Does the public feel the need of perfectly working weighing scale in hospitals?

Avi

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Then, how Singapore got lead, or South Korea? Why there healthcare is far better than us?
We need to ask that question.

This is not about R&D or education, in terms of R&D India is equivalent to any western nations in healthcare. And most of studies these days are public.
In whole Asia, yes in whole Asia, no body give better MBBS degree than public institutes of India. But when these students become doctors, even MD from AIIMS or KGMU. These doctors become same in Pvt. Hospitals.

They give prescription of medicines of Abbott or other big companies, instead of other(even reputed companies), which cost almost 1/4th. Why is that?

Arpit I will answer to that in detail.

1. R & D for clinical research, I beg to differ simply because the results don't show up the equivalence.
2. Singapore has a lot of western inputs and investment to reach, coupled with approach and laws.

3. MBBS degree are nothin to be proud of , I repeat the 4.5 years of bookish knowledge won't help you treat a patient. Basic graduation equivalent to MBBS is at least 6 years in Europe and western world. When you talk about MBBS its only Indian, Pakistan, Bangladesh , Nepal thats the benchmark you are fighting. the Chinese has been dependent on traditional medicine for long to emerge out.

4. I am working in a corporate and responsible for mid and junior level doctors in my hospital, do we even consider any Indian degree holder to join unless he has a foreign fellowship. lets take an example after doing MD(Pediatrics )/DNB( Pediatrics) somebody approaches us for registrar role we would consider the ones who have done fellowships from abroad so that can elevate them to Jcs later on.
I am the head for my department , my registrars must have EDIC / MRCEM to apply simply because I have suffered a lot working with non trained people possessing only Indian degrees. If you want t be a consultant in a corporate of significance the unwritten rule is foreign fellowships/qualifications which is sad but true and there is a real reason for it , we better pay a little more to a doctor who treats vs a doctor who pretends to treat.

5. Last point why do doctors prefer certain drugs because of other reasons than commission. I personally don't take any commission from Pharma guys simply because whatever they offer is insignificant to what I earn in the bigger picture.

1 gm of paracetamol I.V generic costing 55 INR you give to a patient with 102 degrees fever vs 1 gm of Paracip made by CIPLA costing 250 INR , give to the patient on a daily basis , do a study over 1000 patients in various conditions and see the results. I have done an exactly same study and validated the justification.
If the patient don't get relief in 30 minutes he is going to curse me , its better for me to use drugs which work than ones which " PRETEND and OUGHT to work ".

6. Last point , try any western medical practice check the charges for doctors/medical consultation and compare India's

Cheap and Quality don't go hand in hand
 
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Avi

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Refer to recent supreme court order as to why doctors and lawyers in India cannot be prosecuted incase of failure.
 

PeeGooFeng41

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Dec 4, 2017
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How do you diagnose hypertension in a patient who has visited a private accredited hospital? Do doctors diagnose with your automated BP reading and put you on medications straight ? Which doctors should be treating you for HTN anyways ?
To your counterpoint, No you don't diagnose HTN with just one reading, usually a 24 hour ambulatory measurement should be done before making any diagnosis.

But even before that calibration of equipment is a must for any measurement to be meaningful. The dependence of readings on cuff size is very well understood but is often neglected. Over diagnosis of HTN and un-necessary treatment is actually fairly well documented phenomenon. There are many sources of error but this is perhaps the most easily fixed.

And it is not just HTN which is the issue here. BP is one of the vitals and as such having a proper reading at the moment is important. Having a skewed reading makes this decision more troublesome and worse, makes the record keeping / medical history error prone.
 
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Avi

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To your counterpoint, No you don't diagnose HTN with just one reading, usually a 24 hour ambulatory measurement should be done before making any diagnosis.

But even before that calibration of equipment is a must for any measurement to be meaningful. The dependence of readings on cuff size is very well understood but is often neglected. Over diagnosis of HTN and un-necessary treatment is actually fairly well documented phenomenon. There are many sources of error but this is perhaps the most easily fixed.

And it is not just HTN which is the issue here. BP is one of the vitals and as such having a proper reading at the moment is important. Having a skewed reading makes this decision more troublesome and worse, makes the record keeping / medical history error prone.

Absolutely agree with you.
But my point being medicine is too complex a subject to be decided by absolutes.

Yes calibration is important , so to are thousands of small things which we are inattentive to. The understanding of these small things make sa difference. Big question is how do we get over these.

1.The first step towards any solution is to acknowledge the problem. Here in India we have this habit reaching a conclusion before understanding the problem.

2. Is our training program adequate ?

3. Does the system has necessary checks and balances in place ?

4. What are the CAPA in case of errors ?

So don't look at it as an isolated issue /or individual , the entire system needs to evolve . when you make regressive laws and media keeps making matters worse , the public should arise and take steps to understand healthcare better.


So should we not have guidelines based on evidence. Tell me how will an AYUSH doctor evaluate a cardiologist/nephrologist for negligence or for the matter a Zila parishad chairman who education is probably till 4th standard.
 
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PeeGooFeng41

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Dec 4, 2017
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33
Absolutely agree with you.
But my point being medicine is too complex a subject to be decided by absolutes.

Yes calibration is important , so to are thousands of small things which we are inattentive to. The understanding of these small things make sa difference. Big question is how do we get over these.

1.The first step towards any solution is to acknowledge the problem. Here in India we have this habit reaching a conclusion before understanding the problem.

2. Is our training program adequate ?

3. Does the system has necessary checks and balances in place ?

4. What are the CAPA in case of errors ?

So don't look at it as an isolated issue /or individual , the entire system needs to evolve . when you make regressive laws and media keeps making matters worse , the public should arise and take steps to understand healthcare better.


So should we not have guidelines based on evidence. Tell me how will an AYUSH doctor evaluate a cardiologist/nephrologist for negligence or for the matter a Zila parishad chairman who education is probably till 4th standard.
To begin with, I do not think this problem or problem of these nature are solvable by pure Legislation. Legislation will simply give way to litigation and will make doctors more and more process oriented. It will create a situation in which doctors will worry more able 'following the process' and keeping their lawyers happy. Also medical practice will become so much of a minefield that you can only do it with a backing of a corporate with a team of lawyers ready to support you. This is essentially north american medical system.

What I believe which can work in most of the complex and disciplines dealing with uncertainty is keeping the skin in the game. Similar to what doctors do with their own family members. Honestly, how it can be done is something I do not understand completely. I have seen in Canada a practice of family doctor which is actually mandated by law which is a lose approximation of this setup. But then the same has existed in our country as well.

If you ask me, I am always a bit wary of 'corporatized' medical practice. I have seen horrors in the hospitals with almost untrained supporting medical staff doing diagnostics which make no sense. BP measurement was just one. I guess the doctors are probably aware of the situation and do take these results with a pinch of salt.

As far as training goes, IMHO Medical profession is more of a 'practice' and 'skill' rather than taught discipline. You can improve the teaching, but IMHO, what will work best will be what law firms do. The small/medium sized outfits that is. You shadow another practitioner after you are done with your taught part of study and learn from them by working closely with them.
 
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Sathya

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Dec 2, 2017
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Write to the Health Minister on the number of rules governing such issues in a consolidated manner with a formal observation to Ministry of Health & Family Welfare as also the Ministry of Labour & Employment.(I think they will be covering this) Of course BIS can also be involved.

Mind you, they too come under services and as such will be governed by the common law.

Mind you, the electronic weighing scales and the sphygmomanometer need recalibration every 6 months (and so do mercury based ones on infrequent basis) and how many hospitals actually do that? Just a thought.

Turns out the actual government fee, is Rs 300 + 100 for lapse of time +100 for travel charges
That scale company wanted 1100, later 950.. to make arrangements probably couple of phone calls.
i asked him whether he ll service the scale, for which he dodged saying other things.

i would have preferred if they calibrated for 500 bucks instead of just documentation.
 

Avi

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Dec 1, 2017
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To begin with, I do not think this problem or problem of these nature are solvable by pure Legislation. Legislation will simply give way to litigation and will make doctors more and more process oriented. It will create a situation in which doctors will worry more able 'following the process' and keeping their lawyers happy. Also medical practice will become so much of a minefield that you can only do it with a backing of a corporate with a team of lawyers ready to support you. This is essentially north american medical system.
The talk right now is regarding legislation , amendments and curbs to be put in place. KPME amendment is one such act recently passed. The media and consumer courts are now asking about accountability via strict legislation.
When the backdrop is such then , we have to follow the nature of practice as you mentioned. This is purely regressive for Indian society as you rightly mentioned and its the general public at large should understand come out in support.

Doctors can still work with these new laws in place but the sufferings of the society will increase more because we would first try to be " Legally Correct " then " Medically Correct ".

If you ask me, I am always a bit wary of 'corporatized' medical practice. I have seen horrors in the hospitals with almost untrained supporting medical staff doing diagnostics which make no sense. BP measurement was just one. I guess the doctors are probably aware of the situation and do take these results with a pinch of salt.
Yes corporates in India have glaring issues , but if you don't have them what is the alternative ?Would you like to take your family for treatment to the government setups. Why can't the government provide world class healthcare. These bad practices in corporates happens only because there are no alternatives , they get away with whatever they want because people will still come to them. The doctors know all these but we don't want to go work in a government hospital where there are no supplies of proper drugs , facilities non-existent , paperwork and work-place politics rule over professionalism , modern equipments either don't work or are lying idle due to lack of operating manpower.
 
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Avi

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Adya death: Fortis took up to 1700% margin on items - Times of India

I am sure patient will be charged only with MRP

It doesn't matter how much margin the hospital profit.

Who is fixing the MRP ?

Not in medical field, happening in all other fields too..

Why selectively blame medical field & fortis..?

You charge & permit everything to happen ..

Now demonize some especially doctors..
This is trial by media.

Do we ever ask how much the media gets paid for their fake news , contents ? Do they have a MRP ?

MRP is what one can charge , why are people bothered then if its 200 @ or 20000%, a platter on a 5 star costs 500% , why are they not obsessed.

What kind of benefit are the government providing to hospitals.

The inborn ability of us south-asians to put our nose , hands , fingers in places most unwarranted and in the process damage an institution which is proving you one of the better services.
 

Aravind

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Aravind

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I remember talking with you about the same @Sathya and i was indeed very happy to see you following the path of a true men of medicine... The commercial nature of medicine as a whole field (just like every other field in India say example banks) has crept into our whole healthcare system.

Just like weighing scale which is the basic necessity another significant basic thing which we all see is pushing for C Sections over Normal delivery. You get docs saying its what is best bcz of a long list of reasoning and then gently add that its your decision but everything else like normal delivery will be risky for both mother and child...

Innocently Ppl trust docs as gods and what they end up is a non issue treated as a issue.

Its not that all the whole community of medicine is bad, but 1% cretins like in all fields complicate the issues..


PS : Hope you watched Mersal.. I liked that movie a lot.. relevant issues of today.. also it portrays the limitations in the system.. a bit over the top in portions but overall a good movie in a similar topic..
C-section is performed when a normal delivery doesn't happen after 2 hours.
Mersal is a bit over the top exaggerated from what i heard from friends.
 
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Aravind

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This is trial by media.

Do we ever ask how much the media gets paid for their fake news , contents ? Do they have a MRP ?

MRP is what one can charge , why are people bothered then if its 200 @ or 20000%, a platter on a 5 star costs 500% , why are they not obsessed.

What kind of benefit are the government providing to hospitals.

The inborn ability of us south-asians to put our nose , hands , fingers in places most unwarranted and in the process damage an institution which is proving you one of the better services.
The baby which was pronounced dead had Lazarus Syndrome. No doctor would expect such rare cases, finally media made it a trial of witch hunt of doctors involved.
Harayana came up with 6 draconian rules, which were boycotted by all Doctors.
 

Aravind

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Yup, only in Western countries, as there doctors coming from Planet Venus. Shiny. So there doctors should be held accountable.

Ours, ours are coming from reddish Mars. No they shouldn't.
Western country Doctors dont face patient loads like Indian doctors do. we got a doctor to patient ratio of 1: 1800 which is worse than sub-sahara african nations.
Doctors in west get paid in millions, a normal MBBS duty doc would make 50k per month. Which a 10+2 Pass person working in a call center makes,
Not to forget patients beat up doctors, kill them sometimes, and destroy their hospital equipment. You dont see all that in west they get good working conditions 48 hrs per week. We dont have that luxury in India.
 
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