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Posts Tagged ‘medical ethics’

It needs “lot of discipline” to cross the road called life !

Posted in great illustrations in cardiology, Infrequently asked questions in cardiology (iFAQs), tagged , , , on January 14, 2012| Leave a Comment »

 21’st  century  Human beings  on the road !

                              A scene  from  Jaipur’s   main commercial  road

Lame  ducks on the road !

             My all time  favorite  news photograph taken  from a Tamil  daily Dinakaran

An After thought

In this fast and furious world ,  the medical profession  too suffers from the same disarray like  the  Jaipur traffic !

  • Let  us prey  for the   Noble professionals  to be  blessed with  more   discipline,  character , conduct  and  knowledge ( yeh . . .knowledge  ranks  last and least !)  .
  • Let us be focused on task .
  • Let us  also  prey for the strength to differentiate  facts from fiction,  distinguish trivia from  the momentous.
  • And finally let us  have the courage to follow the truth !

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And the “sickness” award goes to . . . that frail man in check shirts with an extensive diabetic foot !

Posted in Uncategorized, tagged , , , , , , , on December 14, 2011| 1 Comment »

There were times medical  profession’s  only purpose was to take care of the sick . Modern  principle of living  has contaminated  every walk of life .Medical profession  leads  by example in this race .

How can one justify celebrating a disease in a grand manner in public domain  in the name of increased awareness  ?

I am shocked to find an ad in a recent  The  Hindu Ad  (25-11-2011)

Some of the words  used are terrible and highly objectionable . It amounts to an  insult to all diabetic patients.

  • Diabetes award !
  • Diabetic  Carnival !
  • Join us in the fun of diabetes !
  • Glitz and glamor of diabetes!
  • Festival of diabetes !

How can a patient celebrate his illness ?

I think  the news paper  which  publish such ads  should also show some sensitivity .

I agree there are lakhs of diabetic patients who do require  intensive treatment  but the fair held in the air conditioned corridors of  a trade center is  never  going to address  this issue.

( Can I ask these organizers to  help and  serve the real diabetic burden in ill equipped public hospitals  across  our state ? )

It  is simply a commercial extravaganza   creating a fear complex among the healthy , rich men and women and make a living

out of   human anxiety . 

Who sponsors these medical  award nights ?

For those who are unaware  of the games doctors and pharma companies play,  here is a shocker – large amounts  of money is pumped into  such public events.

This is part of  a  larger board  room  strategies ( Can it be a conspiracy  !) to increase the per capital consumption of drugs of our population . And no doubt   doctors are integral part of this scheme with or without intention .

While MCI can penalize  a individual doctor  even for accepting a pen as gift from pharma company ,

they can do nothing but simply watch  as millions are  exchanged  in the name research , health education ,  and awareness .

The height  of  the  irony is  , these events are sponsored by WHO and the world  forums as well  !

Ironically   the  doctrine of  modern medicine  seems to suggest   . . .“Ethics is   primarily for individual physicians and do not  apply   for institution ”  This is the single   most dangerous  concept that is  playing havoc with human health”

It closely mimics the principle  of   war justice  . An  individual shooting another individual  is a definite  crime ,  while  multiple  individuals  killing  multiple   individuals   is not a crime , it is a war !

Disclaimer

The author has no  personal grudge  against any hospital or organization instigation. It ‘s   an expression  against so many commercial activities that occur  in the medical filed on day-to-day basis !

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200 years of Inappropriate cardiology care !

Posted in bio ethics, Cardiology - Clinical, Cardiology -Interventional -PCI, cardiology -Therapeutics, Cardiology -unresolved questions, Cardiology-Land mark studies, tagged , , on July 14, 2011| Leave a Comment »

It was  the year 1812 ,  exactly 100 years before the Titanic sank  over the Atlantic  , a  small bulletin from  Massachusetts General Hospital was  released .  It  later on became  the  single most  important  journal  for the medical community.  The appearance of  an article about  angina pectoris in the inaugural issue ,   reiterates the  importance of cardiology  even in those   days of primitive  medical care .

The volume. 1  : No. 1  issue of NEJM egan with a classical and critical observation of angina pectoris written  by Jhon Warren .

http://www.nejm.org/doi/pdf/10.1056/NEJM181201010010101

The first issue of NEJM . . . Witness to 200 years of medical excellence

Those were the days  when angina  was treated with tincture  opium and Fowler solution (Arsenic  potash ) .They  can be  termed as  height  of  inappropriateness  and  also  condemnable acts  . . .  is it not  ? 

200 years  later   . . .  in 2012  what  do you think has changed ,  in terms   of  appropriateness  of management   of angina pectoris  ?

What a surprise ,  two centuries  later ,  even as we are  treating  angina  in hi-tech cath labs  with bio-degradable stents and metabolic modulators   ,   bulk of our  population is  grappling with inappropriate therapy for angina pectoris .

Today ,patients are subjected to  questionable modalities  in the management of CAD ,  which the following paper   tries to expose !

Keeping the inappropriate flag high . . .200 years later in 2012


What a way to progress in Medicine !  The reason for this  “200 year  old ailment”  is  attributed to  extreme scarcity of common sense !

( A study , which says regular exercise  can be  as good as PTCA in multivessel CAD ,  would  sound  as a  “nonsense article”  for most  cardiologists  of  current  generation  !)

Finale

When we look  at human history , where billions  lived ( and continue to live ) in this  age old planet , it  would appear  a trivial matter  whether you treat angina pectoris with Tincture opium / Arsenical potash or  Prasugrel  / Rosuvsatin . . .

Whatever be the scientific advancement  the ultimate outcome on human health will depend on how we apply it. So, all young  medical fellows beware of this   !

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Why cardiologists would love to outsource history taking and physical examination to para medics ?

Posted in Cardiology - Clinical, Cardiology-Coronary artery disese, cardiology-ethics, Cardiology-Land mark studies, critical care ccu, tagged , , , on May 18, 2011| Leave a Comment »

Most important MCQ in clinical cardiology

Many cardiologists  would love to do away with detailed  clinical examination because  . . .

  1. They think it is an inferior job to do  . By skipping  it , they get a false sense of superiority.
  2. It is a time killer  and eat into precious cath-lab  time
  3. They no longer believe in  these “perceived – primitive” medical methods.
  4. Fear of colleagues making  fun of hem if they  indulge  in detailed clinical examination.( At-least in India ! )
  5. To give more job opportunities  to para medics.
  6. They are no longer confident about making a good clinical examination as they  are neither  trained  adequately nor interested in it !

Answer :  All of the above can be true .  The 6th response is  likely to be  more  correct !

While cath labs can prevent few deaths occasionally . . . it is the general wards and OPDs that add life every day

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Discontinuing medical education : Why current medicine is often not the correct medicine ?

Posted in Cardiology - Clinical, cardiology -Therapeutics, cardiology innovation, cardiology-ethics, history of cardiology, tagged , , , , , , , , , , , , on May 16, 2011| Leave a Comment »

One of the greatest medical sermon of our times  is   “Doctors must   constantly update their knowledge , Continuing medical  education is as sacred as their profession  !  If you are not updating your knowledge you cease to a doctor “

It is fashionable , but true  to state  modern medicine lacks humane  care . Modern medicine  is  challenged by a huge  technological ,  commercial  onslaught  where common sense takes  the back seat

Hence , doctors need to renew not only  their  academic competence   but also  their ethical  fitness  every  year !

Aggression  could be the other  name for  modern medical care . For every  new  invention , treatment   or guideline that  is  approved  an equal number  is shelved after few months or years  for safety reasons.

Bulk of  medical updates  for  current age physicians  is nothing , but asking   them to forget  all those wrong things that has been meticulously uploaded in their brains in the recent past  ( Recall the classical story of drug eluting stents )

If this is the  case . . . then  . . .  what for  we  are  updating ?   and  for what  we are  learning and forgetting  ?  and  . . . how frequent we need to forget ?  Of course  , there is a big chunk of   human tribe  who  can never master the art of forgetting ! Some mistakes are permanently etched in their terra byte hard disks .

Is there a place  for backdating and discontinuing  medical  education  ?

What  man- kind needs  at times of  medical  crisis  ,  is  not  the current  treatment  but the correct  treatment    .It is our duty  to  find  all those  trustworthy  drugs  & treatment modalities  that were  sent  to  the gallows by the modern medical forces   for various reasons !

If  some of  the gems in  medicine are  left behind in  past  “time domain”  ,  it is  mandatory  for us  to go  back in time and   catch it , adopt it and disseminate it !

Further ,  whenever  the  hyped   “medical updating sessions ”  turns out to be  synonymous with adding nonsense (It is  becoming all too common these days   !) we should resist   it by all means !

For many . . . Hippocrates and his medicine sounds dirty now !

If  only we back-date  our knowledge   .  .  .

Todays  youngsters  can learn a secret that liver enlargement can be diagnosed easily  with their  hands ,  without  waiting for a  CT scan report !

If only we back-date  our   knowledge  . . .

We can realise  Aminophylline can save so many  lives of cardiac  failure  , which  our newer inotropic agents are struggling to accomplish .

If only we  back- date  our knowledge  . . .

We can calmly manage  acute MI with lignocaine  even in a country side  .  Amiodarone unfairly replaced  this  efficient  anti  VT  molecule  for no academic reasons !

If only we back- date  our knowledge  . . .

We  can  advice simple non pharmacological intervention for  stage 1 HT   than prescribing the  glamorous  sartan molecules  form a  multinational  ARB shoppe.

If only we back- date our knowledge  . . .

We can  promptly recognise  cardiac failure  without  ordering  for the error prone   BNP . Back dating also  helps us to under stand  that post infarct angina is a  glaring sign  for presence of   viable myocardium  and prevent us from undertaking a  2000 $ PET  excursion !

If only we back- date our knowledge  . . .

We can  send  all our uncomplicated , asymptomatic   STEMI  patients ( in class 1 )  straight to  their  home rather than to cath lab  play grounds !

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Why the future looks bleak for our patients . . . unless some drastic things happen !

Posted in bio ethics, medical quotes, tagged , , , , , , , , , , , , on February 1, 2011| Leave a Comment »

It is often said optimism is key to success . From the patient’s and physician’s  perspective   it is the willpower that has saved many lives. Positive minded patients  do not die without fighting. We  know self belief can do wonders in medical  care  !

If  self  belief is  the ultimate healer ,   trusting the   doctor  and  the hospital  are  equally important  . Patients believe in  doctors and doctors believe in science . Science is not sacred .It is man-made   .Those men  who create  science  need not be  holy  either !

Can  we  trust modern medicine in the current form  ?

I am afraid the answer is  too tilted towards  . . . “No”   I am not a pessimist  in the strict sense  . However ,   the future   looks bleak  in most places  ! unless some strong remedial measures are under taken.

Statistics   suggest , patients  are  rapidly losing   the belief   in their physicians   ,  considering the track record of our  health care management in recent  times . Global trends in the last 5 decades indicate the health care delivery system has gradually  been  hijacked from the Govt to the private hands.

It is  quiet a shocking  revelation ,   the private  sector  health care  has done  more damage  than  the state   driven health care . How  foolish   our expectation  can  be !   For fulfilling the millennium  goal ( Health for all )  most  countries  have  handed  over the  baton  to the  greedy corporates .

How on earth , one can expect  the   private / corporate  sector  to provide  equitable health   for all  . It  would be wealth for all  those involved in  this flawed medical care  system  at the cost of  poor !

Read this book  . . .To understand the nuances of how our health care industry is bulldozing  , like an army tank into the population  and  most of us  is a victim or a partner to this .

Click here  for  the  Book review

From The Hindu January 2011

Final message

Entry of capitalism into health sector is probably the worst  infliction   man kind  has suffered , than all those deadly viruses and bacteria   over a last few centuries !

Medical science is a phenomenal  gift  created , nurtured and grown by the sixth sense of our ancestors .Their only aim was to provide relief to the sufferings.  Now their dreams,  vision and goals lie  shattered .

No hospital  has a  specialty called  “humane care”  , while  many  have  a separate  department   to  do a  neuro  metabolic imaging    for a  depressed  man with Alzheimer  disease   in his nineties   and  a  Bio – Robot  driven    fuzzy logic  lab   to  predict cardiac  events  in a soon to die rich man . Absolute waste of resources !

There is  no doubt , we have become a  sort of  salves to  science  . . . (Irrational science to be precise ! ) It is a man-made monster.  Even a most conservative person  (including the author )  could    be causing  some damage as we  are forced to follow  the unruly scientific publications .  Probably  . . .yes . . . we can’t eliminate  it   but   identify  futility of modern science try to get  rid of it . !

A related article

Those were the days   . . .  When doctors practiced medicine  . . .and much more  . . .

A  wonderful  piece of writing   by Dr Susikaran  Thangasamy from the open pages of  India’s national newspaper

‘The Hindu” http://www.thehindu.com/opinion/open-page/article1137935.ece

What is the remedy ?

First of all , every one should answer this question to their conscience

What ails  our health care  system  today ?

Do not be part of it . . .  solutions  will come automatically !

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The paradox of “high cost” low quality medicare !

Posted in Uncategorized, tagged , , , , , , , , , on October 4, 2010| Leave a Comment »

Medical science is  not like mathematics or economics .

  • It is about how a  bundle of human cells(organs) behave at times of adversity .
  • It is  about how our mind  takes on the body .
  • It is also   about , how the care takers  Heal/Manipulate /Manhandle  these cells at times of distress !

We know, two persons with identical injuries , sustained in a car crash one dies within an hour  , while the other with a  many fold serious injury successfully fight the trauma and walk out of hospital with victorious  .That is the fighting spirit .This  is either  inherited  are  nurtured or both.

This implies , an accidental injury may be an  external , unpredictable  event,  while the  response to  that injury is predetermined or even a predictable response !

In the name of modern science , we “the human animals” are trying to buy this fighting spirit  with money.We are made to believe ,  survival and well-being is a commodity and  can be  bought with high cost  medicines , and high cost care .

Remember  , one of the most astonishing medical  fact is , while we  may struggle to induce  swine flu  in  a laboratory on a given  individual ( Even if ,  H1Ni  viral  concentrate is  infused or inhaled  )   , an  other person gets this disease  , while simply  flying over an  infected country  . Such is the complexity  of  the host response  system in medicine .

So , it is foolish to think health can be bought or maintained  with  money power or modern hi-tech medical care .At best it can save   few lives  with  its   life supporting drugs and devices . Ultimately,    human survival  is determined  by the way we  live  and the way  our  ancestors lived and how we fight the illness.

Yogi’s  of  Himalayas lived for more than 100 years without the need for drug eluting stents and LV assist devices .

Having totally misunderstood  the concept of health and illness the world is wondering how on earth , we can reduce the escalating cost of  healthy living  (pseudo health  !)

An article in the current NEJM ponders over ,  Why in  Grand junction,  Colorado ,USA ,  the health care cost is very much lower ,  without compromising the quality of life and survival.

The answer is very simple .There is some body in that county , who  dares to think beyond  raw  science  and adds  little  bit of common sense ! Obviously he has to be rewarded and  this  model need to be replicated  elsewhere.

http://healthpolicyandreform.nejm.org/?p=12706

This article discusses the phenomenon  of  high quality , low cost medical care , but what it misses out is , the reverse could also be true !

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