merely taking some token  action and showing  protest will not solve the problem. It does not compensate for the  damage done to medical profession. Sympathy, compassion and trust of the doctors towards patients will definitely reduce. Who will be  the ultimate sufferer, does not need a Einstein brain to predict.

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

     Patients might get their revenge for the  naturally occurring disease, but they will lose compassion and trust of doctors in the long run. If that is the way to impart justice in this era, doctors will have to find some way to save themselves.

 

#Expensive-modern-health-care: Reminiscent of an ancient realm of medical regulation #Medical-lawsuits


With the evolution of medical science and medical care intertwined with  medical business, braided changes in  medical  regulation is not an far off expectation. But reticulation of evolution to modern medicine  and health care has not happened  in  isolation. Simultaneously there has been  progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care  has also ushered.  Every one now wishes  to live longer  and  dreams of better quality of life with support of progressive medical care.  Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and corporate invested money into health care, which was unthinkable few decades back in the  past.  This reticulation of business and  health care really took away the profession from control  of doctors. As it is no more simply treating a disease and involves many more issues.  New model of business in  health care is  still  not a mature process. It has emerged and progressed in  just  for few decades, as compared to  medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a  long way to do real justice to every one.   No one really knows how to regulate this difficult area,  which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and  relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is  amalgamation of  intricacies of science with minds of  patient and doctor’s skill in  newly evolved milieu of financial complexities.  Results are not encouraging for the profession.

 An effort to govern or  regulate the medical profession  is not new. Hammurabi  had initiated to  write the rules of the game. This single professional species was managed with cruel regulation 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi,  5000 years ago,  was  not even at the   doorstep of medical science, but he  promulgated some rules. It is difficult to say whether he was naïve or  brilliant  enough to make it more mathematical. He fixed  heavy prize for saving lives and used to  cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly  knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still  remains  somewhat  unfair to doctors.  In other words, it has not attained enough  evolution and maturity.

  Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical  science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to  regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times.  Almost universally, the earlier work or contribution of  a doctor  to society is  not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can  conveniently be  passed on doctors by application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished. Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such  regulatory systems will dissuade  other good people joining the profession, again  resulting in  further inhibition and flourishing of profession for the good.  Obviously,  harsher  penalties will discourage a physician surplus.

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

In an effort to institute  a  well controlled  healthcare, our society is in a way re-entering the realm of an ancient medical regulatory  system. Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the  poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body. Evolution of medical legal system and medical regulation has to evolve and mature, to enjoy  benefits of medical advancement to the fullest. Fear factors and  Impact  of present legal complexities,  on doctors  is  already on a par with that of  Hammurabi  era.

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