Violence against Doctors

Rising cult of Violence! Shock, dismay, horror and anguish! These are the emotions everyone felt seeing the Hyderabad bomb blasts. In this country of Gandhi and Buddha, violence is raising its ugly head more frequently than ever. Proving the doomsday predictors that we are living in vainglorious uncertainties! The real tragedy is that the perpetrators choose soft targets like the holiday crowds. This rising cult of violence is also affecting another soft target for the protagonists of violence – the Medical Profession. And it’s the small Nursing Homes and private hospitals in semi urban areas which are more prone to these types of unwarranted brutality against the unsuspecting medical professionals. Corporate hospitals can afford the high security and the manpower required to handle such situations. But the poor doctor practicing at a remote place is highly vulnerable. Usually the patient is brought in a moribund condition, and if he does not survive, the doctor is held responsible. Manhandling the doctor, destruction of furniture, equipment and property have become commonplace. The actual culprit responsible for the pt’s death (like the truck driver in motor vehicle accidents) goes scot-free. This gross injustice has increased of late. Recently all the private doctors of Karimnagar closed their hospitals in protest against such a horrific incident. Unfortunately, the such incidents are blown out of proportion by both the print and the electronic media. The pt’s relatives are interviewed extensively but the doctor’s point of view is seldom presented. Thus the doctor loses whatever public sympathy he might get. The onus is on the medical profession to educate the public against the gross injustice meted out to doctors, who only try their best to save life or limb. If these incidents continue to happen, doctors will refuse to attend any Emergency and it is the public which will pay the price!

Treat the Patient: Not the report, not the disease!

Treat the patient: Not the organ, not the report, not the disease!! In the good old days, a Family Doctor used to cure all the medical problems of the family with a simple prescription costing less than Rs 10/- . Now with all the burgeoning corporate hospitals and ubiquitous Superspecialits, the Family Doctor has become an endangered species!! It is said “A specialist is one who knows more and more about less and less till he knows everything about nothing”!! These days, if a patient goes to a Specialist, he is ordered a battery of Investigations including Blood tests, Ultrasound Scan, CT Scan, MRI, Angio etc., costing thousands of rupees. Unfortunately the old art of diagnosing an illness by the bedside is dying out. And the patient is asked to go to another Specialist, simply because he doesn’t with that particular organ that is defective. Now this Specialist refers the patient to another one and so on. In the end, the patient ends up with a lot of Lab reports, Xray films, Scan reports, Referral slips and costly prescriptions!! In these days of Superspeciality practice, it is essential to remember that the patient comes as a whole and it is ludicrous to say “I am going to look after your heart only”. Every doctor should have a holistic approach to the patient and depend more on his clinical acumen and less on the Investigations to come to a working diagnosis. In fact it is high time the old Family doctor concept is revived!

Drug-coated Stents or Sugar-coated Stunts?

Drug-coated Stents or Sugar-coated Stunts? The worst doubts have been confirmed. It has been fully established in a recent study that Coronary Interventions are being overdone, all over the world esp in USA and India. In a multicentric study involving >2000 pts going to be published in NEJM, Dec 2006, Dr JS Hochman of NY University and Dr EG Nabel, Director, NHLBI, Bethesda, USA have found that Coronary stents, esp the heavily priced drug coated ones are being deployed in some pts, where they may not be beneficial and even may be harmful! PTCA and Stenting has become more a cosmetic exercise than a life saving treatment. While the benefits of PTCA and Stenting are well known in Acute MI within the golden hour and in pts with Unstable angina not responding to medical treatment, the indications for other classes of pts is nebulous. Unfortunately, Interventional Cardiology, like any other branch of Medicine, is being practiced to cater to the needs of the Industry rather than the needs of the Consumer, the patient. This will continue as long as we don’t follow the basic ethics of Medical practice --- Primum non nocere (First do no harm). But then who is going to fund all thoses foreign trips and high tech Cardiology conferences?

Hospital Phobia!

Hospital Phobia! These days, we hear of young people in their 30s and 40s dying suddenly due to cardiac arrest. This is doubly tragic as they make an unceremonial exit at the peak of their earning age. Most of the deaths can be prevented if they consult a doctor at the first suspicion of a heart attack. Unfortunately, most people, especially men, hesitate consulting doctors for various reasons. One of them is a morbid fear of getting their worst fears confirmed, which would mean a loss of income, time and even the spectre of Death looming large. Another cause is the ego factor, as the male ego interferes with acceptance of another male in charge of his life. This is especially true for men employed in high positions or in the high socio-economic brackets. Among people from the lower strata of society, the fear of the high costs of Emergency medical treatment discourage people from seeking early medical treatment. These factors explain the high pre hospital morbidity of heart ailments in our country. It is imperative that we should prevent these sudden deaths of young people at all costs. This can be only done by health education, awareness of cardiac problems and providing pre-hospital health care facilities. The need for a periodic annual heart check up is mandatory for everyone above 30yrs, particularly if there is a risk factor like smoking, diabetes, hypertension or a family history of heart attacks.

A Healthy Budget!

A Healthy Budget The recent budget presented by the Finance Minister, Sri Chidambaram is laudable on many counts. Of course, the Rs 60000 crores loan waiver is based on electoral compulsions rather than economic rationale. Nonetheless, the election year budget had some sops for everyone. The 5yr tax holiday for hospitals in Tier 2 and Tier 3 cities is very much welcome.This will encourage doctors to establish new hospitals in semirural areas. Also the altered Income Tax rules will benefit many doctors. Health insurance premiums have been declared tax free, so that a higher percentage of the population can now be covered.. The ailing Pharma Industry also has received some relief measures and many lifesaving drugs will be cheaper now. Excise has been cut on small cars and many electronic items, so doctors can now buy more cars, computers and medical equipment! Ever since Mr Manmohan Singh presented the pathbreaking budget of 1994, the liberalization gates have been thrown open. Since then, Indian economy, often compared to an Elephant, has woken up from its slumber and started marching forwards steadily. Now the Elephant has already overtaken the Russian Bear, the South Eastern Tigers, and poised to overtake the Chinese Dragon and the American Bald Eagle. Let us hope that under the guidance of able FMs like Chidambaram and Manmohan singh, our country will soon attain Superpower status…… Jai Hind!

Practicing Community Medicine?

Practicing Community Medicine? It is surprising to know that even in major cities, patients prefer to go to doctors belonging to their own caste. Casteism is the boon or bane of Hinduism. But to extend it to Medical Care is sheer lack of common sense. And to learn that this is actively encouraged by some doctors is highly unfortunate. It came as a shock to learn that there is a community based doctor’s association in our own town of Rajahmundry. It is okay to confine oneself to his/her caste in aspects like marriage. But to extend the same to professional relationships is downright unethical. It is definitely not in the best interests of the patient. When referring a case to another doctor, the qualifications, experience and merit of the specialist should be taken into consideration and the referral should not be definitely based on caste! Unfortunately in India, the ground-level as well as political thinking is always community based. We cannot expect the centuries old Caste system to disappear completely overnight. But I don’t understand why doctors should fall into the “caste trap” and follow such inexemplary practices. After all the Medical Profession is a big community by itself!

India: The Heart Disease Capital of the World??

According to “The Lancet”, a leading medical journal, India will soon have 60% of world’s total no of heart patients. The data is based on a study by Dr Xavier of St John’s Medical college, Bangalore and Dr Saleem Yusuf, Hamilton Hospital, Ontario, Canada. While this is good news for Cardiologists in India, its bad news for the Indian populace at large. India is facing the twin burden of Communicable and Non-communicable Diseases as the nation undergoes a demographic transition from an underdeveloped economy to a Third World Superpower. The India growth story, so well publicized by the media, seems to be limited to the top income brackets of the society. In fact there is more unequal redistribution of wealth, with the rich getting richer and the poor getting poorer!! It is high time health authorities realize the importance of Prevention of Heart Disease and allocate enough funds and health personnel for the same on lines of the anti-AIDS programme, which has yielded encouraging results. What the country needs is more Heart Disease Prevention centres and not more Cath labs.

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