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Posts Tagged ‘hippocrates oath’

I stumbled upon a TV reality show where a mother of a child  was crying inconsolably ,whom she lost when it fell  into a open  bore-well pit .She was blaming it as her fate and the hole was sent by Lord Yama (God of death )

I  just got  curious ! This article was written  in a flash.

I used to get questions from anxious parents  of  children with holes in the heart .(Asymptomatic small VSDs or ASDs  who come for  periodic echo-cardiograms) .I reassure and  convey  the message , most of these  holes are tiny and will close automatically and they need not worry.Even if it doesn’t, it poses little problem.

 

asd clsoure

But .after watching  that haunting TV show, I have started to warn  the parents  that  holes in the heart may not be that dangerous  but  be wary of  holes in the roads  and unclosed bore wells  in our country !

Every single parent was amused  with  my statement  ! Some how it appeared sense to me !

I made a mini google research. It is estimated thousands of bore-wells are dug every day and kept open in allover the country side .It is like live land mines .  Some press reports  suggest at least one child dies in India every day due to uncovered bore-wells and man holes ! (May be really true !)

The following are  some of the  samples.

One

borewell deaths 4

One more

borewell deaths  3

Two

You can understand the gravity of the problem , one engineer has devised a special  child retrieval Robot for such accidents.

baby snare bore well cath lab snares asd vsd device av loop how to snare a device

Three

A news report  in Times of India  .What shall we do about these ?

asd vsd borewells pits holes in the heart

It is a horrific truth in this  civilised world .Nature creates  holes  in the heart due to defective gene in some . It appears  less dangerous to me. After all a hole in the heart  threatens only one life,while  a hole in the road  kills many people.

As a cardiologist  , I am saying  this with anguish as our  team  along with  surgeons  work  over time to close intra-cardiac  holes  with device ,  the  holes in the road are often  callously  kept open   forming   death traps  for our children .The men responsible for such things deserves no  pardon.

The story is never ending . . .

borewell deaths 2

Post-amble:
Doctors are not just the  noble professional who provide relief  from  illness . They  have  other social responsibilities  too !
I believe ,  as physicians bound by Hippocratic  oath , we should  help tackle issues that threaten  our pubic health  system , especially in this case were the victims are  vulnerable children !
In fact ,  pediatricians should come forward to work with Govt to  improve safety  issues for children  and  orthopedicians  should help  prevent road traffic accident while  cardiologists  shall  work with the Govt to prevent  heart disease . . .  etc etc .
Though  bore-well deaths are  a pan India  phenomenon , One state in India ( TN)   has taken a   new initiative recently  and has  banned digging  bore-wells without prior permission and stipulated strict guidelines .Others can take a cue from here !

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medical morality

Tree of life : When professional morality suffers a mortality . . . human health becomes a causality !

Greatest threat to the future of  human health is  . . .

  • Not from  exotic  infectious agents , bird flu  or  mosquito  fevers
  • Not from  epidemic of cardio vascular disease
  • Not from  thousands of  published  diseases in ICD code
  • Not from  aging population and failing  vital  organs
  • Not from  lack of availability of life saving  drugs and devices
  • Not from  lack of  hospital beds.
  • Not from  good sanitation
  • Not from  hunger and poverty
  • Not from  lack of para medical workers
  • Not from  lack of health awareness and education

But from  . . .

  • The way  health care is administered in this planet .
  • The way  noble professionals are created .
  • The way  trivial health  issues prevail over  major  health crises  that  wallop the health budgets.
  • The way by which  medical morality is systematically destroyed
  • The way   “concept of  health” is  sold  as a  buyable  commodity by insurance companies.
  • The way  medical journals churns out  junk articles in the name of research.
  • The way corporates indulge in  delirious pursuit  to  increase  bed occupancy rate of their  patient  ware houses (Also called Hospitals)
  • The  way greedy drug companies aim to increase the per capita drug consumption of  ill informed  homo-sapiens  by discovering  pseudo  drugs for pseudo  illness
  • The way   health insurance policies are misused
  • The way  rich spend billions for reconstructive  cosmetic  surgery while the poor die for want of basic medicines !

 

Link to a wonderful  article  on moral education for our kids in medical school !

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April-May  is  carnival time in India . . . cricket carnival.  In IPL  . . . Indian premier league , eight teams  will fight for the cup . IPL 2013  became a  smashing  hit  , until  last week  when  three players were arrested for  spot fixing in  an  over . And for the past 10 days the entire Indian  media has gone into  manic reaction over it !

Still ,  the  sport was wonderful , the skills shown were extraordinary , and what happened  was an aberration just like in  any other aspect of life  .  IPL is perfect mix of  sports , business , commerce and some sleaze .  Actually in a successful  business model  , one should actually be surprised  if  corrupt  practices  does not occur !

The game of cricket can never be killed by money !  The way  the issue was handled by  the media and the  reactions and public debates   for me  looks irrelevant . Is it justified ? 

We the people and media has  much much important things to do in India !

scandals in india

Fixing a Fix  . . .

Politicians fix voters by giving money !
CBI is fixed by Government  for money  !
Media  fixes  news  for money !
Students of the noble profession are desperate  to  fix examiners with  money !
Finance ministry’s  annual budget  is fixed by business tycoons !
Private medical colleges fix entrance exams after getting money !
Super powers fix  terrorists selectively  for money for self benefits !
Drug companies  fix doctors with  money !
Doctors  fix  labs  by  getting money !
Anxious parents try to  fix  marks of their children  for  money !
Government  fixes  tender  for money !
Some Judges fix  verdicts after getting money !
Live kidney donors are fixed  by criminal cartels for money !
Advocates  fix  false evidence   with  money !
Police fix innocents as criminals after getting money !
Thousands of marriages are fixed  with  money after  hiding  illicit  relations !
Huge  bank loans are fixed  based on  false affidavits and  promises !
TV reality shows are fixed with mad money !
Even pilgrims fix  Darshan  time by  paying huge money !
And finally  . . . One cricketer bowled   one of  the  balls . . .wide . . . .  in one of  the  over after getting money  !
The whole world erupted !
cricket scam India
Postamble
Can  there be  any justification for  justifying wrong  things in life ?
  If life is a fight between  good and evil  , I thought  it is absolutely absurd to justify  it  until recently  . . . but a  great epic of  India , Bhagawad Gita  which is considered as the  ultimate guideline for living ,differs (Or is it my perception !)
The summary of the epic goes something like this
  • Whatever happened has been good.
  • Whatever happens is good
  • Whatever will happen is also good.
Bhagavad Gita  has one more sermon  to  confuse  us ( me )  completely !
“Do your duty , do not expect any  returns and do not watch injustice silently  , protest  and fight  it with your full  potential” !
I welcome  the experts  of the Bhagawatham  to clarify me on this issue !

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Ego can be a  great  motivator and destroyer as well. It has the  potential not only  to damage the self  but also the people in the near domain .This has been proven in all walks of life. Medical practice is no different . In fact ,it can have the more devastating effect as the victims are often the poor patients.
The medical ego can be individualistic,  departmental, institutional, etc.

Often in the dormant  form , can raise to gargantuan  levels when stimulated or challenged.  In its mildest form it occurs every day in the office practice. A physician  often thinks he is always right and fails to get a second opinion even in difficult  cases . Some where  along  the medical  curriculum  ,  doctors have to be taught that ,  what we know is only a fraction of what we are supposed to know ,  and  the importance of self auditing. This never happens in most medical schools.

Individual Physician ego

This exist in several forms . Ego with fellow colleagues is the most common type . Failure to accept a error in diagnosis is the most  frequent form injured physician ego. There are many instances doctors carry on with the wrong diagnosis tag (On their patients)  even after some authentic documentation is available against it. This especially happens when the correct diagnosis is made by  a junior colleague . Eg : “I still think it is a pheochromocytoma let us do the scans again”  Same tests  are repeated . In the intervening period  involves  treatment delay  and  financial costs for the patient. It is obvious , such an  ego in emergency rooms can be  disastrous .

Few doctors have a habit of asking for fresh set of investigations even if the patient has recent records of his illness . This is because many  feel interpreting   investigations ordered by other doctors is an inferior job .(Of course ,  financial incentives for repeating the  tests  could also be a motivation  )
Ego with paramedics and fellows

This is also quiet common. Doctors expect  their orders to be carried out at any cost.  They take it very seriously , if a nurse or a junior doctor behaves independently . This is understandable as it raises the fundamental question  who the  boss is ? !  But ,  the problem here is, even a smart move in the interest of patient is  not always relished  the physicians . (Because it is  perceived as an  insult to the consultant ) . You can’t act smarter than me !

We know the major responsibility  of caring a patient lies with staff nurses and  junior doctors .(It is a universal medical rule the consultant will be remote from the patient care unless of course it is needed).If the specialist exerts an  academic ego on them , there is every chance for the patient to suffer as  even vital interventions could be delayed.

(Eg :   Sir , I withheld  the beta blocker in  this  patient  as he  had a  bradycardia ! I thought it is  better to remove the urinary catheter as the patient was struggling with it  etc and etc )

I have observed  , even  some of the shrewd  directives  from the residents and junior doctors have elicited  big hue and cry from some of the renowned physicians of our region.While many   recognise the good work done by the junior colleagues  , still  their  ego does not allow to  appreciate and complement them . This is not a good sign for the  medical professional .

Specialty ego and departmental ego

This is new phenomenon . Traditional ego was between surgeons and physicians. Now , with medicine growing leaps and bound there is probably a medical and surgical specialty for every human organ . This helps the physicians ,  to shrug of the collective responsibility . It  has become a  dangerous trend in many institutions.

God created  human body as a single entity  . Specialists  share their  organs  , convert a  human body  into a commodity (Has to  make a living out of it )  As the medical science is branching out at a phenomenal rate  it becomes   a difficult task for them  to come to the rescue of the patient when they need a collective intervention  . Further , conflicts of interest and ego clashes take a front stage.

Even in an  academically and ethically superior medical center it is a  herculean task to arrange   for . . .example
An ENT surgeon and neuro surgeon to operate a nasal tumor together.

A hybrid procedure of PTCA and CABG (Could be very useful in many situations)  can not be practiced  that easily .

The issue here  is not simply logistic .It goes beyond that . . .

(Why should I  sweat for some one else’s fame ?)

Institutional Ego

It has a peculiar issue .The  admitting  physician is  vested with supreme powers – he becomes  the sole caretaker  for the given  patient .Though it fixes responsibility , it has a potential  risk , as this  patient automatically  becomes untouchable for other consultants . There are centers in which even intra departmental  consultations are lacking .I know at least a handful of cardiologists who  do not talk with each other  even at times of crises in cath lab. This is more prevalent in fully commercial institutions .

In this regard  group practice with fixed financial remuneration may be a  lesser breeding ground for ego clashes.

Another form  egoism may be financial  discrimination , which  is seen in some of the big corporate hospitals . There are instances some doctors and institutions  shy away poor or relatively poor  patients .There are institutions which feel allowing entry to   less sophisticated public  inside  their premises is detrimental to their reputation and ambiance.  

Ego issues with patients.

Generally doctors show great respect for their patients. Information sharing is the major issue. What to tell and what not to,  can  some times reach really difficult proposition. Does the patient have a right to criticize the treatment ? Whether you like it or not some patients do it .

Few suffer from a  worst  form of physician ego , that is directed  against their own  patient. Doctors are  rarely  comfortable when patient ask probing questions.This is acceptable in few instances. The root of the problem is doctors rarely accept their ignorance .

There are many instances  where a consultant   refuses  to see  his own patient  once he  gets  a second opinion from another doctor . It need to be realised  this is actually the fundamental right of the patient he is executing .No need to get offended .

Why this ego ?

It is the  part of normal human psyche. There is no reason to believe doctors  are different . But the following could be unique factors .

  • A subconscious feel of  ” demi god” status  conferred  by the patients .
  • Failure to have an open mind approach .
  • This translates into fixed ideas about a patient and his illness.
  • This is especially common in countries  where , single doctor or a family of doctors run nursing homes .

The other substrates  for ego growth among physicians are

  • Academic  excellence
  • Practical skills
  • Popularity in the society
  • Financial superiority

Negative ego : A feel of inferiority also creeps in for many physicians  who  find to hard to acquire the above .And this  can  have  a serious effect on  the patients .It is  shocking to note many of  the academically incompetent  have a strong  dose of ego .This is most dangerous for the society.   A deadly combination of  incompetence  and arrogance

What is to be done ?

  • Containing  the  physician egoism  could be more important for doctors  than attending to  sophisticated CMEs and conferences and workshops .
  • Counseling is required for many .
  • Behavioral science with the specific tips for  self-regulation is to be included in the basic undergraduate medical curriculum
  • Courage to tell the truth to their patients to be imbibed.

Final message

Hippocrates said some 2000 years ago the fundamental quality of a doctor  is  to accept his limitations and ignorance .Every action of his or her, should aim  only at removing the suffering of the patient .

Now we are in the era where , market force  have literally hijacked the medical filed  . A  medical degree  can be bought in a weekend university shopping (At least in India it is possible ! )  .

In this scenario  if our students grow with one more wise  ie “hyped up ego”  one can imagine  where our profession is heading for !

We need to initiate a debate on the issue . And there need to be a movement to cleanse  the contaminated profession. It should be  in the league of nuclear  treaty ,  war on terror or the global environmental protection.

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