What is the colour of a doctor’s money??

It can be anything but black! It is basically made of two layers of sodium chloride. The first layer was prepared by the sweat of the medical school. The second was formed slowly after obtaining the so called degree. The denomination of this money is determined by the degree one obtains, slogging it out in a rat race, sometimes also missing out on how their kids grow up. If you are on the surgical side, it has some blood red patches here and there. A physicians’ money may have grey (matter) color sprinkled about. A colleague working in anesthesiology, intervention cardiology or emegency medicine have it soaked in adrenaline. There might be a few dots of yellow on some money. Believe me, no pathologist spills the sample intentionally! Also don’t blame any body if E. Coli grows on some money. So, my friends, a doctor’s money can never be black. And the most amazing thing is that he can keep it minting till Alzeihmer’s or Parkinson’s!

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Post shared from Dr. Deepak Arora – a motivational speaker and a dear friend.

 

 

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PG Coaching – The Necessity!!

“Competition is always a good thing. It forces us to do our best.”

 

Every year thousands of medical graduates sit to write post graduate entrance exam. They put themselves through this cut throat competition to get the few coveted seats all across India. To help them get through this exam and give them the correct direction, some students join coaching institutes for guidance. I am myself am associated with one such institute and love to teach students about the intricacies of entrance exams. One such event while teaching a class made me question the whole system.

 

The Incident: 

As I was pruning a batch of eager minds for the next phase of PG entrance I was shocked to hear a student ask me a question on Vascular Surgery, something I had studied in 2nd year of my PG 6 years back.

I was surprised to see that this concept had already been asked in the PG entrance exam. My wife, a pathologist and a teacher herself also told me that some of the Pathology questions asked in the recent AIIMS entrance exam were so tough that some Assistant Prof’s could also not identify the slides.

 

Student who spends 5 years of their life studying basics of medicine are suddenly expected to  answer PG level questions to get admission in a PG course. The irony speaks for itself.

 

The Afterthought:

MBBS students preparing for these exams on their own find it extremely difficult to crack such exams without the guidance of somebody who is an expert in the subject. This is the reason why in recent years there hardly have been any students who have aced the exam without attending these coaching classes. Unfortunately, the classes in medical colleges don’t pay attention to these topics, which only leaves MBBS students with one option, which is to attend classes in coaching institutes.

 

People might criticize coaching institutes but unfortunately with the kind of questions being set in the exams, there is no other way out for students. In stark contrast, the USMLE exam is concept based and majority of the students appearing for this exam do so without attending coaching classes. It appears that these entrance exams have become a test not only for the students but also for the faculty members who are guiding them. This fact has led to mushrooming of coaching institutes (physical or satellite centers) in almost all Indian cities.

 

What’s more surprising is that most of the students join these institutes by 2nd year of their college itself. Every year apart from studying for their clinical courses they also study for the entrance exams to get an edge over others.

 

All this makes one wonder if the opportunity of getting a PG seat is now limited to students who have access to PG coaching? A graduate doing his/her internship in a tier 3 city or rural areas won’t have access to such kind of study material and guidance. In such cases they are getting robbed of a chance to compete equally.

 

Preparation for PG should require brushing up of the knowledge that a student acquired over the years at medical school and not learning a new course altogether. But with the present system and structure of exam it looks like now a student has to study PG level coursework to get admission as a PG.

 

Some might say that it is leading to knowledge enhancement among undergraduates but the flip side is that it is very superficial knowledge and this whole exercise does not impact any clinical skills to these students. It basically ends up converting them into ‘fact cramming machines’ and I don’t blame them because after-all it is an exam which rewards them based on how good they are in mastering that skill. The day is not far when a MBBS student is supposed to know as much as a specialist.

 

The Conclusion:

Now when I start teaching a batch of students for entrance I am not just guiding them and giving them the required nudge, in my head I am in a competition to teach my students something more than what they studied all these years. It no longer feels like an exam for students to enter specialty course but an exam for the coaching institute and their teachers to prove their merit.

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Olive Oil Cuts Breast Cancer Risk – PREDIMED Trial Data

A recent study has shown that the ammunition against breast cancer is stocked in a women’s kitchen. Data from a large randomized control trial has recently indicated that  women can dramatically reduce their risk by following a version of the Mediterranean diet that goes heavy on extra virgin olive oil.

Data from  a clinical trial known as PREDIMED, which was designed to assess the cardiovascular effects of Mediterranean diet, demonstrated that women who followed the diet were 62% less likely to be diagnosed with breast cancer compared with women who were only asked to reduce the overall fat content in their diets. The results were recently published in a reputed journal, JAMA.

Although the study’s main focus was cardiovascular disease, researchers also tracked the incidence of five types of cancer, including breast cancer. Patients in this trial were divided into three groups:

  1. Mediterranean diet supplemented with extra virgin olive oil
  2. Mediterranean diet supplemented with mixed nuts
  3. Regular low-fat diet.

Study analysis showed that the women in the extra virgin olive oil group were 62% less likely to be diagnosed with breast cancer during the course of the study as compared to women in the regular low-fat group.

Researchers wrote that the  women in the extra virgin olive oil-heavy Mediterranean diet group got 22% of their total calories from the oil. However, the researchers wrote that for olive oil to be beneficial, it should contribute at least 15% of the total calorie requirement.

There are many reasons why extra virgin olive oil is a potent cancer-fighter:

  • It is rich in oleic acid, a substance that helps in killing cancer cells
  • It’s also high in squalene, a compound that has antioxidant effects.
  • Polyphenols like oleocanthal & oleuropein have also shown to reduce the spread of breast cancer.

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 This is the first prospective randomized clinical trial to see whether a Mediterranean diet can offer protection against breast cancer. The data seems promising but there are certain points which need to be kept in mind:
  1. The study included white women between the age of 60-80 and they had Type II diabetes or at least three risk factors for cardiovascular disease, such as high blood pressure, too much “bad” cholesterol or a history of smoking. So, more studies are required in young patients to see if this diet benefits them as well.
  2. Also more studies are required to see if the same holds true for other racial groups as well

The good thing is that more and more Indian families are shifting to olive oil but what has to be clearly kept in mind is that this study was conducted for Extra Virgin Olive Oil and not routine olive oil. So next time you go to buy cooking oil, make sure you choose Extra virgin olive oil to cut your risk of breast cancer.

The Rat Race

Introduction:

Life of a medical graduate is a rat race. Right from the point when a student starts preparing for pre medical tests till he/she becomes a specialist or a super specialist, they keep running to ace some exam.

In this race no one ever questions the road on which they are running. Most of them don’t even know why they are running. They are on that road just because they were told to. All that matters is to reach the finish line.

The Start Line:

Lets start from the PMTs.16 year old students are supposed to study Physics, Chemistry, Botany and Zoology to clear their high school exam. At the same time they are also expected to study the same course more thoroughly for medical entrance exams. When the course is same and the kids are same why do we need different exams to judge their aptitude?

In practice this system has only led to rote learning of course syllabus over years. Students cram up their study materials without understanding completely, not because they don’t have the aptitude to understand but because the system doesn’t need them to.

And that’s just the starting. Once the students enter into healthcare courses after clearing PMTs they are met with a curriculum completely different from what they were taught for 10+2 years.

The same race repeats the next time they have to give an entrance for Post Graduate courses. Instead of focussing on treating maximum number of patients during internship a student is supposed to study anatomy and biochemistry that they learnt in 1st year. This not only leaves them unprepared for the challenges in the real world when they start practicing alone but also puts the general population at risk.

The Race:

The curriculum of medical education is such that it promotes the rat race. In the first year you race to ace anatomy, physiology and biochemistry without realising it’s application. What would a 1st year understand by dissecting a digastric muscle in 1st year when he/she doesn’t even know when and why to reflect it? Till the time students reach 3rd year to study surgery all the dissection they had done in 1st year is forgotten.

Teaching medicine subject wise is a wasteful exercise. Medicine should be taught system wise. Say you are dissecting the tongue today on a cadaver, if you are taught about the anatomy, its blood and nerve supply, its attachment and functions, associated pathologies and surgical modalities  during the same course, it would be more helpful and easier to retain.
Instead of making students run blindly towards scoring marks at the end of every year we need to ask if that exercise is fruitful or not.

The Finish Line:

Medical students study for years to become doctors and specialist, but even after one finishes the course it’s hard to understand where they stand. The race doesn’t end here. Once they step into the world they race against the next doctor in their city to get maximum number of patients. The competition based result centric education system has changed the core of medicine in our country. While trying to fight the battle between passion vs examination protocol we lose the sight of why we wanted to become a doctor: the patient.

That folks, is the funny thing about rat races. It doesn’t matter if you are a winner or a loser, you end up being a rat.

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About The Author:

This article was written by Dr Prerna Motwani .

Electronic Health Records (EHR) – A necessity for Indian Doctors? 

The latest edition of eHealth Magazine highlighted my views regarding Electronic Health Records ( EHR’s). I have been regularly using EHR’s since I entered practice and I personally feel that all doctors should use it, as they simplify data collection and analysis.

   
 Another big advantage in our country is that patients often forget or lose their medical documents. In that case EHR’s can help doctors in retrieving the patient’s medical information and treat them in a better manner. 

AMRIT for Indian Breast Cancer Patients

In my previous posts, I have highlighted the misery of poor Indian breast cancer patients who test positive for HER 2 neu. These cancers are usually aggressive and need to be treated with targeted agents like Herceptin. The problem is that each dose of Herceptin costs close to 50-60 thousand rupees in our country and this drug is not available in any government medical college.

Even with the introduction of bio-similars like CANMab, the cost of treatment remained to the tune to 40-45 thousand rupees per dose. I know many families, who sold their houses & jewelry to fund for their loved one’s Herceptin treatment. One such patient was Mrs. Laxmi (name changed), who had Stage III HER-2-neu positive breast cancer. She hailed from an average middle class family and the news of diagnosis of breast cancer was a huge shock for her. To add to her woes, she got to know that she would require close to 6 lakh rupees to fund for her Herceptin treatment. After a lot of deliberation with the family, she decided to fund her treatment by selling her wedding jewelry. Fortunately, things worked out well for her and she is still alive & healthy, 5 years after her cancer diagnosis. Other patients are not so lucky, as they do not possess such reserve money to fund for their HER treatment.

The Indian government’s new AMRIT scheme (Affordable Medicine & Reliable Implants for Treatment), might turn out to be a huge boon for these breast cancer patients. This scheme aims to bring down the cost of essential cancer medicines by 50-60%. The first AMRIT center was inaugurated recently at AIIMS and soon other centers would be started all across the country. Although the list of drugs which will be made available at these centers has not been released, I am hoping that Herceptin would be one of them. This would really help us in treating HER 2 positive patients, thereby leading to increased survival rates.

If this scheme is properly implemented, it will truly turn out to be an “AMRIT” for Indian cancer patients.

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Breast Cancer Awareness Drive

During my training in America, doctors there used to ask me “Why doesn’t India have a Breast Cancer Screening Program?”
Well today, I can proudly say that we are working towards it. You always have to take small steps to fulfill big dreams and that is what we did yesterday by launching the W Pratiksha Hospital Cancer Awareness Drive.
I was happy to see the media supporting the project and giving it the importance it deserves.
We are going to having regular camps in the surrounding villages for the next six months and anyone who would like to volunteer is most welcome.

It was heartening to see one of my treated patients (a breast cancer conqueror) being felicitated during the event. She shared her thoughts with the media as well and told them about the importance of early detection and management.

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