Sunday, May 10, 2015

AIIMS May 2015 Recall

Recall May 2015 questions and help us in publishing a free e-book. All contributors will be acknowledged.
Click here to recall

Monday, May 4, 2015

The P G Wodehouse of medicine!

Involving a long and gruelling stint of study to qualify and everyday exposure to human pain and suffering, the practice of medicine is perhaps one of the last you could expect to serve as a base for comedy. But it is the saving grace of humanity that it too has people capable of seeing — and sharing — the funny side of their life. Like this doctor who found greater fame with his uproariously comic series of books centred on his profession.
Dr Richard Gordon
Richard Gordon
Though doctors too have left a mark on literature — Anton Chekhov, Sir Arthur Conan Doyle, Mikhail Bulgakov, A J Cronin, Khaled “The Kite Runner” Hosseini, W Somerset Maugham to name some — comedy has not been common.
Making up the deficiency is Richard Gordon (actually Dr Gordon Ostlere (1921-), with his long-running “Doctor” series and their array of film, stage, TV and radio adaptions. (His only companion in the genre is possibly H Richard Hornberger or “Richard Hooker” (1924-1997) of “M*A*S*H: A Novel About Three Army Doctors” (1968), also adapted for film and TV, and its two sequels.)
Gordon studied at St Bartholomew’s Hospital, founded in 1123 and the oldest to be working at its original site — Smithfield in Central London. (More commonly known as Barts, it is already immortal in literature, as the venue for the first meeting of Sherlock Holmes and Dr Watson, whose alma mater it is) and then worked there as an anaesthetist. He did a stint as a ship’s surgeon, as an assistant editor of the British Medical Journal and author of medical textbooks, before leaving practice in 1952 to become a full-time writer.
His series breaks new ground for the celebrated British style of humour, marked by a distinct undercurrent of satire and sarcasm, colourful and unusual descriptions, similes and metaphors, sharp wit with deadpan delivery, bolstered by the English language’s extraordinary capabilities for comedy — as exemplified by the works of P G Wodehouse.
But unlike Wodehouse, his settings are not only stately country mansions or clubs for the idle rich, but medical colleges (the fictional St Swithins) and practices in the metropolis and suburbs and even a merchant vessel in the South Atlantic, though they are peopled with a similar cast of eccentric and idiosyncratic characters — in Gordon’s case, pompous senior specialists, cheeky or unsure junior doctors, authoritarian nurses, difficult and uptight patients and a range of other singular but entertaining participants.
The series begins with “Doctor in the House” (1952), which sees Gordon joining St Swithins, making friends with the foppish Gaston Grimsdyke and Tony Benskin (who would go on to become recurring characters, along with tutors, the Dean (Dr Lionel Loftus) and Sir Lancelot Spratt — who is said to retire and later die in this work but returns in subsequent instalments, even starring in quite a few of them.
This is uproariously funny (take the scene where an obstetrics examinee spectacularly muffs his practical of child delivery, slipping and sending the whole papier mache model of mother and child and his instruments flying in all directions. An examiner looks at him sourly, picks up a forceps and hands it to him. “Hit the father on the head with it and you’ll have killed the whole family”.)
“Doctor at Sea” (1953) sees a bored Gordon signing on for spell as a ship’s doctor in a tale of nautical diseases and other marine misadventures, “Doctor at Large” (1955), “Doctor in Love” (1957) and “Doctor and Son” (1959) about his first years in the profession and changes in his personal life (though in the last, Gordon is now Simon Sparrow, while Grimsdyke and Sir Lancelot reappear).
Till here, the books were semi-autobiographical, but the subsequent ones are more of inventions, sometimes verging on high farce, and with more innuendo.
“Doctor in Clover” (1960), “Doctor in The Swim” (1961) and “Doctor on Toast” (1961) are various escapades of Grimsdyke, “The Summer of Sir Lancelot” (1965), “Love and Sir Lancelot” (1965) and “Doctor on the Boil” (1970) star the testy old specialist, “Doctor on the Brain” (1972) sees the Dean and Sir Lancelot writing each other’s obituaries, “Doctor in the Nude” (1973) about a major snafu ahead of the Queen’s visit, and “Doctor on the Job” (1976) about a strike in the hospital. “Doctor in the Nest” (1979) and “The Last of Sir Lancelot” (1999) are some of his struggles with the NHS and to keep the hospital from closing.
Despite their names, “Doctor’s Daughters” (1981), “Doctor on the Ball” (1985) and “Doctor in the Soup” (1986) are not part of this canon.
Chronicling the changing face of medical education and practice across the second half of the 20th century, Gordon also proves that laughter is the best medicine!
by Vikas Datta
(Vikas Datta is an Associate Editor at IANS. The views expressed are personal.)

Sunday, April 26, 2015

Cervical Spondylosis: A Ready Reckoner

A rising number of people under the age of 40 are suffering from cervical spondylosis because they don't exercise enough and spend too much time in front of their computer screens.

PG aspirants have to read continuously for hours at a stretch either in their room or library. Many of them complain of neck pain and headache, little knowing that these could be early symptoms of cervical spondylosis. We present an interesting article which gives a bird's eye view of this problem and how it can be prevented. 

In early February, 32-year-old Swati Shial was diagnosed with cervical spondylosis, a degenerative weakening of the spinal disc usually triggered by an incorrect posture or by overusing neck muscles. 

As an account director with a media agency, Shial easily spends more than 10 hours working on a laptop six days a week. The mind-numbing neck pain began while she was working on a crucial presentation that led her to stay glued to her laptop for three consecutive weeks, sometimes for three to four hours at a stretch without a break. "It started with the pain affecting my sleep but I got seriously worried when I also began to experience a constant tingling in my hands," says Shial, who lives in Vila Parle, Mumbai.

She was advised to place her laptop in a way where the screen was higher than her eye level to ensure a better sitting posture, exercise her back muscles to strengthen them, and use a memory-foam pillow. Shial's pain improved within weeks.

Catching them young
"Less than a decade ago, the condition affected people aged above 60. Yet, she is among the increasing number of young professionals under 40 years, who are being diagnosed with the condition," says Dr Abhay Nene, a consulting spine surgeon at Wockhardt Hospital, who treated her. "I get two cases each day of young people with neck and back pain; the frequency a few years back was about one case in a month. Most cases are triggered by repetitive injury and stiffness because of lack of adequate movement," says Dr Yash Gulati, senior consultant, department of orthopaedics at New Delhi's Indraprastha Apollo Hospital.

Ergonomics at play

Ergonomics at the workplace makes a huge difference. The lighting, desk height, placing of computer in terms of angle, height of the computer and placing of the footrest, all play a role in improving spine comfort. "Chairs must be comfortably cushioned with arm rests. The back should be tilted ten to fifteen degrees back and should not be ramrod straight as believed. For tall people, the chair should be deeper to support the thighs. The knees should be at the same level as the hips," adds Dr Gulati. 

Taking a break from the workstation once every hour for five minutes is advised. "Ideally, you should stretch every 30 minutes but since it's not practical, an hourly break is a must. Just get up and walk for a few minutes while stretching the arms, neck, back and legs," says Dr Rajesh Malhotra, professor, department of orthopaedics, All India Institute of Medical Sciences (AIIMS). 

Early signs

Neglecting the pain could lead to a slipped disc, which is a far more painful condition. "One of the first warning signs of cervical spondylosis is pain in the neck and shoulders, which may lead to excruciating pain shooting down the arms," says Dr Nene. "If unchecked, it could hamper body's coordination abilities and make it hard to perform simple, day-to-day activities such as buttoning a shirt or brushing hair." 

In the early stages, improving posture and strengthening neck and back muscles by exercising regularly helps reverse the condition. "Swimming is the best exercise to strengthen back and neck muscles. Tennis and badminton also help, but if the pain is severe, we recommend physiotherapy," says Dr Gulati. 

Doctors, however, warn against popping painkillers indiscriminately. "I recommend paracetamol, which is the safest drug, on SOS basis but it is best not to depend on any medicines and be regular with the physiotherapy sessions. Most cases are relieved of the symptoms and very rarely would one need surgery."    

Relieving pain

PG aspirants should take a break after every hour of study and do some stretching exercises. Special attention should be given to the ergonomics at the place of study.

Saturday, April 25, 2015

US lawmakers move to speed up visa approvals for Indian doctors

Citing a shortage of physicians in the US, two lawmakers have introduced a bipartisan legislation to speed-up visa approval for Indian and Pakistani doctors slated to work at US hospitals.
Called the Grant Residency for Additional Doctors (GRAD) Act of 2015, the legislation introduced by Democrat Grace Meng and Republican Tom Emmer, both members of the House Foreign Affairs Committee, would direct the State Department to speed up the visa approval process for international physicians.
The lawmakers say "currently, foreign physicians scheduled to serve their residencies at American hospitals are encountering extremely long delays in obtaining J-1 visas from US Embassies in their countries, particularly in India and Pakistan".
The J-1 is a temporary non-immigrant visa that foreign physicians use to work in US medical residency programmes.
The holdups have resulted in major dilemmas for those doctors and the US hospitals -- many in rural and underserved communities -- at which the physicians are set to work, they said.
In many instances, the delays have forced hospitals to withdraw offers from foreign physicians who had already accepted.
"The excessive delays in approving visas for international physicians is causing unnecessary havoc for those doctors and the American hospitals that are depending on them," said Meng.
"This ineffective approval process must be improved so that these doctors can enter the US as planned, and provide the critical medical care needed in many communities throughout the country," she said.
"As American hospitals face doctor shortages, this important legislation will increase healthcare access across the country by eliminating the persistent backlog of J-1 Visas," said Emmer.
"By improving oversight and training at US Embassies we can ensure our Foreign Service Officers have all the tools they need to properly process each application in a timely manner," he said.
"This bipartisan bill doesn't just address issues important to the State Department and the applicant; it will also benefit the patients of underserved hospitals by giving them access to medical care when they need it most," Emmer added.
With over a million doctors, the US has 24 doctors for 10,000 persons.
With a membership of over 100,000 physicians, fellows and students of Indian origin in the US, the Association of American Physicians of Indian Origin (AAPI) claims to be the largest ethnic organisation of physicians.

Wednesday, April 22, 2015

Facebook post by Dr. Priya Vedi

Dr Priya Vedi's Facebook message before she committed suicide:

"Hello everyone I want to remind something to our society. I am married since 5 years with Dr Kamal Vedi. We don't have any physical relation till now, which should be present in every normal marriage. After 6 month of marriage I searched for the reason why Dr Kamal Vedi unable to make relation with me. I found a fake gmail account in his laptop in which he was doing chatting with his gay friends and gay porn, gay pics, connection with gay communities and these messages were before of our marriage. Then I asked him, he told me someone hacked his email. I believe him with suspicion but till now he tried to do sex 8 to 10 times with me but was unable to do with me, we never had intercourse. I never told this to anyone because I was in love with him. I thought one day everything would be okay . But then he started to find faults in me and my family. They torture me a lot mentally in these five years. In these five years I was just a wife tag for him. Usne mujhe har choti chiz k liye tarsaya.

One month back he accepted that he is gay or bisexual he don't know, but I know he is gay because he never had erection when he was with me. He had sex with his male partners including Hamaz from Kashmir, who is also one of his gay friend. 
I found Dr Sagar Thukral was also on his fake email account. He came to BHU to meet him in Delhi and used to come to his home in Delhi. His gay friends Sanket and Saurabh were also involved with him.
In spite of knowing this, I decided to help him to be as a wife. But he tortured me a lot mentally. And at last night he tortured me emotionally so I am unabl to take breath with him. 
And last Dr Kamal Vedi I loved you a lot, you took my all happiness from me. You are not a human being you are a devil, who take away my life from me.
If someone in our society is like him please don't marry to a girl to save yourself, you people by doing so not playing only with someone emotions also with a girl and her family's life."

Her Facebook profile page was on Monday evening turned into a tribute page at around 7:30 pm, probably by the IT team of the social networking website. The page read, "Remembering Priya Vedi", and the suicide note had disappeared from its timeline.

Tuesday, April 14, 2015

Doctors call for amending PCPNDT Act; to protest

Doctors will shut down their clinics on April 15 to protest the "improper and clerical implementation" of the Pre Conception and Pre Natal Diagnostic Technique (PCPNDT) Act 1994. 

"There is no denying that PCPNDT Act has demonstrated misuse of authority to its fullest. Because Government cannot do anything about the social evils of dowry, inheritance, violence against women, it shows arrest of doctors for incomplete filling of form "F" as its achievement towards control of female and female infanticide. 

"We may not all agree with what should be done, how it should be done, but we are all in 100 per cent agreement that PCPNDT Act in its present form has stifled use of ultrasound technology instead of curbing female foeticide. That this Act needs to be repealed and amended is beyond doubt," Medical legal Action Group Convenor, Dr Neeraj Nagpal said. 

The Indian Medical Association (IMA) at a meeting yesterday has decided to support the protest.

Doctors protest assault on Allahabad medico

A day after a doctor in Allahabad was assaulted by infuriated relatives of a deceased patient at Anand Hospital, city doctors tied black ribbons on their arms in protest. The doctors, who protested under the banner of the Indian Medical Association (IMA), did not stop work. 

"The Allahabad incident is very sad and the IMA has decided to start a silent protest against it. Doctors will work but tie black ribbons around their arms. While the protest is a silent one for now, doctors across the state will go on an indefinite strike if the accused are not arrested by Tuesday morning," said Dr. Jitendra Chikara, president of IMA's Meerut chapter. 

Meerut-based Dr Vishwajeet Bembi said, "The incident is a sad. Doctors are generally on the receiving end when it comes to such incidents. We cannot fight back but we will show our displeasure and continue to work silently." 

Doctors told TOI that the protest was started after IMA (Uttar Pradesh) president Dr Sharad Agarwal issued instructions to doctors across the state to tie black ribbons. 

Dr. Rohit Gupta, a doctor at Allahabad's Anand Hospital was brutally assaulted by a group of seven persons on Sunday early morning. The incident came a day after an 80-year-old patient named Virendra Pratap Jayaswal was admitted to the hospital due to sudden pain in the kidney. Gupta had arrived the hospital to see a patient when the news of the death of patient broke out and the patient's relatives thrashed him in the ICU. 

The video of the doctor being assaulted went viral on social media and the doctors throughout the state planned to protest in the matter. Though the doctors in Allahabad went on a strike in Allahabad on Monday, other doctors protested by tying black ribbons on their arms. 

Infuriated over death of a patient, relatives and family members had ransacked the intensive care unit and surgery theatre of an Anand Hospital in Allahabad and allegedly thrashed Dr Rohit Gupta on Sunday. Both sides have lodged cross FIRs against each other at Colonelganj police station. Irked over the incident, Allahabad Medical Association (AMA) had blocked Stanley Road and shutdown health services in the city. 

The video of the doctor being assaulted went viral on social media. Dr Gupta is recuperating at another hospital. He alleged the mob snatched away his mobile and gold chain. Colonelganj police said they would go through CCTV footage to identify culprits and assured of strict action against the guilty. 

According to reports, Virendra Pratap Jaiswal (63) of Katghar was admitted to a private hospital on Saturday on complaints of toothache. His condition started deteriorating in the night and he died during the course of treatment in the wee hours of Sunday.