Vol. | Issue No. | August · PC-PNDT Act Consumer Protection Act NEET Exit Exam Vol. 46 | Issue No....

PC-PNDT

Act

Consumer

Protection

Act

NEET

Exit Exam

Vol. 46 | Issue No. 2 | August 2017

The

GRASP

For Private Circulation Only

Official Journal of the Association of Medical Consultants, Mumbai.Published Quarterly in May, August, November, February

Innovation in Practice

th12 Nov 2017

AMCON 2017at Hotel Sahara Star

Opp. Domestic Airport,Vile Parle East

Vol. 46 Issue No. 2 August 2017| | 1

President Dr. Smita SharmaPresident Elect Dr. Vipin CheckerImm. Past President Dr. Veena PanditVice President Dr. Mukesh GuptaVice President Dr. Ashok ShuklaHon. Secretary Dr. Vivek DwivediHon. Treasurer Dr. Deepak BaidJoint Treasurer Dr. Manoj PatelJoint Secretary Dr. Rajendra NagarkattiJoint Secretary Dr. Nilima Vaidya-BhamareOffice Secretary Dr. Jayesh P. Shah

Prog. Committee Chairperson Dr. Sushmita BhatnagarEditor - The Grasp Dr. Kritika Doshi

Director Dr. Lalit Kapoor

Office Bearers (2017 – 2018)

Dr. Ajit K. Desai Dr. Dilip Naik

Dr. Rajendra Chawhan Dr. Sabh Singh Khambay

Dr. Sujata Rao Dr. Kishore Adyanthaya

Dr. Gurudas Kulkarni Dr. Debashish Das

Zonal Directors

Area Representatives

Consultant Benevolent Scheme Dr. Shrikant Badwe

H & A Cell Dr. Suhas Kate

MMC Cell Dr. Bipin Pandit

AMC-NoAH Dr. Niranjan Agarwal

Medicolegal Cell Dr. Sudhir Naik

Social Service Cell Dr. Shivbhagwan N. Agarwal

Media & Communication Cell Dr. Mukesh Gupta

Affiliate Unit Cell Dr. Kishore Adyanthaya

Chairperson of Cells

EDITORIAL BOARD

Editor

Co-Editors

Advisory Board

BOARD OF TRUSTEES

Managing Trustee

Trustees

Website

Web Editor

Web Co-Editor

Dr. Kritika Doshi

Dr. Pradeep Baliga

Dr. Lalit M. Kapoor

Dr. Sujata Rao

Dr. Mukesh Gupta

Dr. Umesh Oza

Dr. Suresh Rao

Dr. Shrikant Badwe

Dr. Bipin Pandit

Dr. Suhas Kate

Dr. Achut Nayak

Dr. Niranjan Agarwal

Dr. Ajit Desai

Dr. Aashish Mody

Dr. Nitin Rao

www.amcmumbai.com

Disclaimer

Unless otherwise stated, the opinions expressed

by the writers are their personal opinions, The AMC

reserves the right to use material published in

‘The Grasp’ for its Website or for any other purpose

deemed necessary.

The appearance of advertisement in ‘The Grasp’ is

not guarantee or endorsement of the product or the

claims made by the manufacturer / advertiser.

ASSOCIATION OF MEDICAL CONSULTANTS, MUMBAI4, Ganpati Niwas, Old Police Lines, Opp. Andheri Station,

Andheri (East), Mumbai - 400 069.

Tel.: 2684 4639 / 2683 6019 (10 a.m. to 6 p.m.)

Telefax : 2682 1109

E-mail : [email protected] Website : www.amcmumbai.com

AMC INDIA Project

Edited by : Dr. Kritika Doshi

Co-ordinated at JASMINE ART PRINTERS PVT. LTD.

Plot No. A-737/3, TTC Industrial Area, Khairane MIDC, Navi Mumbai - 400710. India.

For Association of Medical Consultants, Mumbai. (For Private Circulation Only)

Dr. Aashish Mody Dr. Prakash Patil

Dr. Amit Thadhani Dr. Pramod Bahekar

Dr. Hitesh Parikh Dr. Pratik Tambe

Dr. Indrani Chincholi Dr. Rajeev Agarwal

Dr. Jayesh M. Shah Dr. Rajendra Lawankar

Dr. Jignesh Thakker Dr. Rajiv Gokhale

Dr. Kalpesh Shah Dr. Ritesh Agrawal

Dr. Khurshed Vazzifdar Dr. Sanjay Pattiwar

Dr. Mahesh Sane Dr. Suhas Shah

Dr. Nitin Rao Dr. Sunil Agrawal

Dr. Pradeep Baliga Dr. Supriya Arwari

Dr. Pradnya Kulkarni Dr. Vikram Khanna

CONTENTS

Vol. 46 Issue No. 2 August 2017| |2

Edit Speak - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03

President’s Precept - Dr. Smita Sharma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05

Hon. Secretary’s Report - Dr. Vivek Dwivedi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07

Cut Practice - Dr. Lalit Kapoor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 09

- Dr. Suganthi Iyer . . 24

Swami Chaitanya Charan Das

Report - Dr. Sushmita Bhatnagar . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

From The Press - Dr. Pradeep Baliga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Dr. Kritika Doshi

Water Birthing - Innovative or Evolutionary? - Dr. Ameet Dhurandar . . . . . . . . . . 17

From Children's Day to Valentine's Day - Dr. Viswanathan Iyer . . . . . . . . . . . . . . . 20

The New Hot Seat for Legal Issues..?? Surgical Pathologists

Doctor's Rights & Responsibilities - Dr. Rajendra Tiwari . . . . . . . . . . . . . . . . . . . . 33

The Abnormal Normal - . . . . . . . . . . . . . . . . . . . . . 38

Innovate & Thrive - Dr. Hemant & Archana Joshi. . . . . . . . . . . . . . . . . . . . . . . . . . 40

Use of a Borescope as a Video Laryngoscope - Dr. Aashish Mody. . . . . . . . . . . . . 44

In Nagaland amongst the Winged Wonders - Dr. Molina Khanna . . . . . . . . . . . . . 47

Doctor's Day

Vol. 46 | Issue No. 2 | August 2017


Dear Friends, surgeons! Senior mentors like him are our

shining beacons who inspire us toWhat an eventful year for us Doctors! We

continue doing good work silently.began the year with prescribing 'generic

Today we are going through a difficultmedicines'. And this was followed by thetransition in Healthcare. In India, Publicgovernment bringing in capping of priceshealthcare is under-financed, short-of cardiac stents and other drugs, some ofstaffed and rural areas are particularlyus faced physical assaults, some of usaffected. As a result, the private sector isfaced irate and angry relatives trying tobecoming the preferred source ofreduce their hospitalization bills, rate ofhealthcare as government spending onLSCS was commented upon by non-health remains low, forcing people to seekmedical armchair 'specialists', hoardingsprivate services. To ensure safe delivery ofshaming the profession in a holier thanmedical services at affordable rates, thethou attitude were put up, and wegovernment is bringing in variouscontinue to wake up to multiple newslegislations including the impending law

articles showing the medical profession into prevent 'cuts' being taken and offered.

a negative light.NABH's guidelines have been proposed as

In the midst of all these negative news a means to improve the management ofabout Doctors, Dr. T. Udwadia was health care delivery in both urban andawarded the Padma Bhushan! I remember rural regions. Would these also apply towhen I was a resident anesthetist at J.J. public institutions? Unfortunately, theHospital, I used to be amazed at his private setups continue to carry the majorenthusiasm to teach and improve burden of healthcare despite the many

laproscopy in its infancy. He pioneered legislations and rules issued! India's

ceMAST to continue his passion to impart existing infrastructure is just not enough

knowledge to aspiring laproscopy to cater to the growing demand.

EDIT SPEAKDr. Kritika Doshi

"You never change things by fighting the existing reality. To change something, build a new

model that makes the existing model obsolete" - Buckminster Fuller


The lack of uniform availability of medical Doctors who work in these areas need to

facilities is a worldwide problem. A recent be lauded for their efforts. Dr. Udwadia the

editorial in The Lancet Public Health, father of Laproscopic Surgery in India

(Volume 2, Issue 6, June 2017, Page e247) said he was humbled when he saw the

mentions how some areas of France have innovations of the surgeons from small

become "medical deserts" due to the towns.

unequal distribution of doctors as a result The sorry state and poor emergency careof government policies. India has always in our city has been experienced by ahad medical deserts!! consultant himself! We have an article on

Can private institutes and public the rights of doctors to highlight how we

healthcare work synergist ical ly? forget our own rights whether as

Mr. Ashok Panagariya - Member, State residents or as practicing doctors dealing

Planning Board on Health Issues with ill and sick patients (on call 24/7).

(Rajasthan) writes that "We need to bring As you are reading this issue, thethe authority of public sector and government is working on bringing in aefficiency and energy of private sector new law called "Cut practices in Medicaltogether. There is a need to incorporate Services Act, 2017"."cooperative thinking" in the system by

While we welcome this opportunity todiverting efforts towards provision ofclean up the system and improve theuniversal basic care i.e. "Good for mostimage of Consultants working in variousrather than best for few".s y s t e m s u n d e r c h a l l e n g i n g

With the new government looking at circumstances, we should continue todigitizing India, Healthcare delivery in practice ethically, legally and remainIndia is now uniquely poised to undergo a united and focused to ensure thatchange at all its stages - prevention, unnecessary victimization of doctorsdiagnosis, and treatment. It is an does not happen. AMC is your associationopportunity for us to unite and showcase and is committed to protecting the rightsour ingenuity in making all these aspects of its members. The unity of all ouraffordable and accessible. members is our strength. I urge you to

Some of our Doctor colleagues who are participate and reach out to us for any

working in rural areas have taken this problematic issue.

challenge, overcome them with their own I do hope you enjoy reading this issue andinnovations and flourished. We present in look forward to your feedback.this issue inspiring stories of consultants

have dealt with the challenges of

innovating in their practice. These [email protected]


Dear Colleagues, Medical students marched to the District

Collector's office. The doctors insisted onGreetings from the Association of Medicala written communication on dealing withConsultants, Mumbai. I look forward toviolence against medical personnel andour quarterly publication to share withestablishments to be sent from the

you the thoughts and philosophy behindCollector's office to all police stations in

the events and working of AMC. When IKarnataka. They also got a Standing order

took over as the President, we conductedto re-sensitize the authorities.

the Zonal Meet 1 at Bombay Hospital. ItThis was a great example of unity inwas a curtain raiser on "SimulatedKarnataka.Learning". This idea of having multi-

speciality program was a first of its kind Fro m C e n t ra l A M C , D r. K i s h o reand we are very encouraged by the Adyanthaya appraised them of the newfeedback we have received. measures that have been implemented in

Mumbai public hospitals to protectWhile we were immersed in this learning doctors. Karnatak AMC members haveprocess our colleagues at Mangalore wentforwarded these to the government. AMC through a harrowing experience. On 16thalso wrote a strong letter condemning theMay, a Professor of Yenepoya Medicalincident to the Chief Minister ofCollege Hospital, Mangalore was draggedKarnataka as well as a letter in support ofout, kidnapped and robbed of hisour colleagues.valuables by the relatives of a patient who

could not be saved. This got the fraternity AMC lent its support to the Dilli Chalointo immediate actions and he was movement on 6th June by writing an

rescued by his own colleagues. official "Letter of support" to the IMA

National President and sending emailsDr. Divakar Rao - President of AMCand SMS to our members.Mangalore along with several other

organisations held a protest March on On 23rd June 2017, AMC was invited to

22nd May. Almost 10,000 medical the NATHEALTH annual meeting at Grand

personnel including nurses, Dental and Hyatt Hotel. AMC was represented by

PRESIDENT’S PRECEPT

Dr. Smita Sharma


Dr. Niranjan Agarwal, Dr. Sudhir Naik, D a b h o l k a r a n d A s hv i n G i dwa n i

Dr. Deepak Baid and myself. AMC has productions with the efforts of the

always been the voice of the medium and conveners - Dr. Niranjan Agarwal and

small nursing homes in this program. Dr. Suhas Kate.

Despite NATHEALTH being dominated by AMC has formed area wise groups of itscorporate entities, we were able to voice members with office bearers as admin-our concerns for the nursing homes as members. The aim is to be able to reachwell as bring the focus to our day to day out to our colleagues in your area in caseconcerns in the presence of the Hon'ble of a crisis. I urge you all to stay with theHealth Minister of Maharashtra. basic purpose of the groups and not send

forwards etc. When there are so manyThe Doctors' Day programmes were very

messages flooding your mobile, we maysuccessful. We are always open to liason

all miss an important SOS call.with the government and the Union

Railway Minister Shri Sureshji Prabu had I also request you to send your individualsent his best wishes for our Doctors' Day. I queries on email so as to address andwould like to acknowledge the efforts of solve them officially by AMC.Dr. D. K. Baheti for getting the Bandra

station venue. AMC thanks Mr. Ashish

Shelar for gracing the occasion. We

released a book "Bridging the Gap" - it

a d d r e s s e s c o m m o n m y t h s &

misconceptions and facts about various

illnesses written by experts in those

subjects and has been edited by Dr. Sujata

Rao and Dr. Nitin Rao. This book is meant

to be distributed to your patients. Soon we

will be coming out with the Hindi and

Marathi versions. I would also like to

thank the Western Railway for theirSome of our members had received

permission as well as the staff and policeinappropriate notices for non agricultural

at Bandra station for their cooperation.land tax. AMC has helped these members

A video of this event is available on to file a Writ Petition in High CourtFacebook : (https://www.facebook.com / challenging it and also bore part of theamcmumbai / videos / 14632052903694 expenses for the same. I am pleased to36/). I request you to visit it and inform you that we have won the case andencourage us with your appreciation. the Hon High Court asking for these

notices to be withdrawn.The evening function at Rang Sharda was

possible only thanks to Mr. Bharat ........continued on page no. 43

AMC meets Hon'ble Education Minister

Mr. Girish Mahajan with recommendations


Dear friends, e-voting and the AMC Managing

Committee is working to implement this.Season's greetings to you all!If all goes as per plan then we will have

History of Mankind is filled withonline voting system functional in the

inventions and discoveries. We humans2018 or certainly in the 2019 AMC

are the most dominant species on Earthelections.

because of our developed brain and itsThis year's Doctors' Day program andcapacity to think and act.Doctors' Week was celebrated by us in

The major changes in human history havevarious ways.

taken place in the last 5 centuriesNo donation can be better than bloodespecially in the field of medicine thanks

donation and organ donation. AMCto the untiring research by countless

helped to conduct Blood Donation campsscholars and scientists.

at various sites in Mumbai and its SuburbsWe are living in an era where things areand about 800 units of blood was donatedchanging so fast that a cutting edgeby doctors which would be used for needytechnology today becomes obsoletepatients. In the same camps Doctors andtomorrow. Keeping pace with the changesother participants pledged to donate theirin society, AMC Mumbai has planned toorgans and it was very successful.make an AMC app. We are working on it

continuously so that this AMC app will AMC conducted various camps for publicmake communication between members awareness and for free health checkup ofand AMC office bearers easier. the populace.

AMC has formed AMC "Whats-App" A major program was held at Bandra Westg r o u p s t h r o u g h w h i c h w e c a n Railway Station on July 1st, wherecommunicate instantly with our members Mumbai BJP President and Hon. MLAabout upcoming AMC programs as well as Advocate Ashish Shelar was the Chiefother pertinent issues. Guest along with many other notable

It was decided in the AGM of 2017, to have guests.

HON. SECRETARY’S REPORT

Dr. Vivek Dwivedi


This camp was visited by many hundreds As our usual practice, AMC felicitated

of commuters and they were sensitised Padma Bhusan Dr. Tehemton Udwadia forabout organ donation and a free blood his dedicated services to the medicalsugar and blood pressure check up was profession and society.done. In the same premises, we held an

Presently, AMC has about ten thousandexhibition of posters on many medical

members and we are growing every day.issues in simple language which was very

AMC is active to sensitize its membershelpful for the people to understand thetowards ethical behavior in ourmedical issues related to their health, itprofession and it conducts regularwas appreciated by everyone. AMC alsobrainstorming sessions in its conferencesreleased a booklet "Myths and Facts inand workshops on these topics.Medicine" for common public. It was

released by Hon. MLA Advocate We appeal to all of our members andShri Ashish Shelar at Bandra Station. This colleagues to follow ethical and honestbook has been authored by various pract ices in their personal andrenowned consultants of medical fields in

professional life so that our professiondifferent specialties and it is in question

does not need any regulatory body andand answer format in simple language so

acts to regulate us.that it's easier to understand the

We should regulate ourselves and shouldcomplicated medical issues. This booktake all necessary steps so that the greatwas appreciated by everyone.

reputation of our noble profession isOn the 2nd July 2017, AMC had organisedmaintained.a cultural evening at Rang Sharda

Auditorium in Bandra West. The musical Let's unite and try our best to make ourplay "Bottoms Up" was presented by AGP society and country amongst the best inworld and Ashwin Gidwani to the the world.mesmerized audience of AMC members

and their families. This program was

attended by 750 people. [email protected]

ASSOCIATION OF MEDICAL CONSULTANTS

MEMBERSHIP

Total Membership of the Association : 9986

Members under professional Indemnity Scheme of AMC : 7554

Persons (Members & Family) under H & A Scheme : 5392

Members under CBS Scheme : 1330


In the last couple of weeks, we have Consultants all along the street. Their

witnessed a lot of frenzied debate on the standard consulting fees was 1 Guinea

(equivalent of Rs. 16/- in those times).issue of fee splitting in healthcare, what

Cronin wrote that it was a practice to sendwith the social media abuzz with a wide

the referring GP 'x' amount of shillings out ofspectrum of views on the subject, some of

this amount. I was quite intrigued. For God'sthem scaling hysterical levels. Print media,

sake this was the nineteenth century!electronic media and even international

medical media have not been far behind. The practice of fee splitting, over the yearsConsequently, I am prompted to make my became, in fact, the worst-kept secret of thecontribution to the resultant cacophony, for medical profession.whatever it is worth!

Coming closer home, in the 1960s, thereFee splitting or dichotomy of fees is quite was a Dev Anand movie, TERE MERE SAPNE,simply the practice sharing fees with during the time I joined Grant Medical

professionals in return for being sent College, quite excited to pursue a medical

referrals. Is this a recent phenomenon? Let career. The character of a Gynecologist, an

us for a moment peep into history. MRCOG from UK, was played by Vijay

Anand. Towards the end of the film, heWhen I was in school, in the 1950s, one ofmakes a candid admission that he wasmy favorite writers was A. J. Cronin who hadconvinced that it was impossible for him towritten masterpieces like THE CITADEL andbuild a good practice without shelling outTHE KEYS OF THE KINGDOM. He was acommissions to the referring doctors. TheBritish Surgeon and his novels often had amovie was seen by millions of Indians.medical background. Cronin wrote in one of

his stories in which he was a surgeon A couple of years later, there was a Hindi

practicing on the famous Harley Street in movie NASOOR (means : Non-healing

London where there were offices of wound). The story revolved around cut-

CUT PRACTICE

Dr. Lalit KapoorDirector - AMC India Project & Advisor - Medico-Legal Cell


practice in the medical field. Fortunately, as unprofessional conduct. However, it is

not too many people saw this movie. I am believed by some that the practice tends to

sure there have been many more such be tolerated in its various forms in the USA

public exposures of which I may not be and commission paying for referrals remains

aware. There was a Marathi stage play called common and in fact tolerated by key

"DOCTOR, TUMHI SUDDHA!" which had a overseeing bodies such as AMA and JCI.

similar theme. It was later staged in bothIn the UK fee-splitting is viewed seriously

Guajarati and Hindi as well.and the Medical Council can strike off the

Subsequently, there have been more name of a practitioner who is found to be

sporadic public exposures to this particular indulging in this practice, notwithstanding

practice, including the infamous Aamir Khan what Harley street consultants indulged in,

expose of the nefarious practices in the in the past.

medical profession.In India, all along, dichotomy of professional

Clearly, this is neither a recent phenomenon fees has been considered an unethical

nor a closely guarded secret. Admittedly, practice though there is no law or statute

the intensity of the practice and the specifically prohibiting such a practice. The

resigned acceptance of it may be somewhat practice, as of now, is thus unethical thoughrecent. not illegal. It is considered as actionable

professional misconduct though there haveIn most parts of the world, the practice is

been no cases, to the best of my knowledgeconsidered unethical and unacceptable.

where such action has been seen to be takenHence it is covert. The reason it is believed

by the Medical Councils.not to be in the interest of the patient is

because it represents a conflict of interest - For another slice of history, way back onwhich may adversely affect patient care and June 16, 1991, AMC had conducted a Panelwell-being, since patients will not be discussion on the subject CURRENT STATUSreferred to the most appropriate Doctor, but OF MEDICAL PRACTICE at the Nehru Centre,will instead be referred to those Doctors or Worli. Cut practice was one of the majorHospitals with whom the referring doctor issues which was discussed at length and ithas a fee-splitting arrangement. was concluded that this practice was

nothing but a form of corruption andThe American Medical Association (AMA)

members ought to voluntarily pledge tohas declared in its Code of Ethics that this

practice is unethical and unacceptable. An desist from it. In addition, it was concluded

American Psychiatric Society has called this that hospitals shortchanging Consultants by


'cutting' their professional fees should also To my mind, here are some of the key issues

which are inextricably linked to the problembe considered unethical and that this fact

at hand and need to be addressed if we wishshould be highlighted. No other specific

to find a durable solution. Merely makingsolutions emerged. This was the first time

populist laws will lead us nowhere. Firstly,any Association talked about these issues on

please consider the following officiallyan open platform.

acknowledged facts :Currently, the issue came under the

A) Pathetic GDP spending of Governmentspotlight on account of a particular hoarding

on healthcare is responsible for the majorityput up by Asian Heart Hospital. Personally, Io f h e a l t h c a re re l a t e d p ro b l e m s .am of the opinion that this was ill-advisedGovernment must increase the GDPand in extremely poor taste. It amounted tospending on healthcare substantially andthe brazen highlighting of an abominablebring healthcare infrastructure to WHOaspect of medical practice resulting inrecommended levels so that patients arefurther denigrating the image of the medicalnot forced to seek treatment in privateprofession in the eyes of the public more sosector even if they cannot afford.

in the backdrop of the recent real physical

and virtual attacks on the profession from 1. Government spending on Healthcare by

both Centre and States is 1.3% of thevarious quarters. Putting up a giant roadside

GDP (20015-16. The figures for China arehoarding was certainly not the best way to

3%, USA 8.3%. Even some sub-Saharaaddress this unsavory and serious problem

and African countries have betterand could even be seen as adding fuel to the

figures. In the WHO ranking offire. The immediate fall-out of this was that

healthcare systems across the world,the political class seized the opportunity to

India ranked a dismal 112 out of 190collect some credit points by promising to

countries.legislate the issue and create penal

provisions for the same. It became a perfect 2. Hospital bed density is presently 0.9

ploy for populism by offering quick-fix p e r 1 0 0 0 a g a i n s t 3 . 5 / 1 0 0 0

solutions to a very complex problem. recommended by WHO. We need to add

1.7 million beds, double the medicalInstead of putting up controversialmanpower and triple the paramedicalhoardings, the right thing to do would havemanpower.been to initiate and lead a serious debate

within the profession and attempt a root - 3. India is currently known to have

cause analysis of the entire problem. approximately 600,000 doctors and 1.6


million nurses. This translates into one D) Ethics is a science of moral principles. It

doctor for every 1,800 people. The has to do with your conscience. It is a code of

conduct. Ethics cannot be taught. They canrecommended WHO guidelines suggest

only be incu lcated, imbibed andthat there should be 1 doctor for every

assimilated. Ethics begins where the law600 people. This translates into a

ends.resource gap of approximately 1.4

million doctors and 2.8 million nurses. Making laws is not enough. We have many

laws - many of them not implemented or not4. In India the Government spends

implement able. Non implementation of$40/person annually for healthcare as

law generates disrespect for Law - which isagainst $ 8,500 by USA.

highly undesirable.5. There are huge gaps in healthcare

Making a law against cut practice will beinfrastructure.

futile and counterproductive - the Indian6. 71 % 0f healthcare expenditure in India is

jugaad will find ways to countermand it.borne by patients out-of-pocket.

Instead, in India as in many countries, the7. Very poor healthcare insurance coverage

Code of Medical Ethics enshrines the factof the population.

that fee splitting is unethical and

B) C o m m e rc i a l i zat i o n o f m e d i c a l professional misconduct and is actionable.

education and the attendant high-scale Why not make all efforts to implement this?

corruption can only act as a fillip to Getting de-registered or struck off the rolls

problems like cut-practice. It is obvious that of the Medical Council is a far greater

the Government has abdicated its disincentive to a doctor than to be fined.

responsibility of not only providingAll that remains to be done is to implement

adequate healthcare but also affordableit by having a Medical Council - A no-

medical education.nonsense Medical Council that is powerful,

unbiased, autonomous and fair andC) Private healthcare services and facilities

consists of men and women of integrityare put at par with commercial activities of

that functions decisively and meansany kind. Yet they are expected to function

business.non-commercial ly!! Being a noble

profession etc, etc. There is some mismatch There is no need for a law.here. If healthcare services are special, they

should be made to feel special by getting

non-commercial treatment by the State. [email protected]


A meeting of representatives from affiliate A M C M u m b a i h a s n o t s e n t a n y

units and AMC, Mumbai was held on 2nd of representation it was decided to hold back

July 2017 at 1:30pm at the MIG club, signing AMC Mumbais signature till after

Bandra. The agenda was signing of the next Managing committee meeting.

necessary papers for getting Federation ofThe Managing committee of AMC met on

Associations of Medical Consultants29 July 2017 at Hotel Karl, Andheri and

Registered with the Registrar of Societies.approved Dr. Lalit Kapoor, Dr. Kishore

The representatives who signed were : Adyanthaya, Dr. Niranjan Agarwal, Dr. VeenaDr. Divakar Rao from Mangalore, Pandit, Dr. Sujata Rao, Dr. Ajit Desai, Dr. SabhDr. Naphade from Ratnagiri, Dr. V. K. Goyal Singh Khambay, Dr. S. S. Rao and Dr. Smitafrom Delhi NCR, Bangalore Dr. Kamini Rao

Sharma to represent AMC Mumbai in thefrom Bangalore; and Mumbai was

FAMCI.represented by Dr. Lalit Kapoor, Dr. Kishore

It was suggested to have a combinedAdyanthaya, Dr. Niranjan Agarwal,

AMCON with all affiliate bodies and call itDr. Umesh Oza, Dr. Ajit Desai and

FAMCICON. The AGM of FAMCI can takeDr. Smita Sharma.

place on the day before AMCON (11thIn the meeting, Dr. Lalit Kapoors name as

November 2017).President, Dr. Kishore Adyanthaya for Hon

All the papers are in order and FAMCI will beSecretary and Dr. Divakar Rao for Hon

registered with the Registrar of SocietiesTreasurers post were proposed and

approved. Since Managing committeeof soon.

Report of AFFILIATE CELL

Kishore Adyanthaya

Chairperson

Dr. Lalit Kapoor

Director, AMC India Project

Niranjan Agarwal

Convenor

"AMC is committed to safeguarding the interest of

ethically practicing doctors. We sent a letter to Shri Pravin Dixit -

Chairman of the Government Appointed Committee for

drafting legal provision on 'CUT PRACTICE". The letter is

printed for our members to view on ........ page no. 54


Rural Healthcare innovations enhance the 2. Untrained staff.

health of rural communities by providing 3. No Backup for equipment Failure.products and services with the available

4. No well equipped ICU to deal with(limited) resources with a focus on

Medical Emergencies.excellence!

5. Lesser paying capacity of patients (costWe achieved Independence in 1947-

of implant, medicines, machinery samedespite this, since independence healthcare

as urban)continues to be inadequately accessible to

6. F re q u e n t Po w e r c u t s , Vo l ta g eall!fluctuation, Poor water supply, Bad

The WHO slogans of "Health for All" &roads, Poor quality of constructions and

"Millennium Development Goals" have notinsufficient telecommunication facilities.

helped to increase the accessibility of healthDespite this, one is required to give goodcare especially in rural areas.results against all odds and that to at a low

It is observed that nearly 70% of ourcost!

population have no or limited access toApart from all these professionalspecialist care; as 80% of the specialist live inchallenges, there are no good Junior

urban areas.Colleges or Higher education centers for our

Only 13% of the rural populations have children! This is another reason why feweraccess to PHC's, 33% to sub centers and Consultants venture into rural practice. But9.6% to hospitals (as per the 2014 statistics). we took this as a challenge, and made extra

efforts for our children to keep theirUnderutilization of Peripheral Centers is a

educational standards at par with those offact and it can be attributed to multipletheir urban counterparts. This involvedfactors l ike access ib i l i ty, qual i ty,exposing them to various Science / Maths / affordability, deficient human resources andEnglish / GK quizzes at Taluka and Districtadverse geographical location.levels, various competitive exams and a

The challenges we faced were :variety of learning Modules. This extra effort

1. L imited resources and implant arose out of the need to impart the best

availability (As an orthopedician, we education to our children despite the

basically deal with trauma). limited resources of rural setups.

Innovation in Rural Healthcare - Our Journey“Challenges are what make life interesting; overcoming them is

what makes life meaningful” - Joshua Marine


Rural practice is definitely challenging. We common. In the absence of the C-arm,

the standard treatment for such #s washave been practicing at Mahad since 1994.

open reduction by posterior approach inThis is a small town on the Bombay-Goa

the prone / semiprone position underHighway at the foot hills of Fort Raigad. We

GA. Since that involved a greater risk ofhave been brought up and educated at

anesthesia, we started doing the SurgeryPune.

in the supine position with a combinedIt was a big decision for both of us to start

medial and lateral approach. That was apractice in a rural area way back in 1994. We

big boon giving us excellent results withstarted our career by setting up an

minimal risk.Orthoclinic while my wife worked as a free

v) We conducted a Polio Corrective surgerylance anesthesiologist.camp way in 1998-99, under the Rotary

i) Orthopedic surgeries required anbanner, where majority of pediatric

implant inventory. Initially we did notsurgeries were done under spinal

have funds to keep stock of all implants.anesthesia (to minimize the risk of

There was no efficient courier service.anesthesia due to lack of proper

Hence we used to request the dealer tomonitoring facilities and trained

handover the implants to the ST personnel).conductor / driver by literally bribing

vi) Readymade finger splints were notthem at times ! That was the only way the

available at that time. We used to makedealer said the implant would reach us in

our own splints by breaking open stickingan emergency !

plaster tins, cutting strips and stickingii) With no Image Intensifier facility them together. Even Thomas splints,

available initially, our surgery used to be Bohlers Frames and traction equipmentunder X-ray Control. We had to modify were manufactured by our local artisan.the OT Table surface from the local

vii)Initially power cuts, fluctuations andcarpenter- we replaced the metal with a

load shedding were a major drawback. Itthick radiolucent glass !

used to affect life of delicate electronic

iii) We used to make our own plaster OT devices. So we used to schedule our

bandages by ordering POP powder from operations early morning to get a steady

Nippani. voltage.

iv) Necessity is the mother of invention. We viii)Working in a rural place makes you learn

used to see a lot of pediatric trauma the basics of plumbing, electric

referred from the coastal areas. The type maintenance and electronics! We had to

III supracondylar # Humerus was be able to fix the C-arm/ Machines if they


failed in the middle of an operation - we availability of nursing staff at hospital in

faced many anxious moments in our our region.

career spanning 23 years. We maintainxi) We had our set of operative and post

and armory of fuse wires, screwdrivers,o p e rat i ve p ro b l e m to o ; w h i c h

spindles for leaky water tabs, plasticdemanded a ventilator / ICU setup. Many

tapes / insulation tapes and spanners of times we have accompanied such

all size for any emergency.patients (giving them assisted ventilation

ix) Mahad always has a fear of flood water by Ambu bag to JJ/KEM Mumbai). In suchentering the town and we faced a major stressful moments what was verytragedy in 2005. Our C-arm X-ray disheartening was the reception we usedmachine / Generator set were to receive at these hospitals. The juniorsubmerged in the flood water. To residents used to look at us as though weovercome this challenge, we got a chain were some idiots, and sadly even todaypulley block and two big leather belts that is the case; I am sorry to say they(like those used in rice mills). With these even pass some naughty comments inwe were able to lift our C-arms to a front of the relatives. What would beheight of five feet during successive most welcome for us - a fully equippedfloods and thus save our C-arm and

Government Hospital somewhere nearequipment.

Pen / Panvel.

x) To address the problem of unavailabilityThe current scenario is slightly better today

of trained nurses, we the members ofthan it was in 1994. While innovative

AMC (South Raigad) along with the Deansolutions are available within the existing

and staff at Dr. Babasaheb Ambedkarfinancial & human resource systems, we

Tech University at Lonere started alooked upon our organization to request our

curriculum course of nursing techniciandear respected Prime Minister to act as a

at BATU, Lonere. Nursing students areradical plastic surgeon rather than a

circulated among different hospitals ofcosmetic one to make life beautiful for the

Mahad and Mangaon. This gives themsick and ailing population in the rural areas.

exposure of working with all specialities.

He is definitely the man of the hour! OnlyThis innovative move by AMC has not

time will tell whether this iron man will beonly made the SSC and HSC pass out girls

able to solve the irony of rural health care inof our region self employed but also has

maintained a steady increase in India.

Dr. Shrikant V. Ranade

(MS Ortho)

Dr. Seema S. Ranade

(MBBS; DA)


Born a Piscian and being an avid Scuba Diver, vaginal birth, thereby enhancing the baby's

water has always intrigued me. As an psychic abilities.

Obstetrician, I have been interested in how In 1983, Dr. Michel Odent, a Frenchwater would affect Birthing. I knew it would Obstetrician from Paris, introduced thishave a positive effect, as it is the very basis of concept in Pithiviers Hospital in France,our existence. Water flows through us and is where he created water birthing suites. Ina healer. We evolved from it and it is the 1990s water-birth gained popularity inessential for our survival and growth. across the globe.

Water is an environment the baby is familiar Water Births was officially accepted in thewith as it has supported and cradled him for UK in 1993, when the Changing Childbirth9 months. report was published (Department of

Health 1993). This publication suggestedI am a firm supporter of natural drug free

that birthing pools and using water as achildbirth and believe women are created

medium for childbirth should be available toand designed to birth naturally, therefore

all women delivering in the UK. The firstwhen left alone in a stress free environmentinternational conference on Water Birth(under supervision), can do so withwas held in London in 1995.minimum medical interference.

WHY WATER ?HISTORY : Water or 'hydrotherapy' has been

used in the form of hot springs and warm Birthing in water is extremely beneficial to a

baths for centuries. The earliest recorded birthing mother as it aids the psychological

water birth came from France in 1803.In the and physiological process. One can either

1970s, a Russian Researcher, Igor give Birth in a pool of water (Birthing), or use

Tjarkovsky, experimented with water and warm water as a medium to relax

birth, as well as training newborn infants (Hydrotherapy). It not only helps soothe the

with special needs to swim in water. He mother during contractions, but also helps

believed that water birth alleviated the with freedom of movement allowing for an

crush of gravity on the brain cells during upright posture that enables descent of the

Water Birthing -

Innovative or Evolutionary?

Dr. Ameet Dhurandar

"Nothing is softer or more flexible than water, yet nothing can resist it" - Lao Tzu


fetal head. The warm calming water cervical dilatation and effacement is

encompasses the mother's abdomen increased, along with contractions and

allowing her to relax her muscles and the descent of the head.

ligaments, creating free movement and 6) Gives the mother a dignified andincreasing the pelvic diameters.

respectful space : A water birthing

Water birth is primarily for low risk mother has absolute control over her

pregnancies! environment: eg: choice of music,

lighting, aroma therapy, the people inBENEFITS

the room etc. She can create a peacefulFor the Mother :

and happy space for her birthing1) Decreases Pain : Reduces the perception experience.

of labor pain by 40-60%, thus reducing7) Gentle birthing : Water not only helps

the use of Analgesics (Epidurals). This isthe mother with the birth process, but

due to the soothing effect of water onalso helps ease the baby- allowing for a

the nerve endings in the lower backserene transition from amniotic fluid to

region.warm water in the pool that is beneficial

2) Enhanced Relaxation : If a mother isto the baby's gentle acclimatization.

relaxed during labor, there is an8) Decreases Perineal Tear : Wateri n c re a s e d p ro d u c t i o n o f b eta -

increases the elasticity of the perinealendorphins which regulate the oxytocinmuscles and the counter pressure of therelease; helping rhythmic uterinewater on the crowning head helpscontractions and maximizes placentalreduce perineal tears.oxygen perfusion. If the mother is

stressed, increased stress-hormones For the Baby :

cause a reduction in placental perfusion.• Enhanced Fetal Oxygenation

3) Reduces blood pressure : The relaxing• Gentle Transition

effect of water reduces anxiety, aids in• Less Birth traumacreating a tranquil atmosphere, and

increases tissue perfusion. • Relaxed and Peacefully environment

4) Buoyancy : helps a mother move freely, • Reduced sensory stimuli

assuming any position, thus putting less• Skin to Skin contact

pressure on the uterus and Inferior Vena• Delayed cord clampingCava. It increases the various pelvic

diameters. Benefits of Swimming :

5) Speeds up labor : Due to relaxation, • Improved physical growth


• Improved cognitive function such as chemoreceptors around the larynx detect

memory and attention. water, the glottis is shut and the water is

diverted to the stomach (DIVE REFLUX). ThisSAFETY

prevents breast milk entering the lungsFor the Mother :

during breast feeding.

WATER TEMPERATURE & QUALITY :

The water used is filtered clean water from

the hospital and should be between 34°C

and 38°C. If the temperature is below 30°C,

The TPR/BP of the mother is taken every 15

minutes in active labour. And FHS is taken

by underwater dopplers every 10 minutes

initially and then after every contraction.

Internal examinations are kept to the bare

minimum and repeated after 2 hours ifit can cause hypothermia to the baby and

required. No Episiotomies are given unlessstimulate the gasping reflex. 40°C and abovethere is Fetal Distress and all suturing iscan lead to maternal dehydration and fetaldone a hour after she leaves the pool (ifdistress.there is no active bleeding) If NST is required

there are waterproof cordless probes BIRTHING SUITE :

available. The Placenta is always deliveredThe birthing takes place in suites where the

outside the pool.inflatable pool is kept next to the bed. If

For the Baby : there is any distress the mother is delivered

on the bed. To prevent infection we useIn-Utero breathing inhibitors : In utero fetalbrand new sterile disposable liners to coverbreathing movements, which start from 10

the pool before filling the pool with water.weeks onwards, cease 24-48 hours before

delivery due to the secretion of PG E2 from CONTRAINDICATIONS :the placenta and therefore the fetus is in

Water birth is contraindicated in pregnancyapnea (expiratory phase). There also is mild

with any medical conditions (GDM, PIH etc),hypoxia, which conserves oxygen and

breach, APH, PPH, Pyrexia, or if there is adecrease fetal breathing movements. The

previous history of shoulder dystocia.hypertonic fluid of the alveoli prevents the

hypotonic water from entering. If the [email protected]


In the year 2011, I started cycling to keep tanker knocked me off the road and sped

away.myself fit. I had tried running, but it did not

enthuse me. The closed, air-conditioned Fortunately, a passing ambulance attendedenvirons of fitness centres were too boring to me within 10 minutes and I was soon onand monotonous for a fidgety person like the way to a nearby hospital. I thank myme. But I took to cycling like a proverbial stars that I was conscious enough to guideduck to water, making new friends and my own treatment. My surgical training attaking on new challenges. Like every runner the trauma centre of Lokmanya Tilakwho pursues a 10k to15k to half-marathon Hospital kicked in and probably saved my

graph, I increased my distances, going from life!!

15 to 40 to 70 kilometres over two to three• Being just a transport vehicle, the

years. On weeknights and on Sundays, Iambulance was not equipped to provide

even started visiting hospitals by cycle,any treatment.

causing many a raised eyebrow!• At the local hospital, staff and RMO were

In July 2015, I signed up for a 200-kilometre ill-prepared to handle acute trauma.cycling event - the BRM 200 km (from

• No cervical immobilization was done.Borivali to Charoti and back). To prepare

• I had to advise them to start IV fluidsmyself for the challenge, I trained

through a large-bore IV access.intensively, cycling a total of 1,100

kilometres from July to November 2015. Perhaps it was the unfamiliar presentation

of acute trauma in a victim who was himselfOn D-day, 14th November 2015, the eventa neurosurgeon that had the casualty wardwas flagged off at Borivali. I had covered 100staff flabbergasted.kilometres in 4.5 hours and was cruising

comfortably. At kilometre 149, my The acute care during the golden hour that

comfortable ride came to an uncomfortably trauma surgeons and neurosurgeons keep

abrupt end. I became the victim of a "hit and talking about is still a distant dream.

run" at Manor. According to eyewitnesses, a Ambulances ought to be equipped to give

From Children's Day to Valentine's Day :

My personal journey and what I learnt

Dr. Viswanathan IyerBrain and Spine Surgeon, Qualilife Brain and Spine, Mumbai.

“Write Injuries in dust, benefits in marble” - Benjamin Franklin


acute treatment and ATLS training should be right to get sick and take leave. We need

mandatory for all medical personnel. you". I owe my recovery to them, too.

Within 45 days, my treating surgeonOnce I was stabilized, I was shifted to a

allowed me to resume conducting OPDhospital in Thane for further care. Radiology

rounds in a wheelchair. My exhilaration atrevealed multiple fractures in my pelvis as

this much-awaited victory, though, waswell as un-displaced fractures in my cervical

short-lived.and lumbar spine.

I was appalled at the lack of wheelchairBeing doctors, my wife and I had access toa c c e s s o n r o a d s , b u i l d i n g s a n dthe best opinions and advice. After all theestablishments, including medicalinitial confusion and panic, we decided tofacilities!follow the advice of just one orthopaedic

surgeon with full faith. In hindsight, I am Simple, everyday tasks like visiting a

convinced that this facilitated my speedy restaurant and getting a haircut needed the

recovery. Seeking many opinions is every help of a few men who carried my

patient's right, but is also important to wheelchair across potholed footpaths and

ultimately repose one's trust in one doctor up flights of stairs. Though most new

whose advice one must follow completely. buildings had lifts, reaching the lift from the

car was an ordeal. Smooth roads, accessTreating physicians tend to underplay theramps and wide entryways are distantr o l e o f a l l i e d s p e c i a l i s t s l i k edreams for the differently abled of our

physiotherapists. I have begun respectingcountry.

their role in patient care much more due to

More than my years of medical training andmy own journey to recovery with them. If

practice, the single sobering month that Iwe emphasize their role, our patients will

spent in a wheelchair made me empathic torealize the importance of allied care in

the plights of my patients.recovery. Medicine is not a "one-man

show". Did I learn anything? Did I stop cycling?

Within 65 days of my accident, I was back onAs doctors, we are trained to analyse issuesthe saddle and have cycled 1,500 kilometresand devise practical solutions. The checklistsince. All surgeons face complicationssystem that we use in surgery was put intoduring procedures. Do we stop doing thatplace during my recovery journey. Eachprocedure? We learn and we move on. Weevent was recorded and each milestonetry to avoid the same complication, but wecelebrated. My desperate urge to return todon't give up.work and my operating rooms propelled my

speedy return to full activity. A few patients I am one of the lucky few to have recovered

even called and chided, "Doctors have no completely from a road accident to resume


Often during our medical practice, we get exasperated with our patient's mindsets, fixed

ideas & beliefs about health & disease and try hard as we may, they fail to follow our

advice and treatment protocol. Closer home, we find that some or other relative/

friend/maid of ours do not bother to share their medical complaints or concerns with us.

Not because they do not trust us or disrespect to us but because of ignorance of their

illnesse and deep-seated beliefs of the disease processes.

We believe that the exercise of debunking the age-

old myths and providing an authorised scientific

explanation will go a long way to build a foundation

of healthcare education of a common man. This will

also enable them to take informed decisions

regarding their medical problems. For the ease of

grasping the variety of myths prevalent in the

population, we have categorized them by specialty.

This is one of a kind book which will bridge the gap

between your patient and their compliance to your

treatment protocol. It will be an asset in your

waiting room. Do not fail to order your copy right

away.

Regards

Editors : Dr. Sujata Rao, Dr. Nitin Rao

all professional and sport activities. It is a Last but not the least, a question that

like having a history of adversity that has no bothered me the very first day after my

bearing on the present. accident was, "How will I pay my EMIs?" As

doctors, we have no medical leave and noYet, I don't want to erase the journey. Itmedical expenses allowance. We must havetaught me the value of a healthy life. It hasfinancial planning to manage a rainy day.helped me understand patients' problems"Prepare for the worst and hope for best" isbetter.a dictum that we surgeons swear by.

The lack of golden-hour care and trauma

On Valentine's Day 2016, I celebrated lifecentres increase the morbidity and

with a visit to my alma mater, Grant Medicalmortality of trauma. It is time we start

College with my family. Life is beautiful anddemanding equal rights and accessibility for

we doctors help preserve it. What more canthe differently abled. Respect for quality of

life should also be our responsibility. one ask for?


CONDOLENCES

Dr. Sharad Sagade

Urologistth

Passed Away : 26 May 2017

Dr. Benoy Shah

Orthopaedic Surgeonth

Passed Away : 10 June 2017

Dr. Rajendra Jain

Gynaecologistth

Passed Away : 8 July 2017

Dr. Tekchand Vira

General Surgeonth


Dr. Kuldip Goleria

Plastic Surgeonth

Passed Away : 19 June 2017

Dr. Fakhruddin Padaria

General Physicianst



Generally, Pathology is an area which Hodgkin's disease but that she had

doctors used to specialise as it was myclopthylic anemia. As per Ms. R., she

s u b s e q u e n t l y u n d e r w e n t r e n a lcomparable to back office. It was a

transplantation for renal failure resultingcomfortable area of medical specialisation

due to unnecessary administration ofto work and not directly involved in patient

Endoxan. Hence both the pathologist andcare. Hence, it was thought of as a hassle

the Oncologist are negligent and liable forfree area to work leaving the patients to face

compensation.the front office consisting of physicians and

surgeons who were directly involved in Held : The medical oncologist had discussedpatient care. However, over the last decade, the case with the pathologist. Only afterthings gradually changed. Since the study of all the slides including the finding ofclinicians rely on the diagnostic reports for deposit of Hodgkin's lymphoma in manythe line of management, gradually the field areas, had Dr. S. , the Oncologistof diagnostics are now the area of direct administered Endoxan to Ms. R. Thus, Dr. S. attack making the pathologists and had acted as any other prudent Physicianradiologists to defend themselves for and did not delay commencement ofauthenticating the reports. Enumerated are chemotherapy. In addition, it was worthy to

few cases as to how the pathologists could note that the slides were still retained by

be in the line of attack. the Pathologist and in his possession for re-

examination by any other Pathologist evenI (1998) CPJ 3 NC ---- Consumer Protectionafter many years. Hence the complaint wasCouncil & Ors. Vs Dr. S & Anr.dismissed.

Ms. R. was admitted for vomiting. BoneII (2012) CPJ 218 NC ---- SD Hospital & MRCmarrow examination revealed Hodgkin'sVs Blymphoma for which Endoxan was

administered. After five doses of Endoxan, Mr. B. complained of pain and swelling in

Ms. R. consulted another Oncologist who right hip for many months and was

reported that the picture did not fit with diagnosed pyogenic septic hip with AVN of

THE NEW HOT SEAT

FOR LEGAL ISSUES....??

SURGICAL PATHOLOGISTS

Dr. Suganthi IyerDy. Director - Hinduja Hospital, Mumbai


femur with chronic osteomyelitis by S his aforesaid ailment at the time of

hospital. Blood tests and histopathology submission of proposal form and hence

reports, as per S Hospital, were negative for there was repudiation of claim after his

death. Complaint was filed by the wife ofTuberculosis and hence Mr. B. was

deceased Mr. S. for alleged repudiation ofdischarged from the hospital. However,

claim without substantial reasons.Mr. B. was not better. Hence, after nine

months, Mr. B. consulted another hospital Held : All the reports of the tests done uponwho diagnosed Osteo-tuberculosis. Mr. S. were examined. It was only the boneTreatment was given and the complainant marrow biopsy which was performed inrecovered. However, there was 40% April that confirmed the diagnosis of Plasmadisability. Hence, complaint was filed that Cell Myeloma. Thus the patient wasthe 40% disability was due to improper unaware of his disease at the time of fillingtreatment at S hospital. his proposal forms. As per literature,

multiple myeloma often does not haveHeld : Surgery was conducted for exploringsymptoms initially which makes it difficult tothe joint and also for biopsy. Pus wasdiagnose the same in initial phase. Theremoved from the joint cavity and sent forBlood cancer was not diagnosed evenculture. Tissue was also sent forduring hospitalisation in March. The samehistopathological diagnosis which revealedwas diagnosed only in April by the bonechronic non-specific synovitis and nomarrow biopsy report. Hence, the appealevidence of tuberculosis as stated in thewas dismissed and money refunded to thereply. However, no document of the samewife of the deceased.was submitted in support. The second

hospital however concluded that Mr. B. had IV (2016) CPJ 631 NC ---- D Vs Govt. of

osteotuberculosis. Hence, it was concluded Puducherry & Anr.

that 40% disability was due to improperMs. D. underwent LSCS and discharged.

diagnosis and treatment by the firstSubsequently, she had pain and wound

hospital. Hence, first hospital held negligentinfection with pus discharge. Three months

and compensation awarded.later, she was operated again and the

III (2014) CPJ 221 NC ---- Bajaj Allianz Vs R discharge summary mentioned that a pad

was left behind after LSCS. Hence aMr. S. took Insurance from 28th ofcomplaint was filed as she suffered physicalDecember and was admitted four monthsand mental damage.later in March for fever and was treated for

typhoid and malaria. One month later, in Held : The second surgery revealed "A pad

April, Mr. S. was admitted for multiple (foreign body) was seen burrowing into the

myeloma and expired. As per Bajaj Allianz, jejunal loops and sigmoid colon forming an

Mr. S. was aware of his illness and concealed abscess cavity". The gross description of the


histopathology report mentioned "Omental Held : There was no medical negligence on

pad of fat and a foreign body" The part of Dr. K. in performing the requisite

m i c r o s c o p i c d e s c r i p t i o n o f t h e procedure. However, as per literature in

h istopatho logy report ment ioned Harrison's Principles of Internal Medicine,

"Ulceration with granulation tissue, the Court held Dr. K. guilty of negligence in

congestion and ischemic necrosis of the not sending a sample of the pleura for

small intestine. Kindly correlate." The OP histopathological examination after

argued that the histopathology report was conducting the necessary surgical

inconclusive as the microscopic report was procedure. Expert opinion revealed

devoid of findings on the foreign body. The "Material removed during surgery should

court held that as per Surgical Pathology be sent for histopathological examination. It

books, few foreign bodies are difficult to is not uncommon that patient may appear

process and slides cannot be prepared as in normal yet suffer from cancer. Naked eye is

the case of dermoid cysts where unlikely to detect abnormal tissue and

microscopic study of nail, tooth and other hence material obtained during surgery

hard tissues is difficult. Histopathology should be routinely submitted for

report is a collective report of both gross histopathology which was not submitted in

and microscopic features. In the instant this case. Hence held negligent for the act of

case, the gross appearance revealed pad ommisison.

(foreign body) burrowing in the jejunum and VI (2013) CPJ 520 (NC) ---- D.H.K. & Ors. Vssigmoid colon forming an abscess cavity. NIMSHence, the presence of a foreign body

Ms. K. consulted Dr. R. for a painless lumpcannot be denied and compensation wasgrowing over 2 months in left breast. FNACgranted.revealed "Features consistent with

V (2009) CPJ 363 NC ---- Dr. K. Vs Panchori carcinoma breast". Ms. K. underwent

Mr. P. approached Dr. K. with symptoms of mastectomy of left breast by Dr. R. and the

pain and collapsed lung. Dr. K. performed HP report dated revealed "Features

thoracoplasty and decortication to drain the consistent with subareolar abscess left

fluid and strip the pleura. Few months later, breast." The second report from Division of

the pain recurred and surgery was Pathology ICMR stated "Features consistent

performed in another hospital and a large with abscess. No evidence of malignancy.

mass was removed from the pleura of the Note : The ductal epitheliosis and the

patient which revealed mesothelioma of regenerating epithelial reactions are likely

the pleura. By then the cancer had spread to show anisonucleosis with dark staining

and though opinion from several nuclei which on FNAC may be interpreted as

consultants was taken, the patient expired. neoplastic.”


As per the Complainants, the treating followed by a biopsy is the protocol. If FNAC

doctors at NIMS had wrongly diagnosed the is done and suspicious, then surgical

problem of Ms. K. as breast carcinoma and biopsy should be done. The next part is the

subjected her to unnecessary mastectomy. staging and evaluation of the cancer once

Hence Ms. K. suffered total disablement of breast cancer is confirmed. In the instant

her lef t arm due to consequent case, there is no evidence to show that

lymphedema. Besides mastectomy Dr. R. followed the standard diagnostic

disturbed her conjugal life and also children protocol including bilateral mammography

were affected adversely. and staging of the cancerous tumor prior to

confirmation that Ms. K. had CarcinomaHeld : As per the Opposite Parties, FNACbreast and deciding mastectomy. The OP'ssuggested malignancy. FNAC is a reliableare guilty of medical negligence as ittest with accuracy of upto 95-96%. In thiscu lminated in a hasty, medica l lycase, based on clinical presentation,unsupportable and insensitive traumaticmammogram and FNAC tests, mass showedmedical decision to remove the left breast.features of malignancy and cancer wasDamages of Rs. 10.50 lakhs was paid.suspected. Hence mastectomy was done

instead of going for limited surgery in the TAKE HOME MESSAGES :

best interest of the complainant w.r.t.• Reports of HPE includes both Gross and

survival.Microscopic.

It is an established fact that subareolar• Report to be fairly conclusive and not

abscess of the breast demonstrates pitfallsambiguous.

for a false positive diagnosis of malignancy• Retention period of slides to be 5-7 yearsthat can occur in any inflammatory process

and permanent if litigation/notice.including those of the breast. These include

the presence of groups of atypical ductal • Second opinion to be obtained if cases ofcells and fragments of granulation tissue. doubt.This could lead to false positive diagnosis of

• Sample for HPE preferable in all excisionmalignancy if the other cytological features

biopsies and wherever relevant.of abscess are not appreciated. Hence the

• FNAC not conclusive.doctors were of the view that this has

occurred not due to negligence but due to • Adherence to standard diagnosticpossible errors that occur in the matter of protocol mandatory.pathological reports.

• Limitations/l iabil ity/indemnity ofThe Algorithm for Diagnosis suggests that telepathology.for a suspicious dominant mass, clinical

• Compensation.examination followed by mammogram to

define the extent of lesion should be [email protected]


Public Health Awareness Exhibition 1st July 2017


Welcoming Shri Ashish Shelarji Inauguration of AMC Healthcare exhibition

Team AMC with Railway staff and police Team AMC partnered with Western Railways

Shri Ashish Shelarji giving his speech


Public Health Awareness Exhibition 1st July 2017

Managing committee & audience Blood pressure screening

Shri A. Shelarji, Managing Trustee & President Team AMC with railway authorities and commuters

President, PCC With AMC Staff Blood donation drive at Ghatkopar

Blood donation at Cooperby AMC staffHindu Sabha Hospital, Ghatkopar

2nd July 2017 at Rangsharada AuditoriumDOCTORS’ DAY Celebration


Stills from Bottoms Up Stills from Bottoms Up

Inauguration of Doctors day program' Bharat Dabholkar & Anant Mahadevan

Felicitation of Past Presidents Dr. Sudhir Naik & Dr. Sujata Rao by President Dr. Smita Sharma

2nd July 2017 at Rangsharada AuditoriumDOCTORS’ DAY Celebration


Felicitation of Padma Bhushan Dr. Tehemton Udwadia

Team AMC with the entire team of Bottoms UpFelicitation of Mr. Bharat Dabholkar

Still from Bottoms Up

Guests in AuditoriumSanjeevani Distinguished Services Award - Dr. Bipin Shah


The nature of Doctor-Patient relationship is those rights. These include :

constantly changing & evolving worldwide. 1) Right to respect for private & family life,

home & correspondenceIn India, doctors are at the receiving end of

verbal and/or physical violence from 2) Freedom of expression & right topatients and their kin. These assaults on informationdoctors have seen an increase in the last

3) Right not to be discriminated against ondecade. The Government and torch bearers

the grounds of race, sex, ethnicity,of ethics always keep on talk ing

religion, caste, creed etc.about/preaching to doctors on ethics &

4) Prohibition of slaveryetiquettes !

5) Right to get a fair trialUnfortunately, very few articles are written

regarding the Rights of doctors ! We doctors work under constant stress and

threat due to the nature of our work. OurDear friends, I will try to elaborate few of ourignorance towards our rights have lead torights -gross suppression of Human Rights of

The doctors are the most insecure species inDoctor community. The last two points

India in the present era. The consultantsmentioned in basic human rights are

specially are under a constant threat ofspecifically applicable to resident doctors

abuse & attack from relat ives &working during their post graduation days &

acquaintances of patients; the consumerthe full timer doctors working in corporate

court, criminal court, human rightshospitals.

commission & our own Medical councils.II] Professional rights :

The Rights of doctors can be : 1) Basic1) Right to decline treatment : There arehuman rights 2) Professional rightscertain circumstances under which a doctor

I] Basic human rights : Article 20 & 21 of may decline treatment to a patient & it willThe Constitution of India have provided not amount to violation of ethicscertain liberties & rights to our citizens

a) If a doctor is unwellwhich a President can't restrict even if

emergency is imposed on our nation. The b) If the doctor has strained relationship

doctors too, being citizens of India have all with the patient.

Doctor's Rights & Responsibilities

Dr. Rajendra TiwariGynecologist, MMC Awardee-2015; Dahanu

P.G. Diploma in Human Rights


c) If a doctor has already declared his gives the patient the right to decide about

timings for professional work; he cannot his/her own body part & treatment

modality. Doctors, while exercising thebe compelled to treat patients beyond

abovementioned right should involve thethese hours.

patient in the decision making after takingd) A doctor can turn down a request for a

informed consent.home visit during night hours on the

6) Referral to other specialists : to treat theground that there can be robbing orpatient a doctor might refer his patient tokidnapping of doctor.other specialist or to multi disciplinary team

e) If a doctor treats a patient in an& can delegate some powers of treatment

emergency, it doesn't mean that he hasto other qualified person(s). This is for the

accepted the patient. He/she may advicebest interest of the patient & it doesn't

the patient to go to some anotheramount to negligence.

specialist or hospital.7) Visits : How many times a doctor should

2) Right to get information : A doctor has a visit his patient is the right conferred to a

right to obtain past medical history & other doctor- this depends on the severity of the

details related to life style etc, if pertinent disease & response to treatment.with the treatment modality.

8) Professional Fees : A doctors has full3) Right to advice investigations : he has got rights to recover his professional dues. Infull right to decide which investigation is order to avoid any confrontations orneeded while treating a particular case. disagreements on payment after the

treatment is over, a doctor should explain4) Selection of drug : according to hishis approximate expenses to the patient. Heknowledge experience & skill, it is within themay collect advance-part payment too!rights of a doctor to decide which drug to

choose for treating a disease amongst the A doctor can charge for certificates issued bybattery of available drugs. him to the patients, except for death

certificate. A doctor can charge for visit5) Selection of procedure : Many diseases ingiven to a medical representative too!medicine can be treated by one or more

than one type of approved treatment. For As per consumer protection act, the medicalexa m p l e , w h e t h e r t o p e r fo r m a profession is "service industry" & weHysterectomy by laparoscopic route or doctors charge for various services offered

abdominal route depends on the clinical as a part of patient management protocol.

scenario & the Doctor's own experience as9) Medical record related rights : Medical

well as available infrastructure.records are the property of the Doctor &

"Autonomy" is said to be one of the Hospital. A doctor should disclose the

important pillar of ethics. This autonomy records of the patient in case demanded by


him/her in writing or demanded by law care : it is the responsibility of a doctor to

enforcing agencies or court of law. ensure highest quality of service. A

physician shouldn't allow or employ any10) Medico-legal cases : A doctor has the

doctor or attendant without validright to refuse medico legal case (unless it is

qualification or registration in hisan emergency case) there is a section 39 of

professional practice & shouldn't allow suchCrPC {Criminal Procedure Code} which

persons to attend treat or performmandates any responsible citizen of India to

operations upon them.inform Police regarding crime happening or

6) Payment of professional services : Acommitted before him. A doctor being a

physician engaged in practice should giveresponsible citizen; it is his duty to inform

priority to the treatment of his patient andthe Police as and when required about

should not engage in "No payment - Nomedico-legal case as soon as possible.treatment" sort of contract.

No right comes without responsibility. It is

7) Advertisement : Not to advertise unlessessential to remember our responsibilities

its mandatory to inform the peoplealong with our rights.

regarding change f address, change ofResponsibilities of doctors : The following is

consultation timings or addition of a newthe list of few of our responsibilities.

facility in the center.1) Character of physician : a physician shall

8) Rebate or commission : At present, therekeep himself upright in character,be

is a discussion going on regardingdiligent, modest, sober, patient & prompt in

commission offered by hospitals to acquiredischarging his duties without anxiety.

patients. The government of Maharashtra is2) The physician should maintain good coming out with a law forbidding "CUTS" Itmedical practice & competence. will no more be an ethical issue but an

offence after the law is passed !3) Membership of medical society : To keep

pace with advancement of ever-growing

medical field, a doctor should affiliate

himself with certain associations & societies(The views of the author are personal.& should continue the medical educationThough it is undeniable that various degreesprogram at least 30 hrs for five years (IMCof professional jousting is prevalent, it mustEthics guidelines).be a rare exception that a doctor instigates

4) Maintenance of medical records : Theviolence against a colleague. If it is proven

medical records of inpatient departmentbeyond doubt that a professional has

and OPD for five years and 2 yrs respectivelystooped so low, he should be boycotted by

to be maintained.the Medical Associations of the area and by

5) Highest quality of assurance in patient the medical community at large.........Editor)

[email protected]


laparoscopic cholecystectomy before in my

life. I had seen a few videos which my friend

Prof. Cuschieri who did one Lap Chole just a

few weeks before had sent me. My residents

and I saw that video a 100 times and then we

planned it mentally before we put it on the

OT list. The case was interesting because

there was a power failure half way through,Some are respected and some are loved, but we had to wait in the darkness till it wasvery few are privileged to enjoy the respect, restored! Then the electrocautery /love and reverence of their peers. Prof. diathermy machine blew up, so we had toTehemton Erach Udwadia is an 80 year old get one from the next theatre and the entireParsi Indian Surgeon and Gastroenterologist procedure took over 2 hours counting all thefrom Mumbai considered by many as the interruptions. It was really exhilarating asfather of laparoscopic surgery in India. He the OT was full of residents from other units.has been conferred with India's third

Also, it was particularly significant becausehighest civilian award, the Padma Bhushan.

the previous night, one of my seniorHe had been awarded the Padma Shri incolleagues had cautioned me that for years I2006 for his contributions to Indianhad been doing experimental surgery onmedicine. Sir is known for his radianthumans. What would happen to me if thingspersonality, his passion for teaching andwent wrong? My residents and I were reallylove for students as well as his compassionvery frightened throughout and we all keptfor patients.checking the patient the whole night!

Prof. Udwadia : “The only way of remainingFortunately, the next morning when I went

active and interested is to find somethingfor rounds, the first question the patient

new to do every day! And if you enjoy whatasked me was when can I go home? That

you are doing, you are bound to be activewas the best post operative round of my

and interested!! And life is full of surpriseslife!!

and new things so interest is natural andI have not really had sadness or heartachesinborn. I feel that the very first laparoscopicbut whenever you lose a patient aftercholecystectomy we did at J.J. Hospital was surgery it's a terrible heartache, because asunique in many ways - I had never seen a

Dr. T. E. Udwadia - My Mentor“In an informal interview with....

Dr. Kushal Mital at ceMAST, Worli”


a surgeon one carries out an act of My message to young surgeons is that work

commission not omission! Hence the onus as honestly, as well as you can and always

of guilt is much heavier on a surgeon than in respect your colleagues. Never run down

any other profession. Unfortunately, that is any of them because most of them are

part of surgery and one has to live with it, better than you.because not every case is going to be a

I have had the great good fortune of asuccess.

fantastic family life, I met my wife when IThere are many other things which cause was 15 and she was 14- we have been thesadness to me. When I started surgery 60 best of friends ever since. It's almost 60odd years back, the surgeon was looked years to our marriage and we have grandupon with utmost respect and affection by children. I have excellent hobbies like I wasthe patient and patient's family. At that time

the member of the Bombay Flying club and we had very primitive instruments, we did

in my college days I was representing myv e r y b a s i c s u r g e r i e s . To d ay t h e

college in cricket, athletics & boxing. it isinstrumentation is magnificent, the depth

very important for a Surgeon to be in sportsof surgery is unimaginable but still

because it gives him a focus and passion.somehow today the surgeon is viewed with

The only regret I have is that I could haveapprehension and even with a sense of not

been a better teacher to my students. They being honest. That is a very sad change of

have turned out better surgeons than I was scene for someone who has seen better

days!! their teacher!”

GST of 18% payable on the above amount.


This paradoxical quote illustrates how we feel as if the ground has been pulled

abnormal mental conditions have become from under us.

normal, how mental health problems have Such disorientation is an inevitable result ofbecome mainstream, how though we have the materialistic worldview that isprogressed technologically, we seemed to mainstream today - a worldview that mosthave regressed mental ly. Indeed, of us have adopted, consciously orsociologists sometimes refer to this subconsciously. This worldview reduces usalarming phenomenon as an anxiety to an aggregation of chemicals bunglingepidemic. around in this big blind world, which too is

just a bigger aggregation of chemicals. SuchEach individual's mental health issues cana conception of life causes a profoundhave complex specific causes. Whileexistential angst which if contemplatedaddressing these individual causes, we can'tunflinchingly would make life almostafford to lose sight of underlying genericunbearable.causes. That universal cause is pointed to by

psychologist William Sheldon of Columbia To make such a pointless life bearable, weUniversity's College of Physicians and divert ourselves from reality by a freneticSurgeons: "Deeper and more fundamental immersion in matter. We seek our self-than sexuality, deeper than the craving for worth by piling up degrees in front of our

social power, deeper even than the desire names, figures in our bank accounts and

for possessions, there is a still more gizmos in our houses. Or we lose ourselves

generalized and universal craving in the in the myriad forms of entertainment that

human makeup. It is the craving for swamp us from all directions. While such

knowledge of the right direction-for achievement or enjoyment gives us some

orientation." We need a deeper meaning titillation, it also triggers further anxiety

and larger purpose for our life. Without this, because none of these externals are really in

The Abnormal Normal

Swami Chaitanya Charan Das

"I told the doctor I was overtired, anxiety-ridden, compulsively active, constantly

depressed, with recurring fits of paranoia. Turns out I'm normal." - Jules Feiffer


our control. Life's vicissitudes can take any spiritual alienation, thereby increasing

and all of these away at any moment. The further our anxieties.

possibility and indeed the inevitability of And our material infatuation too hassuch dispossession of the things that shore worsened with the advent of technology.up our self-worth causes us further anxiety. With the extensive and intensive use ofIronically, the very things we seek for technology for marketing lifestyle productsdecreasing our anxiety end up subjecting us and even addictive indulgences, people findto greater anxiety. Thus, both these factors- a whole universe of enjoyment alluringthe fundamental spiritual alienation and the them. Hoping desperately to find pleasuresubsequent material infatuation-contribute somewhere in this techno-fuelled super-to our increasing anxiety. These two causes bazaar, they get increasingly obsessed withare actually one because spiritual alienation the materialism that indentures them toleads to material infatuation, though once anxiety.triggered, they both feed each other.

To address our anxiety by tackling ourThis fundamental cause of anxiety is like a spiritual alienation and material infatuation,seismic disturbance point below the surface wisdom-texts such as the Bhagavad-gitaof the earth. From that point originate the stand ready with coherent and cogentvibrations that wreak havoc on the earth's spiritual knowledge. It helps us understandsurface. Similarly, from our spiritual that we are at our core spiritual beings andalienation originate the many vulnerabilities are meant for a life of loving harmony withthat lead to our being afflicted by myriad our source, the whole whose parts we are.mental health issues.

To regain our spiritual wholeness, we canUnfortunately, our spiritual alienation is begin by challenging the status quo that has

only being aggravated by the onward march deemed abnormal mental health issues

of progress in today's world. As our world normal. For those intrepid enough to

has progressed from the modern to the explore the possibility that we are meant for

post-modern times, the mainstream a better life, timeless spiritual wisdom

intellectual ethos has relativized all shows the way out of the ocean of anxiety to

knowledges and indeed all knowledge- the shore of security and serenity.

systems. Consequently, spirituality, despite

being a much-bandied word, has beenChaitanya Charan Das is a researcher andreduced to a feel-good laissez-faire. In thisauthor in science and spirituality. He hasspiritual free-for-all, people frantically trybeen an invited speaker at severalout various ways to feel good withoutinternational conferences on the interface ofknowing any process to realize the good thatscience and spirituality.exists at their spiritual core. Thus,

intellectual confusion exacerbates our (contributed by Dr. Ashok Shetty)

[email protected]


Dear Brothers and Sisters, 3) Safety : Gift your staff a whistle and a

folding knife as part of their uniform. AskThis article is written to put forward how wefriendly policeman, ex service man to teachhave changed small things to innovate andself defense to our staff. When there is a hintpractice.of a problem/difficulty, ask staff to blow

We live most of our life by reflex....Bywhistle. Good people help. Bad people run

following same routine habits....Weaway. If whistle fails, knife will help. We have

prescribe in English, wear excess clothes,a right to self defence. We become tigers.

etc. Let us think and change. These areNot lambs. With our own strong team, there

some of the changes we have made in ouris no fear of violence.

practice -

4) We Must Use local language : Law says1) Greeting with a Namaste : To Greet all,

that biggest clinic board must be in Marathi.say Namaste with smile.Law says," Every prescription must have

Let us Love our patients & staff. Do for them,registration number". Print it on your letter

what we would do for our children.head.

They too will love us and never leave us.We wrote this article in English - Had we

This is another insurance against medicowritten this in Gujarati , Marathi, some of

legal cases.the consultants would not have read it. That

2) Participate in all AMC activities. Selfless is why English is a disconnect as when weAMC workers do great jobs for us. Join in write in English, many of our patients do noteach activity. Unity is strength. Tell all. understand.

Stress on local language : Our Doctors go to

USA where they have to score 8 out of 10 in

written, spoken English. We are intelligent.

We must score 10 out of 10 in Hindi,

Marathi, Gujarati. Mother tongue is the

broadest road to heart. Use it.

We get disconnected with people. Let us use

people's languages.

INNOVATE & THRIVEDr. Hemant & Archana Joshi

“A person can achieve everything by being simple and humble” - Rig Veda


Mumbai has 45% Marathi speaking, 19% languages in Unicode free. Now, when you

Gujarati, 14% Hindi, 13% Urdu and only 20% type in English, the computer prints in the

Know English. 80% do not understand language you choose. Gmail also has this

Medical English. facility. We translated WHO's "Pocket book

of hospital care for children & DietaryOur Mythology tells us that Lord Ram fought

Rawan with the Vanar sena. He must have guidelines for Indians" in Marathi. "Talk the

communicated with Vanars in their language of the people" - It helps to learn

language. We fight with YAMRAJ but only many languages. Learning a new language

with the help of the patient, relatives & our has an advantage of keeping our brainstaff. Hence, talk, write and communicate in active.the language that they know best.

---------------------------------------------------------Business is people. No people, no business.

Empower the patient, relatives & your staffExample case : For one of our female child

with all information. For this wheneverpatients, we had prescribed Amoxicillin tds

possible, write everything including notes& Paracetamol sos. She took Paracetamol

on the opd & indoor case paper in thetds & amoxicillin sos. She worsened.

language all understand - Hindi, Marathi,Marathi prescription would have avoided

Gujarati, depending on which language allthis error.

know best.Many such errors happen daily. We worked

This makes things simpler, reduces errors,at it & now we prescribe in Marathi/Hindi.brings transparency and increases patient'sMany Pharma companies write brandtrust. They understand all about their healthnames in Devanagari.

and compliance increases.Go Multi lingual but Use local language to

5) UNIFORM :reach out to your patients- Psychiatrist

Dr. Harish Shetty says, "Print lot of patient i) Make Hindi name badge compulsory.education leaflets. It multiplies practice." This improves care as everyone canDo it in many languages. Our bills,

read their name. All become moreprescriptions, that we write must be in

responsible.Devnagari script first. It is possible to make

ii) To prevent cross infection let us ensureeverything written bilingual - Computers dothat all our staff daily wears freshlyit easily. This improves compliance, reduces

washed uniform.errors, increases happiness, practice.

iii) Let us all design & wear healthy uniformsOn your Computer : Write google input

tools. Follow the steps to down load Indian suited to our climate :


Our uniforms are not healthy. Health was

not thought of while making them. In

Mumbai's humidity, we sweat more which

reduces our efficiency and cause skin

problems.

Park's text book of PSM says that 25-26

degrees Celcius is best room temperature

for our body and for best work efficiency.

For us, 27* is warm. 28* causes sweating He started using a loose hosiary T shirt. It is

and 30* is intolerable. banyan with collar. It gave him 100 units of

comfort. Air circulated through its natural

holes giving natural air conditioning! He was

most comfortable of all at any place, any

time.

We need to have hosiary uniforms and

minimum layers of clothes...For us & for our

staff.

Women too can choose similar respectable

healthy clothes.I n M u m b a i , e v e n i n w i n t e r d ay

For 1.6 meters skin surface, a lady wears a 5temperatures exceeds 30 degrees. We

sweat. Work efficiency reduces. The meter sari & 5 meters of inner wear.

discomfort, sweating increase with each

layer of cloth. Design, Wear& promote

minimum layer healthy uniforms.

Earlier Dr. Hemant used to wear an Apron, a

shirt, and a banyan (3 layers of clothes). He

used to feel hot & uncomfortable. He

stitched a shirt with collar like Apron. He

A salwar - kurta, hosiery top with hosierystopped using a separate apron. That

reduced one layer of cloth. That gave him pant has less layers of cloth, more warmth,

10 unit comfort. Then he got rid of banyan. less discomfort and less cost. It is also more

airy, comfortable, healthy, efficient withThat left only 1 layer of cloth. That gave him

pockets for pen, mobile, purse. No dupatta.30 units of comfort.


iv) For asepsis, UK has a policy of "Bare

below Elbows”

To Summarize :

1. Make whistle & folding knife part of

uniform. Learn & teach self defense.

2. Publish leaflets in many languages.

3. Put registration number on prescription.

4. Biggest board of clinic, hospital, shop,

must be in Devnagari, the script of

Marathi, Hindi.

5. Prescribe, write, communicate inIt is easy for hand washing as there is no

Devnagari /Hindi/Marathi/Gujarati etc.wrist watch, bangle, rings. They wear the

6. Healthy Uniform for all.watch on chest. like this. No Tie or

dupatta also. 7. Bare below elbows.

v) In Pediatrics, the nurse wears colourful 8. Chest watch.dress. Let us also try to be efficient,

9. Use air conditioners.colorful, happy.

10.Participate in all AMC activities.vi) It is good to use air conditioners - Even at

home, All the time. Set them at 25.

Children grow best at this temperature. [email protected]

continued from page no. 6......

Last but not the least is the burning issue

of the proposed

committee to make these laws. I am happy

to inform that we have met the Hon'ble

Education minister Mr. Girish Mahajan“Law on Cut Practice."

and expressed our concerns. He assuredAMC has always stood for honest and

us that our recommendations will beethical practices and we would like to

considered. The Government will lookonce again reiterate that our members

into all aspects of the situation so that theabide by the MCI norms. These norms can

honest hardworking and committedsoon become laws and we at AMC would

doctor is not victimised. On this positivedo our very best to see that the laws are

note, I sign off and look forward to seeing fair and not a source of harassment to our

you on 12th November at the AMCON.fellow consultants. We have sent our

recommendations to Mr. Pravin Dixit the

Chairman of the Government appointed [email protected]


With advancements in technology, a lot of is available online on AMAZON and many

companies have made innovative video varieties are available, though all are the

laryngoscopes with high resolution images same.

and ease of intubation. The only drawback is

t h e c o s t o f t h e e q u i p m e n t a n d

maintenance. we have been using a much

cheaper alternative (cost Rs. 3600/-) for the

last 3 years with a reasonable success rate.

The Borescope is a 5 meter long camera with

an LED light of its own. The intensity of the

light can be adjusted according to

convenience. It is basically meant for use by

car mechanics to see the inside and under

surface of the engine under the bonnet. And

also by plumbers to see for choke ups in the

drainage pipes. With a few modifications

the same can be applied for Anaesthesia

use. The link to buy one is provided below. It

The Borescope can be attached to the

laryngoscope blade with the help of a plastic

adaptor which I had with me from some

other imported laryngoscope set. Other

option is soldering a small u shaped

semicircular holder (for the wire) to the

blade of the laryngoscope. The other end of

the borescope is a USB and can be

connected to an OTG complaint ANDROID

SMARTPHONE OR A TABLET. The live images

(vision) can be seen on the phone screen for

help during intubation.

Since the diameter of the wire was small, I

have encircled it with the rubber tubing of a

blood pressure cuff. The extra length of the

Use of a Borescope as

a Video Laryngoscope

Dr. Aashish ModyEditor - Website, Gen. Surgeon


wire allows us to keep the phone on the am working on the concept and will surely

patient's chest for vision. come out with some innovation soon.

The inherent LED light is very bright and the

light of the laryngoscope blade is not

required. An OTG adapter is required to

connect USB port of the camera to the

phone, which is available anywhere for less

than 200 Rs.

The Borescope can be attached to all the

blade sizes and is very easy to master theThe most stable application available on the

technique. The only things that requiredplaystore free of cost is CAMERA FI. This

practice were fixing the camera on the bladeapplication allows us to get i) full screenso that it showed an exact horizontal imageclear vision; ii) option of video recording theafter the blade is rotated to keep the tongueintubation procedure, iii) click photographs,

All these can be a great help for medicolegal

purpose if required.

to the left, and keeping the tip stuck to the

blade so that it does not come in the way of

the endotracheal tube during intubation.

The image is very clear and there is no

fogging of the camera tip.

The Borescope is also available in smaller

length of 2 meters. The bore at the tip is 7

mm and is also available of 5mm with

exactly the same quality of vision.

(If a small modification can be done, it would

be possible to wrap the bougie material

around it and use it as a fibreoptic bougie. I


In conclusion, the Borescope has got physician at Borivli who provided me with

innumerable possibilities and modificationsthe first Borescope to stimulate my brain.

for use in the field of anaesthesia. A, sincere

thanks to Dr. Bhavin Shah, practicing chest [email protected]

The adapter is available online and also

locally at any mobile shop. The attachment

will have to be locally made as per the

design. Only the lower attachment in the

shape of a U can be shouldered to the

laryngoscope blade. I am trying with the

local companies for the same.

“Education is not the learning of facts, it is rather the training of the mind to think!”

- Albert Einstein


If waking up at unearthly hours, trudging through "Grimmet", the ubiquitous bird

around with binoculars, seemingly aimlessly field guide was a dead giveaway. It reminded

in the vast green environs and often lugging me of the brushing up done regularly before

around heavy duty camera equipment, is the practical and viva exams.

your idea of fun, you are well equipped to beWe got a small inkling of the trouble that we

a birder.would face right at Kolkata airport. We

I took to birding when a friend introduced received a message from our group leaderme to the Mumbai bird race over 2 years that we would be unable to drive to our finalago. After scouting out the birding areas in destination which was Khonoma village tilland around Mumbai, followed by a few late in the evening due to a sudden strike callweek end trips further out, my appetite for in Nagaland as a result of some politicalbirding wasn't satiated. The Northeast is a issues. But all of us were on a high as webirding hotspot in India. were going to a dream birding destination

and even this news failed to dampen ourAn irresistible opportunity for a birding trip

spirits.to Nagaland with a group of 8 birders- some

old friends and some new acquaintances

was memorable. The entry to Nagaland was

through Dimapur, the only airport in the

state. The flight would be via Kolkata. At

Kolkata airport while waiting to board the

Dimapur flight, we had a good time trying to

figure out who amongst the people at the

airport were going to be our birding pals for

the next week. Anyone intently going

In Nagaland amongst the

Winged Wonders

Dr. Molina KhannaM.D., D.N.B. Gastroenterologist

There is an unreasonable joy to be had from the observation of small birds going about their

bright, oblivious business. - Grant Hutchison

Crested Finchbill


care that we did not enter the main road

outside the airport. We were all actually

pleased that we got an extra session of

birding squeezed in due to the unexpected

delay.

After leaving the airport at dusk, we reached

Khonoma (about 70 kms from Dimapur) late

in the evening. We were told that the strike

was to continue for a few more days but weWe arrived at Dimapur just around noon would not be affected much as Khonomaready to spend a few hours at the Dimapur and our other destination Benreu were partairport until the Bandh had relaxed at of the unaffected rural interiors. Hopefullyaround 6pm. We had lunch at the airport things would clear out by the time we had tocanteen which was more like a roadside get back to Dimapur for our return flight. OnDhaba with wooden benches. But none of the day before we were to leave Dimapur tous were complaining. After lunch we met a catch our return flight, the political situationyoung journalist at the airport who was worsened, with mobs and blockades alongcurious to see us so composed despite such the highway to Dimapur. We felt it safer toan unusual and testing situation. We go back and spend the night in Khonoma asexplained to her that birders essentially do the rural interiors were not much affected.not lack patience. After taking a few pictures Despite only a 2 to 3 hour drive to Dimapur,for the local newspaper, she left, but only we left at sunrise to catch our noon flight.after warning us that things would not be We were confronted with huge trees felled

easy in the coming days due to this unrest. and lying across the road to prevent vehicles

Very soon our binoculars were out and we passing through. We took the help of the

went further afield around the airport to locals to bypass this barricade. But every

start birding right away. We obviously took few kilometres saw mobs blocking the

Mountain Bamboo Partridge

Sunbird on

a banana flower

Khonoma Village with a traditional Morung


highway. Fortunately most of them

relented and allowed us to pass through

after we showed them our flight tickets. We

finally reached the airport well ahead of our

time and heaved a sigh of relief. There was

also a sense of exhilaration after sharing an

adventurous ride.

The next few days were filled with

wonderment. We would start before dawn,Nagaland was an unimaginably fascinatingtravel to various areas to see beautiful,and riveting experience.exotic and variously hued aves from sunrise

to almost noon time only taking a break for a Birders are fond of making lists. They make

packed picnic breakfast. Then we would be life lists, year lists, day lists, location lists ofback to the hotel for a wash, lunch and some all the bird species they have seen. Manyrest and back to birding around 2.30 pm till birders can be quite competitive in buildingsunset. The evenings were spent discussing up their bird lists (number of species of birdsthe day's sightings and topics involving the you have seen). We saw 125 species of birdsavian world. on the entire trip. Identifying various birds is

Inhaling lungful of the crisp air on a chilly definitely a challenge which most birders

winter morning, unmindful of the crick in relish. But the joy of just observing birds in

the neck due to the constant upward gaze at their natural habitat, their mannerisms and

the treetops through the binoculars and their interaction with other birds can be aenduring hand numbing colds, some of the source of exquisite delight. Birding days willbirding moments are etched in my memory. definitely have a few 'aha' moments eitherThe yellow bellied fantail dressed in her on seeing an elegantly feathered andblack and golden yellow finery, prancing gorgeously colored bird or sometimes evenabout fanning her tail, delighted us with a a plain Jane, if it is enough of a rarity. Butr ing s ide v iew of an exquis i te ly these moments are few and far between.choreographed classy avian item number.

Most often birding is all about the patience The sight of a multihued sunbird with itsand the stillness, almost a meditativemetallic sheen glinting in the sunlight as itexperience as to see birds… it is necessary tohung on to a magenta colored bananabecome a part of the silence!flower and digging its delicately curved beak

on the minuscule fruit on it, was truly

mesmerizing. Spending almost the entire

day in the verdant, virgin territory of ruralDr. Molina Khanna

Khonoma village with its terraced fields


For the benefit of it's members and for the promote an integrative and affordable

benefit of the entire medical fraternity, AMC healthcare system and improve the health

has stepped into an academic partnership of the communities in India.

with the Symbiosis International University, The eminent personalities which graced thePune. The aim of such partnership is to event were Shri. J. P. Nadda, Union Ministerprovide higher education technologies to for Health & Family Welfare, GOI, Mr. Alokmedical professionals, to exchange ideas Kumar , Advisor, NITI Aayog, GOI,and methods in an attempt to keep-up with Dr. Soumya Swaminathan, DG, ICMR,the rapidly globalizing and transforming Dr. K. Srinath Reddy, President - PHFI,healthcare sector. Dr. Henk Bekedam , WHO Country

Representative, Dr. Shirshendu Mukherjee,To achieve this aim, Symbiosis International

Mission Director, Grand Challenges India,university invited AMC to Symhealth 2017,BIRAC, Mr. Ram Jethmalaniand many more.An International Conference on Healthcare

in a Globalizing World on May 4, 5 & 6, 2017

at Symbiosis, Lavale campus, Pune.

AMC was represented by Prof. (Dr.

Ms.) Sushmita Bhatnagar at Symhealth

which was a very well organized and well-

attended International conference with

more than 1300 delegates from various

health and health related specialties

registered for the event. This unique event

showcased all the aspects of healthcare and

also divulged into the expanded sectors

such as Management, Information

Technology, Law, Communicat ion,

Geospatial Applications, International

Relations etc.

Discussions to explore enriching healthcare

delivery through an interdisciplinary

approach were not just interesting, but also

paved the way for future interventions to

Academic partnership

AMC & Symbiosis

Dr. Abhay Saraf, Organisisng Secretary -

Symhealth 2017 &

Prof. (Dr. Ms.) Sushmita Bhatnagar


‘MEDITOONS’by

Dr. Ganesh Choudhari



FOR SALE in South Mumbai, Navjivan Society, Lamington Road, ownership

premises with seven Rooms, approximately 1500 Sq. feet Carpet area plus lobby,

long standing 10 bedded Maternity & Gynaecological Nursing Home. Can be

purchased by professionals, medical centers, laboratories etc. Contact : Ms. Kavita

23084949 1 to 4 p.m. Monday to Friday. Email : [email protected].

KARL STORZ Rigid Broncoscopes 3.5 X 30, 6.5 X 43, 8.5 X 43, 8 X 40, 5 X 30, Straight

Forceps, Crocodile Serrated, Light Serrated, Light Carrier, Suction Cannula available

as set or separately. Contact : 98201 65435.

Available Air Conditioned Consulting room at "Comfort Clinic Nursing Home",

Kemp's Corner for afternoons/evenings. Contact Manager : Mr. Vithal Shinde for

details 98205 48540 or Email : [email protected]

Once in a life time opportunity for practicing in queen of Suburbs - Posh

Polyclinic, Linking Road, Bandra West - Requires Doctors on hrly basis. PHYSICIAN,

CARDIOLOGIST, ORTHOPAEDIC, SONOLOGIST. Contact : 9324105722, 9323757850

FOR IMMEDIATE SALE - Prime Location, 25 Bedded, 4000 sqft Carpet,

11 ft ceiling, running Hospital, 2nd Floor private elevator, 6 private rooms,

consultation rooms, ample water and electric @ Vartak Nagar Naka Thane. With

clear title. Contact : 98673 28707

For Sale - Laparoscopic instruments, General Gynaecology instruments, Labour

Table, Patient Examination Table, Micro Suction machine & Reception Table. What's

App No.: 98201 22479 Email : [email protected]

CLASSIFIEDS AVAILABLE / REQUIRED

CLASSIFIEDS MATRIMONIAL

NRI Groom Mumbai based, Gujarati, Vaishnav, Doctor parents request matrimonial

alliance for their USA based, green card holder, doctorson, Nov 1988, 5'9, fair,

handsome, MBBS (Mumbai), MD (Internal Medicine (USA), pursuing Fellowship at

Pennsylvania, USA. Girl should be Hindu, highly qualified, Postgraduate, USA based,

with basic education from India. Contact : 98202 67627 / 98201 62896 /

[email protected]

Mumbai based Gujarati Doctor Parents Seeking Alliance for their Daughter,

Persuing M.D. Anaesthesia, Sion Hospital from Gujarati Post Graduate Doctor Boy

Contact : 98336 33335 Email : [email protected]





In India; Doctor's day is celebrated on 1st July as 2. Raheja Hospital, Mahim : Dr. Ritesh Agarwal

a mark of respect to Dr. B. C. Roy. AMC & Dr. Vikram Khanna (Booklet distribution,

celebrates this day by holding activities for the Public Awareness Exhibition, Bloodbenefit of society. This year, AMC organized and Donation Drive-1 Unit).conducted blood donation drives, public health

3. H. J. Doshi Ghatkopar Hindu Sabha Hospital,exhibitions, BP and BSL monitoring at multiple

Ghatkopar: Dr. Bipin Shah & Dr. Arun Shethlocations across the city. The center of

(Booklet distribution, Public Awarenessattraction was a public awareness and

Exhibition, Blood Donation Drive-20 Units).healthcare exhibition held at Bandra station.

4. Kandivali Hitvardhak Mandal : Dr. Jayesh P.We had educative posters about all specialties-Shah (Booklet distribution, Public Awarenessmaking people aware about common medicalExhibition).ailments. In addition, we had blood pressure

and blood sugar testing and Organ Donation 5. Palghar, Poisar & Dahanu : Dr. Rajendraa w a r e n e s s b y t h e R e g i o n a l O r g a n Chawhan (Booklet distribution, PublicTransplantation organization. Awareness Exhibition, Blood Donation

The event was inaugurated by Hon'ble Minister Drive-332 Units).

Shri Ashish Shelarji. It was heartening to see 6. Rukminibai Hospital, Kalyan : Dr. Pradeepnot just railway commuters and the general Baliga (Booklet distribution, Publicpublic but motormen, Railway Guards, police

Awareness Exhibition, Blood Donationofficials, dabbawalas, female commuters,

Drive-71 Units).station master, chief guest Ashish Shelarji

7. Dombivali Gymkhana : Dr. Pramod Bahekarhimself along with the Corporators who availed(Blood Donation Drive-59 Units)the opportunity to screen themselves for

8. Possa Hospital : Dr. Vivek Dwivedi &Hypertension and Diabetes - the two major

lifestyle disorders. Dr. Severin Possa (Booklet distribution,

Public Awareness Exhibition-420 Units).The general public was also gifted our

publication "Myths & Facts in Medicine - 9. Essel World & Water Kingdom and AgarwalBridging the Gap" on this day. This booklet was Nursing Hom, Bhayander - Dr. S. N. Agarwalreleased by Shri Ashish Shelarji during the (Booklet distribution, Public Awarenessinauguration of the public awareness drive. He Exhibition).was very impressed with the booklet. Several

On 2nd July, the Doctor's day program ineminent doctors of AMC had taken tireless

collaboration with AGP World was successfullyefforts to conceptualize and compile this book.

organized and conducted at RangshardaA similar exhibition was done at Raheja

Auditorium, Bandra. A variety entertainmentHospital, Cooper Hospital and other centersprogram, The New "Bottoms Up" of Ashvinalong with blood donation drives by the doctorsGidwani productions, with Mr. Bharatand public for the patients. The list of centersDabholkar sent the doctors into fits of laughter.who participated are :Felicitation of Dr. Tehemton Udwadia was an

1. Cooper Hospital : with kind permission ofhonor to the association. The DistinguishedDr. Ganesh Shinde (Dean), and co-operation,services award of the year 2017 was bestowedsupport and guidance of Dr. Kulkarniupon the very deserving Dr. Bipin Shah.(Booklet distribution, Public Awareness

Exhibition, Blood Donation Drive-12 Units). PCC - Dr. Sushmita Bhatnagar

“Doctor’s Day Report”


May 2 : Sterilisation surgery killed 33

Mumbai women in 10 years

May 20, 2017 : Digital network to connect

four public cancer hospitals

May 10, 2017 : Illegal orthopaedic implants

worth ? 8 crore seized

May 11, 2017 : Price cap for more medical May 25, 2017 : India has only onedevices anaesthetist per lakh people :

May 15, 2017 : Private hospitals may have May 29, 2017 : ICMR says nod not sought :

to display data

May 19, 2017 : Country lags in controlling

TB, diabetes, heart disease

May 06, 2017 : SC upholds stay on domicile

rule for PG medical seats

May 11, 2017 : Doctors must take patient'sMay 24, 2017 : Rs. 11-cr proposal to beef up

consent before invasive proceduressecurity at civic hospitals

May 14, 2017 : Now, Ayurveda doctors to

be in charge of PHCs :

May 29, 2017 : State sends zika alert to

doctors & civic bodies

Mumbai :

Cancer care in India is poised for a digital

leap courtesy an initiative between cancerMumbai : The FDA

hospitals, led by the city's Tata Memorialhas seized unlicenced orthopaedic implants

Hospital, and one of the country's biggest ITand has filed 34 cases against companies

companies - will help patients reach thestoring or selling such implants.

right doctor quicker.

The World

F e d e r a t i o n o f S o c i e t i e s o f

Anaesthesiologists officially launched aIn a move to empower

landmark online resource tool mapping thethe state's rural and tribal belt, the

total number of anaesthesia providers,government has decided to hire Ayurvedaworldwide.doctors to be posted at primary health

centres, across areas which suffer due to

shortage of allopathy doctors.

ICMR spokespersons told media that its

FROM THE PRESS

Dr. Pradeep Baliga

Editor's Note : Media reports relating to Docotrs and Healthcare have increased and it is not

possible to publish details of all. The author can be contacted if more details are needed.


approval is a must for uterus transplants,

regarded as only a research procedure and

not medical treatment, but the hospital did

not seek permission. Every pregnant woman in the

state can soon avail sonography test at

designated private set-ups for free. The

state government will tie up with private

sonologists and radiologists to render the

vital test to pregnant women for free

irrespective of her financial status.

A low-cost online service run

by Tata Memorial Hospital doctors has

helped 10,799 patients from 22 developing

countries get a second opinion on their

cancer diagnosis and a treatment plan

without visiting the hospital in three years.

A hoarding put up by a

p r i vate h o s p i ta l h i g h l i g ht i n g t h e

controversial "cut practice" in the medicalThe MCI issued thisfraternity has upset the IMA (HQ) so much

statement in response to the query from thethat it wants it removed. The hoarding nearNABL, a constituent of QCI.the airport is the brainchild of cardiac

surgeon, Dr. Ramakanta Panda, who owns

the Asian Heart Institute in Bandra-Kurla

Complex.

Every fifth person who

underwent a test for influenza H1N1since

Jun 19, 2017 : Govt plans to tweak

undergraduate courses

May 30, 2017 : 45 city nursing homes

operating in violation of rules

Jun 08, 2017 : Many are overcharged for

cathetersJun 27, 2017 : Doctors can prescribe

branded medicines with generic ones

Jul 02, 2017 : State plans law to ban

kickbacks to doctors for referring patients

Jun 09, 2017 : India first country to launchJul 04, 2017 : 17% hospitals flout abortion

campaign linking smoking to TBrules, reveals inspection

Jul 04, 2017 : Only qualified doctors can

sign lab reports :

Jul 08, 2017 : Superbugs making

Jun 18, 2017 : Govt panel to check doctors' gonorrhoea difficult to treat

cut practice

Jun 20, 2017 : Free USG test for pregnant

women soon :

Jun 07, 2017 : State allows blood banks to

lend blood to each other

Jun 09, 2017 : Saves cost by cutting out

hospital visit :Jun 28, 2017 : Doctors, nurses seek HC relief

Jul 03, 2017 : 10 ambulances on two wheels

to rush to your help

Jun 14, 2017 : Pull down hoarding onJul 04, 2017 : Doctors may get cadre like

'doctor's cut' :IAS, IPS

Jul 06, 2017 : Ambulance sirens set to get

louder at 120 db

Jul 11, 2017 : 1 in every 5 tested for H1N1

Jun 19, 2017 : Hospitals get cheap labour, virus positive :

societies some moolah


April in the city has tested positive for the

virus.

Mumbai : Eight private hospitals

in Maharashtra reused 1,306 catheters for

more than 1,000 patients after charging

them as much as 77% of the retail price, a

FDA report revealed.

India's national

tuberculosis control programme is denying

'desperate' patients' access to the new drug,

bedaquiline, said a Mumbai doctor in an

article in The Lancet.

The draft rules prohibit

pharma companies from providing any

travel facility, tickets of air, rail, ship or cruise

to any medical practitioner or their

relatives.

The Vedantaa Institute of

Medical Sciences, Palghar, is the 1st medical

college to have registered under the

Companies Act, 2013.

Jul 23, 2017 : State revokes ban on pan

masala

Jul 11, 2017 : Private hospitals reused

catheters :

Jul 24, 2017 : First successful cadaver organ

donation at JJ Hospital

Jul 15, 2017 : Code to ban bribes from

companies in final stages

Jul 27, 2017 : Sex ratio falls, teams set up to

curb gender testing

Jul 17, 2017 : Diabetes is becoming an

epidemic

Jul 28, 2017 : Hepatitis B found in 1% of

blood units donatedJul 19, 2017 : 34 blood banks under ACB

lens

Jul 21, 2017 : State seeks tough law against

cut practice by doctors

Jul 29, 2017 : Most hepatitis patients are

HIV positive

Jul 31, 2017 : Over 2,000 cases filed againstJul 22, 2017 : Antibiotics in poultry making

prenatal sex determinationhumans resistant

Jul 24, 2017 : Uterus transplants pose

extreme risk to donor's life

Jul 26, 2017 : TB policy denies medicine to

those who need it most :Jul 12, 2017 : Hospital blood banks can't

seek replacement donors

Jul 16, 2017 : State doctors who have their

cake and eat it too

Jul 28, 2017 : Drug cures thalassemia

patients of Hepatitis C

Jul 18, 2017 : Read these new rules before

going in for a 'stem cell cure’

Jul 28, 2017 : New pharma ban code not

tight enough :Jul 19, 2017 : Centre appoints 5 doctors on

Oversight Committee

Jul 22, 2017 : State gets its first Pvt Ltd

medical college :

Jul 30, 2017 : New symbol to set allopathic

doctors apart from Ayush practitioners

(Sourced from various agencies)Jul 22, 2017 : Doctors' shortage, expired

medicines a bitter pill for public health [email protected]

Date post:	16-May-2020
Category:	Documents
Upload:	others
View:	7 times
Download:	0 times

Vol. | Issue No. | August · PC-PNDT Act Consumer Protection Act NEET Exit Exam Vol. 46 | Issue No....

Documents