Lowering NEET Percentile- an Illusion of Merit


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

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

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

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

Govt cuts NEET-PG cutoff by 15 percentile

Govt cuts NEET-PG cutoff by 15 percentile

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

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Medical Consumer Protection Act: A Loss making deal for patients too?


       With the evolving medical science and health care getting intertwined with business, braided changes in medical regulation and law are not an unexpected development. New models of medical regulation, business and law in health care have emerged and progressed in last few decades.  Despite a wish to govern and regulate medical profession strictly, the laws and regulations still have to go a long way to provide real justice to everyone.   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 sorrow and other uncountable emotions, all intertwined with financial aspects.But the wish of administrators to govern medical profession strictly with punishments is not new.  Hammurabi (5000 years back) at the start of civilization believed that doctors needed to be punished in case there was a poor outcome. Strangely it was at a time, when no one understood the complexity of human body and the limitations of medical science; even basic anatomy and physiology of body was not discovered.  

      Considering the limitations of medical science along with uncertainties and complexities of human body, regulation of medical profession and system of punishments still remains somewhat unfair to doctors, even after 5000 years.  It is still based on principles of revenge and retributions rather than developing a robust system by learning from mistakes. By application of an average wisdom, doctors can be easily blamed for poor outcomes, as they are always and universal a common visible link between treatment and poor outcome. 

           One of the examples of easy punishments for doctors is Medical consumer protection act that was implemented in 1995 for medical services. Patients were defined as consumers and hence doctors were converted to service providers in lieu of some money.  Consequently the changed definitions altered the doctor-patient relationship in an irreversible way.   

    The reality is that neither doctors, nor patients are ready for such a legal relationship. More-over   the system is not robust enough for such a change.   To work with weak infrastructure, non-uniform medical education, poor numbers of support staff, inept health system along with legal complexities has pushed doctors into a shell and predisposed them to harassment. 

          Rather than   developing a system to promote   good doctor-patient relationship, Medical Consumer Protection Act has created a situation of ‘us versus them syndrome’. It caused erosion of doctor-patient relationship and escalated cost of care.   Propagation of stray and occasional incidents about negligence case in court or their outcomes are given disproportionate wide publicity in media. The patients are unable to understand the correct application of such stray incidents to themselves. Such cases may be frivolous,  just one in million or a rarity, but people always try to imagine themselves being in the hospital chaos due to the   scenario projected.  It gives a negative projection about medical services and enhances patients’ fear to seek treatment at right time.

    There is a growing mutual mistrust; doctors too have started looking at every patient as a potential litigant. Especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients. 

    With the mandate to practise evidence based medicine, doctors need to document everything and to offer everything possible, leading to skyrocketing medical costs.  To save themselves, doctors have to do mammoth paper work, leading to consumption of time that was meant for real deliberations for the benefit of patients.

           Consequently insurance companies, medical industry and lawyers have become indispensable and have positioned themselves in between doctor and patients. Besides creating a rift between doctor and patient, they charge heavily from both sides; from patients (medical insurance, lawyer fee) and doctors (indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall inflated cost of health care.

       Not uncommonly doctors are used as scape goats to have a concession on the patient’s treatment from administrators.  

       Medical consumer protection act has increased the anxiety and insecurity among   medical professionals.   Doctors can be dragged to courts for trivial reasons, for example the sense of revenge, simply for non-satisfaction, to extract money or simply for avoiding paying for services.  In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctors does not exist. These money-making ideas are further stoked by the much publicized incidents of high compensations granted by courts.

     Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on their confidence and belief, which takes a lifetime to build.

     Whenever there is adverse outcome in any patient, all the doctors involved start looking for whom to blame among themselves. Due to legal pressure they try to pinpoint each other’s mistakes.  Mutual understanding takes a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other,  creating a strange sense of enmity among medical professionals.

    The ease with which doctors can be harassed has led to rampant misuse of medical consumer protection act and it has instilled a sense of deep fear and insecurity in the mind of medical professionals. The act has been used as a whip against the  doctors by all, including  medical industry, law industry and administrators.  Only doctors are visible as those who deliver care, so they remain at receiving end for poor outcomes and all these industries remain invisible.    The industry has used the protective systems against medicolegal cases to gain  maximum benefits  out of doctors’ hard work.   

      In court cases, a certain element of doubt always remains in mind of a doctor whether he will get justice in the long run, or will end up being  a victim of sympathy towards patient or clever lawyering.  So taking medical decisions in critical situations is becoming more difficult  in view of the future uncertainty of disease.

             Windfall profits for lawyers is a strong  incentive   for  law industry to promote   instigation  of patients by against doctors .  One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements on ‘sharing and commission basis’. There is no dearth of such relatives and lawyers who are ready to try their luck sometimes in vengeance and sometimes for the lure of money received in compensations. 

       Consequently doctors are now an easily punishable human link for poor outcomes.  Medical professionals work with continuous negative publicity, poor infrastructure, and preoccupied negative beliefs of society and burden of mistrust.

  Strangely  Medical Consumer Protection Act applies  only to doctors, that too selectively. All  other professions and services  are   out of it, not even other constituents of health services. Selective application is what is  demoralizing the doctors.  Considering the uncertainty and kind of work done by  medical professionals, actually it should be other way around.Mistakes are always easy to be picked with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.

            Nothing else has ever distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Decision making also becomes difficult  by uncertainty of prognosis,  grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight with luxury of time and fault-finding approach.  The possibility of complex medico-legal situations in doctor’s  mind are enough to distract doctors from their primary point of intentions ‘the treatment’.

          Therefore increasingly, financially secure doctors are staying away from the riskier jobs. No wise person will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by  slogging  the  entire  life.     

     Patients can have poor outcomes for many reasons. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. Whatever court decides,  while consuming years, the harassment of doctor is full and permanent. Even if court decides in favour of the doctor, there is no compensation possible for the sufferings and agony spanning over years.  Therefore, a single mistake can undo all the good work of past, and the illustrious future work that could have been accomplished.

        If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career at risk, why would anyone put himself in that difficult  position?  

         Medical Consumer Protection Act  has become a tool to harass doctors and money making tool for lawyers, medical industry or administrators. But  it would be naïve to assume that by whipping doctors and regulating them in such a harsh manner will be helpful to patients in long run.  The consequent insecurity among doctors, practise of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment)  are few of the  side effects, which will  definitely be passed on to the patients inadvertently.  After all doctors have to save themselves as well. As a result,  now the battle of life and death will be fought with less zeal, with subdued and demoralized soldiers.

          Patients are unable to realize their loss for punishing their saviours. For doctors, no rewards if you win, but sword hanging if one loses.  Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Consequently being consumer may be overall a loss making deal for the patients.

     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

Moral bankruptcy of administrators #unpaid doctors


     In an era when doctors are being punished for small mistakes or merely perceived negligence, the blunders committed by administrators are not even noticed. Doctors are not paid for four months and for protesting the same, they were given termination letters.  It seems that doctors need to live with blatant injustice all their lives.

 Any punishment for the  administrators for mismanagement? 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.

    Doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.

             It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.

         The indifferent behaviour has also unveiled the approach of  tokenism such as ‘mere lip service’  showing respect to corona warriors.

      The strong political and legal will is absent to solve Doctors’ problems.

 Unpaid doctors; Medical staff protest on- termination order?

New Delhi: Doctors, nurses and paramedical staff of East Delhi Municipal Corporation-run hospitals continued their protest on Thursday as well over non-payment of salaries for four months.
Meanwhile, an order issued by the medical superintendent of Swami Dayanand Hospital, Dr Rajni Khedwal, stated that services of all senior and junior resident doctors would be considered terminated from February 4 and fresh interviews would be conducted accordingly. The order also stated that all Diplomate of National Board (DNB) residents and contractual doctors would be marked absent.

“We all were there in the protest, none of us went for our duties. We have also asked the administration to speak on our behalf because they are too part of the hospital. Maybe the matter will be resolved tomorrow. Unless we get a concrete statement regarding salary, we will continue the protest,” said Dr Atul Jain, president of the hospital’s resident doctors’ association.

Meanwhile, EDMC commissioner Vikas Anand said that no order had been issued regarding the termination/suspension of the striking doctors’ services so far. The termination order is only for the DNB workers and for the rest of the medical staff, it is based on ‘no work no pay’ as per the SC rule, he clarified.

“The salaries will be provided at the earliest. We have a very good team of doctors at Swami Dayanand Hospital. The only request is that they should join back and resume services,” said the commissioner.


Anand also said that the salaries for the months of February and March would be paid on time. “EDMC is going through a financial crisis and even in such difficult times, the corporation is sensitive towards the interests of its employees. Their due arrears will be paid in the month of May as per the availability of the funds,” he added.

     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


Doctors treating anarchic & lawless society # Doctor killed for perceived negligence


   In an act of revenge that took over two years, a doctor with a government hospital in Yavatmal – 650 km from Mumbai – was shot dead, allegedly by a family member of his patient who had died under the doctor’s supervision two years ago.

   Attacks and assaults on doctors is an indicator of a lawless, uncivilized society, poor governance and broken health system.  Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession.  The impunity with which criminals can dare to take law into their hands and punish doctors instantly at will is a blatant disrespect to courts and judicial system. In absence of strict laws for protection of doctors, health care workers have become vulnerable to  assaults and revenge.

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

            Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project   single stray incident   as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves.

 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.   Role of doctor associations, parent institutes have been spineless and not encouraging.

        The demonstration of the cleft that separates doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.  

Relatives shot and kill doctor for perceived negligence

Family members of the patient had alleged that it was due to the negligence of Dr Hanumant Dharmakare, medical officer at the R P Uttarwar Kutir Hospital, that their son Arbaz (20), who had met with a bike accident, died in May 2019.

The police are on the lookout for the main suspect, Aifaz Shaikh, the elder brother of Arbaz, who is believed to have shot the doctor.On January 11, Dharmakare was shot dead in broad daylight by an unidentified person on the Umarkhed – Pusad Road in Yavatmal. The police team found that the application concerned the death of his nephew Arbaz.When the police questioned Tousif further, they found that his nephew Arbaz had met with an accident on May 4, 2019. Arbaz had been riding a bike with his brother Aifaz (then 22) and a relative Moshin, when the accident took place.The family had rushed the trio to the local hospital, where Dharmakare was the on-duty doctor. The family alleged that due to negligence on the part of the doctor, Arbaaz lost his life. The family even had a fight with Dharmakare and they allegedly threatened that he would have to pay for his actions. Bhujbal said that during the police investigation, they found that for the past two years, the family had been looking for an opportunity to get back at Dharmakare. They had kept an eye on his movements even earlier this year, following which they decided to allegedly kill him last Tuesday. It was Arbaz’s elder brother Aifaz who allegedly fired at the doctor and fled from the spot on the bike.

Are we a lawless society? More problematic is the government apathy and silence of human right commission. Here comes the point that what is the role of our doctor’s organizations, human right organizations, parent hospitals and institutes.

   Good Governance lies in prevention of such incidents. Knee-jerk policing activities after every incident are of limited benefit.   Moreover  the  impunity with which people  dare to take law into their hands and  tend to punish doctors instantly for perceived negligence,  is a blatant disrespect to courts and judicial system.

     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

NEET-PG-Counselling: A larger public emergency issue due to Pandemic


        NEET PG Post-Graduation after MBBS is an entrance qualification exam, one of toughest and important exam not only for medical students but for medical colleges and hospitals. As this exam will decide and form the back bone of the health care system in the whole country. Ultimately this exam will be the check gate to supply specialist doctors to medical colleges, hospitals and private health institutions in all the states.  Post graduate trainees form the bulk load of doctors performing the duties.  Needless to say these doctors form the back bone of the total health system across the country. For last two years, these junior doctors were at the forefront of the fighting the pandemic. 

       Since NEET PG was to be conducted in Jan 2021, but due to pandemic got postponed to Sept 2021 and result were declared few months back.

      NEET PG counselling is not only issue for doctors but an actually a larger public health issue and kind of emergency due to pandemic, which will decide the availability of doctors to public.

         Actually it is in patient’s interest to have early counselling.

         It is a sad situation, when the world is preparing to tackle the wave of pandemic due to Omicron Variant, other countries are ramping up their health care infrastructure and manpower, and Indian doctors are being dragged on roads by police instead of employing them in hospitals.

       Its importance assumes an emergency situation in face of looming pandemic. If the administrators had perceived it as merely a trivial doctors’ issue and remained complacent, it had been a grave mistake.

     What was the emergency to change and frame new rules when a pandemic of such a large proportion was going on?

    A delay in academic counselling means a wasted year for the NEET PG aspirants. It also means that 50000 doctors are missing from the medical system and  the health care force because of bureaucratic delays, at a time when health care staff is overworked and in desperate need of more hands.

      Point to ponder here is that is it the doctors who desperately need help? More precisely and in reality it is the patients and public who need doctors desperately. An early counselling is in public interest actually, the point administrators have failed to understand.

       But sadly, it is up to the wisdom of administrators that decides “what is emergency and what is not” rather than medical wisdom, a case of misplaced priorities.

     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

Want to be a Doctor: Expect No Justice


           

        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.

At a time when Political groups, terrorists, drug addicts, celebrities commit crimes and get a priority hearing by courts and speedy relief (whether deserve or not worthy), doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.

             It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.

          The barbaric response of Police towards peacefully demanding doctors has unmasked the real indifferent attitude of Government and administrators as well as apathy of courts towards medical profession. The cruel behaviour has also unveiled the approach of  tokenism such as ‘mere lip service’  showing respect to corona warriors.

      The strong political and legal will is absent to solve Doctors’ problems.

      It also shows the scant  concern of the Government to provide a real good health care system despite showing a verbal concern for medical services. It also explains why successive Governments irrespective of political moorings  have terribly failed to provide healthcare to its people.  Why patients fail to get a bed, oxygen, doctors or nurse is consequence to the misplaced priorities of administrators.

    Who would be the worst sufferer of the apathetic attitude of the Government? Doctors will suffer initially till they continue to choose medical profession. Once they also become apathetic like administrators, it would be the patients.

Delhi: AIIMS, FAIMA doctors join protest after police crackdown

A day after resident doctors protesting delays in NEET-PG counselling alleged that they were assaulted by the police, doctors from the All India Institute of Medical Sciences (AIIMS) as well as those associated with the Federation of All India Medical Association (FAIMA) have decided to join the stir.

Doctors from AIIMS, one of the only big tertiary-care government medical college hospitals that had stayed away from the protest, in a letter to the Union health minister, said that they would withdraw from all non-emergency work on Tuesday if no concrete steps are taken.

“It’s high time for the government to release a report of what has been done till date, and what are the government’s plans moving forward for expediting NEET-PG counselling. If no adequate response from the government is received within 24 hours, AIIMS RDA shall proceed with a token strike on 29/12/21 including shutdown of all non-emergency services,” the letter read.

This would hamper patient care in the city further. With emergency departments of big hospitals like Safdarjung and Lok Nayak affected by the strike, patients were being referred to the AIIMS for treatment.

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In addition, FAIMA called for its resident doctors’ association to withdraw from all work, including emergency services, after Monday’s incident. The protest began with withdrawal from outpatient department (OPD) services in November end by two national organisations – the Federation of Resident Doctors’ Association (FORDA) and FAIMA.

The protest slowly intensified with doctors boycotting even emergency work, following which on the insistence of the government the strike was paused for one week.

The strike resumed on December 17 as FORDA members withdrew from all services.

     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

Medical Education: Doctors- Victims of Grave Injustice Expected to Impart Justice to all


        Non-uniformity of medical education is treating  medical students  as  slaves and  killing enthusiasm of young doctors.

    Medical profession is an extremely strenuous and highly specialised field that requires individuals to dedicate their lives in the service of others. As part of medical professionals’ education and training, they are necessitated to undertake training across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government.    In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman for proper pay and working conditions.

Ensure uniform stipend to Interns: Binoy Viswam, Rajya Sabha MP

Great disparity in stipend at Govt. Private Colleges

     Medical education is one field where  one can notice the  extreme  variations of the unimaginable magnitude that are beyond comfort.  

      Falling standards  of medical education is the most important  side effect  which  should be an  important issue, but sadly it is the last  priority  on the list of administrators. Each and every medical college can be different and student passing out of many colleges receive below average medical education.

     Another important  variation is in the stipend and remuneration of  young  trainee doctors receive. It varies from college to college, city to city, state to state as well as North to  South and East to West. Besides being a cause for heartburn. it is a cause for  extreme  dissatisfaction among medical students.

      Needless to say the arbitrariness exercised  by various authorities to pay  them at their will is a reflection of grave injustice imposed by administrators.

    Another arbitrariness reflecting injustice is variation in fee of medical colleges. The steep fee charged by private medical colleges and restrictive bonds of Government  medical colleges in name of expensive medical seats need a sincere and honest introspection by authorities. The basis for calculations of the cost of medical education should be transparent and shown in public domain.

     Needless to say that medical students have been sufferers  of poor and arbitrariness of inept  administrative policies. Just because they decided to be doctors, they have to endure poor,  unjust  and arbitrary policies.

     Ironically as a child decides to be a  doctor, he is exploited in name of such policies of  unreasonable  high fee, poor education and low pay. That too while working in  extremely inhuman   conditions,  long and hard working hours. Strangely these medical students  suffer grave injustice  inflicted by the society  since  start of their medical education, but when they become doctors, everyone  expects sympathy, empathy and honesty.

    In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman.

      Still the sufferers of grave  injustice themselves  are expected to impart justice to everyone  along with  burden  of mistrust.

Ensure uniform stipend to Interns: Great disparity in stipend at Govt. Private Colleges

Binoy Viswam, Rajya Sabha MP, has urged Union Health Minister Mansukh Mandaviya to ensure equity in payment of internship to medical students in private and government medical colleges across the country.In a letter to the Minister, Mr. Viswam said that the National Medical Commission’s Draft Regulations on Compulsory Rotating Internship, 2021, issued on April 21 and gazetted on November 18, had said that all interns shall be paid stipend “as fixed by the appropriate fee fixation authority as applicable to the institution/university/State.”

Ambiguity

“The phrasing of this provision allowed for great ambiguity and arbitrariness. It may also result in management of private colleges denying stipend to the interns as they have complete discretion without any safeguarding mechanism. The ramifications of the same are already being seen in colleges across the country as great variance exists in stipend amounts being paid in government colleges as opposed to private colleges,” he pointed out.

A right, not charity

Mr. Viswam said that medical profession was an extremely strenuous and highly specialised field that required individuals to dedicate their lives in the service of others. “As part of medical professionals’ education and training, they are necessitated to undertake internships across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government,” he said.

The MP requested the Minister to consult with all stakeholders, including State governments, medical college managements, medical professionals, and students to formulate a policy that ensures equity among medical students. A uniform stipend to all interns would ensure that, he added.

The erstwhile Medical Council of India had come up with a public notice on January 25, 2019, on Graduate Medical Education Regulations, 1997. The Board of Governors that superseded the MCI was considering a provision that said “All the candidates pursuing compulsory rotating internship at the institution from which MBBS course was completed, shall be paid stipend on par with the stipend being paid to the interns of the State government medical institution/Central government medical institution in the State/Union Territory where the institution is located.” However, it was not gazetted until the Board was dissolved.

     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

The Book-‘At the Horizon of Life & Death’: Doctors’ struggle with death


The 300-page book contains 20 stories divided into three parts viz – Larva & Pupa Syndrome, Hope & Fear & Medical Lawsuits. The book is available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive  etc.

      While doctors are usually blamed for any mishap, be it natural poor prognosis or genuine complications, rarely people get to know their side of the story — how a dying patient affects their psyche, how they deal with these patients and their kith and kin, what are the kinds of abuse and threats made when they are not able to save a life despite their best efforts. Dr Pankaj Kumar, Director Critical Care at a Delhi Hospital, India has come out with an insightful account of these very aspects of a doctor’s life.

         His book ‘At the Horizon of Life & Death’ is a Reality Fiction that reflects the sensitivity involved in dealing with patients facing death.

     Through the eyes of its protagonist Dr Anand, the book captures significant moments in the treatment trajectory of critical patients. The book tries to create awareness regarding pertinent issues faced by the medical professionals like demoralisation, expensive medical education, the extreme pressure and suicidal ideation, the plight of the nurses and support staff, assaults and violence and the medico-legal intricacies involved in day-to-day practice among others. The author has also taken care to guide aspiring doctors to make well-informed career decisions.

     Part One (Larva & Pupa Syndrome)-  talks about the expensive medical education, and the issues students face in medical college.

    Part Two (Hope & Fears) talks about the beginning of doctors’ professional journey, the disease demons they face while dealing with critical patients, dilemmas of doctors and patients near death situations.

    Part Three (Medical Lawsuits) is about how doctors are always working under the threat of medico-legal lawsuits.

        While stories are fictional, the scenarios and the problems in them are very real — things that he faced or saw his colleagues facing.

     Medical profession has become victim of mistrust generation and blame culture. Everyone keeps harping about the few black sheep in the community, while larger good work of doctors is not highlighted enough.

    The stories span from Dr Anand’s initial days in the emergency room and capture his struggles in complex medico-legal scenarios over the next four decades. This book is an effort to bring back focus on the treatment of the patient as opposed to the mistrust, legal frameworks and policies surrounding the healthcare practice.

           The book is self-published, available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive  etc.

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     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

 Side Effects-Implementing Medical-Consumer-Protection-Act in Haste


        Medical consumer protection act was implemented in 1995. Patients defined as consumers and hence doctors converted to service providers in lieu of some money.  Consequently the changed definitions altered the doctor-patient relationship in an irreversible way. Instead of the earlier congenial relationship, now-a day’s doctors and patients are fighting in courts, whereas most of aspects of the law still remain grey after 26 years of implementation. Here in this case even courts differ in the interpretation (among themselves) of the law after more than two decades of its implementation.

        The doctors are supposed to treat, provide relief and save lives are the most affected, it is needless to say that the way of treating patients has been altered like never before. Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on someone’s confidence and belief, which takes a lifetime to build.

   The reality is that neither doctors, nor patients were ready for such a legal relationship, and the system was not robust enough for such a change.  To work with weak infrastructure, non-uniform medical education along with legal threats pushed doctors into a shell and forced defensive practice.  It caused erosion of doctor-patient relationship and escalated cost of care.

   Medical business, insurance and legal industry made full use of the opportunity to have the benefits of changed doctor-patient relationship.  Doctors were used as scapegoats for poor infrastructure by administrators and further exploited by law industry.

   Justice eluded doctors at all stages.

      It is discouraging for medical professionals to note that courts are still clarifying the law even after 26 years of its implementation.  What is more disheartening that many more aspects about the medical-consumer protection act are either remain  unclear and create difficulty for doctors.  To differentiate medical mistakes, poor prognosis from negligence is a very fine line and difficult to judge. Therefore medical profession has  become  a subject to blackmail by patients, lawyers and sitting ducks for punishments. The consequent insecurity among doctors, practice of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment)  are few of the  side effects, which will  definitely be passed on to the patients inadvertently.  After all doctors have to save themselves as well.

 Consequently being consumer may be overall a loss making deal for the patients.

     The point to ponder is that courts themselves differ on interpretation of law even after 26 years of its implementation.  

The Supreme Court has reiterated that service rendered by medical officers on behalf of a Hospital, free of cost, would not fall within the ambit of  medical consumer protection act.

https://www.livelaw.in/top-stories/consumer-case-not-maintainable-over-medical-services-given-free-of-charge-doctor-salary-hospital-supreme-court-187291

     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

 Pendency at Hospitals Vs Courts: A Comparison- Imparting Justice Vs Health


Justice and Health- Both are crucial for happiness of the living beings as well as society as a whole.  Hospitals are full of patients and so are courts with litigants. None of the people go to hospital and courts happily and everyone invariably wants early relief.

   Once a patient visits hospital, he will ponder over about the benefit of the visit. So is the person visiting the courts. Did they were imparted justice?

      None of patient, who visits hospital, comes back without treatment. Doctor gets few minutes to decide. Most of the time, for the investigations and the treatment few visits are required. But there is no pendency. In Government hospitals, even appointments are not given. A doctor sitting in outdoor will see hundreds of patients. On emergencies night duties, doctor will not be able to count how many he/she has stabilized or numbers treated.

      Even in such chaotic systems, doctor can be punished, dragged to courts or assaulted for unintentional mistakes, that are  almost always secondary to load of patients or inept infrastructure.

      The work at hospital continues day and night, 24 hours and 365 days, despite almost always lesser number of doctors and required manpower. Systems in hospitals  are designed and maintained meticulously   to have no pendency what-so-ever situation is.   Larger number of patients go back home treated and very few unfortunate patients are unable to recover, but still whatever is required- is done invariably.

        Justice is needed for satisfaction of soul and peaceful mind, is of same importance what is to the health of body. Justice delayed gives a sense of hurt and pain to soul. Pendency in courts simply reflects the grave injustice people are living with.

44 million pending court cases: How did we get here?

       There are about 73,000 cases pending before the Supreme Court and about 44 million in all the courts of India, up 19% since last year.

According to a 2018 Niti Aayog strategy paper, at the then-prevailing rate of disposal of cases in our courts, it would take more than 324 years to clear the backlog. And the pendency at that time was 29 million cases. Cases that had been in the courts for more than 30 years numbered 65,695 in December 2018. By January this year, it had risen more than 60% to 1,05,560.

Grave injustice for medical professions:

  1.   A doctor making wrong diagnosis (gets few minutes to decide) can be prosecuted, but courts giving wrong verdicts (get years to decide) are immune?

   2. Compare the remuneration of lawyers to doctors. Doctors gets few hundreds to save a life (often with abuses) and lawyers can get paid in millions (happily).

   3. Doctors treat the body and larger is still not fully known about mechanisms. Still doctors can be blamed for unanticipated events. Whereas  law is a completely known and written subject.

   4. If health is citizen’s right so should be a timely justice.

         Despite doing so much for patients, still people’s behaviour to doctors and hospitals is not respectful. Doctors are punished for slight delays and people and courts intolerant to unintentional mistakes. But people can’t behave in the same manner to courts and legal system and tolerate the blatant injustice for years.    

     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

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