Member

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From Blogs:

Dr. Bruce Campbell, a Professor of ENT Surgery, known informally among medical bloggers as Headmirror, doesn’t think it’s a good idea to nap in the operating room and talks about the difficulty that most of us have leaving work behind even when we take a break.  Bruce, is the “Blogging Surgeon” on WUWM - Milwaukee Public Radio! Scroll to the bottom of this link and listen. It’s well worth your time.

Our intrepid surgeon from the South African low veld, Bongi, has a run in with the good old boy setup that exists in all academic hospitals and waxes eloquent on healthcare professionals’ twisted sense of humour (that’s with a u).

Not content with being a plastic surgeon, a creator of exquisite quilts and a prolific, erudite blogger, Dr. Ramona Bates tries her hand at penning Haikus. I liked this one…

Too big , too small, sad
Cut, sew, reduce, augment, lift
Happy, happy girls

In the fortnight since the last edition of SurgeXperiences, one that she hosted, Ramona has posted about Breast Augmentation & Reduction, being Tongue-tied as a child and has reviewed articles on reducing incidence of ear deformity in FaceLift and the prevalence of persistent pain following breast cancer surgery.

Inspired by Ramona, Dr. T the Anesthesioboist, produces a Haiku about her work…

Hard metal, soft flesh,
cylinder poised, larynx found:
the pillars of life.

…and shares a glimpse into a marriage.

Dr. Smak shares a similar story about the Greatest Generation.

Dr. Chris Coppola’s book “Coppola, A Pediatric Surgeon in Iraq” is out. Here’s a great review of the book by Dr. Harriet Hall.

Dr. Philip Alexander, a surgical gastroenterologist and author of the blog Manali Hospital, who works with his wife, Dr. Anna, an internist, in The Lady Willingdon Hospital in the picturesque Kullu valley operates on a patient with elephantiasis who had been refused surgery in many hospitals over the last fifteen years.

From Mckmama comes this story of how some nifty work by an interventional cardiac electrophysiologist called Dr.A (No. Not this one) cures a young kid with supraventricular tachycardia.

Dr. Westby Fisher, the medical blogosphere’s own cardiac electrophysiologist relates the tale of a patient being rejected, then accepted, to the cardiac transplantation list and poses some difficult questions at the end.

Dr. Jeffrey Parks, the Buckeye Surgeon, shares his thoughts about an article in the New Yorker about an entity known as Chronic Traumatic Encephalopathy (CTE) which is a variant of cognitive dementia that develops in people who are subjected to repeated blows to the head (pugilists and football players especially). Buckeye also had to deal with something that didn’t belong in the chest of a nonagenarian lady and some unnecessary tests ordered by a PCP on a post-op patient who was doing well.

Mark, the self-described mouse asthmatologist, takes a really close look at a fungus.

911DOC at M.D.O.D. tells us how to use the force to reduce dislocated shoulders.

Dr. Kevin Pho says surgeons don’t receive enough training when resident work-hours are capped.

Dr. Margaret Polaneczky, aka TBTAM, weighs in on the pros and cons of Mammographic screening and the recent article on Cancer Prevention in The New York Times. On a lighter note, she gives us a recipe for feeding the chemo tummy.

Bone MD asks who is needed more, superspecialist or super-generalist orthopods?

Jasmine Hall from OnlineNursingPrograms.Net lists 10 Unbelievable Robots Transforming Medicine.

Take a look at the superb collection of radiological cases in Dr. Keshav Kulkarni’s Daily Dose.

Here’s a sampler from Dr. Sid Schwab’s blog for those of you who want more surgical posts.

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Surgical News:

Poorer Outcomes After ‘Off-Pump’ Bypass Surgery via Dr. Ves Dimov’s tweet.

Longer-term outcomes for people who had coronary bypass surgery “off-pump,” meaning without the use of a heart-lung machine, were worse than for those undergoing the conventional procedure, a major study finds.
One year after surgery, about one in 10 patients getting the off-pump procedure had died, suffered major complications, had heart attacks or required repeat bypasses, compared to 7.4 percent of those who underwent operations using heart-lung machines, researchers report in the Nov. 5 issue of the New England Journal of Medicine.

Barbara Duck, The MedicalQuack, shares this story about an innovative method being used to repair the breastbone after it is intentionally broken to provide access to the heart during open-heart surgery. The technique uses a state-of-the-art adhesive that rapidly bonds to bone and accelerates the recovery process.

Dr. William Ganz, co-inventor of the Swan-Ganz Catheter, dies at 90.

Your next body is growing in a lab right now, says Gizmodo (via MedGadget).

A new miniature, hand-held microscope may allow more precise removal of brain tumors and an easier recognition of tumor locations during surgery.

Laser eye surgery (PRK & LASIK) to correct vision problems does not appear to be associated with lasting changes to cells lining the inside of the cornea at nine years after the procedure, according to a report in the November issue of Archives of Ophthalmology, one of the JAMA/Archives journals. (via ScienceDaily)

Among postmenopausal women, the risk of hip fractures increases steeply with age and is seven times higher in 70-year-olds than in 50-year-olds, according to a study in this week’s PLoS Medicine. (via ScienceDaily)

Despite being highly effective and beneficial for many patients, unexpected consequences are emerging in patients who are prescribed proton pump inhibitors (PPIs) for reflux diseases. Physicians are warned to monitor these effects and prescribe these medications carefully, according to a new commentary published in the November 2009 issue of Otolaryngology — Head and Neck Surgery. (via ScienceDaily)

New Mayo Clinic research studied the association between prostate-specific antigen (PSA) levels and prostate size and found that routine annual evaluation of prostate growth is not necessarily a predictor for the development of prostate cancer. However the study suggests that if a man’s PSA level is rising quickly, a prostate biopsy is reasonable to determine if he has prostate cancer. (via ScienceDaily)

The effectiveness of a screening colonoscopy may depend on the time of day it is performed. According to a new UCLA study, early-morning colonoscopies yielded more polyps per patient than later screenings, and fewer polyps were found hour by hour as the day progressed. (via ScienceDaily)

An Indiana University study involving 2,453 women ages 18 to 68 found that lubricant use during sexual activity alone or with a partner contributed to higher ratings of pleasurable and satisfying sex. (via ScienceDaily) - I think this could qualify for next year’s IgNobel Prize.

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Humour:

Mrs. Kerri Morrone Sparling digs into her archives for us to enjoy again the open letter to her Pancreas.

KevinMD thinks there’s something strangely disturbing about the anatomical imagining of cute Hello Kitty’s insides and finds anatomy on the street.

From MedGadget - 3D CT Scans of a Lego Toy MRI.

Some comics from my posterous blog: the trojan, the x-ray technician & the 5 second rule.

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Update: November 14 is/was (this post was posted when half the world was still on Nov 14)

World Diabetes Day

and Kerri has a wonderful video up at her blog.

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There is no host yet for the next edition

SurgeXperiences 311

to be posted on November 29, 2009.

If you are interested in hosting, contact Jeffrey Leow

Deadline for submissions is on Friday, November 27.

Please send in your submissions early via this form.

You can subscribe to SurgeXperiences via RSS feed or email.

An aggregated feed of credible, rotating health and medicine blog carnivals is also available.

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The next edition

SurgeXperiences 310

will be hosted by me in this blog on November 15, 2009.

Deadline for submissions is midnight on Friday, November 13.

Please send in your submissions early via this form.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.

The current edition (309) is hosted by the quilting plastic surgeon Ramona Bates.

Here is the catalog of past SurgXperiences editions for your reading pleasure.

If you wish to host a future edition, please contact Jeffrey who runs the show here.

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Note: This post is related to the previous post requesting support for the NCHRH bill that is likely to be proposed in the Indian Parliament this year. Again, I would greatly appreciate any publicity that you can give for this issue. Please link, reblog, tweet, digg, stumble, or share in all the other myriad ways of Web 2.0.

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The current issue of The Week (only available on newstands, the website shows last week’s issue) has an article by Gunjan Sharma on the Medical and Dental Councils of India. I urge everyone to read the article.

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Some excerpts and my opinions (in italics)…

Medical education in India is ailing. A diagnosis was done by a task force constituted by the Union health ministry following complaints of corruption against seven medical education regulators, including the Medical Council of India and the Dental Council of India. Its prescription has left the medical fraternity and the Prime Minister’s Office divided.

Questions they ask each other and even themselves: Are the regulators so bad that they be abolished?

Yes I think it would be better to abolish them and start afresh with new faces and new laws.

Won’t remedial steps help?

Not likely, as the people with the same old style of functioning will likely be still in charge.

And more importantly, is the newly recommended National Council for Human Resources in Health (NCHRH) an apt substitute?

It may not be apt. But anything would be better than the present dysfunctional system. It is worth a try. As the old adage goes, desperate times call for desperate measures.

The health ministry then announced the NCHRH, and put on its website the task force’s report and the draft bill to constitute the NCHRH. when it sent its recommendations to the PMO for a cabinet note of approval, the PMO rejected them, for want of wider consultations.

The news on the grapevine is that vested interests (read politicians and powerful private business houses that own and operate many of the country’s private medical educational institutions) are behind the rejection by the PMO.

The medical fraternity, however has a deep-rooted dislike of the councils, though there are some who feel the existing system could work with positive changes. They call the MCI and the DCI “dens of corruption”, which can do anything from recognising a college to giving it university status for a price.

I think “deep-rooted dislike” is putting it very mildly.

“Over the last 10 years, these bodies have become mere auctioneering institutes. Everyone knows that a huge amount of money is exchanged for recognising or extending seats in medical and dental colleges,” says Dr. C.R. Soman, former professor of the Thiruvananthapuram Medical College, who runs an NGO to fight corruption in the medical system.

Health and Medical Advancement Trust, Salem, has been lobbying for transparency in the councils. Its executive trustee George Paul says the only way to tackle corruption in medical education is to have a regulatory body with members having no conflict of interest with the medical institutions. Also, “the government should institute an independent vigilance mechanism to accept valid complaints against malpractices. the proposed appointment of a powerful ombudsman is a welcome first step,” he says.

I agree completely with George about the members having no conflict of interest. The grapevine says one of the prominent doctors involved in the NCHRH task force back pedalled because of vested interests. Typical Indian crab mentality that does not allow anyone to get ahead.

Curiously, officials in the health ministry are tight-lipped. Health Secretary Naresh Dayal (he retired on September 30), who headed the task force, declined to speak to THE WEEK on the issue. So too did Debasish Panda, joint secretary, who was a member of the task force.

According to Dr. Shetty, the root cause of corruption in medical education is a shortage of seats, and consequently, fewer doctors than required for the population and even fewer specialists.

Though there is truth in what Dr. Shetty says, I do not completely agree with him. Yes, there is a shortage of seats and there are fewer doctors than required. But corruption does not ensue from shortage. Corruption ensues from the ever growing number of filthy rich business men and some powerful politicians with ill-gotten wealth finding out that medical education is a lucrative business. And of course, having spineless people in the governing / regulatory bodies who bend over backwards to ease the way for the rich and the powerful to rape the system.

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Note: Though this is a medical post that concerns hospital care in the USA, I believe the issues covered in these videos are universally applicable to hospitals and patients all over the world. I urge everyone, especially those visitors who are not from the USA to view the videos.

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In a series of three short videos, produced by Dr. Val Jones of Better Health,  Paul Levy, President & CEO of Beth Israel Deaconess Medical Center, and author of the blog Running a Hospital talks about providing safe, quality care in hospitals.

In the first video Paul discusses his innovative approach to keeping patients aware of the safety record of his hospital.

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In the second video Paul discusses how patients can have a better hospital   experience, by keeping themselves informed and having an advocate.

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In the third video Paul discusses how to keep in touch with friends and family while in the hospital, and how to get the best aftercare.

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Nobody can disagree with Paul’s opening lines in the first video

For the most part patients cannot really find out very much about a hospital’s quality measures and record on safety.

Here in India, I think we can safely remove the first four words and the “really” and replace “very much” with “anything”. While Paul and BIDMC are pushing the envelope with the publication of safety data every quarter, no hospital in India has even made an attempt to address the issue of transparency about safety and quality.

Here’s what he says about the data published in his hospital’s website…

…and in addition it presents a summary every quarter of what kinds of harm we have caused to our patients that could’ve been prevented. We do that because we think that it helps people improve our processes of care and our results by knowing where we stand relative to audacious goals that we’ve set for ourselves.

One of those “audacious goals” is to “eliminate central line infections,” a problem that plagues intensive care units and hospitals around the world.

The Levy-BIDMC philosophy of transparency in a nutshell…

The main purpose of transparency is to hold the organisation accountable to a very high standard that we’ve set for ourselves. Transparency is not about competition with other hospitals, it’s not about finding fault, or blame. But unless you have an audacious goal, like zero central line infections, you’ll never really get as far as you can go.

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The second video is about the necessity for every patient to have an advocate for themselves. Paul says…

The best way to stay safe is to bring someone with you who can be your advocate. When you’re a patient, you’re in a vulnerable situation…you may not be hearing things clearly, you may not be asking the right questions because you’re upset. And your advocate, your friend, your spouse, your partner is there to ask those questions. To take notes, to follow-up, to let you know what he or she heard… One of the key roles of an advocate is to talk to the nurses who dispense medication to you. To discuss with them what the purpose of the medication is, to actually look at the vial and see if it’s the right dosage and the right medication. … Another thing that patients and their advocates could really focus on … is to be clear why they’re there! What’s going to happen to you? Over what time table?

The major problem that hospitals and doctors face in India is one of plenty. Too many advocates for a patient. There are times when as a young intern and resident medical officer I have walked into a patient’s room to find more than a dozen members of the patient’s extended family waiting to “talk to the doctor.” Most often the team taking care of the patient has to fend off queries from people at the periphery of the circle of family and friends while their time is best utilized dealing with the one(s) in the center.

Paul talks about the importance of having a clear “Clinical Pathway.” I can already see some of the doctors and nurses shaking their head and saying, if not aloud, then to themselves at least, “We wish there was a clear clinical pathway for every patient or disease.”

A key aspect of hospitalisation is to learn as much as possible before you get there about your own medical condition, about that disease or that treatment in general. To talk with the doctor in advance, do your homework so you know what the expectations are.

Though this may not be possible in all situations, especially in medical emergencies, there are huge advantages to the patient if they are a bit knowledgeable about their disease and the treatment options.

From personal experience and from anecdotal accounts from my friends and colleagues, I do know that most of us (doctors in India) do not see this as a big advantage. More often than not, it is a major stumbling block in building a trusting relationship with the patient. One of the things that a doctor (at least, here in India) hates is a know-it-all patient or family member who questions or second guesses every step in the evaluation or treatment.

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The third video has stuff in it that has little and great relevance in the Indian scenario. Keeping in touch with friends via email and web pages is not relevant in the vast majority of Indian hospitals with the exception of the top rung megacorporate hospitals in the major cities.

The stuff about “appropriate food” is hugely relevant. Every Indian doctor or healthcare worker who watches the video will have a tale (or two or more) to relate about totally inappropriate food that makes its way into patients rooms in Indian hospitals.

Paul says…

Nurses and doctors cure the patient but social workers heal the family.

The concept of medical social workers is almost non-existent in India. It is often the role of the circle of extended family and friends to support the patient and the immediate family during and after an illness and hospitalisation. It is not considered an imposition to take care of one’s family member or a friend who is sick or is recovering.

A friend of mine, who runs his own business, took a month off to go visit and take care of his nephew who was being treated in a rehabilitation clinic in the US. He related to me one instance that he witnessed and could not digest. He got quite friendly with an elderly lady who was a patient in the same floor as his nephew. One day he saw the old lady talking with an elderly gentleman in the cafeteria. She called my friend over and introduced him to her husband (they had been married for more than 30 years) who was visiting her. They were at the end of their visit and the husband was saying his goodbyes. My friend says the lady told her husband as he was about to turn away to leave, “Thanks for coming.”

My friend just could not understand why a wife would thank her husband for visiting her in the hospital! He shook his head and told me, “It’s a different culture, Vijay!”

I agree.

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To overcome the acute shortage and uneven distribution of human resources in public health delivery system, the Ministry of Health & Family Welfare aims at overhauling the current regulatory framework. Toward this end, it is proposed to set up a National Council for Human Resources in Health as an overarching regulatory body to achieve the objective of enhancing the supply of skilled personnel in the health sector.

The general public is invited to go through the report of the Task Force and the draft bill and sent their comments / observations on the suggested provisions by the 15th October, 2009.

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Related Post: Support the NCHRH Bill

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Note: This post is related to the previous post requesting support for the NCHRH bill that is likely to be proposed in the Indian Parliament this year. Again, I would greatly appreciate any publicity that you can give for this issue. Please link, reblog, tweet, digg, stumble, or share in all the other myriad ways of Web 2.0.

I would be grateful if  Indian bloggers and blog aggregators like DesiPundit and Blogbharti publicized this.

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Fellow medical blogger and colleague in my town Dr. George Paul is a highly respected teacher and practitioner who is well known in the dental & maxillofacial surgical fraternities. He and a group of like minded individuals have been actively involved in increasing awareness about irregularities in the functioning of private dental colleges and the poor role played by the Dental Council of India. I had forwarded him a link to my post asking for support for the NCHRH Bill.  George in turn forwarded it to his extensive mailing list. He also called me up and told me about an editorial by the Editor Emeritus of the Indian Journal of Medical Ethics Dr. Sunil K Pandya, published in the current issue of that journal, which highlighted all that is wrong with the Medical Council of India. Here are the most relevant (and telling) excerpts from the long and detailed editorial.

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via Indian Journal of Medical Ethics - Medical Council of India : the rot within [links mentioned were added by me]

Consider two recent news items. The first in The Times of India on June 6, 2009 carried the headline “MCI members on erring college board“. In the text of the report, which investigated medical colleges in Chennai that charged capitation fees from students in violation of the law, the reporter noted: “Even as questions swirl over the impunity with which private medical colleges are charging illegal donations despite an explicit Supreme Court ban, it now appears members of the apex regulatory body - the Medical Council of India (MCI) - themselves have strong links with the offending institutions. “Two senior officials of MCI, the authority tasked with keeping a vigil on medical education, are currently board members of one of the colleges caught demanding capitation fees in the TOI-Times Now investigation. MCI president Ketan Desai and vice-president P C Kesavankutty Nayar are on the board of management of Sri Ramachandra University (SRU), which demanded Rs 40 lakh from students seeking MBBS admission.” Asked whether it was appropriate for him to be a member of the board of management of an institution that he was supposed to monitor in his capacity of president of the Medical Council of India, Dr Ketan Desai replied: “I am the UGC nominee and my colleague, Nayar, is the MCI nominee. It’s just like how the Dental Council of India members are on the board of several dental colleges. But I have never attended board meetings of SRU for at least three years now. We are there only as ex-officio members.” (18)

Were it not for Dr Ketan Desai’s formidable reputation, such a statement could have been attributed to naivety. The lie to his disclaimer was unwittingly provided by officials within the SRU. As the reporter pointed out, “Amazingly, the two medical colleges in Chennai are virtually unmindful of the peculiarity of the situation. An SRU official told this reporter, ‘The top MCI officials are on our board. We will talk to them about the allegations (of illegal donations) and sort them out.’ ” Dr Ketan Desai’s expertise in “sorting matters out” will stand him and the SRU in good stead and to mutual benefit. An independent report appeared on page 11 of the same issue of The Times of India as that on Dr Ketan Desai and Dr Nayar. Entitled “Trouble for UGC chief, CVC registers complaint against him on host of charges“, it informed the reader that the Central Vigilance Commission had registered a complaint against the UGC chairman, S K Thorat. The allegations against him ranged from his involvement in pushing through a Rs 224 crore e-governance project, corruption in the grant of deemed university status and misusing UGC resources to run his own institute, Indian Institute of Dalit Studies. (19)

Isn’t there an old English saying about birds of a feather?

In the minutes of the general body meeting held on March 1, 2009, we read an account of the presidential address delivered by Dr P C Kesavankutty Nayar, “president (acting)”. Dr Nayar stated that “The ‘intellectual informational inputs’ that were received through this Herculean exercise were diligently compiled… in the commemorative Souvenir that was released today under the caption ‘Tryst with Consensus’.” (17) In the context of Dr Nayar’s reference to Hercules, those at the helm of affairs might consider the fifth of the Twelve Labours set to Hercules. King Augeas was best known for his stables, which housed the single greatest number of cattle in the country and had never been cleaned. Hercules was asked to perform the task of cleaning these stables in a day - deemed almost impossible since the livestock were divinely healthy and therefore produced an enormous quantity of dung.

In the context of cleaning up the Medical Council of India, where shall we find an Indian Hercules today?

[read the entire editorial here]

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Quis custodiet ipsos custodes?

The need now is not a Hercules to clean up the MCI, but for the government to demolish the entire shoddy edifice and replace it with something like the proposed National Council for Human Resources in Health, which ought to have independent constitutional powers comparable to other autonomous constitutional bodies like the Election Commission.

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Update 10.09.09, 10:30 AM:

Just found out about this article (via George again) that was published in the Kochi edition of The Indian Express - Docs launch online campaign by Sudha Nambudiri.

Even as the Union Health Ministry Task Force has suggested that all regulatory bodies, including the Medical Council of India, the Dental Council of India, the Pharmacy Council and the Nursing Council, be scrapped, an interesting petition has surfaced in cyberspace among the medical community in the country. The petition, addressed to the Prime Minister, seeks to garner support to revamp all fields of medical education and to bring it under a single regulatory body - the ‘National Council for Human Resources in Health (NCHRH)’. The online petition titled ‘Support group for National Council for Human Resources in Health Bill’ hosted on the web by PetitionOnline.com, http://www.PetitionOnline.com/NCHRH/ has more than 590 signatures till date and is fast gathering momentum. “I personally agree with what this petition says, and I think you might agree too”, is how the request goes. “All of us in the medical field in India know that the Medical and Dental Councils have become bloated bureaucracies that do very little for their members. I do not suppose the new council will turn out to be any different, but we can hope that there will be a change for the better,” was the comment by a doctor. It is learnt that the campaign has gained momentum following reports that the present members of the MCI, the DCI and other organisations are wooing MPs to delay or scrap the proposed Draft Bill to overhaul medical education. Meanwhile, in a hard-hitting editorial in the Journal of Medical Ethics, renowned neurosurgeons Dr Sunil Pandey … of Jaslok Hospital and Research Centre have asked how the heads of such boards could continue despite High Courts passing severe strictures against them.

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via Movin’ Meat: AMS.

I haven’t looked at the numbers lately, but Altered Mental Status, or AMS, must be in the top ten, if not the top five most common ER presentations. AMS, as a triage complaint, is like a bizarre little birthday present for an ER doc. You just don’t know what you’re going to get when you walk into the room — and there’s a tremendous range of possibilities. It could be someone with a stroke, or a septic septuagenarian. Odds are, it’s just a drunk, or someone stoned on street drugs, or overdosed on prescription meds. Less exciting and much more work (and infinitely more likely to be a huge pain in the butt). They may have nothing at all, or something really trivial like a fainting spell. Sometimes you get the really interesting stuff presenting with AMS: a first time DKA or a carbon monoxide poisoning, for example, which is a fun detective game requiring good clinical skills. I’ve seen it all, a million times over, so I’m quite comfortable with the protocol, but you never really know what it is till you get in there.

[read the rest of the post here]

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“Giddiness” is to Radiology as “AMS” is to the ER or Casualty as we call it in these parts.

Most Indian radiologists, if they stopped to think about it, probably would not be surprised at how many (walking-talking) people who come in for a CT Brain have “giddiness” as their only presenting symptom. It sure is a giddy world out there!

Incidentally, I saw a similar brain metastasis - as the one seen by Shadowfax - a few days ago. Different presenting story though. Not the pervasive “giddiness.”

An elderly gentleman had a sudden convulsion and was brought to the casualty. CT Brain showed a similar left parietal nodule with vasogenic oedema.

Image from Shadowfax’s post. I like his labelling!!

The patient that I saw had no prior history of cancer or any other major illness. Chest radiograph taken on admission showed a mass in the left hilum. CT Thorax done the next day confirmed a left parahilar malignancy with few metastases in the right lung, liver and ribs.

As in the American AMS, you never know what you’re going to get in an Indian giddiness, either.

And I agree with Shadowfax. Cancer Sucks.

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Note: This post is a request for support for a healthcare related bill that is likely to be proposed in the Indian Parliament this year. I would greatly appreciate any publicity that you can give for this issue. Please link, reblog, tweet, digg, stumble, or share in all the other myriad ways of Web 2.0.

I would be grateful if  Indian bloggers and blog aggregators like DesiPundit and Blogbharti publicized this.

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A few days ago I received an email from a young Indian doctor who is the major force behind an advocacy group made up of similar young doctors who have been fighting a long legal battle against the Medical Council of India. I know the previous sentence sounds all “cloak-and-dagger-ish,” but I do not want to reveal names as I have not asked him/them if that is acceptable.

The email was a straightforward request to sign an online petition -

Support group for National council for Human Resources in Health bill

I must admit that I had no idea that there was such a bill being proposed and what its purpose would be. The best information that I could get online was in this news article in the The Times of India, with a rather dramatic headline…

MCI scrapped, single council for medical education

In a complete overhaul aimed at cleansing the medical education system in the country, a task force of the Union health ministry has decided to scrap all regulatory bodies, including the Medical Council of India, Dental Council of India, Pharmacy Council and the Nursing Council, sources revealed. There will instead be a single regulatory body - National Council for Human Resources in Health - which will oversee seven departments related to medicine, nursing, dentistry, rehabilitation and physiotherapy, pharmacy, public health/hospital management and allied health sciences, sources involved in the revamp process said on Thursday. The move now needs a formal government notification. The council will be constituted as an autonomous body independent of government controls with adequate power, including quasi-judicial.

This will not only perform the regulatory functions but also carry out assessment and accreditation of medical and health institutions across the country. Simply put, the council will coordinate the entire gamut of medical and health education in India. This will include drafting courses and the period of study, including practical training, subjects of examination and standards of proficiency, conditions for admissions to courses, provide guidelines on curriculum planning, monitoring and overseeing implementation of UG/PG courses with flexibility for local specific modules.

“Medical education today is dictated by bank balance and caste. The existing councils, besides being unwieldy, have failed to provide a synergistic approach. There is an urgent need for innovation in health-related education. It is unfortunate that medical seats are auctioned in front of students today. This is the best surgical solution for cleansing the system,” a source told TOI. The report which was discussed with Prime Minister Manmohan Singh on August 26, 2009 by the task force states: “Professional councils such as the MCI/ Nursing and Pharmacy Councils have been set up to regulate the practice of their respective professions, including education. However, many of these councils have drawn criticism from all sections of society and got judicial censure on several occasions.”

Sources said the Centre will now take this move to all the states before implementing it. On its part, the Union health ministry has already readied a draft bill titled The National Council for Human Resources in Health Draft Bill, 2009.

Though all central and state universities shall conduct their own examinations and award degrees, the national council will conduct national-level exit examinations to standardise UG/PG medical and allied health courses. This screening examination shall be mandatory for students who have successfully completed UG from a foreign institution that is not recognised by the council. With this, the National Board of Examinations (NBE) shall be archived.

With a mere 9% of the UG medical students offering [sic] PG, the task force has proposed that prominent hospitals across the country be allowed to offer post-graduate courses. “PG seats are so few that students have no option but to study what is given to them rather than what they want to pursue,” a source said. [all emphases are mine]

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I personally agree with most of what is said in the above news article. All of us in the medical field in India know that the Medical, Dental Councils etc., have become bloated bureaucracies that do very little for their members.

I do not suppose the new Council will turn out to be any different, but we can hope that there will be a change for the better.

I request you all (including my friends from other countries) to sign the online petition and to spread the news.

Let us hope that at a time when nations like the USA and UK are involved in overhauling and streamlining their healthcare systems, we in India can start the process too.

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