Mal-Practice in medical profession is deep rooted. To control it IMA has laid down a Code of Ethics

Mal-Practice in medical profession is deep rooted. To control it IMA has laid down a Code of Ethics. The future will tell us- How far the Code of Ethics is going to be effective? But it is a good move from IMA. It will create awareness amongst the health care providers. The main questions raised are:

        What is a costly gift? A common mans pen costing Rs.2/- is costly or a Peare Cardin or Parker pen costing more than Rs.200?  Besides price it also depends upon whether it is given to a rural doctor or to one in a corporate hospital. The gifts are custom made as per the status of a doctor.      

      Gifts vary from Stationary like letter pads, diaries, pen stands, calendar & other table wares. Kitchen wares like jugs, mugs, cutlery, lemon set, dinner set etc. Car accessories like sun screen, car perfume, back rest, neck rest, tissue papers etc. Linen & dress material like saree, shirts, blazers, ties, cuff links, socks etc. Home appliances like suitcases, wheelers, sky bags, mosquito nets, bed sheets, pillow covers etc.

 Medical books, journals, CDs, & medical literature in various forms are also gifted. Will these articles also be freebees?

     Travel expenses, boarding & lodging etc. born by the companies is another form of freebee? For attending a conference, symposium or a workshop the companies offer right from Registration Fees to pickup facilities from railway station, airport etc. How all this is going to be monitored? If at all one or two unfortunate Doctorss are trapped then the crime will be established against them & such malpractices can be stopped in future? It is not like a PCPnDT Act which has sensitized the whole system.

          Scholarships. In this context it is worthwhile to understand how far the companies are involved? There are various scholarships, training programs, higher education, operative procedure learning programs etc. Which are totally sponsored by well known MNCs all over the world? For which applications are sent through various medical associations. Candidate are then selected on the recommendation of this association.

Dependence on Pharma Companies Secondly the conferences & workshops are sponsored fully by a single company or by many companies jointly undertaking different events. If these sponsorships are included in the list of freebees then what will be the fate of the learning opportunities for the young Doctors? Who else will bear the expenses?

For Company what is more important; Doctor or company's product Thirdly a new trend has emerged which is more dangerous of all. The companies pickup youngsters, spend a lot to give them all sorts of training to make them masters of a particular procedure or surgery, sponsor all their workshops, seminars etc. Arrange their talks in different forums & different cities to popularize them. During the talks they arrange free dinners, cocktails to the delegated & distribute them all possible know how about that topic along with a folder which may contain a letter pad & pen etc. For a company not only its product but also its Doctor is equally important who patronizes its product.

 Commercialization of Conferences Still a new trend is emerging. For organizing Annual Conferences a lot of budget is needed. Doctors of course pay registration fee but it is not enough to meet the expenses of the elaborate & lavish arrangements. So the organizers look towards sponsors. Many of these sponsors book a particular scientific session, along with their own speakers. For this a huge amount which may be in lacs is being donated. The company’s trained Doctor will then give his speech on the topic in which that company’s product is utilized. The slides & text for the speech is also provided by the company. That means a total corporatization is taking place at subtle level. Depriving a Doctor coming from a small place, having his own innovative ideas of an easily available method which would be more useful, cheaper than others. He is left to present his scientific paper in the least important session, when hardly any audience is left who is interested to hear him. He gets no attention & no encouragement.

Hence it clear that on one side learning opportunities for Doctors are at stake if you are strict with the sponsors. On the other hand company’s recent marketing trends are difficult for everyone to understand. The Doctors & Associations unknowingly fall prey to such offers as mentioned above. Against which indirectly the companies keep increasing their profits.

 In the same catagory come the corporate hospitals. Just like a Pharma or Equipment company they send their specialists to various cities, arrange their talks and arrange free dinners & cocktails for local Doctors. To make it official these symposia are held under a medical association’s banner which could be API, ASI, IOA, PMPS, G. & O. Association, or IMA itself. This means that all the medical education, training & learning programs are in the hands of Corporate World whether a hospital or a pharma / equipment company.

More over if prior permission is taken from MCI or State Medical Council to organize these symposia, the medical council approves “Learning hours” for attending it. In the permission letter name of sponsors, speakers, organizers, venue etc. have to be filled up.  A certificate is then awarded to a doctor with endorsement of “Hours”.  These learning hours are needed when a Doctor has to renew his registration with medical council from time to time. Without attending a minimum number of hours his registration cannot be renewed.

 It is the greatness of IMA to have taken up an initiative to first clean our own system by following the Code of Ethics. For that IMA has decided to create awareness amongst them through a final draft which it plans to bring out in 3 months. But the problem is how many Doctors are members of IMA? They are fragmented into innumerable associations e.g. Surgeons Association, Hand Surgeons Association, Neurosurgeons Association, Endoscopic Surgeons Association, Vascular Surgeons Association, like that the list is never ending. Each & every specialty with its sub specialty & super specialty has an association. Similarly locally they are split into Private Doctors Association (GPs- General Practice), Private Specialists Association (API, ASI, IOA, G&O etc.), In service Doctors Association, Medical College Teachers Association, Former Medical Teachers Association, Private Hospitals Association, Nursing Homes Association & so on.

The main point is that besides formulating Code of Ethics from time to time, IMA should also empower the medical fraternity by imposing confidence into them, by standing with them in time of need, by becoming their voice, by ensuring security to their life, position, dignity & respect which they definitely deserve. IMA being the only National body & the parent body can do it. But for that first of all it has to strengthen itself by making each & every Doctor its member. It is not an impossible task though it may be difficult.  MCI & state councils have the lists of all registered Doctors. Just compare with these lists & calculate how many from this list are IMA members. Now all those who are not members have joined one or the other association. IMA should contact each & every association’s office bearers & request them to join IMA along with all their members. For that these other associations may compulsorily charge some extra fees from new members & during renewals which will go to IMA. Like this IMA will become the sole & strong parent body which can protect the interests of medical fraternity.

Along with imposing controls & ethics, there is a need of the hour to make IMA strong & a powerful body to represent the voice of not only Doctors but hospitals & patients as well.

Pre-marital sex not shocking, every breach of promise to marry is not rape: Bombay HC

This is an example of changes in our society. Which is now little bit more open then before. The metros & other cities are full of students both male & female. With the result that intimate friendship turning into sexual relationship seems natural. The girls should not take it granted that her boyfriend is committed to marry her. Because having sexual relations & its out come before marriage itself is not having any social permission or legal protection. This High Court verdict is an opener to all the youth specially the females. The boys on the other hand may take advantage of this.
Hence it is very important to understand the law related to such issues & human bodily demands. Most important lines in the verdict are:-
"Today the law acknowledges live-in relationship(s). The law also acknowledges a woman's right to have sex, a woman's right to be a mother or a woman's right to say no to motherhood. Thus, having sexual relationship with a man whether is her conscious decision or not is to be tested independently depending on the facts and circumstances of each and every case and no straightjacket formula or any kind of labelling can be adopted," the judge said.

Are the organizers in government are immune to legal enquiry? Again a surgeon declared culprit and put behind the Bars.

Are the organizers in government are immune to legal enquiry? Again a surgeon declared culprit and put behind the Bars.

Dr. Arora accused in botched eye surgeries arrested, a case registered against the private hospital, a Mathura based N.G.O. and camp organizer Mr. Munjeet Singh has been detained after 60 operated cases lost their eye site in camp surgery at Gurdaspur’s Ghuman Village.

But on the other hand 19 women died in a sterilization camp at Bilaspur, Chhatisgarh. Surgeon arrested and after I.M.A.’s demonstration the drug manufacturer was arrested only when testing laboratories proved that the antibiotic Ciprox-500 contained Rodenticide. Surprisingly! No camp organizer, no permission giving authorities and no permission taking people arrested.

Is it the Botched Management & Government machinery; or the Surgery

Is there any difference of procedure adopted against a GO or an NGO i.e. a government organization or a non government organization?

Govt. of India, State Governments, IMA and other medical organizations should pay attention to the above fact. Why G.O. is immune to enquiry and action where as N.G.O. is vulnerable?

Under local anesthesia, the surgeon makes a tiny incision in the anterior most part of eye to reach the Cataract or the hazy lens of the patient. The lens is removed by making small pieces. During this process a thorough wash is given many times by using a fluid called Ringer Lactate (RL). It is supplied in 500ml bottles. After that the artificial lens is fitted inside.

What is the method of Eye Surgery in camps?

                 

Human Eye

 

Opinions of renowned Ophthalmologists:

1.       Dr. L.N. Chandak, Director Chandak Eye Hospital, Ajmer and

2.       Dr. Arun Kshetrapal, Director Kshetrapal Eye Hospital and Multi-Specialty said that the irrigation fluid (RL) is the most probable culprit leading to blindness. One bottle of 500ml is used in 6 to 8 eye operations. There are chances of bacterial or fungal infection in these bottles. Bacterial infection leads to blindness after 2 to 3 days and fungus causes blindness after 10 to15 days. They also said that the other eye drops used during and immediately after operation may also be sometimes responsible for complications.

They further informed that the fluid inside the eyes (Vitreous) is a very good & suitable medium for the growth of bacteria & fungus. That is why the washing fluid has to be 100% safe.

3 types of RL:   2 in plastic & 1 in glass bottle

1.Dr. Chandak said that they do culture of the RL 3 days before surgery and used it only if culture is negative. 2.Whereas Dr. Arun Kshetrapal said that they sterilize it before operation. 3.My doubt was that the RL comes in plastic bottles. He said that they procure only glass bottles of IV fluid RL and re-sterilize it before operation so as to ensure safety to the patient’s eyes.

When asked on how they ensure that the fluid RL is not contaminated?

 

Are these similar measures being taken in mass surgical camps? Can the government expect from an NGO, it’s Trustee, or sponsors that they will have any of the above knowledge? Those who give permission should be held responsible because the permissions are signed in A/C chambers; no one goes to the field to ensure a quality check. Has anyone done culture of RL? Because RL is generally supplied in plastic bottles due to cost effectiveness.  Glass bottles are less likely to contaminate & as Dr Arun said it can be re-sterilized. For the camps does anyone guide them tobuy glass bottle & think in the same way?

How long the authorities will not be held responsible?

Giving a blind permission for organizing mass surgeries will result into blindness only. If the authorities throw light on the DO’s & DON’T’s before allowing to hold these camps then only the patients will be blessed with light in their eyes.