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Wednesday, June 03, 2015

Violence against doctors

The rising knowledge base on the internet, growing awareness of the limitations on healthcare professionals, and a general rise in intolerance levels among lay people, combined with adverse publicity through insensitive media have made violence against doctors a "daily" affair - especially in India. The trend is disturbing, to say the least. Had it been limited to angry shouting or shunning the particular doctor, it would have been all right. The problem is, the violence is now actually causing harm to doctors and their hard-earned property. 

It would be difficult to trace the time-line of this process. Doctors were, at one time, perceived to be honorable, noble professionals whose only avocation in life was to save lives. Changes in society have caused this thinking to get eroded over time. And, it is not just doctors who are responsible for the decline in moral values. Today, the medical education sector is completely at the mercy of immoral, dastardly businessmen and politicians, who have increased the cost of learning to unthinkable levels. When I did my M.B.B.S., the cost of the entire course to me was less than Rs. 3000/= ... which, even 30 years ago, was not a very big amount. We earned back our investments during our internship, which paid us Rs. 450/= per month as stipend. Thus, there was no angst, or desire to earn back my investment, and doctors in my time turned out to have good morals and a more altruistic attitude towards sick people. Post-graduate education was almost free; we just had to buy our books. In fact, as house-physicians and registrars, we got paid every month for the hard work that we put in. 

Today, the investment is in lakhs of rupees, and for post-graduate entry into the choicest of branches, the investment amount is in multiples of 1 crore! (1 crore is 10 million, and 65 Indian rupees is equivalent to 1 USD). How can society then expect today's newly graduating doctor to be altruistic, to treat patients at low cost, to be charitable? Their first goal will be to get back their investment, not to give free treatment, right? Thus, society has reaped what it sowed. Today's doctors are not the brightest students either ... those who have deep pockets, regardless of their intellectual levels  are doctors today, while the truly deserving student with an economic disadvantage is often the one who misses out on becoming a doctor. So, you not only have avarice, but also incompetence added to your pot of miseries. 

Coming now to the media: in India, doctors were at the receiving end when one Mr. Aamir Khan, in his signature program on changing society, painted all doctors in the black. Falling short of calling them blackguards of today's India, he messed up the minds of his millions of viewers by convincing them that doctors over-investigated, over-referred, over-treated and over- everything in their bid to bleed their patients dry of money. This may be true of about a percent of doctors, and you will find that most such doctors are actually in this profession only for business and profit, and not for doing any good to society. The damage Mr. Khan caused to the image of the entire medical profession is yet to be mitigated. A small episode within a recent movie again showed doctors to be the modern scourge of society (Akshay Kumar in Gabbar Is Back, 2015). 

The negative media exposure that doctors got through the above few examples raised the intolerance of patients. Often, they do not know the effort doctors put in to save the lives of their near and dear ones. Do they realise that often they are the guilty ones: they bring their patient late ... just so as to try some alternative therapy, so that admission  and its higher costs can be avoided. Sometimes, they are actually not interested in saving the old parent or grand-parents' life, and make a show of causing violence to hide their dark deeds when the old person dies due to late arrival. Again, I am not saying that all care-takers are bad, but over 20% are in fault, regardless of their intention ... mostly because they do not have the finances necessary to bring their sick family members or friends in for emergency care.

In the last several months, tens of attacks have taken place in various parts of India, Pakistan, Bangla Desh and other South Asian countries. These populations have similar ethnic and ethical backgrounds; they have the same access to media; they have the same mental make-up. Is it therefore surprising that similar attacks are taking place in each of these countries? However, the problem is most serious in India, where doctors have been brutally and mercilessly beaten up for being the messenger of bad news rather than being negligent. Swift justice is meted out by a crowd of the relatives of the patient, accompanied by the student wing of recognised political parties (read hooligans) who break the hospital's furniture, create mayhem, beat up the doctor and his staff (including helpless nurses who are from the same society that the patient and their relatives are), and file a police case and a consumer court complaint against the doctor and his nursing home. Harrowing stories of doctors getting critical injuries and getting admitted to ICUs have emerged. 

But, I hear that doctors are now organising themselves to hit back at the belligerence with more of their own. When an attack of such nature is anticipated, doctors send out messages to all the other doctors of their area, and a group of doctors assembles at the venue before the news of a patient's bad turn or demise is communicated to the relatives. The relatives are clearly told that violence of any kind will be recorded on cameras installed at different locations of the hospital or nursing home, that there is a law that will punish the perpetrators with heavy fines and imprsonment plus recovery of the costs of the damage caused to the property and the treatment costs to healthcare staff who get injured in the attack. 

In the coming months, the entire issue will be more and more clear as society and doctors are at loggerheads with each other. I hope that good sense prevails. 

Thank you for reading this article. Although it does not directly address a health issue, it is highly relevant and appropriate that we are even discussing it in a public forum. 

Fever is a symptom and not a disease, but ...

As I have mentioned in my earlier post, fever is not a disease by itself. Treating it with paracetamol merely causes the fever to subside, without actually affecting the underlying cause of the fever. It is important to know the following additional facts about fever:

  1. High fever can produce fits in infants and toddlers; although these fits look very dangerous to parents and care-takers, they are merely a reflection of the immaturity of a small child's brain and nervous system pathways; no long-term medicine is needed except in the rarest of circumstances.
  2. In children (and adults) of all ages, fever increases the thirst and fluid requirements of the patient; thus, febrile children or adults must be given extra liquids - usually 10% more than the usual for every degree Centigrade the fever is above 38 degrees.
  3. A patient who is running a fever should never be force-fed food; nor should food be withheld from one who desires it. In short, let the patient decide what, how much and in what form he needs. Starving a child with fever is a criminal act, since it further weakens his/her body and prevents it from fighting the underlying cause of the fever (usually an infection with bacteria).
  4. Very high fever (more than 105 degrees Fahrenheit) is termed malignant hyperpyrexia ... and in the extreme case, it can be potentially fatal, i.e. kill the patient due to complete derangement of all systems in the body.
While most causes of fever in children are easy to manage and not life-threatening, fever accompanied by any of the following additional symptoms should be considered as "not just fever" and such children should be referred to a Paediatrician immediately:           
  • High grade fever
  • Uncontrolled or repeated or very large-sized vomiting or loose stools
  • Irritable, excessively jumpy or crying child
  • Older child who remains in bed all the time and refuses to drink liquids or appears inactive, dull or lethargic
  • Has had fever-associated fits in the past, or during the present illness
  • There are significant symptoms pointing to a serious infection such as arching of the back (meningitis), dark coloured, blackish urine (malaria), stomach bloating (typhoid) or moist, hacking cough with sputum and chest pain (pneumonia)
Learn to understand fever and try not to panic.  Check out the link to my earlier detailed post on fever to learn how to manage fever at home. When in doubt, go to your child's doctor immediately.

My Child Care book is now available off the net

Dear Readers,

I have updated and revised my original child care book that I first wrote a decade ago, and have now made a soft copy available on the internet for sale at a very low price. Do check out the link below: 

Click here or see the full link below, copy and paste it into the address bar of your browser and click "go".

I trust that you will like it and will buy it. Proceeds will be shared between the marketing site and me, and I will use the money to help children from poor communities in Mumbai and around Mumbai to realise their true potential. Thank you very much. 

If you do buy it, please write a comment about this in this blog and I will be sure to add you to my prayers. Also, after browsing through it and using it for a few months, do write to me a testimonial, telling me how you found the book and send it to my email address

Thank you.

Friday, May 22, 2015

Hidden Disabilities

I am writing this post to sensitise my dear readers about disabilities in people (here, I will stay with children, since this blog is about them) that are not obvious, but need attention all the same.

First of all, disabled people are also people. Just because a child is deaf, or visually challenged, does not mean he/she has no other aspects to his/her character; such a child can, and does, have emotional needs, ambitions, desires, etc. They still experience pain when hurt; they still laugh, cry, express anger, feel depressed, agonise, enjoy, and so on. We must look beyond the disability and express not just sympathy, but also try and understand what they need and how they must be integrated into society.

This post is about children whose disabilities belong to one of the following categories:

a) They are not routinely symptomatic, but can develop symptoms when stressed - e.g. a child with epilepsy, or one with allergy
b) A child who is physically normal but has neuro-developmental issues - e.g. a child with attention-deficit-hyperactivity disorder (ADHD), a child with autism spectrum disorder (ASD), or a child with behavioural issues related to a neurological disease (e.g. a child with sensory perception disorder (SPD)
c) A child with visible disability, but who is ignored or misunderstood - e.g. a dyslexic child is punished for getting poor grades because the teacher and parents think he is faking, or is naughty, or anti-social.

What is needed here is to understand that such children are all children with special needs. They need understanding of their condition. A sensitive healthcare policy at the national level, a sensitive person who is bearing the brunt of facing such a child, and a sensitive family are all important, nay, pivotal, to the well-being of such a child.

What such children can undergo are the following:

a) aggravation of their medical problem if they are not understood
b) violence and injury at the hands of disciplinarians, peers and parents
c) misdiagnosis leading to improper treatment
d) humiliation and ridicule - sometimes worse than physical violence
e) loss of opportunity/time/ etc. because the society has not begun to modify their environment for such children.

To prevent these from happening, let us all decide to try and be more empathetic towards children with hidden disabilities; let us be sensitive and non-judgemental towards them; let us be sincere and honest about our knowledge gaps and try and learn more about these problems; and, if we are caring for such children, let us be more caring and careful while dealing with them.

I welcome your comments. Thank you.

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Dr. Fuhrman