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Thursday, December 29, 2005

TargetPG TNPSC Interview Buster

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"TargetPG TNPSC Interview Buster"

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Contents of the Interview Buster

Preface 9

Purpose of the interview 10

Is TNPSC different from the orals you had in your MBBS 10

How to Prepare 11

Golden Rules 15

The general scheme of the interview 18

Self Introduction 19

Aims and Career Goals 21

General Knowledge Questions 21

Books to read 25

Reference Books 25

Questions from Medical Science 26

FAQ - Frequently asked Questions about the interview 29

Windsor Knot 35

Department of Health, Government of TamilNadu 42

Directorate of Medical Education 43

Medical Colleges 45

Madras Medical College 45

Stanley Medical College (SMC) 46

Kilpauk Medical College 51

Chengalpattu Medical College 51

Thanjavur Medical College 51

Madurai Medical College 52

Coimbatore Medical College 52

Tirunelveli Medical College 52

Mohan Kumaramangalam Medical College (Salem) 53

KAP Viswanatham Medical College (Trichy) 53

Thoothukudi Medical College 53

Kanniyakumari Medical College 53

The King Institute of Preventive Medicine 53

Directorate of Medical and Rural Health Services 55

Department Functioning: 57

Department of Public Health & Preventive Medicine 57

Directorate of Indian Medicine and Homoeopathy 58

Directorate of Family Welfare 59

Indicators and Goals: 59

State Commission on Population: 60

Drug Control Administration 60

1. The Drugs & Cosmetics Act 1940: 61

2. The Drugs Price Control Order 1995: 61

3. Drugs And Magic Remedies (Objectionable Advertisements) Act 1954: 62

4. Narcotic Drugs And Psychotropic Substances Act 1985: 62

Tamil Nadu Medical Services Corporation Limited 62

Organization: 63

Activities: 63

Tamil Nadu State Health Transport Department 64

Tamil Nadu State AIDS Control Society 64

Tamil Nadu State Blindness Control Society 67

Reproductive and Child Health Project 69

RCH priorities: 70

Achievements of RCHP in Tamil Nadu 70

Lessons from RCH Project Phase-I 71



Maternal Health 72

Infant and Child Health 73

Adolescent Health 73

Mainstreaming India Systems of Medicine (ISM) 74

Family Welfare and Population Stabilization 74

Urban Health 75

Behavior Change Communication (BCC) 75

Health Management Information System 75


Danida Assisted Tamil Nadu Area Health Care Project-Phase III 76

1.Introduction 76

2.Organisation and Management: 77

3.Achievements and Progress during Phase III: 77

3.1. Construction activities: 77

3.2 Improving Awareness (IEC): 78

3.3 Improved Technical Knowledge & Skills of Service Providers (Training): 79

3.4 Health Services Mangement: 79

3.5 Improvement of Medical Supplies: 81

Proposed Activities for 2001 and 2002: 81

Programmes under DANIDA 82

1. Danida supported National Leprosy Eradication Programme (DANLEP) 82

2. Danida supported Revised National Tuberculosis Control Programme (RNTCP) 83

3. Danida supported National Blindness Control Program (DANPCB) 83

India 80

President of India 80

Vice President of India 80

Prime Minister of India 80

Council of Ministers 80

Governors and Chief Ministers 84

Lt. Governors & Administrators 87

About Tamil Nadu 88

History 89

1st to 9th centuries 89

9th to 13th centuries 90

14th century 91

17th century 92

20th century 92

Politics 93

Population 95

Culture 96

Economy 97

Textiles 98

Industry & Manufacturing 99

Agriculture 100

Biotechnology 100

Software 102

Businees Process Outsourcing Services 102

Knowledge Process Oursourcing 103

E-Governance 103

Social development 103

Magsaysay Award winner from Tamilnadu 104

Districts 104

History of Tamil Nadu Districts 105

Who's Who About Tamil Nadu 108

Council of Ministers as on 01-01-2006 108

Secretaries to Government of Tamil Nadu as on 01-01-2006 111


Information about all the districts in Tamil Nadu


Industries, Dams etc


Places of Interest

Basic Information about all the medical colleges

Common Questions

Questions you should NOT answer !!!

Doubts asked by the senior batches

Saturday, December 24, 2005

TNPSC Oct 2005 Theory Results

The candidates whose Register Numbers are given below and who have appeared for the Written Examination conducted by the Commission on 16/10/2005 for direct recruitment to the post of ASSISTANT SURGEON (GENERAL/SPECIALITIES) IN THE TAMIL NADU MEDICAL SERVICE 2003 - 2004 have been provisionally admitted to the Oral Test. The Oral Test (Interview) will be held from 18.01.2006 to 08.03.2006 at the Office of the Tamil Nadu Public Service Commission, Omanthoorar Government Estate, Anna Salai, Chennai - 600 002. Individual intimation regarding the date and time of the Oral Test will be sent to the candidates separately

IF THE IMAGES BELOW DO NOT LOAD PROPERLY, due to the extremely high traffic due to a large number of visitors to our site, you can see the images at the following url

TNPSC 2005 Oct 16th - Results of Theory Exams

Friday, December 23, 2005

TNPSC on October 16th 2005

Get the TargetPG TNPSC Book for Rs 175 at 30% Discount You can get the book directly from us if you are in a remote area with no medical book stores. Book will be send by Courier. Courier Charges Rs 25 for any place within Tamil Nadu and Pondicherry. Total Rs 200
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TargetPG TNPSC 1995-2003 Assistant Asst Surgeon Recruitment Exam Original Question Paper Solved Answers with Explanations by Dr.Bruno - Kalam Books

Highlights of this book

Original Question Papers from 1995 to 2003

2120 Original Questions

Answers Extensively Referenced from Standard Textbooks.

Detailed Explanation for Each Answer.

Questions with more than one answer (or no answer) are pointed

Relevant Diagrams and Tables

Other possible points in the topic that have been asked and can
be asked are explained.

High Yield Topics are enumerated

Comments, Tips and Mnemonics for solving.

Notes on Preparation and Strategy Management.

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Saturday, December 3, 2005

Entrance Examination (PGM-CET 2006)

No.DMER/PGM-CET 2006/Notification No.1/2-A, Date : 1/12/2005


Entrance Examination (PGM-CET 2006) for Admission to Medical Postgraduate Courses (MD/MS/Diploma)

Entrance Examination (PGM-CET 2006) for Medical Postgraduate Courses ( MD/MS/Diploma) will be held on Sunday, 29th January, 2006 from 10.00 a. m. to 1.30 p. m.

The cost of application form alongwith the Information Brochure of PGM-CET 2006 and Examination fee is Rs. 1800/- to be payable by Demand Draft / Pay Order drawn on any Scheduled commercial Bank in favour of " Director, Medical Education and Research, Mumbai" payable at Mumbai. The Application Form and Brochure will be available at the following Government Medical Colleges from 5/12/2005 to 22/12/2005. Application forms duly filled in alongwith attested photocopies of required certificates can be submitted from 5/12/2005 to 23/12/2005 at any of the following Government Medical Colleges. The application form should not be sent by post/Courier, such forms will be rejected without giving any intimation/reply.


Grant Medical College, Byculla, Mumbai


B.J. Medical College, Pune


Shri Bhausaheb Hire Govt. Medical College, Dhule


Dr. V.M. Medical College, Solapur


Government Medical College, Miraj


R.C.S.M. Government Medical College, Kolhapur


Government Medical College, Aurangabad


Government Medical College, Nanded


Swami Ramanand Teerth Rural Medical College, Ambajogai


Government Medical College, Nagpur


Shri Vasantrao Naik Govt. Medical College, Yavatmal

Eligibility Criteria

1) A candidate must be an Indian National.

2) A candidate who has passed final MBBS degree examination from a recognised medical college situated in Maharashtra, affiliated to Non-Agricultural Universities or to the Maharashtra University of Health Sciences, Nashik and who has obtained full registration either from the Medical Council of India or from the Maharashtra Medical Council after completing one year internship training, will be eligible for PGM-CET 2006. The Inservice candidates working on the establishment of Directorate of Health Services, Directorate of ESIS and Brihanmumbai Municipal Corporation will be eligible to apply as per the eligibility criteria prescribed by the concerned establishments.

3) A candidate who is undergoing one year internship training and is likely to complete the same by 31st March, 2006 also will be eligible for PGM-CET 2006.

4) A candidate who is domicile of Maharashtra and who got admission under 15% quota of All India Entrance Examination for MBBS and who has obtained the MBBS degree from the University situated outside the state of Maharashtra and has obtained full registration either from Medical Council of India, New Delhi or from the concerned State Medical Council will also be eligible for PGM-CET 2006.

5) For more details regarding eligibility and other rules, please log on to website and refer to the PGM-CET-2006 information Brochure.

(Dr. W. B. Tayade)

Competent Authority & Director,

Medical Education & Research, Mumbai

Tuesday, November 29, 2005

Realities of a Educational Loans

Are you planning to take an Educational Loan. Please read this before you do so.
This is what applies the Medical field
But the worst off would be medical students. Given that they earn paltry sums until they complete their MDs, it makes sense to take a loan only if your dad owns a nursing home or is willing to shoulder your EMI burden for several years to come!

Little correction. They earn paltry even AFTER MD. Hope you know that the payment for MD graduates which Tamil Nadu Goverment now offers is Rs 10000. (Rs 8000 for MBBS and Rs 9000 for Diploma)

TNPSC 2005 - FAQ

1) For a candidate getting appointment in Service this time, will he be able to write TNPGMEE this time.
YES. There is no problem. It is your choice
2) What will be the first month salary for one who joins the forthcoming service. Whether Rs.8000 or Rs.13,500
The basic is 8000. With this you have DA and other allowances which will come around 14000. The exact amount will vary depending on the HRA and other minor differences from area to area
3) How much will it increase in one year (Increment)
The Increment for Basic is Rs 275. So you will get about Rs 400 to 450 rise per year
4) Period after which one is eligible to write Tamilnadu entrance. Whether 2 or 3 years
Please see See below "landmark judgments on that site
5) How much will be the stipend for a Service PG for master degree. (MD/MS)
Pay and DA. That will come around Rs 13000 by the time you are eligible for
6) How much will he be paid after finishing PG while in service
You will complete PG probably in 2012. By that time, you are eligible for 6 regular increments. One increment for is added for PG. So totally you have 7 increments. Now, your increment per year is about Rs 400. So that will come around Rs 3000. You will be getting Rs 17000 if you finish PG and Rs 16400 if you have not finished.

In addition your take home pay will be less by Some 2000 to 3000 (depends on how much you pay for Insurance, PF and Tax)


For more FAQs, please see

1. If I take a pg seat in tamil nadu in All India counselling, and not joining in the college, instead joining in service, what will happen? Please explain with regard to remaining fees, rules for writing the exam again and about TN exam

If you take a seat and DO NOT JOIN, then there is NO PROBLEM
If you join and leave, then that is called as DISCONTINUING the course

The candidates (including the candidates selected under the All India Quota) who discontinue the course on or before 25-5-2006 shall pay the sum as specified below by way of Demand Draft taken in favour of the Secretary, Selection Committee, Kilpauk, Chennai –10 payable at Chennai to the Deans of the respective Colleges.
  • For P.G. Diploma Courses Rs.20,000/-
  • For P.G. Degree / Five Year M.Ch. (Neuro-Surgery) Courses Rs.30,000/-
  • For MDS Course Rs.30,000/-

The Candidates (including the candidates selected under All India Quota) who discontinue the course on or after 25-5-2006 shall pay to the Deans of the respective Colleges the sum as specified below by way of Demand Draft taken in favour of the Secretary, Selection Committee, Kilpauk, Chennai- 10 payable at Chennai.
  • For P.G. Diploma Courses Rs.30,000/-
  • For P.G. Degree / Five Year M.Ch. (Neuro- Surgery) Courses Rs.60,000/-
  • For MDS Course Rs.60,000/-

The candidates who have joined Post Graduate Degree / Diploma / 5 years M.Ch Neuro-Surgery / MDS courses in any discipline and discontinued the courses on any grounds and if the discontinuance has resulted in a seat being wasted, they are eligible to apply only after a period of 2 years from the date of discontinuance of the course. If the candidate’s discontinuance does not result in a seat being wasted, he can apply for the next selection for which he/she is eligible.

2. After how many years can the batch which is going to be recruited, write the tamil nadu pg? Your batch Balamurugan sir said it is 2 yrs. Is it true?

Please see See below "Landmark judgments" on that site

3. What will be the probable date of result for service exam?

April 2nd week

4. What will be the probable date of counselling for service ? Will there be atleast one week between result and counselling?

May 2nd Week (depends upon the election)

5. I heard that the DA is increased from 50% to 70%. So my friends are telling that the starting pay will be aroung Rs.16,000. Is it true?

Close to that

Monday, November 21, 2005

A piece of advice for aspirants of TNPG

Please don't "over think" in Tamil Nadu PG........
Tamil Nadu PG (as well as TNPSC) Questions are from the same question bank that is followed for the MCQ Part of your theory exams by MGR Medical University. Eventually the level of the questions will be from I MBBS to III MBBS.

It is this reason why you have question like "Hypokalemia is " and the "nerve injured in Fracture Neck of Humerus is " Though these questions are cakewalk for you, they are apt question for the I MBBS Students.....

It is for the same reason that you get questions like a wave in JVP and Rowsing's sign (Final MBBS)

The most unfortunate aspect of this question bank is that of late they have introduced MCQs in MD and MS Exams also.... some times question from that Question Bank (PG level ) enter into the TNPG or TNPSC question paper and every one (except those with a diploma in that speciality) is in for trouble

So the best way is to Read the question carefully and clearly.... think once.... think once only (and if you don’t know, skip the question and proceed to the next) and mark the answer

Using your logic and abstract thinking where it is not warranted will land you in trouble

All the best

Wednesday, November 16, 2005

Hallucinations... Please don't be under an Illusion !!!!

Question from AIPG(All India PG) 2003 and the related discussion

105. All of the following are features of hallucinations, except:

1.It is independent of the will of the observer.
2.Sensory organs are not involved.
3.It is a vivid as that in a true sense perception.
4. It occurs in the absence of perceptual stimulus.

Ans. 2
Sensory ORGANS are NOT involved in Hallucination... Only SENSATIONS are involved.......... and only those hallucinations occuring in Delirium Tremens are as vivid as in true perception

Hence the answer can be only 3


my dear bruno its the choice 4 which is true in this regard AS THERE IS ALWAYS A FALSE SENSORY PERCEPTION IN HALLUCINATION

When You see scooter and think it as a Truck it is Illusion..............
Only when u see a truck WITHOUT there being a Scooter.. It is hallucination

Only when you hear drums without there being a bells is Hallucination

Coming to text book example

When you see a snake when there is a rope, it is Illusion
When you see a snake without there being a snake it is hallucination


Sad When u see ur roll number against Rank one in the merit list of all india
entrance, Wink Is It illusion Twisted Evil or hallucination Wink

I think...then, Wink its time to wake up!! Idea

When you get some rank.............. your roll number is in the result....... but you see it as rank 1...... it is Illusion

If you see your number as rank 1 even without writing the exam..... it is Hallucination

If it is time to wake up, it is hypnopompic !!
If it is time to go to sleep, it is hypnogogic !!

IN this question we have to SPOT A WRONG STATEMENT. Lets consider each options one by one.
1. This is a TRUE statement as hallucination are independent of observers will, basic part of defination.

2. This is a FALSE statement,SENSORY ORGANS ARE INVOLVED,not structurally but in functionaly(Ref Kaplan and Saddock's Comprehensive Text-book of Psychiatry,pg-810)Hallucination is a false SENSORY perception even in abscence of any perceptual stimulus.Had the sensory organ not been involved we couldnot have been able to type them in to auditory, visual , tactile and etc. types.NOTE THAT THE SENSORY ORGANS ARE NOT STRUCTUALLY INVOLVED BUT THEY ARE DEFINATELY INVOLVED IN A FUNCTIONAL MANNER.
Say for example, for an hallucination to be AUDITORY, observer must be aware that EARS are involved in hearing (true or imaginary), and when person tells that he/she can hear voices in EAR even in absence of any real voice, we term it as AUDITORY hallucination.So for hallucination to be auditory the person must hear them in his/her EARS. so only functional involvement and not structural.
Any perceptions that occur without involvement of sensations are termed as Extra-Sensorial Perceptions(ESP).

3.This is a TRUE statement as they can be vivd as true sense perception.For example person having auditory hallucination can tell very minute details with full description of what he seems to hear from voice, which is comparable to true sense perception.

4. This is a TRUE staement as they occur in abscence of any perceptual stimulus, a basic part of defination.

SO it is obvious that only 2 is a false statement. Hence 2 should be the answer.

quoting the prevoius post ..........they can be vivd as true sense perception.For example person having auditory hallucination can tell very minute details with full description of what he seems to hear from voice, which is comparable to true sense perception.

Thats the problem... only certain hallucinations are as vivid as in true perception........

And sensory organs are involved functionally....... that means the sensations are involved in the absence of a stimulus.......... this definiton of sensory organs is for Illusion where there is a stimulus and sensory organs are involved

Sir,what you want to tell is actually a part of EXTRA SENSORIAL PERCEPTION . If sensory organs are not involved,DO YOU MEAN TO SAY THAT A BLIND PERSON CAN ALSO EXPERIENCE VISUAL HALLUCINATIONS??
I dont agree with you, as you can get it confirmed from any of the psychiatrist close to you.

You can have hallucinations with your eyes closed........... but it is the illusion which needs your eyes............... Sensory organs are not needed for hallucination... only SENSATIONS are involved........... Just tell me whether you understand the difference between sensory organs and sensations or according to you both are same

Sir, there is no meaning of perception of sensations without any sensory organs, even though both dont mean to be same.
And a person can experience a VISUAL hallucination with CLOSED eyes,but NOT if the person is BLIND(congenital or acquired), which clearly indicates that sensory organs(here eyes in visual hallucinations) are involved in perception of hallucination(a false perception)in a functional manner of perception (EITHER TRUE OR FALSE)only without any structural or physiological changes.
THIS is a very clear fact to undrstand.Is not it??

I agree and understand that Visual cortex is involved in hallucination............ Thats clear to me.... but i am not understanding that eyes are involved............

Or let me ask you a question....... are impulses transmitted in optic nerve when a person is experiencing visual hallucination ?

Impulses are transmitted during illusion.... for example the eye sees and the optic nerve transmits a image of rope... and the brain interprets it as snake ......

Sir, I understand that there is no transmission of impulses through optic nerve(suggesting that no physiological changes occurs in reality)in visual hallucination.
But EYES(IN VISUAL HALLUCINATION) ARE INVOLVED FUNCTIONALLY FOR THE PERCEPTION OF HALLUCINATION.AND SINCE HALLUCINATION IS A FALSE PERCEPTION THERE OCCURS NO ASSOCIATED REAL PHYSIOLOGICAL CHANGES IN EYES.And as I had already mentioned in my previous post that a blind cannot perceive visual hallucination, suggesting eyes are involed merely for the function of perception, either true(where physiological changes do occur as in illusion)or false(as in hallucination where no actual physiological changes occurs).
The point lies in the fact that eyes (or any other sensory organ) are required by the observer for perception of visual(or any other sensory type) sensory organs are involved for functional perception without any true physiological changes in the sensory organs.

I hope this is the best possible way to explain the fact

Dear Dr. Bruno,

The hallucination examples are really great....

I enjoyed them a lot.


Sir, I understand that there is no transmission of impulses through optic nerve(suggesting that no physiological changes occurs in reality)in visual hallucination. Thats why we say that eyes are not involved........ visual cortex alone is involed in optic illusion..........



And as I had already mentioned in my previous post that a blind cannot perceive visual hallucination, Which book says so ?? Rolling Eyes May be persons who are congenitally blind may not experience visual hallucinations because thier cortex is not developed suggesting eyes are involed merely for the function of perception, either true(where physiological changes do occur as in illusion) Correct
or false(as in hallucination where no actual physiological changes occurs). No dear......... in this case eyes are not involved.... the cortex perceives images without there being a signal from eyes

The point lies in the fact that eyes (or any other sensory organ) are required by the observer for perception of visual(or any other sensory type) hallucination. No not needed, Hallucinations are the sensations which the observer perceives without the sense organs so sensory organs are involved organs are not involved.. the corresponding regions in the brain are involved for functional perception without any true physiological changes in the sensory organs. correct How are eyes involved without there being a physiological change........ obviously you know the fact.......but you are still confused between the difference between eyes and vision.......

I hope this is the best possible way to explain the fact Me too

Hi Bruno,
Is VISUAL CORTEX in Brain a sensory organ or not Question

Visual Cortex in Brain is not a sense organ...........................

In fact one book quotes brain as "senseless" because it has no sensory receptors....... and so we never experience pain when brian is handled

But another book says that brain is not "absolutely senseless" as Retina is said to an extension of brain..............

But Visual Cortex or for that matter any cortex is not a sense organ

Hi again,

If u r saying in HALLUCINATIONS sensory organ involvement is not there,then tell me WHY DO STRUCTURAL DISEASES OF SOME SENSORY ORGANS & CONDUCTING MECHANISM CONTRIBUTE TO THE FORMATION OF HALLUCINATIONS,eg. otitis media often may be associated with tinnitus or an irritative lesion of the visual cortex may produce hallucinoses or temporal lobe damage may show as auditory hallucinations. ALSO, HOW CAN A COCAINE ADDICT ABLE TO LOCALISE THE COCAINE BUGS OR TACTILE HALLUCINATIONS OEVR HIS BODY Question

Do reply back.

Otitis Media / Meniers with Tinnitus... This is not hallucination... In this case, there is transmission of some signals through the nerves!!!!!!! and the brain interprets this as sound and the SENSE ORGAN IS INVOLVED........Only if there is a tinnitus with NO ear pathology (or physiology), it is hallucination

Cocaine bugs...... the patient is able to localise, and there are no bugs........... Again there sense receptors in skin are normal.... there is no transmission in the peripheral nerves........ but the brain assumes that there is a sensory impulse from skin............. This is exactly the definition of hallucination........ Perception without stimulus..... and the perception can be localised too ....... you can see a lion on your right side or you can see a zebra on your left side, just one feet in front of you or 100 feet away when there is nothing in front

Go back to the previous examples

When You see scooter and think it as a Truck it is Illusion..............
Only when u see a truck WITHOUT there being a Scooter.. It is hallucination

Only when you hear drums without there being a bells is Hallucination

Coming to text book example

When you see a snake when there is a rope, it is Illusion
When you see a snake without there being a snake it is hallucination

Also seeing rank 1 against ur name without writing the exam is called as dreaming or extra sensory perception AND NOT HALLUCINATION. WAKE UP MATE.

It is given in all pharmacological books , No changes occurs in the cases I quoted.... If there is a change in the receptors and when the receptors are involved, we call them as Illusion!!!!

You are still confusing between Hallucination and Illusion !!!!

Can you give your definition of ILLUSION


Tinnitus is a sensation of noise caused by abnormal excitation of auditory apparatus, or its afferent pathways or the cortical area.

Tinnitus from Stedman

Tinnitus Aurium :
Sensation of sound in one or both ears associated with disease in the middle ear, inner ear or the central auditory apparatus

Tinnitus Cerebri :
Subjective sensation of noise in head rather than in ears

Only the latter type comes under hallucination........ and as Stedman says( not me ,Stedman) "heard in head" without involvement of ears.......... This is a typical Hallucination...... Appreciation of a sense without the involvemnt of the sense organ..........

When we appreciate something with the involvement of the sense organs, but there is misperception, we use the terminology ILLUSION

Do TINNITUS CEREBRI & TINNITUS AURIUM differ qualitatively ??? I mean to say whether a pt. can differentiate b/w. the two qualitatively ???

A patient cannot differentiate between the yellow discolouration caused due to hemolysis and the yellow discolouration due to Ca Pancreas !!!!

I just wanna know whether the two types of sensations (regarding tinnitus aurium & cerebri) different ? This is in context to the choice no.3 of the AIPGE question.

he question in AIPG 2003 doesnot ask whether the two sensations are different or not..........

The question was to find the wrong statement regarding hallucinations

The choice 2 given was "Sensory Organs are not involved"

But the fact is that in Hallucinations sensory organs are not involved and sensory organs are involved only in illusion

So Choice 2 is correct and we all know that choice 1 and 4 are also correct.... Hence the answer is Choice 3 which is wrong

Hi Bruno, Smile

I agree with u in all the points. Infact there was never any doubt in my mind about illusion,hallucination,delusion & dreaming (AIPGE rank 1 example). Smile
But the problem here is that even choice 3 is correct because as u urself indicated that true sensory perceptions & hallucinations cannot be differentiated clinically, implying that HALLUCINATIONS ARE AS VIVID AS TRUE SENSE PERCEPTIONS ( eg., as in the case of tinnitus cerebri & tinnitus aurium where qualitatively both of them could not be differentiated neither by the pt. nor the clinician ). No Doubt that it isn't true all the times but happens most of the times

Text books say that of all hallucinations, only the hallucinations occuring in alcoholics are as clear as in normal perceptions..... Others are not as clear !!!!!!!!!!!!

So that point is not true for all hallucinations in general

Hi mate !
Infact all the conditions under ORGANIC HALLUCINOSIS are as vivid, complex & well organised as in true sense perception.
The causes include : Hallucinogenic drugs( LSD, Psilocybin,mescaline,cocaine,cannabis,phencyclidine,so on & so forth...);
Alcohol ; Sensory deprivation ; Release hallucinations ; Migraine ; Epilepsy ; ICSOL ; Temporal arteritis ; Brain stem lesions(Peduncular hallucinosis).
What do u say

Though there is a big list of causes of organic hallucinations, please note that event though there is a big list for the incidence may not be big too........... (like secondary hypertension, for which we again have a big list of conditions like phaeochromocytoma, Cushing, THyroid Storm, Coarctaion etc but the incidence of primary hypertension is still great)

Any how, About the point that all ORAGANIC HALLUCNIATIONS are as clear and as vicid.............Reference Please !!!!!!!!!!!!!

Ahuja says that in Delirium tremens the hallucination are as clear as normal perception

Go thru ORGANIC HALLUCINOSIS in neeraj ahuja.
Also DELIRIUM TREMENS is not as uncommon as Secondary hypertension. Its much more commoner phenomenon.
Moreover its not the question about incidence of organic hallucinations but about whether the particular phenomenon is a part of a syndrome or not.

You might know that Hallucinations can be classified according to

1. Etiology
a. Organic
b. Non-organic/functional

2.Sensation affected
a. Visual
b. Auditory
c. Gustatory
d. Smell
e. Tactile

Types of Hallucination

a. Visual --> only this is as clear and vivid as normal........... This is an exception; not a rule
b. Auditory
c. Gustatory
d. Smell
e. Tactile
a. Visual
b. Auditory
c. Gustatory
d. Smell
e. Tactile

Now you can find that all the conditions listed under your list form a small part...... in fact in Schizo we have auditory hallucinations and in Temporal lobe epilepsy we have hallucinations of smell........ They are not as clear and as vivid as in normal perception

Hallucinations are as vivid and clear as in normal perception.... This is a wrong statement

A type of Hallucination (as an exception) is as vivid and clear as in normal perception... This only is a true statement

Please refer the question in AIPG 2003

Friday, November 11, 2005

About Court Case in Karnataka

PG Aspirants: Fight for our righte - Merit Vs Might: "Post Graduate Aspirants Group: Karnataka State Junior Doctors' Association (KSJDA)

Wednesday, November 9, 2005

Ethical dilemmas.

Ethical dilemmas.

From Journal of Post Graduate Medicine

Pandya SK
Department of Neurosurgery, Seth GS Medical College, Parel, Bombay.

Correspondence Address:
Department of Neurosurgery, Seth GS Medical College, Parel, Bombay.

How to cite this article:
Pandya SK. Ethical dilemmas. J Postgrad Med 1997;43:1-3

How to cite this URL:
Pandya SK. Ethical dilemmas. J Postgrad Med [serial online] 1997 [cited 2005 Nov 9];43:1-3. Available from:;year=1997;volume=43;issue=1;spage=1;epage=3;aulast=Pandya

:: Introduction Top

Dilemma: difficulty, impasse, perplexity, predicament, quandary.
All medical doctors face situations from time to time, where the proper course of action is not clear. We are tempted, then, to paraphase Hamlet: “To do, or not to do - that is the question ...”

Take the case of a patient with confirmed malignant cancer of the breast whose chest x-ray film shows a rounded metastatic deposit. She now presents with a history of a recent focal epileptic fit but without any neurological abnormality on examination. Computerised tomographic scan shows what is most probably a metastasis in the left parietal lobe over the motor strip. Are we justified in advising excision of the tumour, knowing that it might leave her hemiplegic and when her general prognosis as regards long-term survival is grim?
Under such circumstances, how do we arrive at a decision? What do we navigate by?

:: Guiding principles Top

Four fundamental ethical principles have received universal acceptance by medical professionals:
* non-maleficence - ‘primum, non nocere’: first of all, do no harm
* beneficence - whatever we do must be for the benefit of the patient;
* respect for autonomy - the patient has an absolute right to make decisions concerning his own well-being, on any test or therapy proposed for him and on measures for resuscitation, prolonged maintenance on a ventilator and other such events.
In order to make such decisions, the patient - and family - need to be adequately informed on the pros and cons of each step. It is the communication of such details, in a manner that is clearly understood, that forms the basis of informed consent.
Justice as with reference to fair distribution of scarce resources; respect for the rights of the patient and family in the context of the rights of society at large; the use of the least expensive means in investigation and therapy; and respect for morally acceptable laws. It also implies the overcoming of personal prejudices - as against homosexuals or chronic alcoholics.
Thoughtful application of these principles to specific instances often helps resolve dilemmas.

:: Some common ethical dilemmas Top

Let us take examples from either end of the spectrum of life.
The treatment of infertility:
In a country where untold numbers of orphaned or discarded infants and children languish in unfeeling institutions where they are denied the attentions of parents and the company of siblings, is it fair for us to embark on such expensive techniques as in vitro fertilization?
On the other hand we have the plea of the barren wife who is willing to sacrifice almost everything to achieve the status of mother.
Possible resolution of dilemma:
Since it is the mother who comes to the doctor seeking treatment and since she has the right to decide on what should be done to and for her, the position of the orphaned children should not be allowed to intrude on the management of her problem.
Those in favour point to the legal sanction afforded to the termination of the life of the unborn foetus. Some have gone so far as to say that this is a welcome means for controlling our mushrooming population. Others have used it to get rid of female foetuses in their quest for the male child.
Many, however, remain troubled. Is this law morally acceptable? Are we ever justified in snuffing out life?
Possible resolution of dilemma:
This will depend on the beliefs and values cherished by the individual doctor. The doctor who holds life, as a sacred boon granted to an individual must refuse to perform or advice an abortion except in the specific instance where continuation of pregnancy may kill the mother. (Here, the operative principle is that the life of the mother is of greater concern than the life of the unborn foetus.)
Must we always strive to keep every baby alive, irrespective of costs?
Take two examples:
A premature newborn weighing 600 grams. Left to itself, it will perish. We can make extraordinary attempts to help it survive. In the process we may lead to a situation where the family is saddled with a severely handicapped individual with poor mental abilities.
A baby is born with meningomyelocele, paraplegia, incontinence of urine and severe hydrocephalus. A light applied to the head shows brilliant transillumination of the intracranial contents suggesting a paper-thin brain. It is possible to repair the skin over the exposed and damaged spinal cord and insert a shunt to drain the accumulated cerebrospinal fluid into the peritoneum. Survival is now assured but the family will bear the burden of looking after a mindless person who unknowingly passes urine and stools reflexly and will never understand, appreciate or communicate.
Possible resolution of dilemma:
The doctor must place the pros and cons of treatment in either instance before the parents. The doctor sympathetic to the social milieu in which the family exists and of the precarious economic circumstances of a particular family will emphasize the liabilities to the parents should treatment be preferred. I have, at times, gone a step further and told the parents that were the child in question mine, I would have decided against treatment.
If it is decided not to treat, should the patient’s life be terminated by a fatal dose of a drug? Some advocate stopping all feeds and supplying only water to take away thirst. The logic offered is that by this means we are not taking away life but allowing nature to take its own course. Is starvation to death not more cruel than instant death?
Possible resolution of dilemma:
Here, as often is the case with ethical dilemmas, the individual doctor’s conscience must dictate the course of action. Such a decision, however, must take into account the fact that the law of the land does not permit any doctor to kill the patient by any act of commission.
Admission to an intensive care unit:
The intensive care unit is already full of seriously ill patients, each of whom needs the special attention afforded in it. A fresh patient is brought to the clinic who also needs this specialized care. There is no other nearby centre that can take him. What is to be done?
Do we continue to treat existing patients and place this patient in a room or ward without special facilities for monitoring and treatment and, in the process, lose this patient? Do we shift the ‘least seriously ill patient’ out of the unit to make way for the new arrival and, in doing so, jeopardize the life of someone who may be on the way to recovery?
What if the new arrival is a ‘V.I.P.’?
A similar dilemma is posed when one has to select which of two patients is to be provided the only available ventilator.
Possible resolution of dilemma:
A new patient presenting to a clinic or hospital has not yet established the doctor-patient relationship with the consultant. Existing patients in the intensive care unit are already under his treatment and he is responsible for their welfare. His primary concern, then, must be for patients already in the unit. If, however, there if definite evidence that one of them can, without any risk, moved out of the intensive care unit to the half-way house of the semi-intensive care ward, such a transfer can be affected so as to take in the new patient.
Demand for euthanasia by a terminally ill patient in unremitting agony:
A patient with widespread cancer is in severe agony, which persists despite use of the maximal therapeutic doses of powerful drugs such as morphine. He begs to be relieved of pain and asks for the use of much larger doses, knowing that such doses will be fatal. Should one oblige?
Possible resolution of dilemma:
Here, as often is the case with ethical dilemmas, the individual doctor’s conscience must dictate the course of action. Such a decision, however, must take into account the fact that the law of the land does not permit any doctor to kill the patient by any act of commission.
Shutting off the ventilator:
The law, as it stands, does not allow one to take a brain-dead patient off the ventilator unless this patient is a donor of an organ such as the heart. What about the patient who is not suitable to offer an organ but whose relatives can no more afford the cost of an intensive care unit?
Should we insist on following the letter of the law so that we are not subject to prosecution under the Consumer Protection Act or the Indian Penal Code?
Possible resolution of dilemma:
The law, in this instance, is faulty. It is illogical to permit removal of the heart, lungs, kidneys, pancreas and other organs for transplantation into another patient and not allow switching off the ventilator. Senior lawyers consulted by us inform us that judges would, in all probability, rule in favour of the doctor, provided the procedure for the diagnosis of brain death before switching off the ventilator was foolproof.

:: Some personal guidelines Top

I have found the following additional guidelines useful. I pass them on for your consideration.
* The golden rule: Do unto others, as you would have others to do unto you. I have often found it helpful to ask myself, “Were I the patient, what course of action would I have wished the doctor to follow?”
* The patient comes first. The raison d’etre of our profession is the patient. We are here to serve him. The sick patient, often in physical pain and always in mental distress, deserves our fullest attention and calls for the best qualities of our mind and heart. His interests and decisions must prevail above all else except when the patient is non compos mentis. In the latter instance, the decisions of his family must prevail.
* The poor patient deserves special consideration He has nowhere else to go. He does not possess the means to command or demand. In our milieu he is often reduced to seeking help with bowed head and hands folded together. And he is ill. Medically malpractice against this group is particularly abhorrent.
* Ensure that your decisions and actions are scientific, humane, effective and in the best interests of the patient and his family. Record them. Once this is done, you need fear no individual, administrator or tribunal.

Ayurveda Drugs - Danger to Life - Poison which kills

The flip side of Ayurveda.

Thatte UM, Rege NN, Phatak SD, Dahanukar SA
Dept. of Pharmacology, Seth GS Medical College & KEM Hospital, Parel, Bombay, Maharashtra.

From Journal of Post Graduate Medicine

Correspondence Address:
Dept. of Pharmacology, Seth GS Medical College & KEM Hospital, Parel, Bombay, Maharashtra.

How to cite this article:
Thatte UM, Rege NN, Phatak SD, Dahanukar SA. The flip side of Ayurveda. J Postgrad Med 1993;39:179-82,182a

How to cite this URL:
Thatte UM, Rege NN, Phatak SD, Dahanukar SA. The flip side of Ayurveda. J Postgrad Med [serial online] 1993 [cited 2005 Nov 9];39:179-82,182a. Available from:;year=1993;volume=39;issue=4;spage=179;epage=82,182a;aulast=Thatte

"A 62 year old male patient was brought to the casualty in an unconscious state. A detailed history from relatives revealed that he was a known diabetic whose hyperglycemia was well controlled with insulin and glibenclamide. Five days earlier he had started an ayurvedic drug for psoriasis. He developed giddiness following ingestion of the drug, but ignored it. Subsequently, he became unconscious. He was diagnosed to be in hypoglycemic coma to which he ultimately succumbed."
While investigating the causes for such sudden hypoglycemia, the attending physician would naturally question, "Could the ayurvedic drug be responsible for the hypoglycemia?". This case was referred to the Adverse Reactions (Ayurvedic drugs) Monitoring Cell of the Ayurveda Research Centre of King Edward Memorial Hospital. On scanning available ayurvedic literature, no reference could be found describing metabolic actions of any of the constituents of this medication. Subsequent animal studies revealed, however, that in occasional mice a significant hypoglycemia occurred, reiterating the fact that the adverse interaction in the patient could have been due to the inadvertent co-administration of the ayurvedic agent and powerful hypoglycemic agents.
This case dramatically illustrates the sequel of self-administering 'ayurvedie' drugs and emphasises the fact that there is indeed a flip side to Ayurveda. We present in this brief article, the other side of Ayurveda.
A question that will arise at the outset is why read about adverse effects of ayurvedic drugs (let alone their uses or benefits) if we do not practice Ayurveda? The answer to this question is simple: over 80% of our population takes ayurvedic medicines - either self-prescribed or through a ‘Vaidya’. These same patients expect to be treated by our medicines while simultaneously taking ayurvedic medicines often leading to interactions of the type described above.
Another point to note is that a large number of herbal preparations are in the market under the label 1 ayurvedic Drugs'. Due to aggressive salesmanship and over-the-counter (OTC) availability, these drugs are prescribed by doctors and consumed by patients widely.
Hence, it is obvious, that at least in our country, we have to be aware of salient beneficial and adverse effects of commonly used ayurvedic drugs as much as of allopathic agents.
Ayurvedic drugs that one is likely to encounter in practice can be discussed under two broad categories: a) the traditional formulations including for example kadhas (decoctions), arishthas (decoctions containing alcohol) or gutis (pills) and b) the so called ayurvedic formulations which are a combination of different herbal extracts (sometimes aqueous, sometimes alcoholic). These plants are prescribed individually or together for a particular condition in ayurvedic texts. However, their fixed dose combination, as marketed, may not be mentioned therein. These herbal medicines are prescribed for a wide variety of non-specific conditions like improving vitality, anti-stress effects, boosting immunity and increasing appetite or memory!
Since, in this article we are discussing adverse reactions, we shall for the moment assume efficacy of these herbal preparations. It is an old adage of pharmacology that teaches us that if a drug is effective it is most likely to produce a side effect [1].
In fact, standard text-books of Ayurveda mention that ayurvedic drugs, if improperly used can be toxic. Charaka[2] states in the Sutrasthana of the Charaka Sarnhita - "A potent poison also becomes the best drug on proper administration. On the contrary, even the best drug becomes a potent poison if used badly".
Ayurvedic texts classify toxic plants (See into different categories depending on the part of the plant that is toxic. Subsequent research has revealed the exact chemical nature of the toxic alkaloid validating the knowledge laid down in ayurvedic texts.

In fact, in Ayurveda, there is a separate science which deals with toxicological aspects and is known as Vishagarvajrodhika tantra' (toxicology)[3].
There are enough grounds to conjecture that some knowledge regarding toxicity of plants was obtained through observation of behaviour of insects and animals towards these plants. Plants, which were never infested with insects, were considered dangerous: these were later shown to contain repellants like anthraquinone, naphthalene or nimbidine. Plants like vinca or nerium from which animals steer clear have later been shown to contain toxic materials. Aconitum does not allow any other plant in its vicinity! An interesting feature about ancient ayurvedic physicians worth noting, and perhaps emulating, is their ability to improvise on information they had, using whatever facilities were at hand. Thus, for example, when the physicians discovered that a particular plant was visciously toxic and perhaps fatal, they evolved ways by which the toxic components could be destroyed and converted them not only to safe but further therapeutically useful entities! The story of Aconitum heterophyllum is illustrative in this respect. The roots of this plant are considered toxic (they contain an alkaloid aconitine) and following ingestion of roots, the toxicity manifests in the form of tingling numbness of mouth and throat, abdominal pain, loss of muscle power, visual and auditory disturbances and finally clonic convulsions [4]. However, aconite forms an important constituent of ayurvedic formulations. The aconite used in the formulations is not a crude agent but one, which is processed. This processing involves boiling of roots with 2 parts of cow's urine (7 hours per day) for 2 consecutive days. The roots are then thoroughly washed with water and boiled with 2 parts of cow's milk for the same duration. These are washed again with lukewarm water, cut into pieces, dried and ground. It has been shown that aconite becomes safe only after this elaborate process and all the steps are 6 essential for complete detoxification[6],[7].
Besides toxicology, ayurvedic pharmacology describes in some detail the side effects that can occur with different therapeutically useful drugs. Further, it also describes ways (which also include manufacturing techniques) to minimise these side effects. Just like we, for example, would advise that NSAIDs should not be taken on an empty stomach, Ayurveda gives instructions regarding time of drug administration, the relationship with food, type of food which should be avoided/permitted with the drug etc. The do's and don'ts are clearly enunciated. For example, amalki (amla, Emblica officinalis) should be avoided at bedtime to prevent harmful effects on teeth [8]. Chyavanprash contains large quantities of Amla - one wonders whether the package insert with any Chyavanprash mentions this precaution! Similarly, pippali (Piper longum) used in asthma should be avoided in patients with peptic ulcer disease and should be consumed with milk [9].
Tribhuvankirti is a combination of several plants which is very commonly used to treat a "cold in the head" and fever. There are clear instructions in Ayurveda that because it contains aconite [Table - 1] it should be used cautiously. When used, it should be taken with tulsi (holy basil) juice, ginger juice or honey[8].
Guggul is derived from the resin of Commiphora mukul [11] and is used in a variety of diseases including hypercholestrolemia (in fact gugglulip has been introduced into the market for this condition) and arthritis[12]. Ayurveda specifies that guggul should be used cautiously in patients with peptic ulcer disease. While on guggul therapy the patient is advised to avoid sour food, alcohol and heavy exercise[13],[14].
The subject of teratogenecity also figures in Ayurveda. Thus, certain plants like Terminalia hebula (harda) are to be avoided in pregnancy. This is a constituent of a large number of OTC preparations. It is a powerful purgative and is supposed to stimulate GI motility and would therefore be contraindicated in pregnancy[15]! This fact is not sufficiently publicised.
Apart from plants, Ayurveda also includes metals in its formulary. Thus, several preparations containing metals like mercury, lead and copper are available readily in the market on OTC basis. These metals have to be deligently processed before they are suitable for human consumption and there is again a long list of do's and don'ts regarding their use. Unfortunately, there are no quality control methods to standardise such metal containing drugs and to find out whether processing of metal is done appropriately so as to render it nontoxic. This thus increases the probability of toxic effects.
The case history of a 70-year-old male patient referred to the ADR monitoring cell illustrates the relevance of being aware of these. This patient was taking a 'herbo-mineral' preparation 'Mahayograj Guggul' in the dose of 4 tablets three times a day, for the complaints of joint pains for well over two years. He got relief from the arthritis but developed symptoms of lead poisioning including severe anaemia with classic basophilic stippling of the RBCs. The case was referred to the ADR cell with the query whether Mahayograj Guggul could lead to this problem. As this preparation contains lead, our centre adviced immediate withdrawal of the preparation.
This particular preparation is prescribed for rheumatoid arthritis in ayurvedic texts[13] and contains several plants and metals as shown in .

Ayurvedic textbooks recommend a special pharmaceutical process to detoxify the metals. The lead in this preparation has to be processed by first heating over a fire till it glows. It should then be cooled by dipping into a mixture of sesame oil, buttermilk, cow's urine and a decoction of three plants, viz. amia (E.officinalis), beheda (T. bellerica) and harda (T. chebula). After repeating this procedure thrice, the lead is heated the fourth time following which it is dipped into a churna (powder) made of the rind of tamarind and Piper longum. This lead is then mixed with arsenic sulphide and wrapped in a betel leaf and warmed in a crucible to a fixed temperature. This process is repeated thirty times before nagabhasma or processed lead is ready for use[16]. In addition, in the doses that this patient was taking the drug he would have consumed a phenomenal 414 mg lead per day for more than 2 years leading to lead toxicity. There are two points to note in this case. Firstly, Ayurveda definitely reconimends Mahayogiraj Guggul for rheumatoid arthritis but has cautioned about duration of therapy, which was overlooked. Secondly, as there are no quality control procedures in existence, there is rio way to know whether the lead in this formulation had been processed in the complex way it should have been.
This brings us to the second group of the 'herbal' formulations marketed under the label 'Ayurvedic'. All doctors are aware that such preparations are available, many may be prescribing them and some will come across patients self-medicating themselves with these drugs. What exactly are these drugs and what do we know about them? Most doctors prescribe these agents, in spite of lack of sufficient clinical studies (using the randomised controlled clinical trial model) proving their efficacy in comparison to allopathic drugs, in the utopian misconception that "never mind if they are ineffective, they will be safe!"
What adverse effects can occur with such formulations? The most glaring are possible drug interactions with the usually co-administered allopathic drugs. Several plants have been shown to alter bio-availability of allopathic drugs[17].
Similarly when used in combination with allopathic drugs they may alter their pharmacodynamics. The example in the diabetic patient described earlier is illustrative. Further, such herbal preparations may produce toxicity, often unexpectedly, per se.
A very herbal remedy is the need to conduct safety studies on them. Protagonists for this believe that with the changing ecological environment, use of pesticides, new manufacturing techniques, modern formulations and combinations of herbs not prescribed in ayurvedic texts, the need for looking at ayurvedic herbal drugs as new drug entities cannot be ignored. This is being seriously considered by the office of the Drugs Controller of India and an amendment to the laws governing manufacture and sale of ayurvedic drugs is on the anvil.
Opponents feel however that herbal remedies are natural remedies and are beyond conventional toxicity studies. Further developmental costs would be formidable.
Is there a via media? Perhaps incorporation of any or all of the methods summarised in [Table:3] would optimise use of ayurvedic drugs.
The Adverse Drug Reaction monitoring cell for Ayurvedic Drugs has been set up at the Ayurveda Research Centre of King Edward Memorial Hospital, Mumbai with several aims. Alongwith documenting anecdotal case reports suggestive of adverse effects to ayurvedic drugs, (please see ADR reporting card) we also, where necessary conduct studies in animals to confirm or rule out the cause and effect relation between the drugs and side effects reported. Further we give information related to ayurvedic drugs.
In conclusion we can reiterate that in view of the fact that we are
a) not using ayurvedic drugs only in the form as described in standard texts,
b) making over-the-counter formulations without much heed to the need for individualisation,
c) giving ayurvedic drugs in combination with allopathic agents which have a narrow therapeutic margin,
d) using raw plant material that is possibly polluted by environmental and ecological devastation,
e) not having good quality control methodologies,
We must beware. We must not wait for a thalidomide- like tragedy in Ayurveda to shake us out of our complacence that ayurvedic drugs are safe!

:: References Top

1. Melmon KL, Morrelli HE. Drug Reactions. In: Clinical Pharmacology. Basic Principles in Therapeutics, 2nd ed. New York: Macrinillan Publ Co; 1978, pp 968. Back to cited text no. 1
2. Samhita C. Sutrasthanam In: Sharma PV, editor. Charak Samhita Varanasi: Chaukhamba Orientalia; 985; 1:126. Back to cited text no. 2
3. Dahanulkar SA, Thatte UM. Historical survey of the evolution of Ayurveda. In: Ayurveda Revisited. Mumbai: Popular Prakashana; 1989; 10-27. Back to cited text no. 3
4. Franklin CA, In: Modi's Medical Junspiudence and Toxicology, 21st ed. Mumbai: NM Tripathi Pvt. Ltd; 1988, pp 279. Back to cited text no. 4
5. Sastri A. In: Sri Vagbhatacharya’s Rasaratna Samuchchaya, 6th ed. Varansi: Chawkhamba Sanskrit Series office; 1978, pp 590. Back to cited text no. 5
6. Sen SP, Khosla RL. Effect of Sodhana on the toxicity of aconite (vatsnava). Current Med Pract 1968; 12:694. Back to cited text no. 6
7. Thorat S, Dahanulkar SA. Can we dispense with ayurvedic Somskaras? J Postgrad Med 1991; 37:157-159. Back to cited text no. 7
8. Gogate VM. Emblica officinalis. In: Drvyaguna Vigyan. 1st ed. Pune: Continental Prakashan; 1962, pp 350. Back to cited text no. 8
9. Swami B. Tribhuvankirti. In: Rasadarpan - part 1, 3rd ed. Patiyala: Swami Publication; 985, pp 393. Back to cited text no. 9
10. Sukh Dev. A modern look at an age old ayurvedic drug gugguiu. Science Age 5:13-18. Back to cited text no. 10
11. Satyavati GV. Gum guggul (Commiphora mukul) - the success story of an ancient insight leading to a modern discovery. Ind J Med Res 1988; 87:327-335. Back to cited text no. 11
12. Gogate VM. In: ayurvedic Materia Medica. Pune: Continental Prakashan; 1981, pp 289-290. Back to cited text no. 12
13. In: Bhavaprakash Nighantu Karpooradi vargu. Varanasi: Chaulkhamba Sanskrit Samsthan; 1969, pp 205. Back to cited text no. 13
14. Gogate VM. Terminalia chebula. In: Dravyaguna Vigyan, 1st ed. Pune: Continental Prakashan; 1982, pp 436 Back to cited text no. 14
15. Gune G. In: Ayurvediya Aushadhi Gunadharma Shastra, Siddhaushadhi, part IV, 2nd ed. Ahmadnagar: Mohan Mandir; 1934; 8-9. Back to cited text no. 15
16. Dahanulkar SA, Kapadia AB, Karandikar SM. Influence of trikatu on rifampicin bioavailability. Indian Drugs 1982; 271-273. Back to cited text no. 16
17. Back to cited text no. 17

Doctor bashing and why the Indian medical profession must evolve.

Doctor bashing and why the Indian medical profession must evolve.

Gandhi JS

From Journal of Post Graduate Medicine

How to cite this article:
Gandhi JS. Doctor bashing and why the Indian medical profession must evolve. J Postgrad Med 2002;48:155-155

How to cite this URL:
Gandhi JS. Doctor bashing and why the Indian medical profession must evolve. J Postgrad Med [serial online] 2002 [cited 2005 Nov 9];48:155-155. Available from:;year=2002;volume=48;issue=2;spage=155;epage=155;aulast=Gandhi

I read with interest the comments by Dr. Pandya on the harassment and violence inflicted on doctors in India.[1] Indeed, in one of the recent issues of the British Medical Journal a Pakistani doctor reports similar events in his country.[2] It is clear even in Britain that doctors no longer have the kudos that their predecessors commanded implicitly as part of their professional role. Certainly in the UK this loss of faith in the medical profession has resulted from large malpractice scandals incriminating senior doctors during the last decade. We saw over the nineties the Bristol paediatric cardiac surgery scandal, the Alder Hey revelations, the Dr Shipman affair, and an array of ignominious ends to otherwise admirable careers. It was undoubtedly the case in these instances that patient care had been substandard. The General Medical Council responded briskly by establishing new mechanisms to monitor the performance of consultants (who hitherto had worked with relative impunity) and by forming bodies such as the National Institute of Clinical Excellence to audit clinical practices. The British people also changed their view of doctors, and there is presently a rising trend of complaints against health professionals and the system of the National Health Service (NHS). For the time being in Britain we are only more aware of the medicolegal aspects of our practice (so that clinical care is improving), but it may be that soon we will work in the litigious culture found in North America.
The spate of aggression against doctors in the subcontinent must also prompt a timely reassessment of the doctor’s role in Indian society. As observed by Dr Pandya and others, frequently the anger and distrust expressed by patients and relatives against doctors stem from poor communication rather than negligence. Patients and relatives feel alienated and powerless. In Indopakistani culture, anger can easily be vented in a fanatic manner that involves injury or murder, and it seems that the current vogue is to channel this destructive force towards the medical profession. Although I suspect there may be political issues that have led to the persecution of individual Indian doctors, surely it is now up to the Indian profession as a whole to actively redeem itself in the eyes of the public. Unlike in Britain, the Indian state is unlikely to show interest in the plight of its doctors, and changes to improve patient care and restore public confidence must arise from within the profession.
As a symbolic step, undergraduate curricula in India must now include teaching on communication between doctor and patient in earnest. On speaking to doctors who have qualified in India and now work in the NHS, the recurrent opinion I encounter is that there is a gross lack of such training. Moreover, the importance of good communication needs to be reiterated throughout postgraduate training. Indian doctors must also now be provoked to create a system to handle complaints from patients and relatives that gives people dignity, and minimises the dishonesty and inefficiency that Indians themselves admit riddles their existing institutions. Control of the quality of patient care is warranted especially in India, where healthcare is primarily in the private sector and patients are potentially vulnerable to serious iatrogenic blunders. Cynics will quickly say that the corruption cannot be erased, but surely every effort will help in reducing the actual burden of dishonesty that is sparking frustration and violence. If there is no accountability or audit in the profession, then barbarism will persist and probably worsen. The minutiae of how such a system of audit can be conceived, formed, financed, and run is not a matter for a bystander such as myself to contemplate. And armchair analyses and cynicism will not suffice, because if the chair is kept too warm too long Indian doctors will inevitably attain the status given to unreliable politicians.

:: References

1. Pandya SK. Doctor patient relationships: The importance of the patient’s perceptions. J Postgrad Med 2001;47:3-7. Back to cited text no. 1
2. Shafqat S. New hazard of medicine. BMJ 2002;324:1045. Back to cited text no. 2

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