Feeds:
Posts
Comments

Archive for the ‘bio ethics’ Category

Sex differences in Idiotic behaviour , If its true , does this spill over in professional decisions too ?

Posted in bio ethics, Gender issues in medicine, Hippocratic oath, history of cardiology, Histroy of medicine, medical quotes, Wintage cardiology, tagged on February 7, 2016| 1 Comment »

“Men are from Mars , and Women are from Venus ” . . . Do you agree ?

Many probably witness the much talked differential behavior among the gender every day. Its argued , men take more risk in life ( often senseless !) , some go to the extreme to suggest Men are Idiots and decorate them with a provocative title MIT (Men Idiot Theory ) (Mcpherson 2011).Risk taking is important in life, but at what cost ? Does women (Who are caring by nature ) help themselves and the society by less risk taking behavior ?

I stumbled upon this rare piece of writing from BMJ which would demand in depth analysis into this gender phenomenon based on evolutionary biology and genetics.

This article concludes, Yes, men . . . indeed tend to take some foolish risks in various life situations that result in potential harm.

Gender difference in medical outcome men are from mars women venus male idiotic theory darwin theory

What is the influence of MIT on medical profession and patient outcome ?

Now , Iam compelled to ask a hypothetical question .Does women medical professionals take less aggressive stance and low risk taking behavior ?

If it’s true, It may have some striking advantage too.

Reference

1.Harris CR, Jenkins M, Glaser D. Gender differences in risk assessment: why do women take fewer risks than men? Judgm Decis Mak2006;1(1): p. 48-63.

2.Eckel CC, Grossman PJ. Men, women and risk aversion: experimental evidence. In: Plott CR, Smith VL, eds. Handbook of experimental economics results. Vol 1. North-Holland, 2008:1061-73.

3.McPherson J. Women are from Venus, men are idiots. Andrews McMeel, 2011

4.Northcutt W. The Darwin Awards: The official Darwin Awards: 180 bizarre true stories of how dumb humans have met their maker. Orion, 2004.

Read Full Post »

Not just two funny quotes . . . but stunning medical truths !

Posted in medical quotes, Two line sermons in cardiology, tagged , on May 2, 2015| Leave a Comment »

These two quotes  on practice of medicine are close to my heart , one from Voltaire , a non medical man (a French poet )  and  the other from ,one of the greatest medical professional of our times, William  Osler .

gretest medical quotes william osler voltaire

It is amazing ,how the thinking pattern of a  philosopher  and a true scientific professional living  centuries apart are almost in sync with a great medical reality !

Read Full Post »

A crazy cardiology tweet and a wish !

Posted in bio ethics, tagged , , on February 27, 2015| Leave a Comment »

I was recently asked to suggest a topic for debate on STEMI in  a major Indian cardiology conference. I wished , this is what we  should be mulling  over, with a set of  virtual  guest lectures and special invitees from heaven ! Plenary  session : State of the Art  STEMI care             Time :  11.AM ,  Speaker : Dr Hippocrates Topic : Aren’t  we erring   on either side of the  Noble profession ? Moderator:  Dr. William Osler Chairperson :  Dr .Harvey Cushings, Dr,Sir Thomas Lewis ,Dr Paul Wood , Excerpts : “While , vast number of  our country-men’s  culprit artery doesn’t even get that  mandatory  Aspirin on time . . . an urban rich  man’s  distal non-culprit artery  is decorated with a fancy  bio-vascular scaffold making  that innocuous lesion vulnerable in the process as well !  Aren’t  we erring   on either side  in the  Noble profession ?

Read Full Post »

It looks like adult cardiologist should avoid doing pediatric echocardiograms !

Posted in bio ethics, Cardiology -Therapeutic dilemma, cardiology-ethics, tagged , , , , , , , , on February 14, 2015| Leave a Comment »

A cardiologist  is  a physician who has  trained himself  in a special  way  to deal with any problem of heart.Ironically , it exists only on paper.The field has developed so vast  no one can master everything .There is no such  “Pan or global cardiology expert” .In fact it would be shortly become unethical to try to become one !

Pediatric cardiology  has developed into such a big field , doing a echo in newborn or  infant has become a comprehensive job and  requires  special talent .This unique  and excellent study from Narayana Institute , Bangalore published in the  prestigious Annals of pediatric cardiology   throws up interesting realities about the quality of echo report done by adult cardiologists in children .The error rate  appears  huge and stands at  prohibitive 38%. While many errors were minor , major  were also not insignificant (23%)

pediatric echocardiography by adults cardiologist

With bulk of the pediatric echo  involves  in the critical decision making  process of device closures and interventions the  data required  becomes vital .The commonest cause for  error is probably not due lack of  knowledge and but to due to lack of commitment and  continuous  exposure in doing echocardiograms in  those age group.

While this paper  decently skirts the issue of quality of pediatric echo done in medium sized hospitals without pediatric cardiology service ,I can say the error rates or inadequate reportage could be significant  in such hospitals  with apparently good ranking .

Final.message

Of course ,we have many  adult cardiologist who do  excellent  pediatric work , It looks like , as a general rule  performing pediatric echocardiograms  by non -institutionalized  adult cardiologist  may not be appropriate ! It may be wise for them to avoid doing echocardiogram in small infants with  truly complex disorders (even perceived  complex) till they gain the required expertise and confidence.

I recall an  adverse  issue happened years ago ,  when I had  missed an associated    PAPVC  in ASD that made my surgeon anxious on table .In a country like ours there is no one to audit our work , “our conscience remains the only option” to deliver the best for our patients  especially so, when they are tiny lives in distress.

After thought

Who am I to suggest  who should do echocardiogram ? , after all every cardiologist is licensed  to do that . One simple  suggestion  would be , if  not confident  they can at least mention in their report it is only  preliminary evaluation and need to be followed up with  an expert . I do that whenever its required  and gives me peace of mind as well !

More controversies* to come

Can adult cardiologist do pediatric intervention ?

* Controversy : One of the meaning for this word  is  “It is a thought  process  set into motion , that aids digging up hidden truths ”

Reference

 

Read Full Post »

Say “nay” to ICUs, we need more Intensive “human care” units !

Posted in bio ethics, cardiology-ethics, tagged , on January 26, 2015| Leave a Comment »

As I was mulling about  the misplaced  priorities  in modern health delivery  , today’s (25-01-2015) edition  of  “The Hindu” , India’s National newspaper carries an exact article by Dr B.M.Hegde .

No doubt  ,his articles are constantly criticized  by the scientific community for  the simple reason, he is forcibly  trying to add wisdom to science !

 

 

Read Full Post »

A new “Null Hypothesis” in medical research !

Posted in bio ethics, medical quotes, Two line sermons in cardiology, tagged , , , , , on December 21, 2014| 1 Comment »

Picture4

After nearly three decades of , treating patients , teaching students and little involvement in research , created a new definition for null hypothesis in medical research  !

Picture7

Read Full Post »

Pacemaker hacking and hijacking : Real threat in a networked world ?

Posted in bio ethics, Cardiology - Electrophysiology -Pacemaker, Cardiology -Technology, tagged , , , , , on November 16, 2014| Leave a Comment »

In this wireless networked world nothing is personal, not even your heart beat.Modern pacemakers and ICDs have wireless connectivity with the manufacturers.This is value added service for regular monitoring and solving  any technical issues.

assets_174815Hacking  a device like pacemaker and ICD  and instant deactivation or triggering a new event   is a distinct possibility .It was shown in a fictional TV series “Home land” that prompted the  ex American wise president Dick Cheny to switch off all wireless function in his ICD. Now ,the US homeland security  cyber emergency  response team has decided to probe the issue .

pacemaker hacking icd

Perils of technology is taking us to new uncharted territories , while your  SA   AV node are at risk of being  remote controlled !

Meanwhile Medtronic has clarified they have increased the security features and pacemaker /ICD hacking is not an issue to be worried . But the threat is genuine !

Reference

1. Frenger P Hacking medical devices a review – Biomed Sci Instrum.  biomed 2013.2013;49:40-7

 2. Barnaby jack , A  young Newzeland computer  expert  demonstrate the hack live in a  Black Hat meet .

3.Fox news

Read Full Post »

Learning Medicine from Mahatma Gandhi !

Posted in bio ethics, medical quotes, Two line sermons in cardiology, tagged , , , , , , , , , on November 1, 2014| Leave a Comment »

Mohandas Karam Chand Gandhi ,  father of my country , India , made these observations in year 1925  about the  fundamental constituents of  violence in society . These words of monumental wisdom came when he was  addressing young Indians in a country- side rally .

mahatma gandhi quotes medical science humanity

Note, his finger points to , what  exactly is relevant to our profession ! He emphasized this  nearly  100 years ago, when medical science was at its infancy .One can only guess what would be Mahatma’s comment about our profession in it’s  current form !

Should we include moral, behavioral and ethical classes  right from the first year of medical  school along with Anatomy , physiology and bio chemistry.Medical council of India obviously need to burn more mid night oil , I wish it happens in my life time. !

Read Full Post »

Why big doctors adore “science” more than their patients ?

Posted in bio ethics, Cardiology -Emerging technology, Cardiology -guidelines, Cardiology -Interventional -PCI, Cardiology -Patient page, Cardiology -Therapeutic dilemma, Cardiology -unresolved questions, medical quotes, tagged , , , on August 31, 2014| Leave a Comment »

As the medical care advances  human care  has taken the back seat. It is said super specialists  read more and more about less and less ! In the  process they  fail to see the  patients  as a single biological unit  instead as collection of organs .

While  organs in turn are looked as  pile of data.Hence the  treatment they provide lack the soul !

In the prevailing circumstances , how do we ensure  modern medicine  does not interfere with  these vulnerable souls,either to live in peace or leave in peace ?

Medical Ethics

Image : Source and Courtesy of http://illuminationstudios.com

It appears doctors are not at fault . The system is  biased towards raw science .Highly trained  doctors are tied down by  both  true and pseudo  scientific Intellect .Often  times they are compelled to do some procedure or interventions  just to  justify  the  premier status of the hospital  .While few do it  to show off  their expertise or  to impress  their peers   others are simply bound by rigid and obsessive  protocols and guidelines . Few others do it  for the burning  desire  of  scientific accomplishment .

One can offer hundred reasons for doing a procedure . . . but we always struggle to justify  with a valid reason for not doing a investigation or  procedure !

In fact , the  concept of appropriateness  criteria came out with good intention .But , it had failed miserably.

The irony is  . . . we need to indulge in something to avoid something.

Example 1 If homocystiene and  hsCRP vanish from the CAD screening industry   Adiponectin and Vitamin D3 comes in with a thunderous applause like a new Hollywood movie  !

Example 2: In cath lab  for leaving alone an insignificant  coronary stenosis , we have to do  another procedure  called FFR to satisfy  scientific ego ! (I know one senior doctor , who left a 80% LAD  lesion for medical management without FFR ( with all his clinical acumen )  was ridiculed for being unscientific !)

Here is a recent perspective article NEJM has discussed  this  important issue that plague us

Why should big  Tertiary  teaching hospital  are  flooded  with super specialists  which by default shun basic human care ?

Read this article*

Super specialist tertiary care hospital NEJM

*The article I have quoted  may  not  be completely relevant here  . . . It  answers  few of the queries raised!

Read Full Post »

Remove “the style” in life . . . and get rid of CAD !

Posted in bio ethics, Cardiology -Patient page, cardiology -Preventive, cardiology -Therapeutics, Cardiology classics, Cardiology Risk assesment, tagged , , , on August 17, 2014|

Coronary artery disease (CAD)  is man-kind’s  greatest threat in modern times.CAD ,diabetes ,Hypertension, obesity, mental illness  has become an epidemic  even among the young !

 

Lifestyle diseases cad risk smoking alcohol

There is a simple solution for  lifestyle diseases !

Just  . . .  Remove style from your life !

lifestyle diseases coroanry cardiology medical ethics inappropriate stents over treatment excess medical care , bio ethics,

Instead . . . try to live like these  Tibetian villagers

life purpose of living

Final message

One study which researched all lives who crossed 100 Years  concluded something like this !

“To live a longer and healthy life* ,Get up early  , have a purposeful daily chore that must include a physical component , work with conscience ,love every one sync with the nature and  lastly and most importantly remove style from your life !

Choose  your life . . . It is simply there in your hand for grabs !

Post-amble.

* Please note , Doctors  are never listed in the top with relevance to health of mankind  ! They simply cure some illness !

Read Full Post »

« Newer Posts - Older Posts »