Posts Tagged ‘hippocrates’
Today , November 2nd 2013 is Deepawali , Nearly 1 billion people celebrate it
Deepawali is an ancient festival of lights , millions of Hindus celebrate It with sanctity.
It is a war on darkness and ignorance .On this day goodness prevailed over evil (Asura)
Unfortunately , In the current versions , it would seem Asura’s also join Deepawali celebrations and enjoy it with more vigor ! which is supposed to eliminate them !
Please ensure , that doesn’t happen . . . at least in your domain !
God is supreme . . . he will never allow the evil to take over the world ! Be a soldier to God’s Army !*For more about this great Hindu festival click on the Link here Deepawali
Posted in Cardiology -guidelines, Cardiology -Interventional -PCI, medical quotes, Two line sermons in cardiology, Uncategorized, tagged cath lab ethics, ethics in medicine, hippocrates, primum non nocere on August 31, 2013| Leave a Comment »
The doctrine of modern medicine goes something like this . . .
For most medical problems , there would be a solution. Keep trying . . . till you get it !
*But , just make sure that problem on hand deserves a solution in the first place !
Modern medicine continues to remind us every day , the much hyped solutions often end up in new problems and many times worse than the original problem !
Oh ! what a great a quote ! When I was boasting myself . . . My wife reminded me , this is just plagiarized version of a 2000 year old Hippocratic thought !
But , Hippocrates’ life was not contaminated with drug eluting stents, I pads, and BMWs
If Hippocrates arrives in cath lab today by BMW which sucks 50000 Rs EMI ,Everolimus coated coronary jewellery will definitely tempt him !
You can’t simply compare lives separated by 2000 years
. . . I told my wife !
Posted in Cardiology -guidelines, Cardiology -Interventional -PCI, cardiology-ethics, Uncategorized, tagged acts of commision is also a medical negligence, cardiology ethics, hippocrates, inappropriate medical care, medical ethics, medical negligence on February 28, 2013| Leave a Comment »
The irony of modern medical care is 9/10 times medical negligence is defined in terms of acts of omission in required level of care . In reality most medical negligence acts are related to knowingly overdoing a futile diagnostic or therapeutic modality.
This irony was never understood by the public, the professionals or even the judiciary .This remains the most dangerous issue facing modern medicine !
Finally some light is appearing in the horizon . A Missouri Cardiologist is suspended for overdoing things he knows best . . . namely coronary stenting !
This may bring chills over many cardiologist’s spine .
Posted in Cardiology -guidelines, cardiology -Therapeutics, cardiology-ethics, tagged appache score, critical care medicine, critical care outcome, ebm, evidence based chaos, evidence based verses experience based, hippocrates, modern medicine on February 8, 2013| 1 Comment »
Critical and intensive medical care is meant for supporting an individual organ (or multiple organs ) at times of extreme distress , till the healing process prevails over .Later , the patient shall be shifted safely out of the unit .
Whatever be the modern technology , the single most important factor that determines the success of ICU outcome lies within the patient body ( One estimate says patient factor constitutes almost 85-90% -Dukes medical center )
Ironically , the modern gadgets, drugs , devices threatens . . . rather fights . . . with this inherent patient fighting mechanism . We will never-ever know how many cellular switches are turned on by our biological high command , that compensates and tries to restore body homeostasis.
Here is a personal experience with a patient management scenario in an ICU . The patient is none other than my father !
He is a 82 year old man who has developed a acute febrile illness which rapidly degenerated into acute respiratory failure and X ray showing infective bilateral pneumonia and probable ARDS .He was on ventilator for 4 days and subsequently weaned off but still heavily dependent on oxygen . His lung is wet with crackles and wheeze intermittently . His cardiac function was excellent . In one of the episodes of hypoxia he developed , mild shooting of blood pressure and minimal ST changes . Alarmed by this he was started on beta blocker , for the first time . It was titrated up to maximum doses for a suspected ischemic episode .
It is well-known , ECG changes are extremely common in hypoxia , tachycardiac stressed individuals .
Sympathetic blockade is important , only if , it is an inappropriate surge . When the body fights a disease it is the only major biological weapon available to him .How is it justified to block it ?
When this was discussed with the team they said they have no power to deviate from protocol and there is one article , that says BBs are beneficial even in COPD !
The patient continues to be in ICU dependent on oxygen with extreme ICU fatigue definitely worsened by the heavy dose of adrenergic blockers which is in my opinion delaying recovery !
Different organ specialist are prescribing drugs according to their level of understanding (evidence is always available for them . . . some where ) and radiology fellows keep taking snaps of distressed organs in various angles in HD quality images . Meanwhile , CT scan seems to have revealed a chronic interstitial process . . . how to diagnose a chronic lung condition in a man who is yet to recover from major acute inflammatory lung Injury ! I do not know ? And the current development is they are considering disseminated tuberculosis !
You may a big physician , the patient may be a very close family member , modern health care system makes you watch helplessly once you hand over patient to a complex care unit .
We hope for the best .
Medical practice . . . however intensive the care may be . . . the bottom line is . . . it should be based on common sense . Modern medicine tends to make this faculty of our brain blunted .
The specialty of Intensivist is largely misunderstood . It goes more with satisfying scientific egos and public perceptions rather than true patient needs .
We need not react to every changing parameter that emanates from the modern machines that keep sending out live data from a seriously ill patient , on a moment to moment basis ! (We simply do not need that ! If only a pilot reacts with jitters to every air pocket turbulence , he will not reach the destination safely ! )
From a cardiologist perspective , the humble request to all Intensivists and critical care physicians is , avoid being in “fire fighting mode” for all those subtle ECG changes that occur in ICUs , especially with multi- system disorder (Caution : Acute coronary syndrome in CCU / post PCI set up is different story altogether where even a minor ST shift can be significant ! )
Heaven’s sake let us rely more in our brain rather than the machines and devices !
Above story is not even a tip of an Iceberg . I come across it every day in many ICUs I visit . The most saddening aspect is , we can not point out these mistakes to our fellow professionals , as it amounts to hurting academic egos .They are more important than patient care at any given point of time !
For any system to work , it needs a strict set of guidelines , other wise the system of care will fail. This is a fundamental basis on which modem medical care works . The only issue is , we should keep checking for any inadequacies in the evidence base and try to correct it. So do not blame the EBM . It has come to stay .That is the future ! You are very pessimistic towards modern science !
Rapid response to counter point
But the real issue is . . . by the time next evidence base finds a major flaw in the existing system of care , damages are already done . So with your clinical acumen every learned physician is free to create his own real world experience .(That is also called Level 3 evidence now ) ** Protocols are not sacred sermons . It may be (rather must be !) violated if there is a need for the benefit of patient .
* This is not an attempt to disgrace the concept of intensive medical care . Please remember , finding fault could be same as finding facts .(At least in medical care )
Update ( February 24th, 2013 Sunday , 12.05 AM )
After 25 days of intensive and aggressive medical care we lost one of the great lives
of modern times which will be celebrated by his sons and daughters forever !
Posted in bio ethics, cardiology journal club, tagged britsh medical journal, cochrane nordic data base master medical check up, hippocrates, land mark article, master medical checkups, medical ethics, primum non nocere on December 31, 2012| Leave a Comment »
If you are a doctor and whatever be your specialty . . . if you do not read this article and understand the nuances probably you will not become a complete medical professional !
While BMJ struggles to propagate a vital truth , this banner on a Indian high way tempted the public to go for 64 slice CT scan . . .just like that !
Accruing medical knowledge and skills is only one aspect of medical profession. Applying it properly in our patient population is entirely different ball game . Let us be disease curers and not disease hunters . This is important because disease hunting is a dangerous game , where victims can be innocent bystanders. This is exactly same thing Hippocrates refered to as Primum non nocere 1000 years ago. It has required a huge statistical study to RE-INVENT this universal fact !