Health Care & Medical Practice in India

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Indrad
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Health Care & Medical Practice in India

Post by Indrad » Sat Dec 30, 2017 2:03 pm

Today Govt has tabled NMC bill in Lok Sabha.
NMC will replace Medical Council of India which was found to be corrupt and unable to regulate practice of medicine uniformly across India.
The new bill has left doctors up in arms as there are contradictory clauses.
Most important for us to know is clause 35: This clause will enable Ayush doctors that is homeopath and ayurveda doctors to practice allopathy after they do a bridging course.
At the same time bill asks for a common exit exam for MBBS doctors across India to get a licence to practice.
http://www.newindianexpress.com/nation/ ... 40519.html
Doctors oppose the NMC Bill proposal to allow AYUSH doctors to practice modern medicine; say its akin to legalising quackery
Published: 30th December 2017 07:01 PM |

New Delhi: Doctors across India are strongly opposing a provision in the National Medical Commission Bill, tabled in the parliament on Friday, that seeks to let homeopaths and practitioners of other alternative medicines practice modern medicine through a short term course.

The Bill, that is aimed to regulate medical education in the country by replacing corruption tainted Medical Council with India with a National Medical Commission, has introduced the concept of “Bridge Course” to promote medical pluralism by allowing AYUSH doctors to practice allopathy.

“The Commission shall hold meeting with Central Councils of Homeopathy and Indian Medicine that will reside on approving educational modules to develop bridges across the various systems of medicine and promote medical pluralism,” the bill says.

Most of the doctors’ bodies however are up in arms against the proposal saying it is akin to “giving legal sanction to quackery in the country”.

“This provision is totally unacceptable to us as it will lead to an army of half-baked doctors in the country,” said K K Aggarwal, president of the Indian Medical Association. ?”First of all, a doctor is registered with a council but in case of a bridged doctor there will always be ambiguity on the registration aspect. Also, if those doctors make mistakes and people pay with their lives because of those mistakes, who is going to be held accountable?,” Aggarwal said.

“We as an association feel that by pushing this provision, the government is giving sanction to quackery.” Aggarwal’s association represents over 3 lakh doctors in the country.

Satish Tyagi, secretary of Delhi Medical Association, too, said that the association will knock on every door possible to “get the contentious clause chucked out from the bill.”

“It (the provision) is every bit condemnable and when the bill talks about introducing a licentiate exit examination for even MBBS pass outs before they can start practicing, how can it allow degradation of medical education by permitting some to practice allopathy just by pursuing bridge courses?” he said. “These two points in the Bill are contradictory to each other.”

Not every medical professional however is protesting the move as some see it as an initiative to enhance doctor-patient ratio in the country.

“Even MBBS doctors are not allowed to work as specialists or super specialist and have a limit to what they can do so I see no problem if doctors from other streams are given basic training in modern medicine and are permitted to work at lower levels than MBBS to treat patients at primary levels,” said Bhaibhav Kumar, a doctor in Dhanbad.


“After all they also pursue five-year courses in other forms of medicine and study physiology and anatomy like MBBS doctors.”

A few studies done in the past have in fact have shown that registered medical practitioner or AYUSH doctors have helped provide medical care in remote areas as MBBS doctors prefer urban postings.

A study carried out by New Delhi based public health research institute, Public Health Foundation of India in 2014, for instance, had highlighted that in as many as 32 per cent of primary health centres in remote and tribal areas, it is the alternative medicine practitioners who carry out clinical care.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Sat Dec 30, 2017 3:18 pm

Bureaucracy will rule over medicine? http://www.thehindu.com/news/cities/Del ... 969597.ece
The Association has noted that the federal character of the Medical Council of India (MCI) is not found in the NMC. All the State governments have representation in MCI. Only five States in rotation will have representation in NMC as a result of which it will take two decades for a State to re-enter NMC.

The Cabinet has cleared the NMC Bill with a 25-member commission appointed by the Central Government. Of these members, 20 will be appointed by a search committee chaired by the Cabinet Secretary. Nomination will be done for 12 ex-officio and 6 part-time members. Three of these will be from disciplines such as management, law, medical ethics, health research, consumer or patient rights advocacy, science and technology, and economics. Only five will be elected by the registered medical practitioners from amongst themselves from such regional constituencies, said the Association.

‘Backdoor entry’

“In effect, it will resemble a situation where the whole parliament is getting dissolved in favour of 25 nominated Ministers by the President, with only five elected Members of Parliament, one from each zone of the country, with no powers to be re-elected. The chairperson, secretary, and members shall hold office for a term not exceeding four years and shall not be eligible for any extension or reappointment and will retire by age 70. This will lead to a possible backdoor entry of bureaucrats after retirement,” said IMA president K.K. Aggarwal.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Sat Dec 30, 2017 3:21 pm

Why are private doctors up in arms against NMC Bill? http://www.dailypioneer.com/todays-news ... -bill.html
“Regulators need to have autonomy and be independent of the administrators. The NMC will be a regulator appointed by the administrators under their direct control,” Agarwal said.

He said apart from abolishing the MCI, the draft Bill also virtually strikes out Section 15 of the IMC Act, which says the basic qualification to practise modern medicine is MBBS.
“It takes away the voting right of every doctor in India to elect their medical council. The MCI is a representative body of the medical profession in India. Any registered medical practitioner in the country can contest the election and every qualified doctor can vote,” he said.

“Abolishing a democratic institution and replacing it by a body in which majority are nominated by the Government is certainly a retrograde step,” Agarwal said.

He said the draft Bill, in its current form allows the private medical colleges to charge at will, nullifying whatever solace the NEET brought.

The Government can fix the fee for only 40 per cent of the seats in private medical colleges, he said.

Also, it inducts non-medical people into the highest body of medical governance changing its perspective and character forever and introduces schedule IV to allow the AYUSH graduates to get registration in modern medicine.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Sat Dec 30, 2017 3:36 pm

Playing devil's advocate:

It is not uncommon in West to have nurse practitioner of various kinds: these include nurse cystoscopist, endoscopist, doing OPD lists on regular basis (dental). Yes there would a specialist available somewhere in the hospital who can be summoned in crisi.

Only difference between us & them is in India there is lack of supervision and standardisation.
Where as success of all such lists in West is more firmly audited.
Secondly at the moment India is lagging behind in doctor patient ratio to even Saharan countries! This could may be the only way forward to bridge that gap.
In particular rural parts of India are devoid of doctors and allopathic doctors tend to gravitate towards big cities.
Finally in India MBBS doctors are not standardised themselves , they need to get their house in order hence govt has a right to interfere in this scenario.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Sat Dec 30, 2017 6:38 pm

no response from gurus? this is like purging medical council of states in US for a national commission..any takers?
Or replacing general medical council with govt run body.

krisna
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Re: Health Care & Medical Practice in India

Post by krisna » Sat Dec 30, 2017 11:48 pm

In India there is severe dearth of doctors esp in rural areas. main reson is no good infrastructure and needs for a family.
recall that as of today(before NMC bill) any MBBS doctor worth his salt refuses to work in rural areas barring a few.
India has a severe shortage of doctors. The gap is filled by others types.

This is not going to be rectified by increasing the number of MBBS doctors x 100 times. reason iot takes huge infrastructure to set up this numbers.
This is very laborious, time consuming and expensive also.
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Already we have many non mbbs doctors- by streamlining their curriculum and making them equivalent with some extra study - can make them do treat patients on common ailments. They are already doing this but without proper backing. Now making it legal helps Indian rural population greatly.
Many are pretty good and come with practical local solutions.
Some dos and donts can be done to help these non mbbs doctors.
Already the existing structure can be scaled up.

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Lot of developments in the past were done by these sort of folks in India . not by MBBS types.
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NMC addresses the shortage of doctors for now and next few years-This is a practical Indian way of solution. This is good and aplauded.
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actually the usa has already incorporated these folks into their mainbstream. people from DO are now mainstream. to address shortage of doctors they allowed physician assistant nurse practitioners etc to treat patients (doctors are named to supervise them on paper only- but not done always)

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usa doctors education- has streamlined a great extent but the quality I see is what expected. I am a insider. I see huge differences- many doctor in usa thinks like a spinal animal - no use of brain- everything depends on imaging like xrays scans mri etc etc or labs. not one relies on good history. horrendous mistakes occur but covered due to swiss chese model effect.
This swiss cheese model effect is very costly to implement. This will get downgraded in future. Huge economy is needed to maintain this model.
Now the holes in swiss cheese individually is getting larger not smaller putting enormous strain on the swiss cheese model.

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The western model should not be APED at any cost on India. Needs Indian model and solutions.

krisna
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Re: Health Care & Medical Practice in India

Post by krisna » Sat Dec 30, 2017 11:52 pm

Already on large scale infrastructure projects like JAM, aadhar, improving villages, toilets, lpg agriculture roads waterways industries tourism and many others etc etc are being taken up by present govt. if these improve the living conditions- in the years to come- this will have an multiplier effect on all aspects of India including medical education.

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Re: Health Care & Medical Practice in India

Post by Indrad » Sun Dec 31, 2017 10:24 am

good insight Krisna thanks.
I shall try to provide insight into Max Shalimar Delhi case as and when time is available.
It is a classical case to understand what awaits corporate hospitals
and also exposes underbelly of medical practice.

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Re: Health Care & Medical Practice in India

Post by Indrad » Mon Jan 01, 2018 10:37 pm

https://timesofindia.indiatimes.com/ind ... 325556.cms
nationwide IMA strike against NMC bill tomorrow may hit services in private hospitals

NEW DELHI: Healthcare services at many private hospitals in the country are likely to be hit tomorrow as the Indian Medical Association has called for suspending routine services for 12 hours to protest a Bill seeking to replace the Medical Council of India (MCI) with a new body.
Services at outpatient departments (OPDs) of many private hospitals may be hit by the protest, but emergency and critical services will remain open.
The National Medical Commission (NMC) Bill, which was tabled in Parliament on Friday, seeks to replace the MCI and also proposes allowing practitioners of alternative medicines, such as homoeopathy and ayurveda, practise allopathy after completing a "bridge course".
The Bill is likely to come up for discussion in Parliament tomorrow.
The Indian Medical Association (IMA), which has been strongly opposing the NMC bill saying it will "cripple" the functioning of medical professionals by making them completely answerable to the bureaucracy and non-medical administrators, has declared tomorrow a "Black Day".
"The NMC Bill in the present form is not acceptable. This Bill is anti-poor, anti-people, non representative, undemocratic and anti-federal in character.
"The IMA headquarter hereby declares closure of all routine services for 12 hours from 6 AM to 6 PM tomorrow across the country," newly-appointed IMA national president Dr Ravi Wankhedkar said.
The Delhi Medical Association (DMA) is supporting the IMA's protest and has called upon all private and corporate hospitals in the national capital to keep their OPD services closed.
IMA members also held a meeting with the Union Health minister J P Nadda nd conveyed their concerns over the Bill.
Dr K K Aggarwal, the former president of the IMA, said they have already written to Prime Minister Narendra Modi and the health minister urging them to redraft the Bill and rectify some of its provisions to protect the interest of the medical practitioners.
He said the provision which allows AYUSH graduates to practise modern medicine after completing a bridge course will promote quackery.
The NMC bill proposes replacing the Medical Council of India with a new body and "possibly" Section 15 of the IMC Act, which says that the basic qualification to practise modern medicine is MBBS, Dr Aggarwal said.

"It (the bill) takes away the voting right of every doctor in India to elect their medical council," he said.
"The Medical Council of India is a representative body of the medical profession in India. Any registered medical practitioner in the country can contest the election and every qualified doctor can vote.
"Abolishing a democratic institution and replacing it with a body in which a majority is nominated by the government, is certainly a retrograde step," Dr Aggarwal said.
He further said the draft bill, in its current form, allows private medical colleges to charge at will, nullifying whatever solace the NEET brought.

Clause 49 of the Bill calls for a joint sitting of the National Medical Commission, the Central Council of Homoeopathy and the Central Council of Indian Medicine at least once a year "to enhance the interface between homoeopathy, Indian Systems of Medicine and modern systems of medicine".

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Re: Health Care & Medical Practice in India

Post by Sachin » Tue Jan 02, 2018 10:20 am

Doctors withdraw strike after Govt. sends NMC bill to Standing Committee
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The strike has been called off, as the bill goes to the Standing Committee. To be honest, the doctors seems to be on a blackmailing game (considering the nature of their jobs). I was just reading in today's news papers. The Public Service Commission in Kerala have called for Doctors thrice to join the state medical service. No one applied. The excuse was that rural service stints were mandatory. And this is in a tiny state like KL, where urban-rural divide is not very high. Looks like the whole new generations of the medical professionals are only focusing on the income aspects (the ethics part have been given up long ago).

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Re: Health Care & Medical Practice in India

Post by Indrad » Tue Jan 02, 2018 12:48 pm

you are right Sachin with moves like this doctors will only get alienated in the society. Fortunately many friends I am in touch with in India are giving the bill a second thought and said strike was absolutely unnecessary.
IMA itself is a corrupt organisation, my PG guide was IMA president for years and he was a fraud.
Further there is an award called Ketan Desai award in name of person who was MCI Chairman for years and treated MCI like personal fiefdom.
MCI became so corrupt that SC ordered investigation and KD had to go.
He was another fraud I came in touch with!!
He used to grease MPs so well that never was a single question asked in Lok Sabha re the way MCI works or gives licence to pvt hospitals.
IMA * medical fraternity need to get their own house in order.
Yes there are serious issues they are getting affected by and I shall try to take them up here...

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Re: Health Care & Medical Practice in India

Post by arshyam » Wed Jan 03, 2018 2:52 am

On what basis are the protesting doctors call Ayurvedic and other streams as quacks? They are also trained in their respective fields, and will still need a bridge course to gain qualification. I have never heard of an Ayurvedic "quack", it's usually assumed to be an MBBS type. Given the quality of some "mainstream" doctors, whom the MCI is ostensibly regulating, it reminds me of the glass houses and stones analogy.

Having seen first hand, I used to take solace in the fact that doctors in the great amreeka are also of similar average quality, but that doesn't mean we should stick to status quo. The rural shortage is real and this is a good practical way to address it. The only concern is that the lure of money and MBBS status might impact the Ayush streams themselves, hopefully there are enough incentives to stay on and specialize there itself.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Wed Jan 03, 2018 8:55 pm

Image
Image

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Re: Health Care & Medical Practice in India

Post by Indrad » Wed Jan 03, 2018 9:24 pm

nutshell grievances handed over to standing committee are following (by doctors)
these are key ideas of NMC bill, allopathic doctors are finding hard to digest:
-NMC will become subservient to the health ministry, given that the representation of the medical profession in the new regulatory framework is minimal
-less representation of doctors more of bureaucrats
-poor regulation over private medical colleges which will likely mushroom
-while tougher criteria to become MBBS, easy crossover pathways to become MBBS equivalent for AYUSH doctors (homeopathy & ayurvedic)
- NMC Bill discreetly intends to equate the post-graduate degrees given by MCI or proposed NMC and the DNB
-easy access for overseas doctors to practice in India entry criteria will be diluted (they won't have to clear NEXT: exit exam for MBBS): this mainly pertains to Chinese & Russian doctors who are working in Delhi corporate hospitals at the moment
-regulation of fee structure of up to 40% of seats in private institutes is under its domain
-Ayurveda has got neglected in modern India; if there is a way to practice MBBS through it it will get further neglected where research is needed.
-there is general fear NMC is more likely to usher in the spectre of Licence Raj and the government’s vice-like grip over the private healthcare system, the persecution of doctors, and substandard healthcare that legitimises quackery.

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Re: Health Care & Medical Practice in India

Post by Indrad » Mon Jan 08, 2018 10:11 am

http://indiatoday.intoday.in/story/dera ... 25643.html

Haryana SIT arrests qualified surgeon who castrated 300 ram rahim followers

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Mon Jan 08, 2018 10:13 am

FIR lodged against ‘fake’ doctor
a lab technician flaunting as AIIMS product arrested for quackery and running big nursing home in Ludhiana
https://timesofindia.indiatimes.com/cit ... 407443.cms

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Re: Health Care & Medical Practice in India

Post by Kabir » Tue Jan 09, 2018 4:08 am

Indrad wrote:
Mon Jan 08, 2018 10:11 am
http://indiatoday.intoday.in/story/dera ... 25643.html

Haryana SIT arrests qualified surgeon who castrated 300 ram rahim followers
Why would the baba get his followers castrated?

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Re: Health Care & Medical Practice in India

Post by Indrad » Tue Jan 09, 2018 1:51 pm

In defence of bridging course: https://blogs.timesofindia.indiatimes.c ... medicines/
Homeopaths undergo a five and a half year, full time, undergraduate course in India. They are trained in every subject that a student of allopathy is taught except pharmacology. This includes anatomy, physiology, biochemistry, pathology, gynaecology, obstetrics and internal medicine. The students use the same textbooks, the syllabi for these subjects are the same, and the time allotted for these to be taught is also almost the same as the MBBS (Bachelor of Medicine, Bachelor of Surgery) syllabus.

In universities where both MBBS and BHMS (Bachelor of Homeopathic Medicine and Surgery) courses are taught students may often share lecture halls for common lectures. The faculty is often the same! As in the MBBS course, the students must complete a rotational internship. This includes six months at a regular hospital.

There are concerns that homeopaths may not be able to interpret modern investigations and diagnostic tests. These concerns are entirely unfounded. Homeopaths all over the country are using modern diagnostic techniques to assess outcomes of their treatment. Patients themselves are doing this! It is ludicrous to suggest that a homeopath is unable to interpret diagnostic test results because of an inherent and insurmountable lack of understanding.

I have sat in rooms with various kinds of doctors, surgeons and paramedical personnel, in my undergraduate years, in my time as an MD-Homeopathy student, while reading for a post graduate degree at the University of Oxford, and in conferences in various parts of the world. I have sensed the scepticism in the room when i introduce myself many, many times.

No one, however, has ever managed to arrive at the conclusion that i will simply not understand what is being taught or said because i am a homeopath. This seems to be the presumption being made by those opposed to the proposed bridge course. In the absence of details of the specific nature of this course, how is it being opposed, if not for this reason? When the training of both allopathic and homeopathic courses is so similar, i fail to understand the logic to this opposition.

The most facile argument concerns the dual registration of homeopaths in another national register once they complete the bridge course. Apparently, this is ‘neither permissible nor open’. I’m not sure what this means but maintaining a register of homeopaths who have completed the bridge course seems to be both ‘possible’ and ‘not a big deal’ to me.

It is time that the opponents relax this perceived sanctity around the medical profession and become more sensitive to the healthcare needs of India. There are large parts of the country where no medical practitioner is present, and none are willing to go. This is despite changes in regulations like making rural internships compulsory and enforcing of bonds for graduates of government colleges, preventing their departure from the country. Homeopaths are well positioned to shoulder the disease burden of the nation. Only in India, because of the stellar training provided to homeopaths, is such a move even possible.

If providing a bridge course can make them better equipped to handle at least some illnesses that they couldn’t earlier and spread healthcare services to far flung areas of the country, what can possibly be the problem? If ignorance of the structure and scope of the training of a homeopath was the problem, i hope this has helped. If prejudice is the problem, the nation will do well to rise above it.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Tue Jan 09, 2018 7:42 pm

Kabir wrote:
Tue Jan 09, 2018 4:08 am
Why would the baba get his followers castrated?
so that they have nowhere to go, also baba is the only one to enjoy these women much like mughal kings and queens surrounded by army of eunuch

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Re: Health Care & Medical Practice in India

Post by Raja » Tue Jan 09, 2018 9:39 pm

Kabir wrote:
Tue Jan 09, 2018 4:08 am
Indrad wrote:
Mon Jan 08, 2018 10:11 am
http://indiatoday.intoday.in/story/dera ... 25643.html

Haryana SIT arrests qualified surgeon who castrated 300 ram rahim followers
Why would the baba get his followers castrated?
So that Baba gets all the babes.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Thu Jan 11, 2018 1:06 pm

Gujarat has launched scheme of bal doctors to monitor health of kids & dispense medication in the class https://www.indiatoday.in/education-tod ... 2018-01-03
(again Ayurvedic medicine is being abused here..if allopathic medications are NO without studying them why Ayurvedic is Yes? Many of these medications apparently are heavy metal, need proper research).

RESPONSIBILITIES AND FACILITIES OF BAL DOCTORS:
The Bal Doctors will be equipped with stethoscopes and medicines which they will dispense to their classmates
The Bal Doctors will be given a stock of Ayurvedic medicines to deal with any health related issue
These Bal Doctors will give Ayurvedic treatment in cases of minor diseases
They will encourage other students to wash their hands before mid-day meal
They will also monitor Weekly Iron and Folic Acid Supplementation (WIFS) Programme (of the National Health Mission) which is held every Wednesday
They will work to make their fellow students addiction-free and give primary information about seasonal diseases
The Bal Doctor will be given an apron and badge so that he looks like a doctor and will be additionally given a torch, Ayurvedic medicine kit, booklets and posters of health-related problems
He will also be trained under a Rashtriya Bal Swasthya Karyakram (RBSK) of the health department

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Re: Health Care & Medical Practice in India

Post by Indrad » Thu Jan 11, 2018 1:20 pm

Jharkhand launches jugaad upay of Intern doctors (!)
Here interns (10+2 or ISc pass) will be trained for 3.5 years and floated under contract in state as Mini doctor
राजमहल (साहिबगंज), जासं। स्वास्थ्य मंत्री रामचंद्र चंद्रवंशी ने कहा कि झारखंड के आइएससी पास युवक-युवतियों को मिनी डॉक्टर बनाने के लिए भी पहल की गई है। जिसमें उन्हें साढ़े तीन वर्षों का प्रशिक्षण देकर एकरारनामा के आधार पर झारखंड में सेवा प्रदान करने का मौका दिया जाएगा। उन्होंने कहा कि 3 वर्ष पूर्व तक जहां पूरे भारतवर्ष में स्वास्थ्य सेवा बहाल करने के मामले में झारखंड का स्थान 18वां था, वहीं आज इसका स्थान तीसरा है।
https://www.jagran.com/jharkhand/sahibg ... 40645.html

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Fri Jan 12, 2018 11:55 am

http://www.tribuneindia.com/news/nation ... 27037.html

In another case getting media attention patient's relatives claim doctors neglected 32 week pregnant who died in ICU later on.
As usual media trial on!
It appears patient was 32 weeks pregnant who came to A&E with sepsis.
Initially typhoid was suspected later bowel perforation was found on CT Abdomen. Immediate laparotomy was carried out but patient later died of septic shock & multi organ failure. Baby also died much before.

India needs a patient redressal forum quickly where frivolous cases are dismissed asap, and negligence cases are triaged.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Fri Jan 12, 2018 12:06 pm

If any one interested ...
this year in All India MD/MS entrance exam (NEET) not only paper was out from before but mass cheating happened at many centres in TN & UP.


Got reminded of my days when Khan industry & Ranjit don ruled these exams and if you approached them with right money your place in entrance exam was guaranteed.
Later CBI busted these gangs but they got bail within a year and settled in suburbs with millions they earned through the racket.
Khan industry was close to Lalu while Ranjit close to congress.

Indrad
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Re: Health Care & Medical Practice in India

Post by Indrad » Fri Jan 12, 2018 10:29 pm

http://www.freepressjournal.in/mumbai/m ... ns/1202463

SevenHill Hospital of Mumbai in financial crisis. Sr doctors not paid over months(!!), electricity bill due for months running in crores and OPD services shut down. No idea how this corporate hospital ran in such a massive loss.

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