Monday, April 7, 2014
Saturday, April 5, 2014
Preparing for the mighty test that’s coming up? It may be scary but you don’t need to worry about it because with simple tips, tactics, and tools you will be able to prepare well and improve your chances of doing well in the test.
When it comes to medical competitive exams, the importance of time management is very high. Since you have a lot to study and remember, you have to be able to manage your time such that you are able to go through all concepts and memorize them without having to rush. Time and again we hear students complain that they were not able to prepare properly and more often than not, the reason is poor time management. This is the reason why we have compiled a few tips for you to use the most basic tools in life to manage your time well:
- Create a time table
- Set priorities
- Stay away from distractions
- Keep calm
Create A Time Table
This tool is old but gold! Such a simple tool, it can do wonders when used right. Simply create your own time table according to your needs and concerns such as the difficulty of the topic in question, the time you’d need to study, and so on. Create a detailed timetable for every single day and make sure you follow it. It has been positively proven that simply writing down your goals for the day can help you manage them really well.
Be very sure to include time for other activities in your timetable as well such as eating, taking a short nap, and a break or two.
What should you start off with? What should you continue into? When you have a clear idea of all this in your mind you will be able to focus on one thing at a time. Otherwise you might get overwhelmed by the sheer volume of portion and be extremely worried. A clear goal will help you a lot in studying and managing time.
Stay Away From Distractions
When you study it is imperative that you stay away from any and all distractions including your phone and your laptop. Simply checking a text message may take a few seconds but this will distract you and you will lose your focus. As a result you will take more time to concentrate. Each time you do this, getting back on track will get more difficult. Avoid such trouble by only surrounding yourself with your books and keeping away from technology.
Positivity is the biggest tool and tactic that you can apply. Always keep in mind why you are studying so hard; always remember the reward that is waiting for you. That will motivate you especially when you are frustrated. Be positive, stay calm, and keep telling yourself that you can do it.
Managing time while preparing for your exam is no rocket science. You just need simple tools and tips that will help you focus. Oh, of course, you also need to eat well and sleep tight!
Thursday, April 3, 2014
Thousands of students across the country were in for a shock when their computer screens turned blank on Sunday afternoon, midway through an online entrance test to National Institute of Mental Health and Neuro Sciences (NIMHANS). Pat came a message that the online test has been scrapped and they would be informed about the new dates.
NIMHANS was conducting its online entrance test for selection to the super speciality/ post-doctoral fellowship / medical and non-medical courses for the academic year 2014-15. Around 5,584 students were simultaneously writing the exam at 18 centres across Bangalore, Chennai, Kochi, Delhi, Hyderabad, Kolkata and Pune on Sunday for 30 courses offered by the premier institute. The exam was divided into four sessions. However, all the sessions were plagued with problems, across centres.
Though the server worked fine in the first session, many students complained that they were issued wrong question papers. One of the students told PG Times that it took him almost half an hour out of 90 minutes to figure out the question paper, only to be told later that it was a wrong one.
The real problem started in the second and third sessions. During the afternoon session, around 4.30 pm, the servers completely went blank, creating chaos. Officials who were looking into the issue realised that the servers had crashed and there was no point conducting the fourth session. So the entire exam was cancelled.
However, NIMHANS officials maintained server problems are common to all online exams. NIMHANS registrar Dr V Ravi said, "It is true that the server crash is the first time in the history of our institution, though such crashes are not uncommon. However, we want to assure students that they need not worry as we have taken a decision to cancel all the exams of Sunday even if the servers were okay. All students need to take exams afresh. The new dates may be in May. We have also launched an inquiry as to why the server crashed and will ensure that this is not repeated in the next exam."
Wednesday, April 2, 2014
Thursday, March 27, 2014
First he skipped breakfast, and then found there was no time for lunch. As afternoon stretched into evening, the famished young doctor considered slipping away for a bite, but there were too many patients turning up at the emergency ward. At 7.30pm, he thought he might take a breather after just one more case. It seemed easy enough. No question of life or death -- just one 10-year-old boy, sobbing loudly over a fractured leg. The child was riding an autorickshaw when it hit a divider and the leg got caught.
Suresh Sana, the 28-year-old postgraduate doctor on duty at MS Ramaiah teaching hospital in Bangalore, explained to the parents that a clear X-ray could be obtained only if the boy calmed down and stopped crying and shaking. But the child proved difficult to soothe. Eventually, Sana dispatched the family to the X-ray unit. When he met them there to get the results, however, Sana suddenly found himself a target of the relatives’ wrath. It was a bewildering turn in the course of his life – until then, a clear upward arc. He had been the first in his father’s village to win a medical seat, and was newly engaged to be married. And here was this patient’s aunt, giving him a sharp slap that carried the sting of public ingratitude. “Why don’t you behave like a doctor?” she snapped, seemingly furious over the delayed X-ray. Then a male relative grabbed Sana by the collar and punched him in the face. His head hit the chipped cream paint of the corridor wall, and he fell unconscious. Down the hall, framed images of goddess Saraswati and the god Venkateswara hung silently above the fracas.
Fallen from grace
Ten or fifteen years ago, doctors in India were still treated as demi-gods. They commanded vast respect and could not, would not, be questioned. A punch in the face over an X-ray? Unthinkable.
But those were the days before healthcare emerged as a hardcore business. Technology has advanced, yet trust has faltered. “Patients have a perception that doctors and hospitals are out to fleece them,” observes GD Ravindran, a professor of medicine and medical ethics at St John’s Medical College in Bangalore. Second-guessing has also become routine, with Internet search habits eroding the previous doctor-knows-best mindset. Those are big bumps in the road toward a shared desire for a positive outcome.
Compared to road rage, however, hospital rage appears far more complex. From all accounts, it stems from frustrating shortfalls in the public health system, crucial gaps in communication between doctor/patient/relatives, low-level political bullying and high expectations for recovery. And don’t discount the brain-wiring. “When a relative suddenly and unexpectedly dies…it is far easier for the brain to blame the doctor and the institution he represents, who are quickly demonized as outsiders with their arcane and mysterious ways,” says Sai Gaddam, a neuroscientist and Bangalore-based author who recently completed a book titled Keepers of the Flame: What Outrage, Snark and Trolling Reveals About Our Social Brain.
Consider the annals of Indian doctor-bashing in recent times. In Tuticorin, a female anesthesiologist was hacked to death in January 2012, allegedly by the husband of a pregnant woman who did not survive an emergency surgery. In Imphal, a professor of medicine was shot in the head in March 2014 while working in her private clinic. In Kanpur, a medical college turned into a virtual war zone in February 2014 after a local politician allegedly exhorted police to mount a raid there, in a hail of rubber bullets. In New Delhi, a female doctor was assaulted in September 2013 by a mob in a public hospital’s casualty ward and threatened with rape. In Hassan, drunken buddies of road accident victims periodically disrupt the emergency ward at the district hospital, manhandling medical staff and breaking furniture – the latest incident was in early March 2014. In Raichur, someone splashed petrol on a nursing home in February 2014 and set it ablaze.
Trouble comes to both government hospitals and private clinics. Sometimes a lucky doctor can run away and hide in a locked toilet. But not always. The weapons vary: a knife, a stick, an iron pole normally used to suspend an IV drip. In the wrong hands, it can be wrenched from a hospital bed and smashed against the side of a doctor’s head, perforating an eardrum. “The sense of fear stays with you,” says 33-year-old Kailash Bagale, who in June 2012 made the mistake of trying to appease an angry mob in a recovery room at the Sri Jayadeva Institute of Cardiovascular Sciences and Research in Bangalore. The pain in his ear subsided after three months.
The hazards of being a junior doctor
In the Ramaiah hospital case, the punch in the face led to a brief strike by Sana's colleagues. This is how such incidents tend to surface – if only sporadically and locally – with short media bulletins detailing a fresh strike, usually by the younger doctors. They carry the lion’s share of responsibility in emergency wards on late nights and weekends, when the atmosphere is most likely to get edgy. If beds are scarce, tempers flare. “Ninety-nine percent of the time, it is the junior doctors who are thrashed,” says Anirudh Lochan, Secretary General of the Young Doctors’ Association of India.
Interviews with three dozen medical professionals and analysts across India indicate that violence against medical personnel has increased over the past three years, despite a wave of state laws passed in 2008/2009 that explicitly prohibit such attacks on doctors, nurses, paramedics and hospital property. The legal remedies were first prescribed in Andhra Pradesh, moving up to Haryana and across to Rajasthan, Punjab, Karnataka, Tamil Nadu, Maharashtra and elsewhere, categorizing such attacks as non-bailable offenses and mandating prison terms of one to 10 years, depending on the state. (Health is considered a state subject in India.) As a deterrent, such laws have clearly failed.
The consequences appear grave. Interviews suggest that doctors are now less likely to take risks, since the death of a patient might provoke mayhem. “If a patient comes in a serious condition and I spend all night in the ICU, if he dies, they will be after my blood,” says Rajan Sharma, an orthopedic surgeon in Haryana. A defensive strategy involves shunting complicated cases to other clinics and hospitals, with the delay actually magnifying the health risks in some cases. And referrals just add to the frustration. At the Bangalore-based Institute of Public Health, director N Devadasan argues that India’s stubbornly high maternal mortality rates can be linked to this practice of referring pregnant mothers to institutions that lie further away from their homes.
The violence has also led to growing fissures within health systems, with younger doctors resentful of becoming punching bags without adequate protection from their supervisors and institutions. Strikes may provide an outlet for outrage, but they also lead to neglect of countless other patients.
Meanwhile, boundaries are blurring between India’s violent political culture and the blue-curtained hospital space. According to medical superintendents and social workers, numerous politicians like to throw their weight around crowded emergency rooms in a bid to pump up the vote bank in their constituencies. Their designated patient must get immediate attention, or else. “Don’t you know who I AM?” seems a common prelude to bullying and shattered windows, courtesy of his or her entourage. At St John’s, security chief MB Aparna also points a finger at groups he considers troublemakers, including the Karnataka Rakshana Vedike and autorickshaw unions.
It can be difficult to grasp the severity of the problem, though, because data is simply not available – unlike in China, where a well-documented spike in attacks on medical staff was highlighted by TheLancet, a prestigious medical journal, spurring coverage in foreign media. In India, doctors are frequently reluctant to file an FIR, wary of getting tangled in a time-consuming process or creating more enemies in their locale. Some give way to the urge to hush up the incident, and simply carry on, albeit demoralized. Moreover, police often seem unaware of the recently enacted laws and favor private exchanges of cash, or apologies, over registering an FIR.
“The ignorance of police personnel should be penalized,” insists Narendra Saini, Honorary Secretary-General of the Indian Medical Association. “Even if they do know the law, they give importance and sympathy to the patients’ relatives, which in my opinion, should be curbed.” Saini reports that he is getting “five to eight times more complaints than I used to,” from doctors who are harassed or attacked.
Tamil Nadu, for one, has promised to post more police on hospital grounds. Elsewhere, some hospitals have taken the initiative to install more CCTV cameras and post signboards in red and black letters spelling out the penalties for anyone who creates trouble. Some are getting slightly more creative: at Victoria Hospital in Bangalore, for example, medical superintendent Devadass PK is excited about commissioning pictorials that will portray the dire consequences of assaulting a doctor or destroying medical property. He describes an image of someone punching a man wearing a white coat, with a big ‘X’ over it. The next frame will show a glum man behind bars. That’s a bit more dramatic than a ‘No Smoking’ sign.
But the law-and-order prescription can only go so far. Consider the clash at Ramaiah hospital, which happened last November. After Sana collapsed, he was revived by another doctor and admitted to the hospital for two days. Physically, there wasn’t much wrong with him – some bruises on his face, and a bit of hypoglycemia due to his empty stomach – but the depression was worrisome. The hospital had encouraged him to file an FIR but he doubted much good would come from that. He rose from his hospital bed and went home to his village in Kadapa district, Andhra Pradesh, where his family grows sunflowers. His parents persuaded him to withdraw the FIR, fearing some further retaliation from a family wealthier than theirs. Sana brooded over the incident, asking himself if he had made any mistakes. He realized that there had been some language barrier, as he couldn’t catch everything the relatives were shouting in English and Hindi. But that could not justify what happened, he reasoned.
When he returned to Bangalore, the police handed over a letter of apology from the boy’s relatives. He tossed out the letter and refused any meetings. “I didn’t want their apologies,” Sana says curtly. “They did the wrong thing.” He still feels an aversion to that particular corridor in the hospital. But he has not given up his specialization in orthopedics. He sits waiting for the next patient, his scuffed sandals hidden by sanitary blue hospital netting.
Reached by telephone, the boy’s uncle declines comment on the case. “Please, Madame, it’s over,” he says.
The Talking cure
In Tuticorin, Tamil Nadu, the January 2012 murder case of 55-year-old anesthesiologist Sethulakshmi has yet to be adjudicated, after being shifted to an understaffed court slated to handle crimes against women. The accused was held in prison for six months then mysteriously released, despite a tough state law aimed at protecting medical personnel. “The legal system in India is so corrupt. Whatever you do, it is totally useless,” says TS Gopinath, the son of the deceased and himself a government-employed doctor in Chennai. But he says that prosecution won’t bring peace of mind either. “We have lost a life. We have nothing to lose anymore,” says Gopinath. The family opted to shut down the private, seven-bed hospital.
Up north, a 29-year-old female doctor who was mauled by a mob last September at Lok Nayak Hospital in New Delhi needed three months off before she could resume work at a different hospital in a different state. (She requested that her name be withheld.) She recounts that she was the lone doctor posted one night in a casualty ward when two patients came in. One woman showed serious signs of ectopic pregnancy, so the doctor gave her priority. The other pregnant patient did not appear to have any complications. But after turning her attention to the more pressing case, she was challenged by another woman who identified herself as a politician. “How dare you deny my patient?” bellowed the woman, clawing the doctors’ clothes and pulling up her shirt. A bunch of male followers surrounded the doctor and called out threats of rape. Meanwhile, a frightened security guard and a nurse had vanished. After about 15 minutes, other doctors arrived and rescued her from the mob of 30-odd people. “When the police came, they should have taken strong action. They just let them go away,” she recalls. The doctor resigned that night. “I was scared they would attack me again,” she says. Her father promptly arrived by train and escorted her out of Delhi.
Siddarth Ramji, who took over as medical superintendent of Lok Nayak shortly after this event, says that the hospital has beefed up security since then. Hospital representatives have also held meetings with community leaders to explain problems of understaffing and request some patience. (For example, Lok Nayak employs 600 nurses, compared to the 1300 that are supposed to be on the roster.) Rules were changed to allow only one attending relative at a time. Having seen previous violent outbursts punished with fines of a few thousand rupees, Ramji, too, is skeptical of legal remedies. “Preventive action is going to be far more important,” he predicts.
In his view, one crucial task is to train doctors to communicate more effectively with patients and their family members. Medical colleges should stop waiting for the stodgy Medical Council of India to introduce changes in the medical curriculum and instead take the initiative to train doctors to become more accommodating in answering questions and more empathetic in their manner.
In Bangalore, St John’s Medical College is held up as a rare example of an institution that fosters communication. There, clinical psychology professor Tanya Machado introduces students to some basic skills through role play, such as breaking the news of sudden death to relatives. “It’s very important to teach doctors that there will be anger in the normal process of grieving. They are going to accuse you of incompetence. Let them cry, let them get angry,” she advises. Other tips: “Try to give the message very clearly. It may have to be repeated a number of times. Maintain eye contact. Don’t stand with your arms crossed.”
Such sensitivity training should also be extended to nurses and office staff, according to VL Sateesh, medical superintendent of the National Institute for Mental Health and Neuro Sciences in Bangalore. New batches of staff are trained to develop listening skills, despite the hectic pace of emergency settings. “If the relatives have the feeling of being neglected, the anger and frustration increases,” he says. Information-sharing is very important, he continues. If a patient arrives in a very serious condition, his relatives should be advised accordingly, not reassured that everything will turn out well.
Based in Mumbai, Shalini Ratan is starting to offer communications workshops for doctors in Maharashtra and elsewhere. Getting beyond their disease-centric training is a challenge. “I know that overnight they can never change,” she observes.
Will the talking cure have any significant impact? Krishnamurthy Balasundaram, the dean and director of Mysore Medical College and Research Institute, reports that violent incidents abated in the last six months after junior doctors were instructed to spend more time responding to concerns of the relatives. “Ours is an overburdened hospital. When doctors are overwhelmed, they get impatient and sometimes become rude. Now they have learned their lesson. Even if you talk to [patients’ relatives] for only a few minutes, ultimately it will take less time,” he says.
Other suggestions include introducing 24-hour inquiry desks at hospitals, a call center for registering grievances, and better mechanisms to file claims of medical negligence in a peaceful manner. (For various reasons, the Consumer Protection Act has not lived up to its promise in channeling healthcare disputes.) Given the multi-lingual mix in urban centers, both medical personnel and security guards must also bone up on their language skills to interact with a broad cross-section of society.
And this election season, politicians must be told to stay out of emergency rooms. A vote soaked in the blood of a doctor is hardly a sign of a healthy democracy.
Sunday, March 23, 2014
Friday, March 21, 2014
A recent amendment in the Pre-conception and Pre-natal Diagnostics Techniques (PCPNDT) Act allows medical practitioners (MBBS doctors) to conduct sonography tests on pregnant women, provided they undergo six months' training imparted within the well-defined syllabus prescribed by the act at accredited institutions.
In addition to addressing the shortage of radiologists, the move will also help authorities shut down unauthorized training centres mushrooming across the country that offer training in obstetric sonography.
Government hospitals in rural areas will also get the trained staff to conduct obstetric sonography as medical officers at these hospitals will be imparted the six months' training on priority.
The syllabus and clear-cut guidelines on who will undergo training and who will be exempt will help appropriate authorities enforce the act effectively, thereby curbing malpractices in the field.
"The Union ministry of health and family welfare issued a gazette notification on January 10, 2014 relating to the amendment of rule 3(3)(1)(b) of the PCPNDT Act to incorporate a mandatory six months' training in ultrasound sonography. This will regularise training in ultrasound sonography for MBBS doctors," senior gynaecologist Sanjay Gupte, a member of the Central Supervisory Board (CSB), said.
The CSB reviews and monitors the implementation of the Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994 and advises the centre on policy matters.
Till now, only gynaecologists and radiologists with post-graduate medical qualifications were allowed to perform ultrasound sonography on pregnant women. The Act also allowed MBBS doctors with six months' training to conduct sonography but there had been a lot of ambiguity about the training aspects.
"The syllabus of the six months' training was not defined. There had also been some confusion on who should conduct the training and where and a number of unauthorised centres had sprung up across the country. All this is now expected to stop," Gupte added.
Senior radiologist, Jignesh Thakker of the Indian Radiology and Imaging Association (IRIS) said that unauthorised centre offering six months training would have to shut shop. "There are a lot of such centres that follow their own syllabus and dole out training certificates to doctors. There are around 20,000 radiologists in the country and this amendment will help make available more doctors trained in obstetrics sonography who can work in rural interiors of the country."
Thakker, however, pointed out some grey areas in the amendment. "If you see the components of the syllabus, the doctors will also be trained in sonography of other body parts, like detecting abdomen ailments, renal stone etc. The Union health ministry wants these trained doctors to also work in emergency situations. Now, who will check if doctors trained in the prescribed syllabus don't conduct sonography of other body parts as well? It is not mentioned anywhere in the amendment that the six months' training is meant only for obstetric sonography. It also does not mention that the trained doctors would work in rural areas. There is no justification for making an amendment except for the training part," he said.
Saturday, March 15, 2014
To contain the yearly phenomenon of all-India quota post-graduate medical seats lapsing to states, the Supreme Court on Friday accepted the Union health ministry's proposal and directed Medical Council of India to notify a new counseling schedule.
Under the new schedule, which reverses the earlier process, the states will first hold counseling to fill their PG seats quota in state government medical colleges from the coming academic year (2014-15). It will be followed by the all-India quota counseling.
Appearing for the health ministry, additional solicitor general Sidharth Luthra informed a bench of Justices A K Patnaik and F M I Kalifulla that every year, many all-India quota seats used to lapse to the states because of the deliberate suppression of vacancy position in PG seats by the states.
The bench saw merit in the health ministry's proposal and ordered its implementation after MCI agreed to it.
Under the new proposal, the first round of counseling by the states will get over by March 30 followed by the first round of all-India quota counseling from April 4-16. The second round of state counseling will be from April 27 to May 3, followed by all-India quota counseling from May 9 to May 13.
But in the third round of counseling, the position reverses. All-India quota counseling will be held from May 25 to June 9 followed by state counseling from June 20 to June 25.
Monday, March 3, 2014
The tussle between the police and medicos took a serious turn on Saturday with nearly 300 teachers of Ganesh Shankar Vidhyarthi Memorial Medical College here tendering resignations in protest against the arrest of around three dozen resident doctors for alleged clash with Samajwadi Party MLA's supporters in Swaroop Nagar late on Friday night. As reports that seven patients died due to the doctors' strike in city hospitals came in, the administration ordered a magisterial probe into the entire episode.
"We submitted our resignation to GSVM principal Prof Navneet Kumar on Saturday evening. Prof Kumar has assured us to forward it to the state government on Monday," said Dr Aarti Lal Chandani, president of the Indian Medical Association (Kanpur) and senior faculty member of GSVM.
"We are into a very noble profession but when our voices are not heard, we have no other option but to go on strike," added Dr Chandani. Demanding that doctors arrested in fake cases be freed immediately, Dr Chandani asked the authorities to initiate strict action against the guilty police officer and police and PAC personnel.
The IMA, Kanpur, as well as IMA's UP branch have condemned the police action. "The police have crossed all limits this time. The doctors will not back out as it is a matter of our dignity," said Dr Chandani. The IMA doctors have called for a statewide indefinite strike on Sunday. They also boycotted the OPD services at all levels, Dr Chandani added.
The district administration, meanwhile, ordered a magisterial inquiry into the Friday night violence. District magistrate Roshan Jacob said, "We have ordered a magisterial inquiry and sought the report within 15 days A senior official will conduct the probe into the incident." Over the death of seven patients, she, however, said, "We are trying to collect the facts in this regard."
The ongoing strike of doctors has paralysed medical care at government and private hospitals. Reports said the strike that started on Friday night has claimed lives of seven patients. The doctors had gone on an indefinite strike to protest arrest of around three dozen doctors for alleged clash with SP MLA Irfan Solanki's supporters in Swaroop Nagar on Friday.
The strike has crippled health services at the emergency units and OPD (out-patient department) of Lala Lajpat Rai Hospital and Cardiology and Cancer Institute of the Ganesh Shanker Vidhyarthi Memorial Medical College in the city.
Doctors of other districts including the state capital have also pledged their support for the striking doctors in the City condemning the "police action".
More than 1,500 government, semi-government and private doctors in Kanpur supported the GSVM students and demanded a legal case against Solanki and suspension of SSP Yashashvi Yadav.
The strike was also supported by six other medical colleges in the state -- in Agra, Saifai, Allahabad, Meerut, Jhansi and Lucknow. While emergency services continued at these hospitals, the junior doctors kept away from duty in support of their colleagues in Kanpur.