October 30, 2008

Goa Medical Council set to counter quacks

In an attempt to stop quacks from practicing in the state, the Goa Medical Council’s disciplinary and ethics committee chairman has

recommended that the council should immediately issue orders to seal premises of those who don’t have qualifications in allopathy, ayurveda or homoeopathy but still practice medicine.

According to a report on the ‘Survey of quackery in Goa’ submitted to the council by committee chairman Dr Ulhas Karpe, there are around 41 quacks operating in the state, with more than 30 indulging in unauthorized allopathic practice.

The report recommends that the Goa Medical Council should give a final warning to registered ayurved and homoeopathic practitioners not to practise allopathy.

“Any premise sealed by Goa Medical Council could be unsealed only after payment of Rs 10,000 and a written undertaking from the owners of the premise should be taken by the council stating that they wouldn’t repeat the mistake,” said Dr Karpe.

There is also a suggestion to start a friendly dialogue between the council and board of Indian/homoeopathy systems to explore ways and means to urge members to stick to their own disciplines of medicine and refrain from trespassing into other disciplines.

It has also been recommended that the council should issue instructions to all pathological laboratories in the state to register themselves with the council and also make it mandatory for all laboratories to function only under supervision of a registered pathologist.

“All opticians should be registered with the council and opticians providing facilities for eye check up or refraction should be instructed to avail the services of a registered opthalmologist,” said Dr Karpe.

“These recommendations have to be approved by the Goa Medical Council,” added Dr Karpe.

Patients in U.S. hospitals report low satisfaction

The quality of hospitals across United States seems to be inconsistent, as per a new study by the researchers of Harvard School of Public Health.

The study published in The New England Journal of Medicine revealed that although the patients are generally satisfied with their care during hospital stay, there is an ample scope for substantial improvement especially in the areas including pain management and discharge instructions.

The data was collected by the federal government in an ongoing survey of patients at all hospitals that get Medicare payments and covered areas such as pain management, discharge information, communication with the hospital staff including doctors, nurses about medications as well as quality of nursing services.

The lead author and assistant professor of health policy at Harvard School of Public Health (HSPH), Dr. Ashish K. Jha, MD, MPH, shared his viewpoint, “These data really represent a sea change for the health care system. Patient-centered care is at the heart of a high-performing system and until now, we have lacked information on how patients feel about their care. With this information now freely available, providers and policymakers can begin to focus on improving patients' experiences in the hospital.”

Nearly one-third of patients gave poor ratings to pain control and management, and one-fifth gave low ratings to communication during the hospital stay. "Given that we spend more than $2 trillion annually for health care in our country, we should expect that the basics are addressed, like always treating pain adequately," added Jha.

“We've been talking about (health care) quality for 20 years, but patients' experiences have not been part of the discussion,” said Dr. Ashish Jha. He further added “Until now, we have had no high-quality information about how patients perceive the care they receive.”

The results showed that nearly 67 percent of patients were satisfied during their hospital stay, especially with the hospitals having a higher ratio of nurses to patients. The first ever national survey stressed the important role of nurses in assuring high level of patient care and satisfaction.

With this first ever report of patients’ experiences going public, people can look forward to much desired improvements in patient-centered care. “As medicine becomes increasingly high-tech, sometimes the basic needs of patients have gotten lost. Our hope is that by systematically measuring and publicly reporting on how patients experience their care, hospitals will be inspired to better meet the needs of their patients,” Opined Jha.

While admitting the need for a significant improvement in hospital quality, Jim Conway, senior vice president at the Institute for Healthcare Improvement also stressed the important role of patients in improving the care during their hospital stay. “If a patient is satisfied with their care, there is a very strong likelihood that the patient is going to be actively managing their care,” said Conway.

October 29, 2008

U.S. study says doctors subconsciously favor whites

Doctors subconsciously favor whites over blacks, U.S. researchers said on Tuesday in a finding that may explain widespread racial disparities in health care in the United States.

A long line of studies have found that U.S. blacks get inferior care for cancer and a variety of other ailments compared to whites but experts concerned about the disparities have struggled to understand why.

"This supports speculation that subtle race bias may affect health care, but does not imply that it will," said Janice Sabin of the University of Washington in Seattle, who presented the study at the American Public Health Association's annual meeting in San Diego.

Sabin said it was too early to know if there was a direct link between the findings and the quality of care delivered to blacks in the United States.

She said the findings reinforce other studies showing racial bias is common in the general population.

"But we have to remember people are not racist if they hold an implicit bias," she said in a statement.

Sabin used data from a study of more than 400,000 people who took an online test between 2004 and 2006 about their attitudes on race.

More than 2,500 of the test-takers said they were doctors.

Rather than overt racism, the test looks for subconscious signs of bias by asking a series of questions.

For example, people were asked to quickly say whether photos of blacks and whites were positive or negative.

"We don't call what these tests show prejudice. We talk about it as hidden bias or unconscious bias, something that most people are unaware they even possess," said Anthony Greenwald of the University of Washington, who created the test and helped with the study.

Overall, 86 percent of people who took the test said they lived in the United States. Out of 2,535 physicians, 76 percent said they were U.S. residents.

Of the entire sample, 69 percent said they were white, while 66 percent of those who said they were doctors identified themselves as white.

Doctors in all racial and ethnic groups showed an implicit preference for whites versus blacks except for black doctors, who did not favor either group.

"The implicit bias effect among all the test-takers is very strong," Sabin said. "People who report they have a medical education are not different from other people, and this kind of unconscious bias is a common phenomenon."

Sabin said the study shows diversity training should be a part of medical education in the United States.

Studies have shown blacks in the United States are more likely than whites to die from diabetes, strokes, heart attacks and cancer. Some studies have shown this disparity persists when incomes, education and insurance coverage are equal.

October 28, 2008

Supreme Court breather to doctors: error of judgement not always negligence

Doctors, living under the constant threat of being dragged to courts for “erroneous” treatment, can now breathe easy.
The Supreme Court has underlined that “a simple deviation from normal professional practices in the high-risk medical profession is not always to be construed as an act of negligence on the part of doctors".

“An error of judgement on the part of the professional is also not negligence per se,” clarified a Bench headed by Justice C K Thakker and D K Jain while quashing the prosecution initiated against a doctor, Mahadev Prasad Kaushik, from Mathura.

Dr Kaushik had challenged a court order dated February 9, 2007, later confirmed by the Allahabad High Court, whereby summons were issued against him under Sections 304 (culpable homicide not amounting to murder), 504 (intentional insult) and 506 (criminal intimidation) of the IPC, in the Supreme Court.

The complainant had alleged that his father Buddha Ram died a few minutes after being administered three injections by Dr Kaushik on May 4, 2001. The two courts found prime facie negligence on Dr Kaushik's part.
However, the Supreme Court said, “Medical profession is often called upon to adopt a procedure which involves higher element of risk, but which a doctor honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Which course is more appropriate to follow would depend on facts and circumstances of a given case.”

The SC granted a breather to doctors, who, these days are hounded by ambulance chasers, a category of lawyers who convince patients to file cases against any treatment “gone wrong”.

The Bench explained, “The standard to be applied for judging whether a person charged has been negligent or not would be that of an ordinary competent person exercising ordinary skill in that profession.”

Taking a pragmatic approach, Justice Thakker, who wrote the judgment, said: “Higher the acuteness in emergency and higher the complication, more are the chances of error of judgement.”

“At times, the professional is confronted with making a choice between the devil and the deep sea and he has to choose the lesser evil,” the judge added.

Relying on the police report, which found that Buddha Ram had a renal failure and died before he was brought to the clinic, the court quashed proceedings under Sections 504 and 506 of the IPC. It also dropped the charge of culpable homicide and noted, at best, it could be a negligent act to be covered under Section 304A IPC....

The doctor’s hands are germ-free. But what about the scrubs?

Amid growing concerns about hospital infections and a rise in drug-resistant bacteria, the attire of doctors, nurses and other health care workers—worn both inside and outside the hospital—is getting more attention. While infection control experts have published extensive research on the benefits of hand-washing and equipment sterilization in hospitals, little is known about the role that ties, white coats, long sleeves and soiled scrubs play in the spread of bacteria.

The discussion was reignited this year when the British National Health Service imposed a “bare below the elbows” rule, barring doctors from wearing ties and long sleeves, both of which are known to accumulate germs as doctors move from patient to patient. In the US, hospitals generally require doctors to wear “professional” dress but have no specific edicts about ties and long sleeves.

But while some data suggest that doctors’ garments are crawling with germs, there’s no evidence that clothing plays a role in the spread of hospital infections. And some researchers report that patients have less confidence in a doctor whose attire is casual.

Last month, the medical journal BJU International cited the lack of data in questioning the validity of the new British dress code. Still, experts say the absence of evidence doesn’t mean there is no risk—it just means there is no good research. A handful of reports do suggest that the clothing of health workers can be a reservoir for germs.

In 2004, a study from the New York Hospital Medical Center of Queens compared the ties of 40 doctors and medical students with those of 10 security guards.

It found that about half the ties worn by medical personnel were a reservoir for germs, compared with just one in 10 of the ties taken from the security guards. The doctors’ ties harboured several pathogens, including those that can lead to staph infections or pneumonia.

Another study at a Connecticut hospital sought to gauge the role clothing plays in the spread of methicillin-resistant Staphylococcus aureus (MRSA). It found that if a worker entered the room where the patient had MRSA, the bacteria would end up on the worker’s clothes about 70% of the time, even if the person never actually touched the patient.

“We know it can live for long periods of time on fabrics,” says Marcia Patrick, an infection control expert in Tacoma, Washington, and co-author of the Association for Professionals in Infection Control and Epidemiology guidelines for eliminating MRSA in hospitals.
Hospital rules typically encourage workers to change soiled scrubs before leaving, but infection control experts say enforcement can be lax. Doctors and nurses can often be seen wearing scrubs on subways and in grocery stores.

Patrick, director of infection prevention and control for the MultiCare Health System in Tacoma, says it’s unlikely that brief contact with a scrub-wearing health care worker on the subway would lead to infection. “The likelihood is that the risk is low, but it’s also probably not zero,” she says.

While the role of clothing in the spread of infection hasn’t been well-studied, some hospitals in Denmark and other European countries have adopted wide-ranging infection-control practices that include provisions for the clothing that health care workers wear both in and out of the hospital.

Workers of both sexes must change into hospital-provided scrubs when they arrive at work and even wear sanitized plastic shoes, also provided by the hospital. At the end of the day, they change back into their street clothes to go home. The focus on hand-washing, sterilization, screening and clothing control appears to have worked: In Denmark, fewer than 1% of staph infections involve resistant strains of the bacteria; in the US, the numbers have surged to 50% in some hospitals.

But American hospitals operate on tight budgets and can’t afford to provide clothes and shoes to every worker. In addition, many hospitals don’t have the extra space for laundry facilities.
Ann Marie Pettis, director of infection prevention for the University of Rochester Medical Center, Rochester, New York, says most hospitals are focusing on hand-washing and equipment sterilization, which are proven methods known to reduce the spread of infection. But she adds that her hospital, like many others, has a policy against wearing scrub attire to and from work, even though there is no real evidence that dirty scrubs pose a risk to people in the community.
“Common sense tells us that the things we are wearing as health care providers should be freshly laundered,” says Pettis. After all, she adds, wearing scrubs in public “raises fear” among consumers. “I don’t think we should feed into that. Scrubs shouldn’t be worn out and about.”

What;s buzzing in the Clinical Research Organization (CRO) industry

India has, lately, been one of the most aggressive sites of clinical research infrastructure-building and growth, likely to conduct 20 per cent of all clinical trials worldwide by the year 2020. The major driver of this growth is the clinical research organization (CRO) industry. CROs are for-profit clinical trials service providers that conduct trials outsourced to them by pharmaceutical companies developing new drugs. India’s CRO industry is clearly in a position to influence regulatory agendas around trials.
The Indian Government is currently considering the legalisation of global Phase I clinical trials. Phase I trials are conducted on healthy volunteers to test the toxicity of an experimental drug, and are different from Phase III trials which are late-stage trials that test the efficacy of a drug in patients already being treated for a disease. Currently India allows Phase I trials only if the drug has already been through this phase elsewhere in the world. These are controversial because of the widely expressed fear that Indians will become “guinea pigs” for foreign companies testing drugs.

To help protect against allegations that clinical trials come to India simply because it is easy to cut corners here, the CRO industry has driven the establishment of a stringent ethical regime which includes institutional review, collection of informed consent from trial subjects, and rigorous monitoring of trials.

But the end-game should be about making healthcare accessible to the vast majority of India’s population. Over the past three decades, the Indian pharmaceutical industry, through its expertise in reverse engineering generic drugs, has already succeeded in making some of the most affordable drugs in the world. India has emerged as “the pharmacy of the developing world”, making vital contributions especially in the global treatment of HIV-AIDS. This success was enabled by a patent regime that allowed process patents on drugs, which has however been replaced by a WTO-compliant product patent regime in 2005. The new patent regime mandates a more stringent protection of intellectual property that favours Western pharmaceutical companies developing novel drugs — thereby curtailing generic companies’ ability to reverse engineer drugs for the twenty year period of the product patent.

October 26, 2008

Top hospitals aspire for air ambulances, rooftop helipads before Commonwealth Games

Ahead of the Commonwealth Games, the most ‘in-thing’ that every super specialty hospital seems to want is an air ambulance and a helipad. Most hospitals are banking on the Games to get permission for a helipad adding an unexplored dimension to patient care and emergency services.
While air medical evacuation is already done in most super specialty hospitals in the Capital, having a helipad on the hospital roof is the next big thing. The All India Institute of Medical Sciences applied for permission from the Civil Aviation Ministry last year. Indraprastha Apollo Hospitals is also hoping for permission from authorities before the Games begin. According to sources, with Apollo in line for a helipad, competitors like Escorts, Max and Fortis are not to be left behind.

Max is also looking at helipads for its newer projects, said Dr Parvez Ahmed, Executive Director, Max Healthcare. They are already into end-to-end emergency service. Recently, an Italian was brought in from Chandigarh, treated and the hospital staff accompanied her back home to Milan. “No concrete decisions have been take yet but we are looking at this opportunity for our newer projects,” said Dr Ahmed.

The Directorate General of Civil Aviation (DGCA) has issued guidelines for planning, infrastructure, markings and safety regulations for construction of roof-top helipads. “Both hospitals, AIIMS and Apollo, have some internal issues that have to be solved first before they are given permission,” said J S Rawat, Joint Secretary, DGCA. Apollo Hospitals had applied for a helipad on the hospital premises five years ago.

Right on track: Apollo Hospitals, Fortis Healthcare

Apollo Hospitals
Turnover: 1,150 cr (Mar ’08)

Today Apollo Hospitals is the country’s premier healthcare provider and has played a pioneering role in helping India become a global healthcare hub.

The group today includes over 43 hospitals in India and overseas, diagnostic clinics, Apollo pharmacies, medical BPO and health insurance services and clinical research divisions.

Says Dr Hariprasad, CEO, Apollo Health City, Hyderabad: “Healthcare industry in India is unaffected by the current recessionary trends, our patient flow, revenues remain unaffected. Therefore our growth and expansion will be on track as planned.”

He adds that “as the dollar is strengthened and also due to huge recession in US and developed countries, more patients can be expected to travel to India from other countries for their healthcare needs, this gives further boost to the industry here.”


Fortis Healthcare
Turnover: 548 cr (Mar ’08)

The group has drawn a blueprint for technology upgradation at its various hospitals.

This is designed to equip the hospitals with cutting edge diagnostics capabilities and latest medical equipment for quality medical services.

“Healthcare being a need-based industry, there’s not much impact of the slowdown. There’s a huge shortage of capacity and how you deliver value and quality care are important. Of course, some players who have over extended their expansion plans may have issues with raising debt and meeting cash flows. All our initiatives, however, are on track and we see a huge potential in preventive healthcare,” says Sudarshan Mazumdar, CEO, Fortis Healthcare.

Travel insurance policy

You’re on vacation with your family in the Maldives. You’ve been basking in the sun, lazing on the beaches, reading a book and gorging for a coupl

e of days. On day three, however, your wife announces that she is feeling unwell. You dismiss it as a result of over-exertion.

But a few hours later, she is worse and seems to be throwing up frequently. She is finally diagnosed as having a bad case of gastritis and the doctors advise that she should be hospitalised immediately. Help is actually a phone call away, provided you are covered under a travel insurance policy.

The insurer simply need to give the details to the insurance company, which gets in touch with the hospital and makes it possible for you to avail of cashless treatment. In addition to sudden hospitalisation and unforeseen medical expenses, there are also other non-medical situations where travel insurance can come in handy. SundayET lists out the FAQs on travel insurance.

When does it come in handy?

One of the most common inconveniences associated with travel is the delay of baggage. With all your personal belongings packed away in your suitcase, you may have no choice at that moment but to go and shop for new clothes. But take good care of your bills.

If you submit them to your insurance company along with the claim form and necessary documents such as a property irregularity report from the airline and copy of your passport with entry and exit marked, you will be compensated for the expenses incurred.

In case you lose vital travel documents like your passport and need to approach the nearest Indian embassy to obtain a duplicate passport, the policy reimburses expenses incurred in respect of obtaining duplicate passport/ travel document.

“The expenses covered are fees paid to Indian Embassy, photograph charges, attestation fees, conveyance charges for visiting Indian Embassy etc,” says Shreeraj Deshpande, head, travel insurance, Bajaj Allianz General Insurance.

Similar compensations can be availed in the case of loss of baggage, hijack, missed connections, accidents, medical emergencies, financial emergencies and so in. While cashless medical treatment is offered by many companies, there are still a few which compensate you later for your expenses.

So, in addition to bills/ invoices, all reports also need to be kept safely. “A travel insurance policy also provides coverage for emergency medical evacuation and repatriation of mortal remains,” says M Ravinder, head of underwriting, A&H, Tata AIG General Insurance.

How to choose ?

While many people talk about travel insurance, particularly with regard to overseas travel, it is also available for domestic travel. But you need to pay immense attention to this process as different plans have different extents of coverage.

“While choosing a plan, an individual should ensure that the travel insurance plan covers the entire duration of the trip, destinations are properly selected, amount coverage is right and that the benefits are adequate,” says Ravinder.

Calculation of the premium also depends on criteria such as sum insured, age, destination of travel, duration of travel and the plan chosen. Policies are generally available up to the age of 85, but after the age of 70, the policy will be issued only after a health checkup.

How long does it last ?

Unlike a life insurance policy, which is renewed on a yearly basis, a travel insurance policy is available for a maximum period of 180 days. This can be further extended for another 180 days. “However, this will depend on the number of claims filed by the traveller in the first 180 days.

Also, this extension is only available for individuals under the age of 70 years,” says Sudhir Menon, head of travel insurance, ICICI Lombard. However, the period may vary in case of a student loan. According to Deshpande, “Student policies are issued for 365 days which can further be extended for another two years (three years in total) depending on the duration of course opted for.”

A travel insurance policy is generally easy to acquire and the process can be completed in a day. It is also available online and even via your mobile phones.

Riders and exemptions

There is generally a long list of exemptions to travel insurance policies. Pre-existing diseases, suicide or attempted suicide, death or disability from war, expenses from HIV or AIDS or similar diseases do not come under the framework of travel insurance.

Moreover, you cannot use a travel insurance policy to compensate loss of objects like manuscripts, money, securities, stamps, coins, ornaments and precious stones etcetera.However, if you are willing to pay an additional sum to the premium, then the extent of coverage can be increased.

“If additional premium is paid under student policy we give added coverage for mental and nervous disorder, including alcoholism and drug dependency and medical expenses incurred for sport injuries,” says Deshpande. Moreover, in-flight coverage can be given to students going abroad for pilot training.

October 25, 2008

Healthcare goes mobile, just punch the number

If you are sick of prior appointments and queues to visit your doctor or if you require emergency medical advice at night, there is hope on the horizon. Your mobile phone could come in handy to arrange a 24X7 medical service for you.

Bangalore-based Healthcare Magic, a first-of-its-kind, real-time, medical consultation portal, will soon tie up with Reliance Communications (RCom), the country’s second-largest mobile service provider, to launch a Doc On Call service by December this year.

“It is a big leap for us to start with one of India’s best mobile service provider. We are yet to work out the financials involved in the deal and the rollout plans,” said Abhilash Thirupathi, vice-president, marketing and operations, Healthcare Magic.

He said the service would be provided to mobile users, who subscribe to the Doc On Call services, which may be priced at a premium to offer quality services.

An RCom spokesperson declined to comment. Any call made to Healthcare Magic will be attended by a doctor on duty at the the company’s Bangalore office. Depending on the symptoms elaborated by the patient and his medical history, the doctor, who attends the call, will suggest immediate medical attention, if necessary, and also prescribe medicines for temporary relief.

Healthcare Magic is planning to appoint about 50-60 doctors on full-time duty for the mobile-based operations, said Abhilash Thirupathi.

The number of mobile phone subscribers in India is expected to touch 500 million by 2010 and the company hopes to bring at least 10 per cent of the mobile users within its network.

Healthcare Magic, promoted by an IIT Kanpur graduate, Kunal Sinha, already offers internet-based call-a-doctor services, which was launched in January 2008. Currently, traffic to the portal is to the tune of 3,500 enquiries a day and the company has a 30-member doctors’ panel to attend to patients’ enquiries every day.

Since the last two months, services have been offered at a single-day, online consultation fee of Rs 40. The services are also available for an annual subscription of Rs 600, said Abhilash Thirupathi.

The portal also offers features such as search for doctors and hospitals, advice on medical and healthcare products, ratings of doctors and hospitals, availability of drugs, medical advice such as the best available hospitals and doctors, discussion forums, insurance policies and sale of medical products.

Now, a computer to decide for a C-section

Doctors often get confused when it comes to deciding whether a particular woman in labour should undergo caesarean or not. But now, a computer can easily take this decision.

Jose Príncipe and colleagues at the University of Florida in Gainesville say that wireless sensors could monitor the progress of labour, and warn doctors when a Caesarean is necessary.

In the new method, software could monitor the progress of a woman's labour, reports New Scientist magazine.

Usually, a Caesarean is needed in case of an abnormally slow birth. However, deciding what is abnormally slow is what poses the biggest problem for doctors. According to Príncipe, it is possible to obtain the necessary data by using wireless sensor to monitoring parameters like the electrical activity of the muscles in the uterus, which can help determine the strength and frequency of contractions.

The computer software can then decide whether the birth is progressing normally or not.

Such an approach can provide doctors with valuable extra input to help them decide more safely when to perform a C-section, say the researchers.

Supreme Court stays High Court directive on hospitals at railway stations

The Supreme Court on Friday stayed a Delhi High Court directive to the railway ministry to provide makeshift hospital facilities at all railway stations in the Capital for passengers in need of urgent medical care.

Appearing for the ministry, additional solicitor general Gopal Subramaniam argued before a Bench comprising Chief Justice K G Balakrishnan and Justices P Sathasivam and Aftab Alam that providing for doctors and storing of medicines were not warranted as every railway station had an ambulance on call.

The HC had, acting on a PIL, directed the ministry to make available at least one qualified doctor and some paramedical staff, an ambulance and also adequate stock of medicines at New Delhi, Nizamuddin and Sarai Rohilla railway stations.

While conceding that the directions were laudable, the ASG pointed out that while passing the order the HC had "lost sight of the fact that these aspects, howsoever laudable, are not only in the nature of economic policy making, exclusively within the discretion of the government, but also requiring huge financial outgo needing budgetary support and approval by Parliament".

He said keeping an ambulance ready coupled with a doctor and medical staff would require huge amount of money without they being utilized. The railway stations have ambulances on call as an alternative, he added.

The ministry stated that the PIL's allegation that one or two passengers die every day on the platforms was not verified by the HC before passing the sweeping order.

Under the Indian Railway Medical Manual, it was incumbent upon the railways to provide medical facilities to passengers who were ill and such medical aid was invariably given as a matter of courtesy, the ASG said.

Indian hospitals see a silver lining in global meltdown

Influx of overseas patients increases as treatment costs in foreign countries shoot up
The global economic meltdown may have pushed the business activities in Ahmedabad to the backseat, but the city hospitals are riding high on the influx of overseas patients. Private hospitals that have been a hub of medical tourism are likely to be benefited in a big way from the inbound traffic of patients particularly from the UK and African countries, according to experts.

In the wake of the prevailing crisis, the cost of treatment in these countries has gone up, which has made the entire cost incurred on treatment and journey to India lower than elsewhere. While some specialty hospitals are already experiencing an elongating waiting list of patients from abroad, others are expecting an increase in the number of foreigners coming for treatment.

The Kidney Hospital, which happens to be a hub of kidney transplants where a number of foreign patients visit every year, is struggling to keep up with an ever-increasing influx of foreign patients, especially from Africa.
H L Trivedi, director, Kidney Hospital (within the Civil Hospital Campus), said: “We are restricting the number of foreign patients due to limitations in the transplant facilities. We have a long waiting list, which we are unable to attend to. We also have to attend to the local patients.”

Dr Pankaj Doshi, medical director of the Shalby Hospital, confirmed the sudden rise in the number of foreign patients and said the hospital already has a waiting list for two months. “The inflow of patients from foreign countries has definitely shot up. While we always have had patients for dental cosmetics and knee surgery, the inflow has seen a significant upturn of late,” he said.

City-based Sal Hospital is, however, yet to see a definitive upturn in the number of foreign patients. But Nitin Shah, medical director of the hospital, said they are expecting a sizeable increment in the number if the meltdown stretches for a longer period.

Medical college plan on ESI hospital premises

The Employees State Insurance Corporation (ESIC) is moving to start a medical college here, on the premises of its 500-bed hospital, at a cost of Rs. 300 crore.

When implemented, this will be the district’s third medical college. It already has two: the Coimbatore Medical College run by the State government, and the PSG Institute of Medical Sciences and Research.

This is part of an ESIC project to start medical colleges around 23 of its hospitals in the country using surplus funds of Rs. 7,000 crore.

At a meeting on the State government’s free heart surgery scheme for children, Rural Industries Minister Pongalur N. Palanisamy said the college in Coimbatore would come up in 18 months.

A team headed by the Dean of the Coimbatore Medical College and Hospital (CMCH) had made a study of the available infrastructure at the ESI Hospital last month and sent a report to the State government.

Explaining the process involved, CMCH Dean (in-charge) V. Kumaran told The Hindu on Friday that the State government would issue an essentiality certificate and forward the proposal to the Central government. It would then be sent to the Medical Council of India.

The Council would inspect the facilities at the hospital, which is to serve as a hands-on training centre for medicos.

If the facilities meet the norms, the Council would issue a letter of permission.

While the Central government (through ESIC) would provide the infrastructure, the State government would provide the faculty resources.

Informed sources said ESIC had appointed a retired official of the Medical Council as consultant to implement the projects at the 23 hospitals.

The ESI Hospital at Ayanavaram in Chennai would become a superspecialty hospital under this project.

October 24, 2008

Many U.S. doctors give patients placebo treatment

Many American doctors give their patients a placebo, usually a relatively innocuous drug such as a pain reliever, in the guise of medical treatment and view the practice as ethical, researchers said on Thursday.

Among 679 primary-care doctors and rheumatologists, who treat arthritis patients, about half reported prescribing placebos at least two to three times a month and most said they did not explicitly tell patients they were getting a placebo.

The idea may be to trigger the "placebo effect" -- a genuine improvement in health driven by psychological expectations of a benefit and not due to the physiological effect of a given treatment -- in cases in which normal treatment might not be warranted, the researchers said.

More than 60 percent of the doctors who answered the survey published in the British Medical Journal said that prescribing a placebo is ethically permissible.

But such actions run afoul of standards set by the American Medical Association, which asserts it is unethical to use placebo therapy on patients without clearly telling them.

"Nobody's really asked American doctors in a systematic way what they they think about placebos," said researcher Dr. Jon Tilburt of the Mayo Clinic in Rochester, Minnesota, who worked at the National Institutes of Health when the survey was done.

"There was probably a time in medicine when (doctors) were using these more routinely in perhaps a more paternalistic era. I think there remains this general impulse among physicians to want to help and to promote the healing that comes from psychological expectations," Tilburt said in a telephone interview.

Doctors who prescribed placebos only rarely provided the sugar pills that most people think of as a placebo. More often they said they prescribed relatively harmless substances such as vitamins and over-the-counter pain relievers.

But 13 percent of doctors who reported prescribing a placebo said they gave patients a sedative, and an equal percentage said they prescribed an antibiotic. Tilburt said those have particular ethical concerns -- sedatives due to side effects and antibiotics because their overuse has fueled the rise of germs that defy antibiotic treatment.

The placebo has an important place in medical research. To test how well a given drug works, one group of patients in a clinical study may get the drug while another group gets an inert placebo such as a sugar pill to see if the drug provides comparative benefits.

But studies also have shown that giving a patient a placebo sometimes triggers true health improvements inspired by a patient's expectations that a treatment may help them.

The AMA, the largest U.S. doctors' group, said doctors may use placebos in treatment only if the patient is informed and agrees to it.

"In the clinical setting, the use of a placebo without the patient's knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient," an AMA ethics panel said in 2006.

"A placebo must not be given merely to mollify a difficult patient, because doing so serves the convenience of the physician more than it promotes the patient's welfare."

October 23, 2008

Tele-medicine could solve India's health care woes: UN official

With the growing cost of health care becoming a major headache for governments across the world, tele-medicine could provide a solution to India and other countries grappling with the problem.

Listing the advantages of tele-medicine, Alice Lee, the chief of the UN programme on space applications said that developed countries too were now relying on tele-medicine.

"In Germany, officials expect to save 300 euros (Rs 19,000) on each patient through tele-medicine. n the US, specialists are not able to reach the patients residing in rural areas" and telemedicine has been effective in such cases," Lee said

Tele-medicine uses satellite technology to establish link between a doctor and patient and is one of the thematic ares of sustainable applications of space technology. It ensure that right medication reaches the patient at much lesser cost.

Lee said that in India, the need for tele-medicine could be gauged from the fact that nearly 85 per cent of doctors reside in urban areas, while a significant number of patients are from the rural ares.

In India in the next 2-3 years, "we plan to connect 512 hospitals with tele-medicine facility," Lee said.

On the specific areas where tele-medicine could prove its mettle in the Indian context, Lee said, "Tele-consultation (between a doctor and patient), tele-survey, tele-X ray, tele-pathology and tele-opthalmology are some of the areas, which can benefit."

Medical negligence cases grow so do ambulance chasing lawyers

Growing awareness amongst public about their consumer rights in events of medical negligence and increasing tribe of 'ambulance chasing lawyers' have contributed to rise in court cases against hospitals, feel experts.

"There are two reasons why the number of medical negligence cases are increasing. First, the awareness among people about their rights against medical negligence. And also in some cases, it is 'ambulance chasing lawyers'. Lawyers encourage patients to file case against the doctor or the hospital in civil or consumer court to earn compensation. Lawyers take a share in return," says Dr Ajay Kumar, former president, Indian Medical Association (IMA).

Lawyers who resort to ambulance-chasing tactics to extract hefty fees from patients has also resulted in rulings on several health-care centres in the country, he adds.

In one of its recent verdicts, the Delhi State Consumer Commission directed a hospital to pay a compensation of Rs one lakh each to families of two patients for carrying out 'unnecessary tests.' The commission said a patient was kept in the hospital for 10 days although the hospital did not have infrastructure to treat the disease.

In another case, a hospital was fined Rs 25,000 for detaining a patient for several hours over non-payment of medical bills.

Ensuring quality care through accreditation

Government hospitals in India have often been criticised and have typically been associated with overcrowding, overworked doctors, high rates of hospital acquired infection, which are avoidable and often fatal, and improper documentation. But some government hospitals are looking to change their public image and shape up their hospitals to run more efficiently and effectively with a focus on quality health care through accreditation.

The Quality Council of India (QCI), a quasi-government body, came up with standards for Indian hospitals called the NABH (National Accreditation Board for Hospitals and Healthcare Providers), which take the best of standards from countries like the US, UK, and Australia.
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While many private hospitals in India have become accredited, the QCI is now actively trying to get government hospitals across the country to get accredited as well, since public hospitals don’t have a framework of quality established within them.

Accreditation focuses on putting standards and processes in place that can help overburdened government hospitals run more effectively and efficiently. For example, the most important area for any hospital is infection control. A 2006 study by the WHO showed that rates of hospital-acquired infections in India are at approximately 25%. This means that 25% of patients who come to hospitals acquire infections other than what they were admitted for.

“Infections can be simply averted by washing hands between seeing patients”, says Dr. Narottam Puri, president of Fortis Healthcare Limited. “In most hospitals, washing material may not be available by beds, or the sink may be 50 feet away from the bed. This is a process fault.” This could be remedied by having sanitizers available at bedsides or sinks placed in close proximity to beds, he says. Dr. Puri says, 80% of hospital infections can be avoided by washing hands.

These are the types of processes and systems accreditation forces hospitals to put in place. While the NABH has a long list of processes and systems that need to be adhered to, accreditation looks at things like proper ways to sterilize equipment, how to handle biomedical waste, administration of medication, patient education, staff training, and fire safety, to name a few. NABH accreditation will also force hospitals to put regular data collection processes in place that will enable them to analyze data on things like hospital infection diseases and take corrective measures — something that most government hospitals don’t have in place now.

In India, only 20 hospitals have accreditation, all of which are private. The QCI is working with government hospitals in a number of states including Tamil Nadu, MP, Kerala, Delhi, and UP to get them accredited. The Gujarat government will be getting all its government hospitals accredited in a phased manner — the first state government to take such an initiative. The QCI also signed a Memorandum of Understanding (MoU) with the Delhi government a year and half back, and any hospital in Delhi that’s interested in getting accredited will be backed up with funds necessary to meet accreditation standards. This includes everything from staff, to infrastructure and equipment. Accreditation, however, is purely voluntary.

Dr. K.K. Kalra, Medical Superintendent of Chacha Nehru pediatric government hospital in New Delhi, is also undergoing the process of getting the hospital ready for accreditation. He conducts regular surveys to check the satisfaction of his patients and 90% of the patients routinely say that services they receive are good to excellent. Accreditation for his institution will spread the word wider and hopefully spur a quality movement across government and private hospitals.

October 18, 2008

Health ministry tells Manipal to cut medical seats by half

The ministry for health and family welfare has asked the privately run Manipal University to halve the number of its medical seats amid concern over the sharing of infrastructure and faculty between Indian and Malaysian students. The system, the ministry maintains, sacrifices the quality of education offered to Indians.

Manipal, a Karnataka-based institution, is trying to retain the 500 students enrolled in its flagship undergraduate programme in medicine. It says a full batch has already been admitted, and the 29 September order will affect 250 students.

Manipal University’s programme in medicine for Malaysian students is an arrangement with the Melaka Manipal Medical College, a Malaysia-based arm of Manipal University.
Under this programme, students complete a part of their course in Malaysia and the rest on the Indian campus.

Malaysians pay an annual tuition fee of 30,000 ringgit (Rs4.13 lakh), part of which is transferred to Manipal University. Manipal declined to disclose how much is transferred.
Indian students—from outside Karnataka—at Manipal University’s two medical schools pay an annual fee of Rs4.14 lakh. Those from Karnataka pay Rs40,000 per year.

“The Malaysian campus is part of our global expansion,” said Anand Sudarshan, who oversees all the education businesses of Manipal Education and Medical Group International India Pvt. Ltd, or MEMG.

But a ministry official, who spoke on condition of anonymity, said the sharing of faculty and facilities—such as the library—between the two programmes is unfair.
“When we went for inspection, we found floating faculty (between the two programmes),” said the official. “Everything is in the same building.”

MEMG operates one of India’s most commercial ventures in education from its headquarters in Manipal, 60km north of the port city of Mangalore in Karnataka.

Over the last 50 years, the group has grown from a single primary school to 125,000 students in a multitude of disciplines, with campuses in Manipal, Mangalore and Bangalore in southern India, Sikkim in the North-East, and international locations such as Dubai, Nepal, Malaysia and Antigua.

In June, the health ministry derecognized the undergraduate degree awarded by Manipal University’s two medical schools located in Manipal and Mangalore. Later, it restored recognition but asked the batch size for the programme to be reduced by half.
Issues raised include shortage of teaching hospitals, use of same faculty for its dental and medical schools

Of its 500 medical students, 75 are foreign students; in line with the norms of the Medical Council of India, or MCI, the regulator of medical schools, which mandates that institutions can admit 15% foreign students in an undergraduate course in medicine.

The health ministry official said even the Prime Minister’s Office is monitoring the situation.
Ramdas Pai, the university’s chancellor and son of Manipal group founder T.M.A. Pai, met Prime Minister Manmohan Singh a few weeks ago to raise the issues of the university, confirmed CEO Sudarshan.

He said some of the faculty members on the list of the Malaysian programme also feature on the faculty list of the programme for Indian undergraduate students so that they get promotions as per the norms of MCI—not because they teach both the courses.
“There are some antiquated norms,” said Sudarshan.

MCI secretary A.R.N. Setalwad did not answer calls and text messages to his cellphone.
Other concerns about Manipal raised by the health ministry include its shortage of teaching hospitals, the use of same faculty for its dental and medical schools and faculty being away on sabbaticals.

In interviews and a written response to the ministry, viewed by Mint, Manipal University said while the teaching hospitals associated with its medical schools are short of beds, the university has 20-year tie-ups with government hospitals that provide it with teaching beds.
The university said faculty was only one senior resident short in one department and offered some concession on issues such as the sharing of hostels with foreign students, agreeing to follow the recommendations of the ministry.

The health ministry official said he is aware of only two institutions that offer programmes in medicine exclusively for foreign students—Manipal University and another privately run medical school, MS Ramaiah Medical College in Bangalore. Both programmes are for Malaysian students. “There is no law preventing such course from running,” he said.

The health ministry official said an inspection of Ramaiah college, which admits 150 Indian students to its flagship course, showed that infrastructure and faculty were not being shared with the teaching centre for Malaysian students.

“Neither pin nor peon is shared,” said Sivram Kumar, the medical school’s dean and principal who graduated from the government-run Bangalore Medical College and has taught medicine for nearly three decades. “We know the rules, and we play with a straight bat.”

PGI to impart medical education, treatment guidelines to hospital in Bhutan

The Telemedicine project of the Post Graduate Institute of Medical Education and Research (PGIMER) was connected with the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu in Bhutan, on Thursday as part of its project to connect with the South Asian Association for Regional Cooperation (SAARC) nations.
The PGI, through this programme, has been connected with Bhutan for imparting medical education and assisting in the treatment of patients by rendering medical advice. Sources at the PGI said it is the first institute in the country, to be connected with another.

Professor K K Talwar, Director, PGIMER and Dr N Tenzin, Medical Director, JDWNRH, held discussions regarding the new facility on Thursday.

“The service will be provided by Telecommunication India Ltd (TCIL), New Delhi by MPLS through BSNL. This is for the first time that international connectivity will be used for the exchange of medical advice on both sides on a regular basis,” said Dr Meenu Singh, coordinator for SAARC Telemedicine Network, at PGI.

“Bhutan is the first SAARC country to be connected under the project. The link with Sri Lanka will be established next. Subsequently, all the SAARC nations will be covered through telemedicine at the PGI,” Dr Singh added.

October 15, 2008

Maharashtra Doctors get a legal shield against attacks

Doctors have finally got protection from the frequent attacks they face. The laws have been made stricter across the state: such attacks will now constitute a non-bailable offence, with the offender facing up to three years in jail.

The state cabinet approved the draft of an ordinance with a strict set of penalties on Wednesday, marking the culmination of a long struggle by doctors.

Among the penalties in the Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage of Property) Act, 2008, is a Rs 50,000 fine on anyone who attacks a doctor or a hospital employee. What should dissuade vandalism of hospital property is a provision that anyone causing such damage would be fined twice the value of the property that he or she has destroyed.

Doctors said the need for such laws was deeply felt. Only on Tuesday night, Sassoon General Hospital was attacked by relatives and friends of a boy who died.

“Doctors were fed up of the attacks. Time and again we had approached the authorities including Home Minister R R Patil. Now, after a struggle of two years, the cabinet has finally passed the ordinance,” said Dr D K Shirole, president of the state unit of the Indian Medical Association (IMA).

The IMA’s city unit president, Dr Avinash Bhondwe, too was delighted. He credited their October 10 token strike for spurring the state government into action.

Doctors had intensified their agitation citing several instances where hospital property was destroyed and staff humiliated, at places such as Malad, Amravati, Beed and Chandrapur.

The doctors’ cell of the Nationalist Congress Party agreed that the strike had worked in their favour. “Doctors had been seething and their resentment showed when they went on a flash strike on October 10.

The government had to take action,” said Dr Dilip Ghule, chief of the cell. He mentioned attacks on doctors at several places, such as Mumbai, Beed, Akola, Amravati, Nashik and Latur.

The ambit of the ordinance runs across medical units and staff. It will benefit not only doctors but also nursing staff, interns, medical and nursing students and clerical staff; not only registered hospitals but also private ones and clinics, besides units runs by government local bodies like municipal corporations, zilla parishads and panchayat samitis.

The government-run Sassoon Hospital has engaged 100 security personnel after Tuesday’s attack. They will start functioning with a week, said Dr Nirmala Borade, acting dean of BJ Medical College. Pune Zilha Suraksha Sangh will provide the personnel.

As of now, Sassoon, frequently the target of attacks, has only 21 Class IV employees as watchmen

October 13, 2008

Medicines may cost up to 93% less in govt’s special stores

Treatment for common ailments such as diabetics, ulcer and hypertension may soon become cheaper. The government’s initiative to set up a retail network of special drug stores to sell unbranded generic medicines, may bring down cost of some medication by a whopping 93%.

The department of pharmaceutical has made a comparative study of treatment cost in case of unbranded drugs and their branded counterparts marketed by pharma majors like Ranbaxy, Dr Reddy’s, Cipla, GSK and Pfizer. The move aims at ending company-chemist nexus, which tries to push costlier branded medicines to customers in the name of substitutes. Experts say the move is likely to trigger reduction in prices of branded drugs.

According to the draft concept note for setting up of generic drugs store, prepared by the department, anti-bacterial azithromycin 500-mg tablet could be made available at Rs 10 while Vicon 500-mg tablets of Pfizer cost Rs 78.30. This consumption of branded tablets for three days (one a day) costs Rs 235, but the cost of treatment with unbranded generic medication will be as low as Rs 30, down by 87%.

Similarly, the generic version of amoxycillin 500-mg capsules will be made available at Rs 3.50, while Novamox 500-mg capsules of Cipla sells at Rs 8.10. While consumption of branded capsules for seven days (thrice a day) would cost Rs 170, unbranded generic medication will lower the cost by 57%.

October 12, 2008

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Chennai Doctors may need 2nd opinion for all surgeries

Soon doctors in Chennai will have to seek a second opinion every time they decide to put the patient under the scalpel. In a bid to monitor
and regulate healthcare, Chennai Corporation will dispatch letters to all hospitals by mid-October making it mandatory for them to seek external opinion before operating on a patient as well as videograph all surgeries and submit records in case of a patient's death.

"It will be made mandatory from November this year. We will strengthen our reporting system further. We will also insist on an autopsy if we are not convinced with the reason for death given by the hospital," said Chennai Corporation chief health officer Dr P Kuganantham. "The death audit system will make the online issuing of death certificates more efficient. Nearly 120 deaths are registered in the city daily. Most of the time, we find it difficult to comprehend the reasons for death. We will now seek specific reasons such as infections and botched-up surgeries. Our death audit will give us all this information," he said.

About 500 hospitals - government and private - are registered with Chennai Corporation for online entry of births and deaths.

The department wants to make it mandatory for hospitals to videograph all surgical procedures and make them available under the Right to Information Act. The idea was mooted after a study by the civic body found several hospitals lacked qualified anaesthetists and trained nurses. Space and ventilation and sanitation facilities were also found to be below standards.

Responses to the proposed supervision have been varied. Some like Dr T N Ravishankar, honorary secretary, Indian Medical Association, rejected it. "A surgeon would not want his opinion to be doubted. And what if the patient does not want a second opinion? If patients object to the procedure being videographed, should we force them? Who is going to bear the cost?" he said. Others like orthopaedic surgeon and Indian Journal Of Medical Ethics editor Dr George Thomas agreed with the authorities on some of the proposals.

Hospitals bank on star doctors, get patients to check in

With seven-star super-specialty hospitals mushrooming across the Capital, it was only a matter of time before doctors became brands in themselves. And former AIIMS director Dr P Venugopal’s recent announcement — that he would join Alchemist Hospital group — has come in a line of ‘star’ movements of late.
When doctors like P Venugopal, Naresh Trehan or Ashok Seth move not just their patients, even the medical fraternity sits up and takes note. For, as many doctors admit off the record, moving a team of doctors from their previous base, and patients along with them, means big business. By securing eminent cardiac surgeon Dr Venugopal’s services the Alchemist group has already ensured that it is in news — even before setting up shop in Chandigarh.

“Doctors becoming stars is a great thing and I am all for it, only as long as doctors act responsibly,” Union Health Minister Dr Anbumani Ramadoss says. “If someone like Dr Trehan recommends jogging every day people will follow, but when I say the same thing it will draw flak.

“Star doctors must keep in mind that they are setting an example.”

October 07, 2008

Nobel Prize for Medicine 2008 announced

Three scientists share the Nobel Prize for Medicine this year. Francoise Barre-Sinoussi and Luc Montagnier receive the prize for the discovery of viruses behind AID, while Harald zur Hausen would get the prize for his research on cervical cancer..

THEY ARE three in number. Two of them are French and the third is a German. The trio is credited with the discovery of the viruses behind Acquired Immune Deficiency Syndrome (AIDS) and cervical cancer and were announced as the winners of the Nobel Prize for Medicine, the most prestigious award in the world on Monday (October 6).

Francoise Barre-Sinoussi and Luc Montagnier, the two scientists of France will share one half of the Nobel prize as they discovered the human immunodeficiency virus (HIV), which causes AIDS. Germany’s Harald zur Hausen, who will receive the other half, proved that ’Human Papilloma Virus’ (HPV) is the main reason which causes cervical cancer. Cervical cancer is the second most common scourge that affects women.

The Nobel citation says that the French pair’s HIV discovery as one of the pre-requisites for the better understanding of the biology of the disease and its anti-retroviral treatment. The new discovery will certainly lead to the development of methods to diagnose infected patients and to examine blood products in a more effective way.

AIDS, one of the dreadful diseases first came to public notice in 1981, when some US medical experts found an unusual cluster of deaths among young homosexuals in California and New York. Till date, this horrible disease has claimed the lives of 25 million people throughout the world. The most striking fact is that 33 million people have been living with HIV/AIDS across the globe. The HIV virus, which causes AIDS, destroys immune cells, thereby reduces the immunity of the human body.

Born in 1947, Barre-Sinoussi is a professor at the Institut Pasteur in Paris and heads the Regulation of Retroviral Infections Unit in the Virology Department. Montagnier, who was born in 1932, is a professor emeritus and also serves as the director of the World Foundation for AIDS Research and Prevention in Paris.

His discovery will now make the understanding of mechanisms of HPV-induced carcinogenesis easy and will also bring a developmental study regarding the prophylactic vaccines against HPV acquisition.

Cervical cancer, the ’silent killer’, is mostly found in women. Almost five percent of cancers are caused by this virus. According to the statistical report, this virus affects some 5,00,000 women per year across the globe. Zur Hausen, the 72-year-old professor, is the former chairman and scientific director of the German Cancer Research Centre in Heidelberg.

The Nobel Prize for Physics is to be announced on Tuesday (October 7), followed by the Chemistry on Wednesday (October 8), Literature on Thursday (October 9), Peace on Friday (October 10) and Economics on Monday (October 13), next week.

The Nobel Prize, founded by Alfred Nobel, a Swedish industrialist was first awarded in 1901. The Nobel Laureates receive a gold medal, a diploma and 10 million Swedish kronor. The awardees will receive the Nobel Prize on December 10, in Stockholm, the capital city of Sweden.

Study examines how doctors discuss medical errors

Mistakes should be considered shared commodities and used for all they're worth, says researcher.

We can learn from our mistakes, but how willing are we to talk about them? And what happens when those making mistakes are physicians, who are often expected to be infallible?

A new University of Iowa study shows that most general practice doctors in teaching hospitals are willing to discuss their own patient care errors with colleagues, but about one in four do not. At the same time, nearly nine of 10 doctors said that if they wanted to talk about a mistake, they knew a colleague who would be a supportive listener. The findings are reported in the Oct. 1 issue of the Journal of Medical Ethics.

According to a press release by EurekAlert, the results suggest that it is important to ensure that learning occurs not just in the person who made the mistake but also among their peers, said the study's lead author, Lauris Kaldjian, M.D., Ph.D., associate professor of internal medicine at the University of Iowa Carver College of Medicine.

"Discussing medical errors can be a form of professional learning for doctors. Mistakes should be considered shared commodities and used for all they're worth," said Kaldjian, who also is director of the college's Program in Bioethics and Humanities. "The findings also point to some challenges for physicians seeking emotional support after making an error."

The study results were based on surveys of 338 faculty and resident physicians at teaching hospitals in the United States. Previously published findings by Kaldjian and colleagues, based on the same data set, showed that doctors' actual communication of medical errors to hospitals and patients seems to occur less than it should when compared to physicians' positive attitudes about communicating such errors.

The two earlier studies also found that the more serious the outcome or harm from a hypothetical error, the more likely a doctor said they would communicate it to patients or hospitals. Similarly, the current study used hypothetical scenarios to reveal the likelihood of doctors discussing an error that results in no harm at 77 percent, minor harm at 87 percent, and major harm at 94 percent.

Kaldjian pointed out there is much value in sharing all errors. "Sometimes you make a mistake and nothing happens. Other times, something bad happens," he said. "But in both cases, we need to focus on the mistake because near-misses -- where no harm was done -- are also valuable learning tools."

The most harmful types of errors trigger automatic institutional reviews. However, other errors may not. "Along with helping improve patient care, discussing both types of medical errors can provide important opportunities for learning and emotional support for physicians," Kaldjian said. "However, the formal settings in which shared learning takes place are unlikely to be optimal for providing the individual support needed by the physician who made the mistake.

"Physicians can go through a lot of turmoil when they make a mistake, even if it hasn't caused serious harm to a patient. "While there are some formal group settings in the profession for learning from mistakes, emotional support may require the privacy and reassurance that are found in one-on-one conversations with trusted colleagues," he added.

More than half of the physicians in the study (57 percent) said they had tried at least once to promote the value of discussing errors by discussing one of their own errors in front of students or physicians in training.

"It's encouraging that physicians try to be role models, especially for medical students and younger physicians, and some hospitals even have peer-support teams to help physicians in the aftermath of an error, though such teams appear to be rare," Kaldjian said.

Kaldjian also noted that doctors who consider themselves their "own worst critic" and do not discuss their errors with others lose out on additional perspectives.

"There can be wisdom and comfort in the words of our colleagues, especially when we have reason to trust their insights," he said. "Medical science also encourages an investigative attitude about errors and can motivate us to be as objective as possible about errors and their circumstances without denying the profound need for emotional support."

Overall, Kaldjian said, increased discussion of errors amongst medical professionals is extremely important for professional learning and emotional support. Such discussions may also help physicians encourage each other to disclose errors to patients as part of patient care and to report them to institutions to improve patient safety.

Balm for NRIs: Chennai couple launches doctor service for parents back home

* When Soumi Mandal left India for the United Kingdom five years ago, it was with a nagging feeling that she was neglecting her ageing parents — her father is a diabetic dangerously irregular about check-ups.
* In Boston, USA, Ramakrishna Ayyagiri was dealing with a similar dilemma when he left for higher studies: “My father has a blood sugar problem and my mother, too, is getting on in years and refuses to see a doctor.”
THIS is a common worry for Non Resident Indians (NRIs), and fuels guilt about them turning their backs on ageing parents at a critical period in their lives. So there was a sense of relief when Mandal and Ayyagiri heard about ‘Doorstep Doctors’, a Delhi-based medical organisation that visits parents of NRIs at home to check up on their health and keeps the children posted about every development.

Touted as India’s first home healthcare service for NRIs and formed around four months ago, Doorstep Doctors (www.doorstepdoc.com) is the outcome of a survey conducted by Dr Sanjeev Ganguly, former clinical research specialist with Ranbaxy, and wife Dr Mohua Ganguly, medical affairs manager with MSD India, among 200 NRIs between July and August 2007. “We found that healthcare needs of ageing parents is the greatest problem, second only to security concerns. It is a source of constant concern for NRIs because they live away from their parents,” Sanjeev says.

“As the name suggests, we take doctors to the doorstep of patients instead of calling them to clinics. This has also enabled us to connect both ends of the spectrum, parents living in India and children settled abroad, who can now assume responsibility for their parents’ medical needs.”

For Mandal and Ayyagiri, this was the next best thing to being at home themselves.

Besides Delhi, the service is currently available in seven cities, and its client list spans the US, UK and Malaysia.

The annual subscription entitles quarterly visits by doctors and is divided into two modules. The basic module is for parents who are aged but not very ill and costs around Rs 2,000 per month.

“We carry out very comprehensive checks like lipid profile, blood sugar tests, liver and kidney function tests, ECG and screening for prostrate cancer, arthritis and gout among others,” Sanjeev says. “It also includes two emergency calls with free ambulance facilities. There is also a doctor bank.”

For unforeseen illnesses, he says, one just needs to call Doorstep Doctors, “and a doctor will visit you”.

The advanced module, priced at Rs 2,800 per month, is for those with multiple disorders — doctors visit more often and parents can call for emergency care four times a year.

2 more genetic diagnostic centres in the offing

The way genetic diseases and conditions are diagnosed is set to change drastically in the state, with the launch of two new genetic diagnostic centres shortly. The centres, which will be set up at Rajkot and Bhavnagar civil hospitals, will function as complete genetic diagnostic centres with facilities ranging from research and training to detection.

At present, Gujarat has a total of four such centres, including one private and three Government laboratories. However, the three government centres have been carrying out research and diagnosis on specific disorders.

For example, the Zoology Department at Gujarat University looks at male infertility; the Cancer Hospital in Ahmedabad focuses on cancer; and the Foundation for Research in Genetic and Endocrinology in Ahmedabad studies chromosome analysis. The new centres, however, are the first two government centres in the state that will provide treatment for all genetic diseases and conditions.

Drug authority caps prices of 79 medicines

In an attempt to ensure uniformity in prices of commonly used medicines like multivitamins, the National Pharmaceutical Pricing Authority (NPPA) has fixed ceiling prices of 79 medicines.

The move is based on the observations by the recently-constituted medicine price monitoring division of the authority. All companies, including small-scale units that are exempted from price fixing by the NPPA, will have to abide by the ceiling prices. Several multivitamin capsules and syrups, eye-drops, and antibiotics like gentamycin have been covered under the price ceiling, notified on October 1.

The price monitoring division of the NPPA has been assigned the task of routinely scanning all publically available price data.

In separate notifications issued the same day, the NPPA carried out upward price revisions in the range of 1-18 per cent for another 33 medicines. Wockhardt, Pfizer and Aventis are among the companies whose products like insulin could fetch more prices now. In case of 11 medicines, the authority announced price cuts in the range of 1-10 per cent. Eli Lilly’s four products and Shreya Life Science’s three — all insulins — will see a minor price reduction due to the NPPA’s decision. However, Eli Lilly has been granted higher prices for another five insulin products.

Dettol antiseptic lotion, the flagship product of Reckitt Benckiser, is another product that has seen a price revision. The NPPA, which had fixed the prices of four different sizes of dettol bottles early this year, extended its regulatory grip over five more dettol bottles. In the case of dettol, which enjoys over 80 per cent of Indian antiseptic lotion market share, the price variation is less than 2 per cent.

This is the seventh such exercise undertaken by the NPPA during the year. The previous price revision, notified on August 6, affected the prices of 188 medicine packs. On the whole, the authority has fixed or revised prices of over 2,000 medicine packs in the current year.

October 04, 2008

Health insurance cover for poor spreads to 11 states

A national health insurance programme, under which people below the poverty line (BPL) pay only Rs.30 and become entitled to treatment of up to Rs.30,000, has just become operational in 11 states.

Launched here in April, the health insurance scheme started with a Rs.22.5 billion seed money allocated in the 2008-09 central budget, labour ministry Director General (Labour Welfare) Anil Swarup said.

Called the Rashtriya Swasthya Bima Yojana, the programme that became operational Wednesday in 11 other states envisages providing smart card-based, cashless health insurance cover up to Rs 30,000 to all BPL families over the next five years, during which as many as about 60 million people will be covered.

Of these, a beginning was made with 120 districts.

The total sum insured will be Rs.30,000 per family per year on a floater basis. It will cover all medical costs in any of the hospitals with which the scheme has tied up.

Government hospitals are not on the list, essentially because most of the services provided in these hospitals are already free of cost. But Swarup said these state-run medical centres were free to join and would be paid for different services at the same rate as agreed upon with private hospitals.

The beneficiary BPL family is free to select the hospital of its choice out of the listed ones. Beneficiaries are also issed smart cards that enable migrant workers to seek treatment wherever they might be engaged.

ICICI Lombard General Insurance Company, a joint venture of ICICI Bank and Fairfax Financial Holdings of Canada, has bagged the contract to introduce the scheme across the country.

"I am sure this scheme will do wonders. Just imagine a poor Indian labourer, who could not even dream of entering a private hospital even for a simple dressing, can now walk into some of the leading hospitals and demand treatment even for some major ailments on the strength of his smart card," said Swarup, architect of the scheme.

"Since private hospitals are out of reach of most of these people, they had no option but to traverse long distances even during medical emergencies to reach a government hospital," he added.

October 03, 2008

As Supreme Court raps, Centre says doctors can’t deny care to HIV+

Doctors who refuse to treat HIV/ AIDS patients will be sternly dealt with, the Centre told the Supreme Court on Wednesday. However, during the hearing on a PIL related to the matter, the court observed that the Government is not doing enough to improve the public healthcare system.
During the hearing of a PIL highlighting apathetic treatment and lack of facilities for HIV/ AIDS patients across the country, the three-member Bench, headed by Chief Justice K G Balakrishnan, on Wednesday remarked, “In rural India, there are hardly any doctors. Even in a 50-bed hospital not a single doctor is available. It’s only on paper.”

As Additional Solicitor General Gopal Subramanium informed the court that the Government has recently asked all the state governments to improve healthcare facilities, and that primary health centres were working satisfactorily in rural areas of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu, the court shot back, “Go and check in any Government hospital in Delhi, Bihar and UP.”

Trying to convince the Bench about the ‘remedial’ measures taken at the highest level to deal with instances of refusal to persons living with HIV/ AIDS (PLHA) or non-availability of basic medicines or treatment for them, the Government counsel said all the states have been asked to implement the office memorandum sent to them recently. According to the office memorandum, “All doctors, nurses and hospital staff, whether in the public or private sector shall treat PLHAs in a professional and humane manner, treating them always with dignity and care. No doctor or nurse shall refuse to treat a PLHA on account of his/her positive status. In treating a PLHA there shall be no discrimination or stigma whatsoever.” It also suggested taking stringent steps against any doctor who refuses to treat any HIV/ AIDS patient.

Starting today, smokers to be challaned like traffic violators

With effect from today, people caught smoking in public will be challaned the same way as traffic norms violators are.
The Union Health Ministry has sent challan booklets to all the states and asked the authorities to send notices on the violators’ addresses, if they are not able to pay the fine on the spot.

“The fine, which is up to Rs 200, will be charged the on the spot. However, if the violator shows inability to pay the challan money then, then they would be sent a notice at home specifying that they were caught smoking at a public place,” said a senior official in the ministry.

“The notified officers will check the I-card of the person to make sure that the notice is delivered at the correct address,” added the official.

Positive Health Awards

The Dr Batra’s Positive Health Clinic has called for nationwide nominations from individuals who have overcome physical disease and disability, for the Annual Positive Health Awards.
In its third year, Dr Batra’s Annual Positive Health Award is an attempt to recognise medical miracles and individuals who have demonstrated enormous fighting spirit to beat the odds to recover from seemingly hopeless medical conditions.

The Positive Health Awards 2008 will be presented at a grand ceremony on October 15, 2008.

Nominations should be sent with the details of the person and case history to: positivehealthawards08@drbatras.com

Health ministry offers sops to HIV+

If the National AIDS Control Organisation (NACO) has so far mobilised $700 million to fight the AIDS menace, the health ministry has go

ne beyond its mandate and requested the concerned ministries for making available free transport, BPL cards and extension of the NREGA scheme to the socially stigmatised 2.5 million HIV positive people.

Even before NACO got the Supreme Court’s stamp of approval on Wednesday on its scheme stepping up medical facilities to AIDS patients that included establishing 650 link anti-retroviral therapy (ART) centres, the health ministry has initiated steps on the social and economical fronts to make life easier for people living with HIV/AIDS (PLHA).

In tune with Additional Solicitor General Gopal Subramaniam’s promise to SC, Health Secretary Naresh Dayal has written to his counterparts in the ministries of railways, transport, food and rural development seeking a slew of concessions and extension of central benevolent schemes to PLHAs.

“While the Centre was giving free investigation and treatment to eligible HIV/AIDS cases, as majority of affected persons are from poor socio-economic classes, there is considerable economic burden due to indirect expenditures that they incur due to loss of wages, transport cost and limited physical ability,” said Dayal, explaining the necessity of his communication.

All his letters had an identical line at the end, “It is believed that the SC is inclined to accept these (Subramaniam’s) suggestions”, probably to fortify them from any possible legal objections from the recipient ministries. The health secretary’s letter to his counterpart in the rural development ministry, Rita Sharma, said Subramaniam had committed to “extend the benefits of NREGA scheme to HIV positive persons. I request appropriate orders be issued to state governments”.

The National Rural Employment Guarantee Act (NREGA) promises enhancement of livelihood security of households in rural areas by providing at least 100 days of guaranteed wage employment in every financial year to every household whose adult members volunteer to do unskilled manual labour.

In an identical letter to food secretary T Nanda Kumar, Dayal requested him to help comply with the ASG’s commitment to the court to extend the Antodaya Anna Yojana (AAY) to HIV positive persons and pass appropriate directions to the state governments, which implement this centrally sponsored scheme. The AAY scheme aims to provide foodgrains at subsidised rates to poor (BPL) families who are unable to manage two square meals a day.

To provide PLHAs free of cost travel from their home to the nearest ART centre for medical help, the health secretary wrote to transport secretary Brahm Dutt and Railway Board chairman K C Jena to take necessary steps.

October 01, 2008

Health insurance may get new law

The government is examining various amendments to the insurance law, including a special statute for health insurance, aimed at improving the functioning of domestic companies and increasing their penetration.

“There are several amendments being considered such as allowing foreign reinsurers to set up branches in India, allowing insurers to raise hybrid capital and having a special statute for health insurance,” Tarun Bajaj, joint secretary in the Union finance ministry, said on the sidelines of a seminar here on Tuesday.

In 2004, a committee set up by the Insurance Regulatory and Development Authority (Irda) had suggested that the minimum capital requirement for standalone health insurers be reduced to Rs 50 crore from Rs 100 crore. In addition, a reduction in the solvency requirement and providing other regulatory flexibilities were suggested. The move was proposed to make the business a more viable proposition for standalone players.

Though the government and Irda have not implemented the recommendations so far, standalone players have already entered the market. “Increasing health insurance penetration and ensuring affordable premium rates remain the key challenge,” Bajaj said.

“Health insurance has been growing at 50 per cent.” We have started seeing some product innovation. But the need of the country is very varied. Another issue is taking care of senior citizens, improving the coverage for senior citizens as suggested by the Sastry Committee Report.” he added

The government is working on a Bill to amend the Insurance Act, Irda Act and laws governing the Life Insurance Corporation and public sector general insurance companies. Among other things, amendments to the LIC Act are proposed to increase the company’s paid-up capital base from Rs 5 crore to Rs 100 crore.

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