April 24, 2009

Refusing emergency patients

The Supreme Court judgment had made it mandatory for hospitals to provide medical intervention under any circumstances, but many hospitals and other healthcare institutions are not following the order.

Hundreds of people die for want of timely treatment. Increasingly, rules and procedures are over-riding the concept of `Save life', and accident victims are the worst hit.

Hospitals' reply

In a situation of medico-legal case, it's mandatory for the hospital to register a case, inform the police, document injuries in several registers, attend courts as and when called for and provide certificates and other papers.

According to many hospital managements, it's a cumbersome process. Doctors must be physically present for inquiries and court hearings, which consumes a lot of time.

A study by NIMHANS found that medico-legal issues were a problem for hospitals because they feared police and legal investigations. Dr C R Chandrasekhar of NIMHANS, who deals with forensic psychiatry cases, said it's the duty of hospitals to take up medico-legal cases.

"Hospitals can't refuse and should help the court. The life of a person is far more important than legal formalities. Avoiding medico-legal case is a crime under law. In 2007-08, of 11,500 neurosurgery cases, 75% were medico-legal cases in NIMHANS," he explained.

Difficult for doctors

Doctors say it's not a pleasant job for them to wait in court and stand in the witness box, where his/her credibility is questioned. "These are long legal procedures, where we have to face many cross examinations," Chandrasekhar said.

Also, many doctors say it's easier for private hospitals to refer patients to government hospitals because the former is not under government control.

Who pays the bill

"In 70 to 80 per cent medico-legal cases, patients are unable to pay for their treatment. Many a time, the person who has brought the patient to hospital doesn't come anymore as he has to foot the bill," RMO of Sanjay Gandhi Trauma and Accident Hospital Dr T Prabhakar said.

A majority of patients are migrants and don't have salary certificate, ration card, etc, without which treatment cost can't be claimed from the CM's Relief Fund. "Hospitals have no choice but to waive the cost. At least patients should have some insurance cover to face any crisis," he felt.

Sanjay Gandhi Trauma and Accident Hospital receives 8 to 10 medico-legal cases every day. The hospital doesn't admit cases related to gangwars, assault, head and burn injuries. In case of injuries related to gang wars and assault cases, if the nature of the emergency is severe, the hospital gives primary treatment and stabilizes the patient before referring him/her to other hospitals. "In such cases, legal formalities are much more complicated," a hospital source said.

Link: Original Article

April 21, 2009

World Alliance for Patient Safety - An initiative to encourage hospitals to report medical errors

With medico-legal cases against hospitals and doctors piling up in consumer forums, medical practitioners say it is time to look inwards rather than fighting a never-ending legal battle.

Medical errors like leaving a mop in the patient’s body, operating upon a wrong eye, administering wrong injection, overdosage of medication etc that have become nightmarish for patients have frightened doctors equally.

Such incidents, which go unreported, will now be quietly recorded and reported to an independent body in an attempt to streamline and improve the healthcare system. All this, however, will still be voluntary.

“Patients or the aggrieved party term it medical negligence but in many cases these are medical errors, which are beyond the capacity of the doctor to reverse. Fearing a legal case, doctors do not report it to hospital administration or any scientific body,” said Dr Nikhil Datar, gynaecologist.

Hence, to encourage hospitals to report such cases, the Indian Confederation for Healthcare Association — consisting of many medical associations and representatives of various associations, nurses, hospital administrators, patient groups and NGOs — met at civic-run KEM hospital on Sunday. The Association launched a patient safety initiative, probably one of the first organised efforts in this direction, under the aegis of the World Health Organisation theme — ‘World Alliance for Patient Safety’.

“We want hospitals to report errors, even if it is done confidentially, so that we can identify problem areas and work on them. It won’t be a about a stamp of approval as much as a real effort to gain excellence in healthcare,” said Dr Akhil Sangal of the ICHA. He cited the example of an initiative of voluntary reporting in the USA, where bloodstream infections across hospitals were reduced by 66 per cent.

“Doctors in the west have started sharing information in confidential meetings. Information shared in these meetings is not taken as evidence in the court of law. This encourages doctors to openly discuss errors and prevent others from repeating them,” added Dr Datar.

Reporting medical errors will be a win-win situation for both the patient as well as the doctors. Maharashtra has already taken a lead to protect the patients by including a clause in a recently-approved ordinance protecting medical establishments against attacks.

Link: Original Article

Is your Medical Lab accredited?

At times, you may have been perplexed about divergent health reports provided by various labs. Reason? Not a single government hospital has an accredited diagnostic laboratory in India.

Of 1 lakh labs across the country, a mere 136 are accredited by the National Accreditation Board for Testing and Calibration Laboratories (NABL).

"If a lab is accredited, it doesn't mean it's competent to do all tests," said Quality Council of India adviser Thuppil Venkatesh.

"Individual tests are accredited and every lab must explicitly mention the tests for which it doesn't have NABL accreditation."

According to him, patients themselves should insist whether the lab is accredited, or the test they would be getting done is also accredited. "A good thing now is that corporates reimburse for medical tests if they're done in accredited labs," he added.

Reports that come with `NABL' logo and certificate number are proof that the tests are accredited. Medical lab accreditation is done only through NABL, an autonomous body and government-authorized accreditation body, and it's a voluntary process. However, accreditation of clinical laboratories is not mandatory in India.

Accreditation needs to comply with particular requirements for quality and competence as per international standard. All staff should be trained, instruments calibrated and observations documented.

"Many labs in India don't go for accreditation because it's expensive. Also, there are no qualified staff. So everyone is going easy," said microbiology professor S Muralidharan.

Link: Original Article

April 19, 2009

New sensor to check medical equipment hygiene

Worried if the hospital equipment being used on you is hygienic or not?

Now leave behind all worries as British researchers have claimed to have developed a sensor which will prompt you when the instrument is infected.

In this new process, a high frequency sound wave is passed through a disinfecting liquid to create bubbles that implode. The force of each implosion removes contaminate particles from surrounding materials.

The sensor developed by National Physical Laboratory (NPL) monitors the acoustic signals generated when the bubbles implode.

Till now, cavitation was one of the most effective cleaning process used widely by doctors and dentists to clean and disinfect surgical instruments.

But there was no accurate method of identifying how much cavitation takes place at different locations in a cleaning system, and, therefore, no measurable way to ensure whether the cleaning process is effective or not.

The sensor listens to the bubbles as they collapse and uses the sound to identify how much cavitation is taking place at a given location.

"Cavitation is a powerful process but until now users have had no way to measure exactly how loud to shout in order to get a useful amount of bubbles, nor been able to quantify how energetic those bubbles are," he adds.

Until now the only way to ascertain cavitation rates was to lower a piece of aluminium foil into the liquid and count the number of 'dents' caused by bubble implosion.

"They've previously had to rely on trial and error. This is dangerous when you are dealing with cleanliness in medical environments, and a waste of energy. The NPL sensor provides a new tool for improving cleaning systems and aiding instrument hygiene," says Hodnett.

The new sensor comes with an added advantage, it helps technicians to fine-tune and optimise equipment so that only required energy is used thus also reducing costs and environmental impact.

The device recently also won the annual Outstanding Ultrasonics Product award from the Ultrasonic Industry Association.

"To spark cavitation we use ultrasonics to 'shout' at a liquid. Our sensor then listens to the response and tells us how much cavitation is taking place as a result of using that particular stimulus," explains Mark Hodnett, a Senior Research Scientist at NPL.

Link: Original Article

Medical device makers oppose quality norms

The extension of quality norms that govern the manufacturing process of drugs to medical devices in recent amendments to the country’s drug laws has left manufacturers of stents, catheters and orthopaedic implants nonplussed — and even angry.

Following the amendements to the Drugs and Cosmetics Act, state drug inspectors are insisting medical devices firms that make catheters and IV cannulae install facilities similar to the ones in a drug manufacturing company.

“State drug regulators are harassing us. They expect even orthopaedic implant factories to install refrigeration units, just because drug manufacturing units are mandated to do so,” said Hindustan Syringes & Medical Devices joint managing director Rajiv Nath.

“The requirements of a medical device manufacturing unit and a drug manufacturing unit are different. You cannot regulate both with the same yardstick,” added Mr Nath, who also heads the Association of Indian Medical Device Industry.

The Haryana drug regulator recently ordered medical devices firm Mecmann Healthcare to shut down, and one company official said a major reason for the regulator’s action was Mecmann’s failure to comply with the provisions for the manufacture of pharmaceutical products under the Drugs & Cosmetics Act.

For medical devices covered under the drug law, companies are required to take a licence from state regulatory authorities to manufacture and sell them in the country. While the licence is a mandatory to export medical devices to west Asia, south-east Asia, Africa and CIS, only ISO certification is sufficient to export to the US and Europe, Mr Nath explained.

According to medical device manufacturers, the industry is facing problems due to absence of clear regulations and necessary licences. The companies claim that they are bearing losses as they have been unable to export for six months now.

“Less than 2% of the 700 units have been registered in 20 years,” Mr Nath added.

To put an end to its woes, the industry has sought central government’s intervention to form separate guidelines for orthopaedic and ophthalmic devices. The country’s medical devices industry is estimated at $2.17 billion today, and is estimated to reach $4.97 billion by 2012 at a growth rate of 15% a year.

Link: Original Article

April 15, 2009

Patients gain as doctors befin 'Group Practise'

When Mahendran (name changed) was referred to the Apollo Hospitals, Chennai for a surgical intervention, he was surprised to note that his medical record mentioned him being admitted based on a recommendation by the Surge group', and not by an independent doctor.

The Surge (surgical gastroenterologist) group, formed a month ago at the hospital, comprises three surgical gastroenterologists, including one laparoscopic surgeon. As is done in the US, the group handles patient care as a team, and amounts billed and received are shared. The big advantage for Mahendran: he not only received three expert opinions about the surgery but also round-the-clock service from specialists, all for the fee he would have been charged if he was referred to an independent consultant.

"It's not easy for doctors working independently to give round-the-clock attention to patients," says Dr T K Neelamekam, consultant-surgical gastroenterologist, Apollo Hospitals. He is a partner in the Surge group. "There are times when you have to operate late into the night. After such long surgeries, doctors either push themselves to come and check the patient's condition the following noon or leave it to their assistants till they return the following evening. It is not fair on the patient. It's also unfair to ask doctors not to go on holidays or take a few days leave. When a group of doctors practise, one doctor is always there to take important decisions."

In Chennai, group practice has become increasingly popular among doctors over the past two years. Apollo, for instance, has a group of anesthetists the Delphi Anesthetics and Pain-management (DAPS) group that works as a team.

In many maternity hospitals, group practice has become an unsaid rule. There are times when a patient lands up in labour and her consultant is not around. To avoid this, hospitals now try and ensure that all doctors in the group see the patient by turn when she visits for monthly check-ups.

A few oncologists that started group practise in the city about two years ago have been successful. Says leading orthopaedic surgeon Dr George Thomas, "Unfortunately, it is not easy to evolve as you need like-minded people. I was impressed with the way it works and even tried to evolve a super speciality group but it did not take off."

Patients are happy with all the attention they are getting. "Never once was I told that I would have to wait for the doctor's decision. My relatives received round-the-clock inputs about my condition every day," Mahendran says. What's more, he made just one consolidated payment, which the surgeons divided based on an agreed formula.

Usually, doctors in a group share the amounts equally. A substantial portion of amounts are reserved for academics and clinical research. "This results in us taking to clinical research and medical education programmes," says P Radhakrishna, a member of the Surge group.

Dr Balachandran Premkumar, laproscopic surgeon, can now afford to take a day off. "When you get a couple of difficult cases at the same time it can drive you up the wall," he says, but now I am happy and the patient is happy, too."

Link: Original Article

No more night calls, say Goa doctors

Shaken by an attack on a colleague while on an emergency night visit to a patient’s house, doctors in Goa have decided that henceforth persons falling sick at night will have to go to the nearest hospital for medical attention.

At a meeting last week, the Goa unit of the Indian Medical Association informally decided not to visit residences of unknown patients. Doctors will now ask that the patient be shifted to a hospital where, if required and called for by the hospital, the doctors will go. Though not all doctors go out on night calls, this will effect the sick to some extent.

The decision comes after Dr Antonio Rodrigues was robbed of Rs 5,000 at knife point in Margao a month ago while on an emergency night visit to a patient’s residence.

Dr Gladstone D’Costa, president of IMA’s Goa chapter, said, “Our state unit had approached the police a while ago for security to doctors on night visits and we were promised the same, but when the time comes we are either told there are no vehicles or no fuel. We appear to be pretty low on the priority list, that’s why we have decided it’s better to be safe than sorry.”

A senior police officer, however, told TOI on Monday that he was unaware of any such request by doctors. “The request might have gone to some other department,” he said.

D’Costa also said that a Panaji doctor who attends frequent night calls had submitted a written letter seeking police protection some months back but has not been provided an escort till date.

Link: Original Article

April 13, 2009

Doctor registered in one state can't work in another

A medical practitioner registered in one state cannot practise in another state unless his or her name finds place in the central register, the Supreme Court has held.

The court has also noted that an unregistered medical practitioner and one without a recognised degree or qualification cannot place the prefix "Dr" before his/her name or claim to be a doctor. The two observations form the crux of a recent apex court ruling upholding a 2007 Bombay high court judgment.

The matter had reached the SC after a bench headed by Justice B H Marlapalle banned ayurvedic and unani practitioners registered under the Bihar Development of Ayurvedic and Unani Systems of Medicine Act from practising in rural Maharashtra. The HC held that they had no recognised degree or qualification. It also banned those with a degree or diploma in electropathy or homoeo-electrotherapy to portray themselves as doctors or use the "Dr" prefix.

The SC ruling means that not everyone practising medicine can claim to be a doctor or use the "Dr" prefix. The judgment also makes it clear that unless a medical practitioner in Indian medicine is registered in the central register under the Indian Medicine Central Council Act, she/he cannot practise in the country.

The SC dismissed the claim of a number of practitioners of ayurveda and unani that once they were registered in a particular state, they had the right to practise anywhere in the country.

The apex court held that the restriction placed by law was a "reasonable restriction'' and such practitioners could not claim that their fundamental right under Article 19(g) to practise their profession was being violated. "Reasonable restriction can always be put on on the exercise of right under Article 19(g),'' the court said.

The SC also held that "what constitutes proper education and requisite expertise for a practitioner in Indian medicine must be left to the proper authority having requisite knowledge in the subject''.

Many of those affected were ayurveda practitioners who possessed sufficient knowledge and skill but held no formal degree, diploma or certificate from a recognised institution.

Nikhil Datar a gynaecologist, told TOI, "The problem is that we have only five recognised schools of medical streams-allopathy, homoeopathy, ayurveda, unani and siddha. Anything other than that is not a recognised stream. You can't be called a medical graduate or doctor in the areas of homoeo-electrotherapy, electropathy, acupuncture etc."

Link: Original Article

Deficient regulation helps medical malpractices thrive

When it comes to matters of life and death, the private medical industry is shockingly devoid of any regulation. Private nursing homes - about 150 of them exist in the Chandigarh Tricity - are not accountable to any authority as they are not registered. So is the case with privately-run clinics and hospitals.

In case a patient has been fleeced or receives deficient services, there is nothing much he could do, except for moving the consumer court. Facing this medical dead end, a Canadian citizen recently approached the UT director, health services, to complain against a Sector-27 dentist, who, he alleged, had not only ripped him off, but also provided wrong treatment. “The patient had undergone a dental procedure in the city. However, his problem recurred as soon as he reached Delhi, where he consulted a dentist again. He was told that the Chandigarh doctor had fleeced him as he had paid Rs 45,000 for a treatment that was not even proper,” said director, health services, MS Bains.

Acting on the grievance, the health department tried to locate the doctor, who had already shut down his clinic. “This is the limitation of non-registration of nursing homes. Though doctors are registered to start a practice, their clinic can be run by anyone who has not been found guilty according to medical regulations,” added Bains.

This unhealthy trend is reflected in Mohali and Panchkula. “There are around 30 private nursing homes in Chandigarh,” said president of nursing homes association, UT, RS Bedi. According to officials, Mohali and Panchkula have approximately 60 of these medical centres each.

Though the health department has drafted and sent a proposal for registration to Union government, it can proceed only when the same is okayed. “Our department was working on empanelling private clinics and nursing homes so that treatment could be provided at the doorstep, and at government rates. When the Centre asked for a list of registered clinics, we informed the government that due to lack of any regulatory authority, we did not have the database,” Bains added.

Why is registration important?

It will ensure that private medical centres also follow the norms decided by Medical Council of India. For instance, a clinic meant for 10 admissions will be prohibited against having more indoor patients. Regulation becomes simpler with director health services of the area authorized to take necessary action against the clinic that breaches MCI norms. Importantly, rates can be kept under a check.

Link: Original Article

April 09, 2009

Teaching love for medicine

How do you attract more students to pursue medicine? Expose them to practical aspects of the field. That's what one of the city's premier hospitals believes.

Apollo Hospital at Bangalore, Bannerghatta Road has come up with a comprehensive medical education programme for Class 11 and 12 students. They will be given useful insights on the healthcare system in the country. The `Young Medical Explorers Programme' will commence on May 1.

The students will not only get a hands-on experience but also expert guidance from doctors.
"There are two objectives of this programme -- to rekindle interest in students, and highlight various career options available in healthcare such as hospital management, finance, etc. Students are more inclined to courses such as MBA. However, through this initiative, they will get a clear understanding of the medical field. They will also be trained on life-saving skills," Apollo Hospitals (Bangalore) medical services director Umesh Gupta told The Times of India.

The hospital has sent out details of the programme and brochures to all schools with the targeted classes. "We finalized on the concept after talking to school managements. We expect more to turn up for the programme because of the ongoing summer vacation," he added.

The hospital has chalked out a curriculum for the students, which includes compulsory as well as optional subjects. The course will be mainly practical. Compulsory subjects include visits to various wards and an operation theatre, radiology section, labour room, intensive care unit and a blood bank. Optional subjects are visits to dialysis, physiotherapy and outpatient departments.

The programme will have four sessions, with six hours per session. Students will be divided into small groups and the hospital's doctors will guide them on the various topics. The sessions will be held on Saturdays. Total number of students per batch is 25. At the end of the programme, the students will be given a certificate.

Acceptance of the application depends on recommendation from teachers or the principal. "If a school is not participating but an individual wants to, he/she has to get a letter from parents stating their approval," Gupta added.

Link: Original Article

World Health Day 2009 - Save lives; make hospitals safe in emergencies

World Health Day, celebrated each year on 7th April, is the anniversary of the foundation of World Health Organization (WHO). The day is a worldwide opportunity to focus on key public health issues that affect the international community and is usually marked by the launch of a long-term advocacy programme. This year focuses on the safety of health facilities and the readiness of health workers who treat those affected by emergencies.

Following an emergency or disaster, people rely on hospitals and health facilities to respond, swiftly and efficiently, as the lifeline for survival and the backbone of support. The tragedy is compounded when a hospital collapses or its functions disrupted. The theme of 2009 “Save lives; make hospitals safe in emergencies”
draws attention to the importance of investing in well-built health infrastructure that is able to withstand disaster and remain operational to help people in immediate need. This years World Health Day will be launched in Beijing as China recovers from a massive earthquake which last year killed more than 87,000 people and destroyed or damaged over 11,000 hospitals and clinics.

Natural calamities like cyclones, earthquakes, tsunamis and famine, etc. and internal emergencies like wars, disease outbreaks, radiological incidents and chemical spills – are all rising. Though only 11% of the people exposed to natural hazards live in developing countries, they account for more than 53% of global deaths due to such cause suggesting that there is a great potential to reduce human death toll in these regions.

It is important to keep hospitals and health facilities safe, as they are more than just buildings. They save lives and protect health round-the-clock and safeguard social stability in times of crises. They are vital asset at the heart of a community, the place where often life starts and ends.

WHO is advocating a series of best practices that can be implemented, in any resource setting, to make hospitals safe during emergencies. Apart from safe siting and resilient construction, good planning and carrying out emergency exercises in advance can help maintain critical functions. Proven measures range from early warning systems to a simple hospital safety assessment, from protecting equipment and supplies to preparing staff to manage mass casualties and infection control measures.

Essentials for making health facilities safer
Develop and implement national policies and programmes to make health facilities safe in emergencies.
Select a safe site for the health facility.
Design and construct safe health facilities.
Assess the safety of existing health facilities.
Protect health workers, equipment, medicines and supplies.
Ensure that health facilities receive essential services.
Develop partnerships between health facilities and the community.
Develop an emergency risk management programme for individual health facilities.
Countries need to develop an emergency response plan for each health facility, test and update response plans with drills and exercises, train the health workers to respond to emergencies and evaluate and learn lessons from past emergencies and disasters.

As the Director General of WHO, Dr Margaret Chang says, "We must never forget: hospitals and health facilities represent a significant investment. Keeping them safe in emergencies protects that investment, while also protecting the health and safety of people."

Link: Original Article

Philips to make India hub for medical equipment manufacturing

After acquiring two healthcare companies in India, Philips is working on a strategy roadmap to make India one of its global production hubs for medical equipment. The company plans to invest substantially on up-grading the acquired manufacturing facilities and increasing their capacity, with plans to start shipping them globally in another 18-24 months.

As per the plans, Philips is evaluating options to manufacture both new equipment and undertake refurbishment of old machines in India. However, the initial focus will be on value-segment medical equipment which has large market potential in Asia, Africa, CIS and parts of Europe.

Philips Electronics India senior director and head (healthcare business) Anjan Bose said the company is currently firming up plans to make India a global production hub. "The investment details are currently being worked out to expand capacities and upgrade the plants to meet global quality and regulatory standards," he said.

Philips last year made two healthcare acquisitions in India — Meditronics and Alpha X-Ray Techlonogies. By virtue of this, Philips acquired a footprint in manufacturing of medical equipment, with five plants that specialise in imaging devices and X-Ray machines. The acquisitions also enabled Philips access critical technology to develop value-segment products.

The company is planning to undertake more such acquisitions in India to further strengthen its value-segment portfolio. "We are exploring such options in ultrasound and imaging devices. The current time could be favourable for such acquisitions since valuations are low and several companies have cash flow issues. The acquisitions will help us to tap rural hospitals and needs of emerging markets," Philips India CFO Coen Reuvers said.

Philips India is also looking at newer business models to grow revenues in the slowdown. "We are planning to start the pay per use model in India, whereby hospitals and clinics will make a small upfront payment for the equipment and the balance amount will be realised on a revenue-sharing basis. We are currently evaluating 10-12 such proposals. This should protect us from the slowdown effect," said Mr Bose.

However, Mr Bose hastened to add that Philips’ healthcare business in India is yet to feel a major impact of the slowdown. "It’s true that there is a delay in decision making than previously. But, we are maintaining our robust growth rate and have, in fact, grown by double digit in the last two months over the same period last year," he said.

Link: Original Article

April 08, 2009

Quality of medical training and emigration of physicians from India

Physician 'brain drain' negatively impacts health care delivery. Interventions to address physician emigration have been constrained by lack of research on systematic factors that influence physician migration. We examined the relationship between the quality of medical training and rate of migration to the United States and the United Kingdom among Indian medical graduates (1955–2002).

We calculated the fraction of medical graduates who emigrated to the United States and the United Kingdom, based on rankings of medical colleges and universities according to three indicators of the quality of medical education (a) student choice, (b) academic publications, and (c) the availability of specialty medical training.

Physicians from the top quintile medical colleges and of universities were 2 to 4 times more likely to emigrate to the United States and the United Kingdom than graduates from the bottom quintile colleges and universities.

Graduates of institutions with better quality medical training have a greater likelihood of emigrating. Interventions designed to counter loss of physicians should focus on graduates from top quality institutions.

Link: Abstract and Full Article

April 06, 2009

Medicine out, engineering in for science students

Jigar Patel, who appeared for his XII (science) final exams recently is on cloud nine. On Sunday, he appeared for the Pre-Medical Test (PMT), moving a step closer to his dream career of becoming a heart specialist.

But, the likes of Jigar are fast becoming extinct! Going by the number of examinees in PMT from Gujarat, takers for a career in medicine are fast dropping. From a number of more than 6,800 wannabe doctors in 2006, the number has dropped to 3,613 in 2009.

Why? You are not the only one asking this question. There is however no clear answer to this. The most plausible explanation is that, career choices keep changing and presently, a career in engineering is preferred. This is reflected in the growing number of applicants for All India Engineering Entrance Exams (AIEEE).

PMT co-ordinator of Ahmedabad, Dr Hemant Shah from Prakash school, says: "Across the country, 1.45 lakh students in 28 cities appeared for the PMT this year. Though the dip is a national trend, Gujarat is witnessing the worst example of this. Most PMT examinees here are from Gujarat Secondary and Higher Secondary Education Board (GSHSEB) and Central Board of Secondary Education (CBSE)."

More than 3,500 students from cities like Surat, Rajkot, Ahmedabad and Vadodara appeared at seven PMT centres in Ahmedabad and Gandhinagar on Sunday.

This drop in number of students opting for careers in medicine has concerned educationists in the state. "The reason could be anything, for example, only 15 per cent of those who give the PMT get admission in government medical colleges. This could be a deterrent," said sources in GSHSEB.

Dean of BJ Medical college, Dr Bharat Shah, spoke about another contributory factor: "It takes 10 years to complete the medical course while engineering students graduate in four years and get lucrative jobs as well. The engineering market is booming now and jobs are easy to come by. Number of engineering seats in government and private colleges and institutions are five times more than medical."

HB Bhalodia, dean of GU, medical faculty added: "Each student after toiling for 10 years has to then invest to setup his or her own clinic. These practical aspects are pushing the fixation with medical careers down. Percentage and results of students decide careers."

Link: Original Article

GE, Intel join hands for tele-health services

Technology giants Intel Corporation and General Electric today announced an alliance to market and develop home-based health technologies for patients chronic conditions.

GE Chairman and CEO Jeff Immelt and Intel President and CEO Paul Otellini announced the alliance today, along with an investment of more than $250 million over the next five years for the research and product development of home-based health technologies.

The market for tele-health and home health monitoring is predicted to grow to $7.7 billion by 2012 from $3 billion at present.

GE Healthcare will sell and market the Intel Health Guide, a care management tool designed for health care professionals who manage patients with chronic conditions.

With the dramatic increase of people with chronic conditions and an aging population there is a need to extend care from the hospital to the home.

GE Healthcare and Intel will work together to accelerate the innovation and commercialisation of next-generation home health technologies. Both companies also plan to expand their current development programmes in home health and independent living technologies to include new areas such as fall prevention, medication compliance, sleep apnea, cardiovascular disease and personal wellness monitoring.

Link: Original Article

Better deals soon for medical tourists

This will bring cheer even to a failing heart. For people travelling to India for a heart bypass surgery or a bone marrow transplant, better deals are in the offing. The tourism ministry has been in discussions with major hospitals to offer incentivised deals as part of Visit India 2009.

"We have met representatives from major hospitals and I am waiting for their offer. We would like to include medical tourism in the Visit India incentive scheme," Sujit Banerjee, tourism secretary, said.

The ministry has held discussions with hospitals like Wockhardt, Apollo, Lakeshore, Moolchand, Manipal, Sevenhills and Sir Gangaram. Over 1.5 lakh medical tourists travelled to India in 2002 alone, bringing in earnings of $300 million. Since then, the number of such travellers has been increasing by at least 25% every year. A CII-McKinsey report projects that earnings through medical tourism would go up to $2 billion by 2012.

A Planning Commission report said that while a heart bypass surgery would cost a patient $6,000 in India, the same surgery would cost the person $7,894 in Thailand, $10,417 in Singapore, $23,938 in the US and $19,700 in Britain.

Besides lower costs, Indian hospitals offer global facilities, latest medical technologies administered by Indian doctors and nurses with high degree of proficiency.

The ministry will be introducing these benefits as part of the Visit India programme under which the tourism industry is offering great bargains to incentivise travel to India. Major airlines, hotels and tour operators have already been roped in to offer free travel for spouse or an extra day's stay at a hotel. The ministry on its part is offering stay at a rural tourism destination, wellness resort and an additional night on the luxury train Deccan Odyssey for passengers who are booked for six nights.

The government hopes that these initiatives will boost foreign tourist arrivals that have sagged because of the economic downturn and Mumbai terror attacks.

Link: Original Article

Gujarat Doctors to fight proposed public health legislation

The medical fraternity in the state of Gujarat is all set to fight against the proposed legislation on public health. Doctors from all over the state will hold a special meeting under the banner of Indian Medical Association (Gujarat State Branch) here next Sunday to register their discontent over the move.
The Gujarat Public Health Act, 2009 carries several provisions that already exist in the current legislation, so the proposed one is redundant, feel doctors. What is more intriguing for them is the induction of certain new regulatory provisions that they feel will make medical treatment in rural and semi-urban areas beyond the reach of middle and lower-middle classes.

They said the new legislation is nothing short of an attempt to unduly enrich big corporate hospitals at the cost of the patients by ensuring high-cost treatment at government hospitals.

“We are studying and analysing provisions in the draft and holding detailed discussions on the possible implications not only on the medical fraternity, but also on patients and others,” said Dr M R Kanani, president of the Gujarat State Branch of IMA.

“The indifference to problems faced by doctors can be seen from the amount of space devoted to the rights of doctors as compared to those of consumers and other stake holders in the draft legislation,” he said.

What has angered doctors is the provisions of the draft law that empowers medically ignorant persons to decide on justification and correctness or otherwise of professional decisions taken by doctors in the course of their practice, said sources.

“Not only that, it proposes to consider ‘dayans’ (women who help a pregnant woman in giving birth to a child) at par with experts by making them part of the supervisory bodies,” Dr Kanani said.

Another aspect that has left doctors disturbed is the proposal to set up special courts for handling medical offences and to enact stringent penal provisions. Kanani said the existing provisions under the Consumer Protection Act can successfully deter erroneous professionals and there was no need to have additional provisions.

The provisions relating to doctors being sent to police custody are against the guidelines issued by the Supreme Court, he added.

On medical public hearings, which the proposed law provides for, he said the need of the hour is to first educate members of the general public about the technical aspects instead of straightaway opening up a forum to them.

Instead of painting doctors as villains, it is imperative to improve the performance of the government-run hospitals, he said adding, these hospitals won’t be left in the cocoon of official protection once the law cames into effect. Kanani went on to say that due attention should be given to issues relating to taxing hospitals.

Link: Original Article

April 05, 2009

A right to a fair trial, a right to life: Dr.Binayak Sen

Since May 15, 2007, Binayak Sen, a distinguished Indian paediatrician and a tireless human rights activist has been imprisoned in a Raipur jail in the state of Chhattisgarh, India. He has been convicted of no crime but is being held under draconian state laws for his alleged association with the Naxalites—an outlawed Indian communist movement, deemed to be a threat to national security. To date, there is no proof of his involvement in extremist activities but he remains incarcerated for supplementary charges indefinitely.

Sen and his wife, Ilina, have devoted their entire working lives to improve the health and welfare of the Adivasis, a marginalised and poverty-stricken tribal population. Violent conflict has prevailed in the region and Sen's relentless exposure of the state's human rights violations of this community are widely believed to be the real reason for his imprisonment: to set an example to others who would dare to expose state brutality and defend civil liberties. A troubling fallout of his incarceration is that much of his good work is slowly being eroded. His clinic, which provided essential health services, is on the verge of collapse, and many patients with both acute and chronic illnesses have gone untreated. The worldwide condemnation of his arrest and calls for his release continue to fall on deaf ears.

Of grave concern now are reports that Sen's health is deteriorating and that access to necessary medical care is being delayed. The right to life is a basic human right under the constitution of India. Every state functionary is obliged to protect the life of a detainee in custody and ensure proper medical treatment for him or her as and when required.

It is outrageous that Sen has now been in prison for almost 2 years in a prolonged trial that keeps shifting charges which are unclear and possibly politically motivated. Faith in the Indian justice system needs to be restored. The Indian Government must intervene and make sure justice is done, so that Sen and his family can return to a normal life and resume serving the poorest communities in the state.

Link: Original Article : The Lancet

April 04, 2009

TB hits PGI emergency doctors

A mere sneeze in over-crowded emergency wards of hospitals could leave you, or your doctor, infected. In a frightening revelation, 12 of the 60 doctors posted in the emergency of region’s premier institute -- PGIMER -- during the past two years have been infected with tuberculosis.

And if medicos run such high risk of infections, it’s not hard to imagine what patients -- who’re already immunosuppressed -- are exposed to in buzzing corridors of PGI.

With the issue raising concern among health workers, a draft prepared to redesign hospitals has been submitted to the Centre. ‘‘In the recent past, we’ve seen four to five doctors getting infected with TB every year,’’ said head of pulmonary department SK Jindal. He added healthcare staff was two to three times more vulnerable to the disease than the general population, which runs a 0.5% risk of getting it.

‘‘Twelve residents -- primarily from transplant surgery, neurosurgery, gastroenterology surgery and medicine departments -- have been infected with TB of lungs and extra pulmonary (bone and spine). But the administration has been slow to act,’’ said Prabhu, the president of resident doctors’ body.

‘‘We have sent a proposal to Union government under Revised National TB Control Programme to redesign hospitals in a way that there is proper ventilation and overcrowding is avoided,’ Jindal said.

A far cry from the tentative arrangements are untidy beds in PGI emergency that are cramped together, with not even two-foot distance between two cots. Not only is there no patient-isolation room for those infected with air-borne ailments, but the huge ward is kept ‘hygienic’ by merely six exhaust fans, that whirl tirelessly to pump out bad air. Ironically, these six exhausts are the only ‘clean measure’ adopted by PGI since its inception. Despite the association of resident doctors apprising the administration about lack of essential elements, nothing has been done to provide open spaces or improve ventilation.

Tejinder Singh, who is the chief engineer at Fortis, said, ‘‘Rooms are supposed to be built in such a way that when a patient breathes out, the air is released directly out of the exhaust outlet. All patients suffering from air-borne disease are shifted to isolation ward, where adequate precautions are taken. We have a microwave filter in ACs that is regularly cleaned, etc.’’

Blaming patient inflow for lack of space, PGI’s official spokesperson Manju Wadwalkar said, ‘‘Though emergency can accommodate 30 beds, we normally have 120-150 patients admitted at a time.’’

Link: Original Article

Technology giants introducing new notions of health technology

Health technology is becoming another popular mantra of the day and is also attracting the technology giants all over the globe (in the hope of a new venture). This has become more evident due to the recent approaches of General Electric and Intel, two well-known technology bigwigs in the realm of the United States of America. What are their primary objectives? It has been learnt that they are tying to make available more health care out of hospitals and doctors’ chambers.

According to the combined declaration of the companies, the joint budget is of $250 million and will be spent methodically in the next five years on research and development of health technologies.
The basic objective, as already said, will be to enable doctors to remotely monitor, diagnose and consult with patients in their homes or assisted-living residences. In short, both are hopeful that this will bring forth a new age in nationwide healthcare scenario and heighten the importance of technology in this sphere.

What has motivated the companies to pursue this trend is not known yet but as indicated by sources, both companies are considering that health technologies may defeat the ominous effects of recession. It should be remembered, in this context, that both companies have fledgling offerings in the field of telehealth and home health monitoring. Intel has just introduced a special-purpose computer with two-way video capability and is called Intel Health Guide. Among its exciting features, there is the presence of a link over the Internet to a doctor, nurse or physician assistant.

On the other hand, the health care business of General Electric worth $17 billion-a-year ranges from medical imaging equipment to electronic health records. It has come to the knowledge that GE has agreed to distribute Intel’s computer system by means of its global sales force.

“Today’s systems just won’t scale,” said Louis J. Burns, general manager of Intel’s digital health group. “Health care has to go efficiently into the home, to enable elders to age in place with dignity.”
Link: Original Article

April 03, 2009

DNB Equivalence: Letter by National Board to Teaching Institutions

National Board has sent the following restrainer order to many institutes;which ideally should be honoured by MCI officials.

From: National Board of Examinations
Date: 7/5/2008
Subject: Re: DNB equivalence

Subject: Non Approval for Appointment to teaching posts for DNB Degree

Reference: MCI Letter dated 14th September 2007


This has reference to the issue of equivalence of DNB qualification with the corresponding MD/MS degree and the above stated letter issued by Medical Council of India. Without prejudice, the regulatory position in respect of the same is as follows:-

(1) Diplomate of National Board is a recognized qualification as per the Indian Medical Council Act, 1956. DNB qualification is included in the first schedule of the Indian Medical Council Act, 1956.

(2) The Government of India in its various notifications issued from time to time has upheld the status of DNB as that of equivalent qualification as MD/MS/DM/MCh. The Government of India vide latest notification dated 1st June, 2006 has upheld that holders of DNB qualification are to be treated at par with MD/MS/DM/MCh candidates even to teaching posts such as Assistant Professor or recruitment as Senior Resident. The copy of notification issued by the Government of India is enclosed along with for your kind reference.

(3) The equivalence of the DNB qualification vis-à-vis the corresponding MD/MD qualification has been upheld by the Hon’ble Supreme Court of India in the matter Kidwai Memorial Institute of Oncology & ors Vs State of Karnataka & Ors.

One letter dated 14th September, 2007 has been issued by Medical Council of India, on the basis of which your University has issued the above stated captioned letter. The Medical Council of India letter dated 14th September, 2007 has been challenged by various DNB candidates before the Hon’ble Court of Bombay, Nagpur Bench and the Hon’ble Court has been pleased to grant interim relief till final adjudication in the matter takes place. The Hon’ble High Court at Bangalore has also granted interim relief in the matter.

(5) The Government of India has submitted its detailed reply before the Hon’ble Court and the salient points in the Government of India Affidavit is stated herein below:-

"The bare perusal of the Indian Medical Council Act 1956 demonstrates that Medical Council of India has been assigned purely recommendatory role for the Under Graduate Medical Education. The provision of the Indian Medical Council Act 1956 clearly lay down that the recommendations of Medical Council of India have to be considered by the Central Government and which alone has to take a decision one way or the other. It is submitted that AIIMS and PGI of Medical Sciences and all such other institutions established under the Act of Parliament are outside the ambit of MCI Act but are under the administrative control of Government of India. The Central Government for reasons well defined in law has all prerogative to take decisions different from the recommendations of MCI.

That the Hon’ble Supreme Court AIR 1988 SC 1048, Govt. of AP Vs Dr. R. Murli, while considering the effect and implication of the Regulations framed by the MCI, on the basis of the affidavit of the MCI that it is only a recommendatory body and the Regulations framed by it are only recommendatory and not mandatory.

It is submitted that the DNB degree/qualification is equivalent in all respect with MD/MS degrees and the letter dated 1st June, 2006 has been issued after considering all the factors by the Government of India. In order to bring parity between MD/MS students and DNB qualification holders, it is submitted that the teaching experience gained in institutions conducting DNB courses should be treated as teaching experience for the purpose of appointment as medical teachers in medical colleges/institutions"

(6) As per the provisions of the Indian Medical Council Act, the role of Medical Council of India is recommendatory to the Government of India. The Medical Council of India cannot encroach upon the powers of Government of India by issuing a letter which even otherwise, is based upon incorrect observations and is a matter of adjudication before various High Courts in the country,

(7) Considering the stay granted by the Hon’ble Court in the matter and the emerging legal position and till such time, the matter is adjudicated by the Hon’ble court, it is desirable for all recruiting agencies that the status quo may kindly be maintained and the DNB degree holders should not be discriminated, demoted or their assignments/employment terminated.

Yours sincerely,

(Dr. A.K. Sood)
Executive Director

Mal-distribution of Medical manpower resultant decay of the Indian medical education system: Existing problems and possible solutions : BMJ

Indian medical education system has seen rapid growth in the last two decades. From a miniscule number, private medical colleges have grown to account for more than half of the 270 medical colleges in 2008 and consequently, India has the highest number of medical educators in the world. This unregulated unequal growth brings two issues to focus: the failing quality of medical education and implementing effective solutions to address an artificial faulty shortage due to doctor mal-distribution. The menace posed by the growing merchandisation of medical education has to be warded off and efforts should be made to ensure maintenance of standards and check the unplanned growth of substandard medical colleges and substandard education norms in universities or their constituent medical colleges. There is a strong case for a review of the entire system of medical education and examinations in the country. Some solutions like increasing retirement ages of MD faculty to 70 years, sharing of faculty, increasing MD seats, allowing clinical MDs to teach paraclinical and preclinical subjects or temporary merger of specialities have been proposed to address the faculty shortage instead of relying on inadequately qualified MSc non-medical faculty.

Establishing a medical college is not similar to establishing a science or Arts College and apart from a huge capital requires a huge number of qualified, competent, MCI compliant manpower to produce quality doctors.1,4,7 Having established a Medical College, maintaining the standards of education to world acceptable levels with a vision to serve poor Indian masses has been a concern of the Indian planning committees. Also, the good name a college attains is due to the accomplishments of its faculty and alumni. In that regard, proper emphasis on the quality of medical education ,inspite of the recent rapid proliferation of private medical colleges, has rightly been the working domain of Medical Councils all over the country and has consumed energies of Medical Council of India over the last forty years. 1, 4, 7 ,10,12

The Medical Council of India (MCI), the regulatory and advisory body on medical education, approves medical curricula and permits medical school existence and allows for recognition of medical degrees issued by various universities. The accreditation process for medical schools focuses largely on the infrastructure and human resources required and little on the process and quality of education or outcomes.15 The implementation of the recommendations of MCI regarding recognition or de-recognition of a medical college is governed by the Ministry of Health and Family Welfare, whilst individual universities also have variable sets of regulations for their affiliated medical schools. As a result, there is no uniformity in the standard of medical education across the country. At the time of independence there were just 19 medical schools with an output of 1200 doctors.10 In 1965, there were 86 medical colleges in India with only a few private colleges7 The college total increased to 112 by 1980(at a rate of 30%), to 143 in next decade (rate of growth of 28%) and since 1990 over past 18 years the number has increased to 271, an increase of ~90% compared with the figure in 1990.7 Today, there are 271 medical colleges out of which about 31,000 medical graduates pass out every year and private sector medical colleges have grown to account for more than half of all medical education institutions in India 13

Evidently, medical education system seems to have had an unregulated growth over the last two decades. It has been pointed out that even the prestigious colleges window dress faculty lists or put up names of non-existing academic members in their staff list. 5 Most medical college permissions were gifts given out as largesse or patronage to political heavyweights from health ministry.1,14 Very few have had adequate space, laboratories or hospitals as per MCI norms. They were and remain ill- equipped and inadequately staffed.10 This unregulated rapid growth in enrolment of medical students and poorly implemented regulations relating to admissions, faculty strength and infrastructure in medical colleges adversely impacts quality of training in Indias medical institutions.

Many reputed physicians and surgeons, professors, directors and deans working in new private medical colleges fabricate and falsify records like even birth records and lie to the MCI and the courts in order to get their medical college of questionable standards approved or recognized. Illegal money is involved in the business of getting new private medical colleges approved or recognized by the MCI and the health ministry. The decay of medical colleges reflects the general trend in this country .4,5 Corruption and bribery have made permanent inroads into medical education since past few decades in health universities or entrance examinations. Even clerks in the universities leak question papers and manipulate marks. 1 Perhaps the worst kind of gross unethical practice in academic medicine happens around the time of inspection by the Medical Council of India (MCI) post 1998-2000, in new private medical colleges. In emergency-like frenzied two day shows, busloads of patients are mobilized to fill up empty wards, carloads of doctors are paraded before the inspectors, and even instruments are hired or shifted between colleges, during the period of MCI inspections.4

Privatization in general has been known to increase the gap between rich and poor, amounting to encouraging survival of the richest which cannot be a acceptable goal of any civil society.8 And, the policy of excessive privatization of medical care delivery system has undermined health services and further limited the access of the underprivileged.3,8

Privately, many managements agree that it is very difficult to get faculty and that it is even more difficult to retain them in the wake of continuous offers or lure from newly established medical colleges. Certain medical college locations in smaller cities or semi-urban areas do not have facilities, ambience, or charm of big cities hence attracting teachers or other qualified staff to such medical colleges has been difficult, and various inducements have been applied. Such colleges have been surviving council inspections by window dressing or luring faculty with money. In certain new colleges which are literally brick fresh, bereft of hostel or quarters or other amenities the teachers delay even more to move or settle down themselves. At times doubts are established whether an impossible set of conditions and heavy financial burden is imposed on Medical college managements, by the MCI just to make management fail MCI inspections, but at the same time, some stringent MCI regulations have helped faculty of Medical colleges by ensuring job availability.

Doubling of medical colleges over last 15 years has improved the number of medical practitioners in India, but will the mere increased numbers mean a higher quality health care delivery system is debatable. Most management fail to fulfill the excellent set of norms stipulated by Medical Council of India. It is worthwhile, in national interest to note that, we have been loosing medically qualified post graduates to Western countries since till recently Medical College teaching jobs were low paid and did not give that richness or respect attained by private practitioners. After the Karnataka Government & Pondicherry scales new implementation in 2007, with a heavy Non Practicing allowance teaching profession has gained respectability vis--vis elite in society like software engineers. Similar uniform pay scale implementation is need of the hour, all over the country to prevent medical teacher mass migrations.

Nearly 27000 teachers are required as per Ananthakrishnans calculations 7 to fill the faculty positions in 270 medical colleges purely for the purpose of teaching MBBS.He ignores the existence of ~300 Diplomate National Board hospitals across India and requirement of faculty for DNB courses. He also ignores MCI recognized institutions exist in other countries like China, Nepal, Malaysia, Netherlands and have been training MBBS doctors of Indian origin. All these institutions have been drawing medical teachers to satisfy MCI or DNB stipulations for accreditation. Hence we have to account loosing faculty to such Institutions. Also his manpower calculations are only for colleges purely teaching MBBS and ignore multiple course Colleges like KMC Mangalore, Manipal which harbor 90 MSc students per year per department and ignores existence of PhD students which evidently will require more teachers. He also ignores the net strain on the same faculty who are simultaneously teaching BPT, MPT, etc in allied institutions. A great academic strain on medical college teachers ,exists,which has never been accounted by MCI nor by Dr Ananthakrishnan.So, on the whole, it means that a great qualified medical teacher shortage exists in India. Either it is due to the excessive number of courses imposed on the same faculty or maybe it is inefficient use of existing qualified medical teachers for non teaching purposes.

Contrary to the opinion of Health ministry, eminent educationists Sood & Adkoli point out that the doctor: population ratio has already exceeded that required by the country and there is mal-distribution of their services. They feel that the menace posed by the growing merchandisation of medical education has to be warded off and efforts should be made to ensure maintenance of standards and check the unplanned growth of substandard medical colleges and substandard education norms in universities or their constituent medical colleges. This mal-distribution of medical manpower is the centered on biased political will and seat purchasing power in the community. With the correction of medical manpower maldisditribution medical standards will harmonize throughout India.11,12

Indeed, given the sharp increase in the number of medical colleges and the doubling of enrolment capacity after1980s it is difficult to imagine that enough trained full-time faculty exist to adequately staff the newly created colleges or DNB Hospitals and maintain reasonable teacher-student ratios.9 Dr Ananthakrishnan proposes to allow MSc from Non Medical Universities to teach Medicine. 7 It will be gross medical impropriety to allow such injustice to be allowed by Medical council of India which is supposed to uphold medical education standards across India. What glory does it give Indian medical education system to have a bunch of unqualified non medical doctor MSc teachers seeking to run coaching medical classes a la science tuition centers we fail to see. What is the necessity to increase number of medical college, or medical college seats, in inadequacy of appropriate medical teachers? Is it possible to permit inadequately trained staff to run these colleges, and will the output reflect quality abroad? Emphasis here is not on excellent university results, these MSc teachers, produce by mere mugging up of unconnected facts or figures or excellent power point teaching but what MBBS educated teachers can produce by moulding young doctor student minds by bringing in relevant clinical experience.

Some Solutions

Today, India has the highest number of medical colleges in the world and consequently the highest number of medical teachers. Yet, shortage of medical faculty and lack of medically oriented teaching by appropriately trained MD faculty have tarnished Indian medical glory. The unprecedented institutional growth has created a national quality challenge for medical education and has resulted in varying standards across medical graduates. There is a national need for well-trained faculty who will help improve programs to produce quality graduates. 5,14 Annual student intake is said to be a critical factor in assessing the requirement for teachers as per Ananthakrishnan,7 and should dictate the employment. A punitive MCI, DNB Board and vigilant state medical councils can act synergistically to decrease medical student intake in Medical Institutions where teachers are not ready to go or do not exist. MCI and DNB Board also need to do more for its medical teachers- give them more respect, recognition, arrange for their pensions, gratuity, relieving orders or get involved in pay scale recommendations as no entity exists till date to safeguard medical teacher interests. Measures are required to ensure private medical colleges proper regulation by the medical council. Further, Indian Health ministry has been known to interfere in the functioning of MCI, DCI and DNB Boards, override MCI, DCI and supreme courts decisions and this is undesirable.12,14,15

Increasing the retirement age of MD teachers up to 70 years will harness hard earned medical experience of senior professors to guide preparation of efficient faculty and will reemploy retired teachers . This will also lead to discipline enforcement, more projects, PhDs and papers of relevance. Else, MCI can think of sharing of medical faculty among medical colleges, or dental colleges, and ensure less burdened teaching schedules. Implementing integrated medical education system-will help, as has been experimented in -KMC Manipal, Sri Ramachandra Medical College. Present paramedical system is a confused network of PhDs who have not enriched Medical education system, a proof of which can be the absence of a single Nobel laureate or international repute medical scientist or of the glory of IISc departments, in 270 odd medical colleges across India, even Manipal, or AIIMS in spite of having the system for 50 years. Merging of homogenous specialities like merging of biochemistry with physiology or pathology, microbiology with pathology, or creation of a discipline of laboratory medicine merging pathology, microbiology and biochemistry has been suggested in yahoo groups like mdbiochemists. Merging of homogenous specialities decreases the requirement of professors in biochemistry and microbiology by providing MCI norm requirements of professors from pathology. Also merging of Anatomy with Surgery will be worthwhile and achieve similar objective of providing deficient staff from Surgery department, who happen to be plenty. It is said to bring about some integrated medical education also. This cure is supposed to provide a broad based intermingling for net objective of efficient medical teaching by qualified professors, peers in interrelated departments. We would further extend their argument in suggesting that the proposed speciality merger need not be complete and final but a temporary arrangement for next 20 years.

Acute shortage of medical teachers needs to be filled. Appropriate solution exists within medical education system itself and help can come from recruitment of medical brethren from clinical sciences to fulfill non clinical department norms, as has been happening successfully ,silently ,without MCI approval ,in Tamilnadu and Andhra pradesh government medical colleges. A whole lot of MD or MS or DNB doctors are ready to serve as Medical teachers, but colleges have never used their teachership as MCI does not permit this. Many such part-time consultants who are practicing in community could deliver excellent teaching assignments and help tide over the so called artificial medical teaching crisis.MCIs generosity to allow MDs of homogenous specialties to teach in Pre or Para clinical sciences for a honoraria, rewards system will effectively ,in a short time solve inadequate improper medical staffing problems forever. Number of seats available in various post-graduate medical courses is approximately 11,005 annually which is one third of MBBS graduates coming out every year. Nearly a third of these seats are diplomas and a diplomate cannot be considered for even a junior lecturer post like an MSc graduate, but will be considered for post of Tutor, the lowest cadre of medical teachership. Thus all DCP (Diploma in Clinical Pathology) and DFM (Diploma in Forensic Medicine) loose out Lecturership to their MD colleagues. Increasing the number of MD seats in Para clinical and preclinical sciences and replacing existing Diploma seats with corresponding MD seats is a just approach and should be the right approach for MCI to follow, since in contrast to before 1960s,in present days no postgraduate seat goes vacant-it means there are no shortage of MD aspirants as wrongly assumed by Dr Ananthakrishnan7 .MCI also has to think of giving Junior lecturership posts to MBBS graduates who have been serving as tutors for more than 3 years in any department .

Continuing medical education

Thus there is a strong case for a review of the entire system of medical education and examinations in India. The American style of giving credits for demonstrable good performance throughout the years can be introduced. It will, of course, be necessary to ensure objective evidence of such assessment and performance.1,8 The Indian Health ministry has realized that efficient medically qualified teachers are in the best position to mould young physician minds hence, Indian National Knowledge Commission (NKC-2008) proposes raising average standards and creating centers of medical excellence, revised medical accreditation; methods of attracting and retaining talented medical faculty members and devising measures to ignite, promote and sustain the research tradition in medical colleges and teaching hospitals.

Medical teacher incentivisation8, i.e increments, promotions, paid study leaves will also attract good teachers to stable institutions. In order to recruit good and gifted medical teachers, it is necessary to provide them with regular attractive salaries, amenities and retirement benefits which are realistic and at least on par with the earnings of those in practice.2 Emigration of high quality physicians who could potentially serve as medical teachers in local Medical colleges may lead to further declines in the quality of medical graduates produced. To address regional inequities for medical training and related availability of doctors, firstly, it may be useful to set up adequately staffed medical research and training institutions in economically backward areas. Secondly, the government could subsidize the medical education of individuals living in backward areas, perhaps by combining such a subsidy with a bond to serve in the backward areas for a limited number of years. Implementing this bond system will be in the control of the health ministry.

For existing medical teachers, high standards of teaching are to be maintained and improved upon with constant seminars and workshops. Teaching aids, computers, medical CDs, DVDs, medical e-books, Internet facilities and availability of the latest journals and literature on the subject should be provided in every medical college or diploma national board certified hospital.2At the post graduate level, it is the duty of the senior teacher to train the young doctor so that he learns to perform according to accepted international standards.2 As a long- term policy, no new medical colleges must be permitted in prosperous states, unless they demonstrate an MCI compliant infrastructure and facilities better than those in existing institutions. A revitalized Medical Council of India must be the only agency permitted to recognize such colleges and health ministry need not have any role.1 Since advent of the MCI it has been noted that Indian health ministry can not only ignore a negative rating by Medical Council of India, but also openly defy the Supreme Court.12

India needs also a MCI controlled and Supreme Court monitored screening system of students admitted to medical colleges under the discretionary management quota so that merit remains the paramount criterion. This requires common entrance examinations to assess student performance across colleges, publicly accessible information on admission standards practiced by colleges, including transparent nondiscriminatory ranking by performance, and enforcement of sanctions on colleges violating norms. A useful first step is the government policy of maintaining a accessible list of recognized colleges, but obviously much more needs to be done to implement ways to increase the supply of MD teaching personnel .Indian policy makers need to think proactively about developing a cadre of doctors focused more on medical education and research. Lastly, the Indian Medical Association, Association of Medical Biochemists of India, All India MD/MS Doctors Association, and other national medical and dental professional bodies must play a greater role to foster true medical and dental education and prevent governmental and political interference.1,12,14

Link: Original Article

Health Ministry, MCI 2006 standoff over DNB

THE UNION Ministry of Health and Family Welfare has said its Diplomate of National Board degrees will be treated on a par with the MD/MS and DM/M.Ch degrees awarded by Indian medical institutions for the purpose of all appointments including teaching posts in medical institutions.
In particular, the June 1 order to the Health Secretaries of all States and Union Territories removes the earlier requirement of one year and two years of teaching experience for the appointment of DNB degree holders to posts in broad specialities and super-specialities respectively. This implies that the DNB degrees in broad specialities will be completely equivalent to the MD/MS degree. And, the DNB degree in super-specialities will be equivalent to the DM/M.Ch degree. In fact, the DNB degrees, awarded by the Ministry's National Board of Examinations (NBE), are the ones that are recognised globally.

The current directive assumes significance in the context of the proposed expansion of infrastructure, student and faculty strengths in medical institutions as part of the implementation of the announced policy of 27 per cent for Other Backward Classes (OBCs) in Central institutions of higher education. Nine existing national medical institutions directly under the Centre's control and the six institutions proposed to be set up in various parts of the country on the lines of the All-India Institute of Medical Sciences (AIIMS) in New Delhi will be covered by this reservation policy.

The NBE was established in 1975 with the aim of elevating standards of post-graduate medical examinations and ensuring uniformity across the country. The NBE became an independent autonomous body under the MoHFW in 1982. The Board has a system of accreditation of hospitals and institutions having adequate trained manpower and infrastructure for training students towards post-graduate and post-doctoral degrees of the Board. Currently, there are 415 such accredited hospitals/institutions across the country.

Entry to the DNB programme is through a very stringent qualifying Central Entrance Test and an institutional-level speciality-specific aptitude evaluation. Qualifying for the degree is through an extremely rigorous evaluation both in theory and clinical knowledge in which the pass percentage is only about 30-35 per cent.

Medical experts say that, by enabling the large number of NBE-qualified post-graduate medical students to enter the country's mainstream health care system, this move would help offset to a great extent the shortage of teachers in medical institutions that could arise as a result of the envisaged expansion. In fact, this shortage is in some sense artificial because the guidelines of the Medical Council of India (MCI) rendered a whole cadre of qualified doctors ineligible for teaching posts.

Decision welcomed

"It is a welcome decision," said M.S. Valiathan, the well-known cardiac specialist from the Chitra Tirunal Institute of Medical Sciences and Technology and at present the National Research Professor at the Manipal Academy of Higher Education. "I could never understand MCI's contention on this issue. In fact, many medical colleges awarding MD or M.Ch degrees today have no credibility. The DNB examination standards are, on the other hand, very high. It is a national examination with no issues such as home ground advantage." Prof. Valiathan, however, added a caveat to his remarks. The NBE's accreditation and certification procedure for DNB training centres needs to be improved further, he said.

At present, every year, there are about 25,000 medical graduates of whom 9,000 obtain MCI-approved post-graduate degrees and about 3,000 qualify with DNB degrees, according to K.M. Shyamprasad, the NBE vice-president. "But," he says, "employment opportunities in medical institutions are significantly limited for DNB degree holders because of the MCI guidelines. There is also scope for at least doubling the number and also institute national programmes in areas where there is shortage of faculty. But the MCI directives prevent many institutions from offering their facilities for training DNB students. The proposed infrastructure expansion will also result in increased capacity of institutions to train DNB students."

These MCI guidelines are formulated by the Post-graduate Medical Education Committee (the PG Committee) constituted under Section 20 of the Indian Medical Council Act, 1956. It was on the basis of the recommendation made by the PG Committee in 1993 that the Government stipulated in October 1994 that for teaching appointments in broad specialities, a DNB degree holder was required to have at least one year's experience as tutor/registrar/demonstrator, or an equivalent post, in a recognised undergraduate medical college. Similarly, for teaching posts in super specialities, a DNB awardee was required to undergo two years' training in a recognised medical college with recognised post-graduate degree course in the concerned speciality.

While the Act only mandates the MCI to prescribe under-graduate courses and degrees, as well as approve the corresponding institutions offering them, it has only advisory and recommendatory powers as regards post-graduate courses and degrees. However, according to the NBE, the MCI had in recent years begun to impose guidelines for post-graduate education as well. These guidelines, as formulated by the PG Committee, rendered a whole cadre of DNB-qualified post-graduate medical students ineligible for teaching posts in medical institutions. This assumed authority, the NBE contends, goes beyond the provisions of the Indian Medical Council Act.

According to Dr. Shyamprasad, the requirement of additional experience was reasonable earlier because DNB students did not do any dissertation for their degrees. "But now since DNB students also have to do dissertations, there is no rationale any longer for insisting on additional teaching experience. Moreover, all over the world the paradigm of medical education has advanced and today it is integrated with clinical science," he points out.

But the MCI has continued to maintain its earlier stand. In 2003, the MCI enumerated specific reasons why it could not accept the equivalence of DNB degrees with MD/MS and DM/M.Ch degrees. However, both the Government and the NBE find no merit in the MCI's arguments and have rejected them.

In August 2004, and again in September 2005, the MoHFW notified that institutions conducting MCI-approved post-graduate courses were also permitted to run DNB courses. However, in November 2005, the MCI unilaterally instructed all medical institutions to refrain from this practice without seeking the Government's consent as required.

It is pertinent that the MCI did not attend a meeting on post-graduate medical education convened by the Health Ministry last week at which the issue of DNB degrees was discussed. According to MCI Secretary Lt. Col. (Dr.) A.R.N. Sethalwad, "the meeting had no legal validity because an executive order cannot override the decision of a committee constituted under an act of Parliament."

But the Government is keen to resolve this standoff between the Ministry and the MCI at the earliest. A Bill is pending with the Parliamentary Standing Committee on Health that would enable suitable amendments to the Act and bring about changes in the MCI's functioning.

Link: Original Article

Chiranjeevi Scheme: Gujarat Doctors want more money to deliver at work

Though lauded nationally, the Gujarat state government’s Chiranjeevi health scheme to reduce the maternal/infant mortality rate has the private doctors grumbling, wanting more remuneration.
Under the scheme, state-government recognised private doctors are paid a specific amount for every institutional delivery taking place in their hospitals, but private doctors claim the payment is inadequate. A normal delivery costs anywhere around Rs 3,000, and a complicated case is well over Rs 10,000.

But, under the Chiranjeevi scheme, they are paid an amount of Rs 1,545 per delivery.

Some of the doctors have now decided to pull themselves off from the scheme, while others are requesting for changes to justify the service provided by them.

A Godhra-based gynaecologist, Dr Shujaat Vali, who has decided to opt out of the scheme, said: “The Chiranjeevi doctors in the peripheral region do not accept complicated patients, but while they churn profit from normal deliveries, the complicated cases are sent to the city-based Chiranjeevi doctors. Over 50 per cent cases at my clinic are of a complicated nature.”

Dr Parul Kotdawala, president of the Society of Gynaecologists and Obstetricians of Gujarat (SOGOG), said: “With the increasing charges of medical services, the initially decided amount does not stand up to support the medical practitioners.”

At a recent review workshop of the scheme by IIM-Ahmedabad, obstetrics and gynaecologists from across the state, under SOGOG, listed out their grievances.

Dr Kotdawala said: “We are planning to survey all the doctors under the scheme to bring out the facts. The scheme is part of the social responsibility programme, and though the intention of the scheme is good, due to the low package, many doctors are compromising with the quality of service.”

Deputy Director of Health Dr Vikas Desai said: “This is a very preliminary level workshop to review the comfort level of the doctors in the scheme and costing of the doctors.”

IIM-A professor Dileep Mavalankar, who is undertaking the study, said: “The main intention of the scheme is not just to lower maternal and Infant Mortality Rate (IMR), but also to provide quality service. Doctors tend to cut corners by unethical means. We are trying to have regional level discussions with gynaecologists to find a solution to this.”

The doctors also pointed out other flaws in the scheme, like operations being conducted by junior doctors and nurses, use of low quality medicines, lack of post-delivery care, and of benefits being accrued by well-off patients through the use of fake BPL cards.

“People from high strata of society produce fake BPL cards and take advantage while the real and poor beneficiaries are left out,” said Dr R B Patel, the president of Godhra Obstetrics and Gynaecological Society (GOGS).
Link: Original Article

Arogya Sena designs health manifesto for LS aspirants

To bring health issues into prominence this election, Pune based Arogya Sena has come up with a comprehensive and unique health manifesto' featuring ways to consolidate public health care system in the country. The Sena will pursue all major political parties to include it in their agenda.

"From increasing budgetary allocations for public health to strengthening public health care system, the health manifesto features 25 prime areas that need special thrust.
We will send it to all major political parties and ask them to include it in their respective public manifestos," said cardiologist Abhijit Vaidya, national chief of Arogya Sena, a social organisation that fights for the health rights of common man.

Elaborating on the features of the health manifesto, Vaidya said, "In order to boost rural health care system, we have suggested setting up of Rural Medical Referral Centres (RMRC). The centre will bring consultation of specialist medical professionals within the reach of villagers by visiting specialists once a week." This initiative will change the face of rural health system and make it accessible and affordable, said Vaidya, who had initiated such a move with the members of Arogya Sena around eight years back in Maval, which has helped more than 250 villages.

Similarly, the manifesto also stresses on initiating affordable diagnostic centres in cities as well as villages for cheaper treatment and emphasises on nurturing effective and efficient ambulance system, said Vaidya.

Besides suggesting ways of controlling prices of medicines, promoting clinical research, special scheme for children health etc, the health manifesto of Arogya Sena also emphasises on issues of sanitation and disposal of garbage in a scientific manner.

"We want humane, efficient, corruptionless, accessible and affordable public health care system for common man which will give round-the-clock medical service," said Vaidya. We will reach out to all political parties with our manifesto either on mail and personally wherever possible, added Vaidya.

Link: Original Article

April 01, 2009

Medico-legal clinics in govt hospitals?

The Karnataka State Legal Services Authority is looking into the need of initiating medico-legal clinics in government hospitals across the state.

Releasing the `People's Health Manifesto - 2009' on Tuesday, Justice Gopal Gowda heard presentation of case studies and testimonies of denial of health service to people.
AIDS victim and peer counsellor Vijaya said she was denied gynaecological treatment in Belgaum district; Savitha, a sex worker, complained of ill-treatment and lack of sensitivity among health professionals; a patient suffering from spinal injury said there's a need for specialists at public health centres (PHCs) and that procurement of disability certificate is difficult.

Health secretary M Madan Gopal agreed facilities at PHCs must improve. "We need one PHC for 30,000 people; now we have one PHC for every 14,000.''

According to a recent study by NGO Belaku on health services in Kanakapura, only 5 of 608 pregnant women interviewed had received free treatment.

Another study, conducted in 13 districts, showed shortage of emergency medicines like anti-rabies and anti-venom drugs in PHCs and district hospitals, and HIV-infected pregnant mothers being deprived medical care in government hospitals.

Link: Original Article

Tele-medicine facilities to help combat vector-borne diseases

To combat vector-borne diseases like malaria in Jharkhand, it was necessary to connect some of the best hospitals across the country with patients in Jharkhand through tele-medicine facilities.

With Jharkhand accounting for seven percent of the total malarial cases in the country, telemedicine facilities should be made available to rural doctors and patients, Chairman of Indian Space Research Organisation (ISRO), G Madhavan Nair, said in his convocation address at the Birla Institute of Technology, Mesra, yesterday.

"It is an effective solution for providing speciality healthcare in the form of improved access and reduced cost to the rural patients and also reducing professional isolation of the rural doctors," he said.

"Of the vector-borne diseases prevalent in the state like filariasis, kala-azar and dengue there is very scanty information on the transmission dynamics of various vector-borne diseases and health seeking behaviour of the tribal poulation is very poor", Nair said.

The use of tele-medicine facilities, he said, calls for participation of engineers, administrators,medical professionals, para medical staff and technicians.

Stating that telemedicine networks had been set up using satellite based facilities in the country, he said it facilitiates the provision of medical aid from a distance.

Is e-cigarette dangerous for health?

The latest craze in the market is the e-cigarette. E-cigarette? Are you hearing this for the first time? It may be if you are living in countries like India. However, it has become much common in several parts of the world.

What is electronic cigarette or e-cigarette then? Well, it is an alternative to smoked tobacco products, that includes cigarettes, cigars, or pipes. In short, it is a battery-powered device that provides inhaled doses of nicotine by delivering a vaporized propylene glycol/nicotine solution. In addition to nicotine delivery, this vapor also provides a flavor and physical sensation similar to that of inhaled tobacco smoke, while no tobacco, smoke, or combustion is actually involved in its operation.

Let’s talk of its appearance now. The electronic cigarette, in general, takes the form of some manner of elongated tube, but many of them are designed to be like the outward appearance of real smoking products, like cigarettes, cigars, and pipes. A common design in the form of “pen-style” has also come up. This name is due to its visual resemblance to a ballpoint pen.

Nonetheless, in spite of all these, use of electronic cigarettes is earning strong criticisms or is being censured severely. As stated by users and commoners, the effect of this device is also dangerous for the health. What’s more, it is also leading to respiratory problems, as stated by observers.

The allegations seem to be grave but they have become enough for Health Canada, the department of the government of Canada with responsibility for national public health. It has already instructed businesses not to promote them or sell them till official safety evaluations get completed. The statement made by Health Canada (CBC.ca) declares, “Persons importing, advertising or selling electronic cigarette products in Canada must stop doing so immediately.”

Is this device dangerous truly? Well, nothing can be said at this moment. But, since there is a rise in the number of allegations and also suspected health problems, there should be a thorough assessment of e-cigarette. Original Article



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