Do not chase people

Let us don’t chase people.
Be ourselves, do our own things and work hard. The right people, the ones who really belong in our life, will come to us. And stay. Isn't it?
🙏🏼GM🙏🏼

Things work out fir the best

Sometimes things work out for the best, when we stop worrying & stressing… and simply go with the flow of our heart.. accept what is, forget what was & gratefully embrace what is to come.
Isn't it?

Our happiness

Let us make our happiness and personal growth a priority in our life. The more we take care of ourselves, the more we can take care of others. Isn't it?
🙏GM🙏

Someone is happy

One of the best feelings in the world is knowing that someone is happy because of us. Isn't it?
🙏🏼GM🙏🏼

The future of the Indian Medical sector

Dr. Narayanan Harimohan (now in Brunei) on Facebook:-
"The future of Indian medical sector looks to me of only two choices, one is shoddy government setups with skilled and hard working doctors but one where quality will not be the priority because of demanding situation and poor infrastructure, and, the second will be multinational corporate hospitals and state of art clinics, managed by insurance companies and businessmen, here  cost will be skyhigh, where  doctors are safe from the constant violence they suffer.

In short, society will suffer for the way they behave with doctors today,  bashing them up when they get an opportunity.
No one will continue taking this like sitting ducks, so doctors of the country will either be part of corporate hospitals (with adequate security and deep pockets and where law will run to their beck and call and goondas and political parties too can be kept at bay easily), or the government setup (which traditionally is protected by the Government)
   
All smaller hospitals, and clinics will close down and the people will face a catch 22 situation and with nobody to blame but themselves for what has happened.....

     And the day will come when the society aches for the friendly neighborhood doctor, and hospital which was easy on their pockets and more appealing than the above mentioned.

Grin and bear it"

Life of a doctor

“CODE BLUE”
someone shouted.
There were sounds of rushing, muffled sobs and wails, metal trolleys banging walls and glass syringes being broken open.
He rushed fastest, asked the relatives to wait outside.
“What’s wrong with him?” insisted the patient’s brother on knowing.
“His heart has stopped. Please wait out we don’t have time” he replied.
The nurses had positioned the patient and started the CPR.

The ugliest sound in the world: the desperate rocking of the bed during a cardiac massage, was heard outside the cabin. The high pitch long beeps of the defibrillator followed by the thuds of a body due to the electric shock initiated prayers even in the hearts of strangers. The relatives of other patients in the ICU waited outside their cabins, watching the faces of those who were crying. Those who could not bear the sight went inside their cabins.

He went on doing the CPR, knowing that the patient was young, and may still respond. The risk of this highly fatal disease to himself and the nursing staff was taken for granted: there is no time to “dress up” for CPR. He was simultaneously ordering the injections to be given. A male nurse took turns and helped him with the cardiac massage.

It is exhausting. Giddy after some time, he looked at the watch. It was about half an hour since the event.  Almost nil chances now.  He asked the nurse to continue, and came out to inform the relatives.
“He has had a cardiac arrest. We are trying, but it looks difficult” he informed the patient’s brother.
“Why? How come?” the brother shouted as the rest of the family gathered.
“We have been informing you many times. He has been critical. His lungs were not functioning well, his brain has many TB tumors, and his kidneys have been shut due to infection for a long time. It is called multiorgan failure”.
“We don’t know all that, doctor. Save him” said the brother.

Young patient. Fever since over three months. Avoided seeing allopaths for over a month. Diagnosed as multidrug resistant tuberculosis, one of the worst and most difficult diseases to treat. By the time they reached the proper specialist through all the “money saving” channels, it was too late. Almost all Government Hospitals have experts and facilities to treat MDR TB, but somehow people think it is below their dignity to avail of services at Govt hospitals. 

The ICU doctor came out after a while. “We are sorry, he could not be revived” he sadly told the relatives.

Then there was a shriek, as the patient’s brother held the doctor by his collar, and slapped him. Exactly the style of Akshay Kumar from some movie.  A lady doctor tried to stop the brother, but was held by the women in the family and bestowed with blows and abuses. The security, who had allowed the relatives on humanitarian grounds, regretted it, and desperately tried to control the relatives.

In an hour, they all left.

He washed himself. There was no time to cry, complain, register a case or go to TV channels or press. There were 22 other critical patients in the ICU, and he was in charge. He had to forgive, forget, digest it all. And then there was a perpetual expectation of the society to “understand” the misbehavior of the bereaved.

In a few minutes, another gasping patient came in on the same bed.  A young girl with continuous convulsions. He rushed and intubated her, stabilised her. He talked to and pacified her panicked parents.

He had forgotten the slaps, the abuses and the blows he received  a few moments ago. Like filmstars who slap qualified doctors on the screen and earn crores for that “entertainment”, he did not deserve a palatial bungalow and  luxury cars, but as a life saver who saved hundreds every year, he was doomed to an asylum walled by expectations, criticism, abuse and overwork. Saving lives was “just a duty” not deserving respect or rewards.

The stress that comes from handling daily CPRs, saving lives and declaring deaths for years together cannot be acted by any of the Tom Dick Harrys on screen. Most of them are not even intellectually equipped to perceive the education, hard work and traumatizing effects of daily deaths and allegations that a critical care doctor faces.

While exceptionally literate and mature film personalities like Mr. Amitabh Bachchan and Ms. Lata Mangeshkar have always praised the doctors and spoken highly respectfully about them, most other “Muttonshop”  artists have only exemplified their own jealousy about the highly educated doctors, trying to show them down one way or another.

I know of some friends who spend a sad, spoilt day even when they see a funeral  passing by.  The doctor and the nurse have to face it every day, still carry on dealing with money savers, skimpy, arrogant, abusive and violent relatives reaching the hospital at the last moment. They have to garner a calm and control possible only with great effort. This tells upon the doctors’ and nurses' mental and physical health. Being blamed and held responsible for someone’s  death (this has become rampant now: to presume that all deaths are someone’s fault) in spite of trying hard to save them  is something no film star, judge or minister will ever understand. Very few doctors or nurses are able to enjoy a genuinely stress free happiness in their personal life.

Of all the doctors and nurses suffering today because of the illiteracy, poverty and defective policy-making in India, the critical care and casualty doctors are the worst sufferers. My heartfelt tear and salute to their unending  suffering for humanity. Also a strong appeal to the press, law authorities and the government to ensure that these highly stressed doctors are not assaulted, unnecessarily criticized or abused.

Just imagine a world without casualties or Intensive care services. That is a choice which doctors still retain.

Addendum:
In a country where BMWs are gifted freely for achievements in sports, for hitting sixers, where multiple crore rewards are given away in various social-political- religious functions and festivals, the "prize" for saving and serving life is  a sad zilch, often with criticism! Millionaires who walk out of hospitals after "miraculous"recoveries hardly ever send more than a greeting and a box of chocolates, that too with the papers for reimbursement of hospital bills!

Please feel free to share.

Before we speak

Before we speak, let our words pass through three gates:
Is it true? Is it necessary? Is it kind?

Is India at war with its doctors?

Is  India   at  war  with  its  Doctors ?

Having  been  in  clinical  practice  for  28  years  I  have  had  the opportunity  to  have  witnessed  the  ‘glory  days’  of  medicine  when  a  patient  with  normal  gall  bladder  operated  erroneously with  diagnosis  of  acute  cholecystitis / cholelithiasis  would  still  touch  the  surgeons  feet  on  discharge. Those  were  the  days  when  ultrasound  was  science  fiction  and  oral  cholecystograms  used  to  be  done to diagnose cholecystitis. Since  then  situation  has  come  when  one  in  4  MBBS, MD, DM, MCh  doctors  have  faced  allegations  of medical  negligence in  courts  and  consumer  forum. 88% MBBS  and  specialist  doctors  have   faced  anger  or  violence  of  patients  or  relatives  in  their  professional  career  at  least  once.

Over  the  years  I  have  listened  to  doctors  complaining, griping  and  moping  over  the  problems  facing  them. They  feel  hemmed  from  all  sides, victimized   and  perceived  as   being  soft  targets. Many  doctors  specially  youngsters  seeing  their  previous  generation  unhappy  with  the  state  of  affairs  have  started  leaving  clinical  practice. Some  move  into  administration, others  business, some  go  abroad, some  simply  retire. I  cannot  blame  them  because  India  has  been  at  war  with  its  doctors  for  the  past  2  decades  and  doctors  feel  defeated. The  doctors  do  not  have  supportive  work  environment, professional  autonomy  or fair  pay.

The  first  blow  was  when  medical  profession  was  covered  under  Consumer  Protection  Act. Doctors  were  equated  with  traders, barbers, bankers, building contractors, insurance  companies, transport, suppliers  of  electricity, board & lodging  and  the  like. Other  professionals  like  advocates  though  originally  envisaged  to  be  covered  under  the  Act  have  been  spared  the  aftermath  due  to  deft legal  maneuvering. SC  in IMA  vs V P Shantha  & ors  included  doctors  only  for  outright  cases  of  negligence  but  unfortunately  now  this  has  extended  to  the  level  where  courts  are  deciding  what  a  doctor  is  to  do  in  a complex  medical  situation. A  cardiovascular  surgeon  operating  on  a  chest  tumor  should  not  have  proceeded  with  surgery  if  neurosurgeon  was  not  available. In  another  case  honorable  SC  opines  If  on  operating  it  is  found  that  an  additional  procedure  is  needed,  it  should  not  be  done even  with  relatives  consent. Patient  should  instead  allowed  to  come  out  of  anesthesia  give  consent  for  second  procedure  and  then  reoperated.  Professional  autonomy  of  doctors  has  been  subjugated  to  judicial, and  administrative  control  and  interference.

This  was  followed  by  repeated  injustice  to  doctors  by    equating  them  with  all  kinds  of  commercial  and  institutional  establishments  by  government  agencies. They  are  charged  commercial , non  residential, institutional  rates  for  water, electricity, property  tax. This  is  done even  when  doctors  are earning  their  livelihood  professionally  in  part  of  their  residential  premises. Chandigarh  Administration  and  Municipal  Corporation  consider  a  doctors  clinic  in  the  same  category  as  a  petrol  pump,  a  coal  depot, cinema  houses, clubs  godowns  and  baraat  ghars  and  charges  property  tax  from  them. This  again  is  not  done  in  case  of  other  professionals  like  advocates.

Another  wound  has  been  caused  by  the  acceptance  of  a  gross  devaluation  of  the  economic  value  of  their  work.   Whether  it  is  Bhai  Kanhaiya  Scheme,  or  CGHS,  or  ECHS  or  even  Third  Party  Administrators  who  decide  what  will  be  paid   for  life  and  death  work. Often  the  reimbursement  from  the  insurer (frequently  delayed  and  with  unjustified  deductions)  does  not  even  cover  the  cost  of  the  treatment. Doctors  are  routinely  and  without  objection  doing  massive  amount  of  work  for  which  payment  is  frequently  not  made  by  the  insurers. The  administrators  also  at  times dictate  the  course  of  treatment  to  be  followed  which  hospital  a  patient  should  go  to  depending  on  whether  hospital  has  signed  their  Preferred  Provider  terms  and  conditions. 

Adding  insult  to  injury MBBS  degree , specialization  and  super specializations  are  sold  openly  at  exorbitant  prices to  the  highest  bidder  with  approval  of  statutory  bodies  like  MCI  &  NBE. Medical  education  is  now  available  to  either  the  beneficiaries  of  social  justice  or  to  the  super  rich. Merit  has  no  role  to  play  in  this  scenario  and  this  is  approved  and  promoted  by the  State.

PCPNDT  Act  shifted  the  onus  of  poor  social  development  from  the  Government  to  the  radiologists  very  conveniently. If  women  do  not  have  their  well  deserved  position  in  the  society  how  does   filling  form ‘F’  properly,  and  displaying  notice  about  sex  determination  in  requisite  color  and  dimension  in  a  doctors  clinic  rectify  it.

The  overt  and  covert  promotion  of  indigenous systems  of  medicine  by  the  State  and  proliferation  of  quackery  without  any  fear  of  law is  another  formidable  bane  of  modern  medicine. From  chemists  to  RMPs  everyone  in  India  has a  birth  right  to  prescribe  modern  medicine  in  India.  Now  another  category  of  non  MBBS  prescribers  of  modern  medicine  in  form  of  BSc  Community  health  is  being  added  by  the  Government.  Besides  devaluating  of  the  MBBS  degree  it  will  be  sold  with  a  ‘rural doctor’  tag  in  the  great  private medical education  Bazaar. Its  value  being  enhanced  because  it  is  to  be  approved  by  MCI / NBE. All  this  obviously  puts  the  qualified  doctors  at  a  disadvantage.

Recently  GOI  has  instructed  various  States  to  amend  their  laws  to  permit  registration  of  AYUSH  doctors  in  the  State  Medical  Register  so  that  they  can  prescribe allopathic  medicines. Reason  for  this  has  been  given  that  MBBS  doctors  do not  go  to  villages.

Final  nail  in  the  coffin  is  provided  by  the  Clinical  Establishment  ACT which provides  total  control  of  medical  practice  in  the  hands of  bureaucracy. An  eye  specialist  under  the  Act  is  forced  to  conduct  delivery  for  a  woman  in  labor. Part  time  medical  practice  cannot  be  done  without  providing  round  the  clock  emergency  services. A  registered  clinic  can  be  inspected  any  time  of  the  day.  But  to  inspect  a  unregistered  quacks  premises  a  notice  has  to  be  given  to  the  quack   before  inspecting  the  premises  at  an  appropriate  time.

Now  there  is  another  notification  that  MBBS  doctors  will  have  to  serve  1  year  in  rural  areas  before  appearing  for  postgraduate  entrance exams. Already  with  charm  of  medicine  fading  among  youngsters. Increased  duration  for  postgraduate  degree  will  further  dampen  any  remaining  enthusiasm. Also  Govt  does  not  have  sufficient  rural  Primary  Health  Centres  or  Jobs  in  them  to  accommodate  43000  MBBS  graduates  passing  out  each  year. This  again  means  corruption.

It  of course  is  the  internal  strife  among  physicians  which  created  the  conditions  ripe  for  their  defeat in  this  war and  they  cannot  blame  outside  forces  entirely  for  their  loss. Defeating  its  doctors  in  this  unilateral  undeclared  war  that  Indian  Government  is   waging   cannot  however  be  good  for  the  country.

*Dr. Neeraj  Nagpal*
Convenor  and  Founder  Trustee
Medicos  Legal  Action  Group.

To be kind is more important

To be kind is more important than to be right. Many times, what people need is not a brilliant mind that speaks, but a special heart that listens. May  Almighty give me strength to do it.
🙏🏼GM🙏🏼