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  From the desk of editor in chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

  Editorial …

16th December, 2010, Thursday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Medscape Rheumatology’s 2010 highlights (Part II)

  1. House enacts historic Healthcare Reform Bill
  2. Six ways to earn extra income from medical activities
    • Work with attorneys: Lawyers who handle medical malpractice cases have come to rely on the expert opinions of practicing physicians to bolster their clients’ claims. Doctors are hired for everything from examining the relevant medical records in a case and rendering an opinion, to testifying in court on behalf of a plaintiff or a physician–defendant. To do this job, it’s useful to also have strong people skills. If you wind up on the witness stand, it’s especially important that you be able to communicate complex subjects clearly and simply to laypeople. Reviewing records might pay $200–$300 per hour or more, depending on the complexity of the case, where you practice, and a number of other factors. Depending on your medical specialty, credentials, and experience, you can command between $2000 and $5000 per day, plus expenses, to estify at a deposition or trial. Cons: Expert witnesses, especially those who testify against doctors, run the risk of being labeled "hired guns" who don’t always endear themselves to their colleagues.
    • See nursing home patients: Some MDs and DOs still see patients regularly in long–term care facilities and believe that it’s worth the effort. It’s not uncommon for physicians to earn in the range of $15,000–$30,000 a year for this extra work. Pros: The pros include very low overhead, flexible hours, and the gratitude of patients who are often forgotten or neglected by their families and caregivers. Cons: The cons include malpractice risks (including potential charges of elder abuse) and unreasonable demands from family members who may visit sporadically and not communicate with each other. The watchful eyes of insurance companies as well as state and federal regulators can be draining, too.
    • Serve as a medical director: By law, all long–term care facilities need to have a medical director who oversees the quality of care, presides over monthly staff meetings, and is available to help craft policies and procedures. It’s not a full–time job. This is a good opportunity for a board–certified family physician or internist who has an interest in geriatric medicine, with compensation averaging about $1000–$2500 a month for about 5–10 hours of work each month. Pros: Overall, there are fewer messy reimbursement issues with long–term care work because you’d be paid directly by the facility on a contract basis. However, not all of the perks are monetary: "Medical directorship offers a welcome change of pace from regular practice," Zydiak says. "It’s also taught me administrative problem–solving skills that were totally foreign to me." Cons: Despite how much patients may love them, medical directors are often undervalued and underutilized, in terms of establishing policies and proce dures to help assure patients’ rights and head off ethical issues before they happen.
    • Team up with pharmaceutical companies: Drug and device companies spend billions of dollars each year to discover and promote new medicines and treatments, and they rely heavily on doctors to participate in these endeavors whether through clinical trials or serving as a speaker or consultant. It’s not uncommon for physicians to earn a minimum of 5 figures a year either speaking or doing clinical studies within their medical practice. Some doctors make in excess of $100,000 annually –– on top of their income from seeing patients. Although some extra money is nice, too much can turn heads –– and not in a good way. In late January, The Boston Globe reported on an allergy and asthma specialist who was issued an ultimatum by his hospital, the prestigious Brigham and Women’s Hospital (Boston, Massachusetts): Stop moonlighting on behalf of pharmaceutical companies or resign from your staff position. The doctor chose to give up his post. Pros: With typical payments running about $1500–$2500 for a single talk, there’s substantial opportunity to supplement your regular income. With regard to clinical trials, the size of compensation for participating in clinical trials, on the other hand, depends on your specialty and how your medical group divides income. Some clinical trials will pay more to physicians who are active in negotiating contracts with pharmaceutical companies, in addition to earning a cut for their role in the actual research. Cons: These arrangements are coming under increasing scrutiny from hospitals, legislators, regulators, and the media. In fact, some of the doctors whom we contacted for this article declined to talk about their involvement with drug companies.
    • Become a media personality: If you have a knack for explaining technical subjects in easy–to– understand terms and don’t mind the spotlight, media outlets want you. As an expert, you can help journalists do their job better by providing a local angle on a national medical topic –– in the form of a quote, a column or opinion piece, or an on–air appearance. Pros: You’ll get exposure for your practice and attract new patients. If, say, 50 or more come to you over the course of a year, that could mean thousands of dollars in additional income. Also, here’s a bonus: You could become the next Sanjay Gupta, the ubiquitous medical correspondent on CNN. Cons: You probably won’t become the next Sanja46y Gupta. Those gigs, as you’ve probably already guessed, are few and far between. Nor will you likely make much money working with media outlets in rural areas of the country. Some newspapers may pay you as little as $50–$100 for a column, whereas TV or radio stations are not apt to compensate you at all. Again, the larger financial benefits are likely to be indirect, in the form of new patients who saw you on TV or read your quote or column in the newspaper.
    • Consult for Wall Street: How do mutual fund managers and other financial professionals who analyze healthcare companies decide what to invest in? Besides poring over balance sheets and working their contacts at the companies themselves, they talk to physicians like you. Your opinion on how well a drug or a device works, as well as a description of some of the common problems that you’re currently experiencing, can go a long way toward helping them decide whether to increase or decrease their stake in a company. Pros: The pay is pretty sweet: about $250 per hour to do everything from filling out surveys to participating in phone calls and panel discussions. Cons: You’ll have to be very careful about the type of information that you reveal, lest you violate any of your nondisclosure or confidentiality agreements. For instance, if you participate in ongoing drug trials, you can’t leak critical details that might be used by a brokerage firm in deciding whether to buy or sell a stock. (Does the term "insider trading" ring a bell?) Sometimes even a hint of impropriety or a conflict of interest might be enough to land you in hot water.
  3. Nine smartphone apps to improve your practice: Smartphone use in the United States and abroad is on a vertiginous rise. These mobile devices are malleable, multifunctional tools that can be helpful to many professionals, including healthcare workers, who can benefit from integrating smartphones and apps into their daily routine.
  4. Treating pain and improving function in patients with arthritis: Several techniques are available to healthcare providers and patients to manage pain resulting from various forms of arthritis. Some of these methods are well studied, but many are not –– although many patients may seek out alternative therapies regardless of their proven efficacy in research studies. Going forward, the research community will need to focus identifying preventive therapy for arthritis, new methods for pain treatment, and performing high–quality studies on efficacy of arthritis pain management. In the meantime, healthcare providers should periodically review treatments for arthritis pain to ensure that management of this pain in their patients is maximized.
  5. Renal safety of nsaids confirmed in large study of RA patients: The use of nonsteroidal anti– inflammatory drugs (NSAIDs), including cyclooxygenase (COX)–2 selective inhibitors (coxibs), did not adversely affect renal function in patients with rheumatoid arthritis (RA), according to the results of one of the largest prospective studies to examine renal toxicity in RA patients, Swiss investigators reported here at the European League Against Rheumatism Congress 2010.
Dr KK Aggarwal
Editor in Chief
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  Quote of the Day

(By Dr GM Singh)

"One swallow does not make a spring, nor does one fine day."


    Photo Feature (from the HCFI Photo Gallery)

 Anmol 2010

Diya decoration competition organized as part of Anmol, Festival of Children with Special Needs in the 17th MTNL Perfect Health Mela 2010 saw an active and lively participation of children

Dr K K Aggarwal
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

150 poor patients to get free insulin quota for a year at Diabetic Mela

The 12 th edition of "Delhi Diabetic Health Mela" will begin at Agarwal Bagichi Trust Bhavan in Punjabi Bagh here this coming Saturday. According to the organiser of the event, Delhi Diabetics Research Centre president A.K. Jhingan, a unique aspect of the two–day event would be that 150 Below Poverty Line persons suffering from diabetes and undergoing treatment in government hospitals will be provided free insulin for a year. The Delhi Diabetes Research Centre, a voluntary organisation working towards creating awareness about diabetes and its prevention since the past two decades, is organising the mela that will focus on preventing kidney diseases and managing diabetic foot complications. (Source: The Hindu, Dec 14, 2010)

SC clears single exam for all MBBS courses

The Supreme Court on Monday gave an important clarification that will enable Medical Council of India (MCI) to go ahead with its plan to hold a single common entrance test (CET) for MBBS and post–graduation seats in all government and private medical colleges from next year, that is the 2011–12 academic session. Appearing for the MCI governing council, senior advocate Amarendra Saran informed a bench comprising Justices R V Raveendran and A K Patnaik that the regulator was not issuing the notification for single CET because of pendency of petitions in the SC. The bench clarified that "pendency of petitions will not stand in the way of MCI notifying the new regulations (proposing single CET) and others from challenging the notification (subsequently)". This clarification will allow MCI to notify its regulations envisaging single CET for MBBS and PG courses in all medical colleges from 2011.
Once MCI issues the notification, there will be a single entrance examination each for MBBS and MD courses offered by all 271 medical colleges, 138 run by governments and 133 under private management. These colleges offer over 31,000 seats for MBBS courses and another 11,000 seats for PG degrees. Saran, aided by petitioner Simran Jain's counsel A D N Rao, had pleaded for single common entrance test, arguing it would protect students from harassment of having to appear in 10 to 15 entrance tests every year. Addressing the concern of state governments afraid of losing their quota in state medical colleges, MCI clarified that state quota would remain intact as ‘National Eligibility–cum–Entrance Test’ (NEET) would draw up a national merit list as well as state–wise ranking list for general category, SC, ST and OBC as well as physically challenged persons. The MCI proposal had said, "In order to be eligible for admissions to MBBS courses for a particular academic year, it shall be necessary for a candidate to obtain minimum 50% marks in each paper of NEET held for the said academic year. However, in respect of candidates belonging to SC, ST and OBC, the minimum percentage of marks shall be 40% in each paper and for candidates with locomotory disability of lower limbs, it would be 45% in each paper." (Source: The Times of India, Dec 14, 2010)

    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC http://www.isfdistribution.com)

Americans feel healthy despite obesity numbers

Globally, heart disease is the biggest killer, and diabetes is the fastest–growing chronic condition. Medical evidence has shown that obesity is a precursor to both. "Chronic disease is the leading cause of death and disability globally, representing 60 percent of all deaths. What’s concerning is that many of these diseases are preventable,– said Julien Forder, senior research fellow, the London School of Economics, which published the study. "We know from research that exercise is one of the most effective lifestyle changes you can make to reduce your risk of developing long-term conditions." He said that 30 percent of cardiovascular disease and 27 percent of diabetes could be avoided if Americans started to exercise.

(Contributed by Dr GM Singh)

Neurologists update guidelines on driving risk in patients with dementia

The guidelines say the following characteristics are "useful" in identifying patients with dementia at high risk for unsafe driving:

  • A Clinical Dementia Rating scale score of 0.5 or higher
  • A caregiver rating the patient’s driving as "marginal or unsafe"
  • Previous traffic citations or crashes
  • Decreased driving mileage
  • Self–report of always avoiding driving in certain situations (e.g., at night or in the rain)
  • Mini–Mental State Examination score of 24 or lower
  • Aggressive or impulsive personality traits

Conversely, the following should be considered "not useful":

  • Self–rating of driving ability
  • Self–report of not avoiding certain driving situations

The practice parameter includes a clinical algorithm, as well as patient and caregiver questionnaires, that may help physicians estimate a patient’s driving risk.

(Dr Monica and Brahm Vasudev)

Aortic aneurysm treatable with asthma drugs:

ScienceDaily: A new study from the Swedish medical university Karolinska Institutet shows that asthma drugs are a potential treatment for aortic aneurysm. These drugs, which block cysteinyl–leukotrienes, could reduce the break down of vessel wall tissue and the dilation of the aortic wall, and thus the risk of its rupturing. This could both save lives and reduce the need for complicated and risky surgery. The results are presented in the scientific journal Proceedings of the National Academy of Sciences (PNAS).

Cutting dietary phosphate doesn’t save dialysis patients

ScienceDaily: Doctors often ask kidney disease patients on dialysis to limit the amount of phosphate they consume in their diets, but this does not help prolong their lives, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology. The results even suggest that prescribing low phosphate diets may increase dialysis patients’ risk of premature death.

Married kidney failure patients more likely to receive new kidney

Kidney failure patients who are married are more likely to receive a new kidney than those who are widows or widowers or have never married, according to a study published in the American Journal of Transplantation.

    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

Do I need endometriosis surgery if I am already planning to pursue IVF?

The question of endometriosis surgery prior to IVF is a somewhat controversial area of reproductive medicine. Most reproductive endocrinologists do not recommend surgery prior to IVF unless the woman has advanced endometriosis, in particular, an ovarian endometrioma. IVF is associated with excellent pregnancy rates (even without surgery) in women who have only mild to moderate endometriosis. When advanced endometriosis is present, such as an ovarian endometrioma, its surgical removal prior to IVF may enhance the chances for a successful IVF outcome and may decrease infectious complications related to egg collection. Thus, in such cases, most reproductive endocrinologists often recommend the removal of advanced endometriosis prior to treatment using IVF.

For queries contact: banerjee.kaberi@gmail.com

    Gastro Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity

What is Maintenance therapy of constipation?

Maintenance therapy is started after disimpaction to prevent reaccumulation of stools.

  • Dietary modification in form of balanced diet that includes whole grains, fruits and vegetables.
  • Toilet training should be imparted after 2–3 years of age as too early and vigorous toilet training may be detrimental. Children are encouraged to sit on the toilet for 5 to 10 minutes, 3 to 4 times a day immediately after meals for initial months. A positive reinforcement to the child should be given in form of star charts and rewards.
  • Laxatives like lactulose, sorbitol, milk of magnesia, and mineral oil have been used in children with equal efficacy; the most commonly used laxative is lactulose. However, recent studies have shown that polyethylene glycol (PEG) (0.5–1 g/kg/day) is superior to lactulose (1–2 ml/kg/day). Side effects, especially bloating and pain, are less with PEG. With long–term use, lactulose loses its efficacy. The dose of laxative should be adjusted to have one or two soft stools/day without any pain or soiling. Once this target is achieved, the same dose should be continued for at least 3 months to help the distended bowel to regain its function. Laxative needs to be continued for several months at the right doses early and rapid withdrawal is the commonest cause for recurrence. Stimulant laxatives (senna, bisacodyl) may be used for a short course in refractory cases as a rescue therapy but are contraindicated in infants.
    Medicolegal Update

Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS

Fracture of bone is a grievous injury

The certification of grievous injury on the basis of fracture of bone/s is done by doctors in accordance with Section 320 of Indian Penal Code, which defines Grievous hurt. Grievous hurt includes fracture or dislocation of bone or tooth. The medical dictionary meaning of the fracture is ‘the breaking of the part especially the bone or break or rupture in the bone or in continuity of a bone.’ This definition is applicable for the radiologist or orthopedician but certainly not for the purpose of certification of injury as grievous. As in many cases during legal scrutiny it was found that the fractures reported by radiologist were tentative, superficial, fabricated or self–inflicted, hardly one mm deep cut in the bone or mere a ponding effect on bone having no any medical or surgical complication.

  • It is imported to understand that a tentative fracture medically/clinically non–significant/uncomplicated/invented by modern scan methods/ cannot be certified as grievous injury.
  • A mere superficial cut and scratch on bone may not be grievous because the meaning of grievous is…………… threatening great harm; "a dangerous operation"; "a grave situation"; "a grave illness"; "grievous bodily harm"; "a serious wound"; "a serious turn of events"; "a severe case of wound or a life–threatening disease
  • It must be remembered that the cutting of a bone does not necessarily involve a fracture of that bone. In a criminal revision at the Patna High Court, in which one received an incised wound, 3" × 3 ¼" × 1, on the lower part of the left leg cutting the bone underneath it was held that where the evidence was merely that the bone had been cut and there was nothing whatever to indicate the extent of the cut, whether deep or a mere scratch upon the surface, it was impossible to infer from that evidence alone that grievous hurt had been caused within the meaning of the definition of Section 320, IPC.
  • The Supreme Court in its judgment, in one case, had clarified that until and unless such a cut on bone does not extend deep up to the medullary cavity it would not constitute a grievous hurt within the definition of fracture under Section 320(7), IPC.
  • In cases of injury, it is the Court that judges finally whether it is simple or grievous. The duty of the medical witness is only to describe the facts and not classify a hurt. The entry made in the wound certificate as simple or grievous is only meant to guide the investigating officer.
    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q: What is the solution to the following problem "Close to 30% students admitted to postgraduate courses at AIIMS this year have quit to take up seats in preferred courses at other institutes, wasting dozens of seats at the country’s premier medical school?" as revealed in a recent news item –

  • This is not a problem at all. It is a "problem" created by the blinkered vision of the planners. Why does this problem not occur in the USA or the IIMs?
  • The basic question is––"Why should higher professional education be free?"
  • I am clear in my view that the government should concentrate its efforts (in that order) on:
    • Removal of illiteracy;
    • Universal primary education till the age of 14 years which is now a fundamental right and a constitutional obligation of the state;
    • Secondary and senior secondary education.
      ‘a’ and ‘b’ should be totally free; ‘c’ should be free or should have very mild fees.
  • Graduate education should be on moderate fees. Higher education and professional education should be on very high fees on supply and demand basis and should be fully or partially self –financing. This does not mean education should be denied to the poor. They should be given adequate financial support by various means, including soft loans. Education for women at all levels should be free. That will hugely emancipate the society by empowering women and, in effect, reducing population growth rate.
  • Residents are paid a decent salary. They deserve it. Let them be paid even more to attract and retain them. Let there be a differential. Let there be incentives paid to those in "less attractive" disciplines. Let there be strong disincentives for leaving a course after joining.
  • The students leave a course after joining at AIIMS because they later get admission to a subject of their choice in another college. It is surprising why the simple solution of all PG admissions being made subject to a single PG entrance process/examination at the all–India level cannot be implemented. This will immediately put a stop to the above "problem".
Our Contributors
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  Docconnect Dr Sudhir Gupta
    Ethical earning

What is reimbursable to a doctor?

In practice one can charge separate fee for morning and evening consultation.

    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

ASMA – Anti–Smooth Muscle Antibody

To help diagnose chronic active autoimmune hepatitis and distinguish it from other causes of liver injury.

    Medi Finance Update

If payment of expenditure is made to relative, which is unreasonable as per the view of assessing officer, then will it be allowed as deduction?

A If payment of expenditure has been made to relative and assessing officer is of the opinion that such expenditure is unreasonable as compared to fair market value, then the expenditure considered unreasonable may be disallowed.

    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
DCI Approval Date
Ivabradine Hcl Tablets 5/7.5mg (Additional Indication) For symptomatic treatment of chronic stable angina pectoris in coronary artery disease patients with normal sinus rhythm, indicated in combination with beta–blockers in patients inadequately controlled with an optimal beta–blocker dose and whose heart rate is >60bpm. 10–Feb–10
    IMSA Update

International Medical Science Academy (IMSA) Update

WHO Medical eligibility criteria for contraceptive use

The United States Centers for Disease Control (CDC) modified the World Health Organization (WHO) tables for medical eligibility criteria for contraceptive use. WHO recommendations were adapted for the US population and contraceptive methods not available in the US were removed.

(Ref: Farr S, et al; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Centers for Disease Control and Prevention (CDC). U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. MMWR Recomm Rep. 2010 Jun 18;59(RR–4):1-86).

    IJCP Special

Dr Good Dr Bad

Situation: A patient with sleep anpea wanted to know his cardiac risk.
Dr. Bad: There is no risk.
Dr. Good: There is a risk.
Lesson: Obstructive sleep apnea is associated with development of coronary artery diseases and heart failure.

Make Sure

Situation: An HIV patient died after sulfa prophylaxis.
Reaction: Oh my God! You should have known that he was sulfa sensitive.
Lesson: Make sure that patients with a history consistent with Stevens Johnson syndrome and toxic epidermal necrolysis or an exfoliative dermatitis due to a sulfonamide medication should strictly avoid the culprit drug and other agents in the same sulfonamide group. Re–exposure to the same agent may be fatal.

    Lighter Side of Reading

An Inspirational Story
(Contributed by Dr Prachi Garg)

The Beggar Gives His All

Before India gained independence, a few young men from the villages wanted to free India from the foreign yoke; they wanted the British to quit India. They needed material wealth to throw the British out of India, so they started collecting money in the Indian villages. One day, they got inspired to collect material things as well. They went from door to door carrying a huge bag, which gradually was filled with money and gifts. As they went, a one–legged beggar kept following them. The young men did not mind.

At the end of the day, they entered into a house to see what they had collected. The beggar also wanted to enter, but since he was not a member of the group, they did not allow him in. The beggar pleaded with them: "I walked such a long distance right behind you. You want freedom; I also want freedom. Our Motherland is not only your property. It is also my property." At first, the young men got mad and told the beggar to go away. Then one of the men felt sorry for him, so they decided to show him the things they had collected. While the beggar was looking at the gifts in their bag, most of them were showing him real contempt. Then suddenly the beggar opened up the bag that he had been carrying. It contained a few coins and some rice. He spontaneously threw all the contents into their bag.

Immediately all the members of the revolutionary group started shedding tears of gratitude, because he had given all that he had to their cause. On that day, they had gone to visit so many rich families, who had given them next to nothing; but this beggar had given them everything that he had! They were deeply moved by the beggar’s contribution.


Mind Teaser

Read this…………………


Yesterday’s Mind Teaser: "House Stove"
Answer for Yesterday’s Mind Teaser:
"Home on the range (or home cooking)"

Correct answers received from: Dr KP Rajalakshmi, Dr Sudipto Samaddar, Dr Muthumperumal Thirumalpillai, Dr KV Sarma, Dr Joshi sachin

Answer for 14th December Mind Teaser: "Crossbow"
Correct answers received from: Dr S Upadhyaya, Dr Vijay Kansal, Dr Rashmi Chhibber

Send your answer to ijcp12@gmail.com


Laugh a While
(Contributed by Dr G M Singh)

Doctor, doctor, my wooden leg is giving me a lot of pain.
Why’s that?
My wife keeps hitting me over the head with it.

    Readers Responses

Excerpts from a letter written by Dr Dixit

Recently the caretaker BOG has taken certain decisions

  1. In a news published in an English daily the MCI has announced that there is shortage of 7,50,000 doctors in our country.
  2. BOG has shown its willingness to facilitate production of more doctors by relaxing various norms required to be fulfilled for opening new medical colleges.
  3. Now a medical college with admission capacity of 250 can be opened with 10 acre land instead of 25 acres. Such college will require a hospital with 900 beds instead of the existing norm of 1500 beds.
  4. The hostels of students can be located in the radius of 5 km from the college.
  5. The medical teacher shall be recognized as teacher till 70 years of age in place of earlier limit of 65 years.
  6. The BOG aims at starting 100 medical colleges every year for the next five years.
  7. In addition it also wants to increase intake capacity of existing medical colleges by 100 each.
  8. Many of these decisions are made available on the website of MCI as amendments to existing regulations.
  9. Hon. Panabakka Laxmi, the then Health Minister, informed the parliament in July 2005 that as per available data there was one allopathic doctor for 1722 people in the country.
  10. After considering the Ayurved and Homeopathy doctors in the country, the ratio comes to 128 doctors per 100,000 populations.
  11. This means that for 781 people there is one doctor in the country as per 2005 data.
  12. As per this statistics there are 6,38,792 allopathic doctors in the country.
  13. Every year around 32000 allopathic doctors pass out from medical colleges. Hence in 2010 there are around 8,00,000 allopathic doctors and the doctor population ratio is 1:1400 to 1500.
  14. World Health Organization in its course book on "Health Manpower Planning" of 1980 describes four methods to decide number of doctors required by a country. The "Health Needs" method takes into account the biological needs of the society for deciding the requirement of doctors. The other two methods include "Service Target" and "Health or Economic Demands" methods. In all these methods one has to collect information regarding the disease load, existing number of doctors as well as the economic and social milieu of the country. The last method, the simplest one is to decide required number of doctors on the basis of population. In this method one should know population of the country. Here the number of doctors required by the country is decided by taking into account international comparison, suggested norms, the statistics available from countries with better health care and study of past trends. Though simple this method is crude.
  15. MCI’s conclusion that India needs 7.5 lakh allopathic doctors is based on this fourth method. It makes no sense to decide doctors required by India on the basis of statistics that Cuba has one doctor for 250 people or USA has one for 500 people.
  16. More doctors do not necessarily mean better health. Healthy society will require lesser doctors!
  17. We must undertake the studies to find out workload for the doctors. The census can be used to find out the age and sex wise disease load in the country. Many of the services such as bandaging, giving injections, dispensing medicines etc are actually provided by nurses and pharmacists. Preventive and rehabilitative services are provided through paramedical workers. Doctors are required for curative services. The work of health promotion and protection is better done by farmers, teachers, environmentalists, engineers and scientists than the doctors. The curative services are on out patient or inpatient level. To calculate requirement of doctors for this purpose we should have data about various diseases. Then we can decide on the number of general practitioners, cardiothoracic surgeons, psychiatrists and pathologists.
  18. In 1950 the WHO expert committee suggested a norm of one general practitioner for 1500 people. While suggesting this WHO had considered that a doctor will work for 2000 hours in a year (6.75 hours everyday for 300 days). In India the role of general practitioners is mostly taken by Ayurved or Homeopathy doctors. MBBS general practitioners are as an exception. If we consider the number of doctors of all pathies then the doctor population ratio comes to 1:781 far better than WHO expectations. Hence there is no deficiency of general practitioners in India. India is unique country in the world which has almost equal number of doctors from other pathies. These doctors too learn medicine for 5 and half years.
  19. It will be clear that India doesn't require more general practitioners. We require more of psychiatrists, anesthetists, cardiothoracic surgeons, neurophysicians and dermatologists. For this we will have to increase postgraduation seats in medical colleges. In a college with intake capacity of 150 there should be 150 postgraduate seats. MCI may relax norms to achieve these numbers.
  20. The problem in India is not the number of doctors but it is the inequitable distribution of doctors in urban–rural as well as public–private sectors. Rather than increasing numbers we have to look into the reasons for why doctors are not willing to work in rural areas. One may have to develop a new model for providing health care to the community.
  21. The present BOG does not democratically represent the medical students, teachers, managements of medical colleges as well as practitioners like their predecessors. Hence it is wrong for the BOG to take decisions that have far reaching impact on medical education and health of this country.

Editorial of December 1962 issue of Singapore Medical Journal: "The doctor requirement" the editor writes– "All these go to show the danger of calculating medical needs on an arbitrary figure. The matured way of meeting a problem of this nature is to utilize available facilities efficiently and without waste, and not to plan a mansion with the possibilities of a flat to bemoan the inadequacy of resources. The former means healthy and economical planning and the latter a perpetual debt–like hire–purchase in an improvident family which must in the end come to grief with the Frankenstein it created. Medical need is a pressing item that all reasonable men must be interested in, but unless we cut our dress according to the cloth, such intent may not at all be a happy augury".

Dr. JV Dixit, Public Health Specialist, drdixit1@rediffmail.com

    Public Forum

(Press Release for use by the newspapers)

Should a diabetic with tight sugar control drive?

Worldwide, diabetics are required to produce proof of good blood sugar control to keep their driving license. A new study by Dr. Donald A. Redelmeier, professor of medicine at the University of Toronto has shown that diabetics, who keep their blood sugar tightly controlled run the risk of having traffic accidents due to low blood sugar, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

The risk was substantial, accounting for almost 50 percent of the accidents. The accidents were mostly related to severe hypoglycemia in association with strict blood sugar control. The findings were published online Dec. 8 in PLoS Medicine. For the study, Redelmeier's team collected data on 795 diabetic drivers. They found that one in 14 of the drivers had been involved in car accidents. Those with low blood sugar were more likely to have had an accident than were diabetics whose blood sugar was not as well controlled. Moreover, the risk for having a car accident increased fourfold if the person had a history of hypoglycemia.

Diabetics should not drive if they feel dizzy or have other symptoms of hypoglycemia. If some one has had a hypoglycemic episode the previous day, he or she should not drive the car next day.

Patients with diabetes should drive only if diabetes is under control and there is no evidence of end organ disqualifying disease. Definitive criteria are not available but an American Diabetes Association table indicates upper limits for acceptable control as follows:

  • Fasting sugar: Normal 115 mg/dL (acceptable 140 mg/dL)
  • 2 hour postprandial plasma glucose: Normal 140 mg/dL (acceptable 200 mg/dL)
  • Glycosylated hemoglobin A1C: Normal 6 percent (Acceptable 8 percent)
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