Morris was removing some engine valves from a car on the lift when he spotted the famous heart surgeon Dr. Michael DeBakey, who was standing off to the side, waiting for the service manager. Morris, somewhat of a loud mouth, shouted across the garage, “Hey DeBakey… Is dat you? Come over here a minute.”

The famous surgeon, a bit surprised, walked over to where Morris was working on a car. Morris in a loud voice, all could hear, said argumentatively, “So Mr. fancy doctor, look at this work. I also take valves out, grind ‘em, put in new parts, and when I finish this baby will purr like a kitten. So how come you get the big bucks, when you and me are doing basically the same work?”

DeBakey, very embarrassed, walked away and said softly, to Morris, “Try doing your work with the engine running.”

A list of blunders and funny incidents in a medical person’s life:

1. The skin was moist and dry.
2. Rectal exam revealed a normal size thyroid. (Long fingers?)
3. The patient had waffles for breakfast and anorexia for lunch.
4. She stated that she had been constipated for most of her life until 1989 when she got a divorce.
5. Between you and me, we ought to be able to get this lady pregnant.
6. The patient was in his usual state of good health until his airplane ran out of gas and crashed.
7. The lab test indicated abnormal lover function.
8. The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately.
9. Exam of genitalia reveals that he is circus sized.
10. I saw your patient today, who is still under our car for physical therapy.
11. The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.
12. Bleeding started in the rectal area and continued all the way to Los Angeles.
13. Both breasts are equal and reactive to light and accommodation. (Excuse me, what are you doing with that pen light?)
14. She is numb from her toes down.
15. Exam of genitalia was completely negative except for the right foot. (Anatomy review time!)
16. While in the emergency room, she was examined, X-rated and sent home.
17. The patient was to have a bowel resection. However, he took a job as a stockbroker instead. (An empowered patient.)
18. The patient suffers from occasional, constant, infrequent headaches.
19. Coming from Detroit, this man has no children.
20. Examination reveals a well-developed male lying in bed with his family in no distress.
21. Patient was alert and unresponsive.
22. When she fainted, her eyes rolled around the room.
23. We will follow her eyes and nose with a foley catheter.
24. By the time he was admitted, his rapid heart had stopped, and he was feeling better.
25. Patient has chest pain if she lies on her left side for over a year.
26. On the second day the knee was better and on the third day it had completely disappeared.
27. The patient has been depressed ever since she began seeing me in 1983.
28. The patient is tearful and crying constantly. She also appears to be depressed.
29. Discharge status: Alive but without permission.
30. Healthy-appearing decrepit sixty-nine-year-old male, mentally alert but forgetful.
31. The patient refused an autopsy.
32. The patient expired on the floor uneventfully.
33. Patient has left his white blood cells at another hospital.
34. The patient’s past medical history has been remarkably insignificant, with only a forty-pound weight gain in the past three days.
35. She slipped on the ice and apparently her legs went in separate directions in early December.
36. The patient had a rash over his truck.
37. Dictation blunder: lasar radar response (as opposed to vagovagal response).

[box type=”spacer”]Loved these bloopers. I am sure you might have some interesting ones too. Just add yours to the comments below and I will update this list.[/box]

Originally published in www.privatepractice.md

India devotes only 5.1 percent of its GDP in the health sector. India’s burgeoning healthcare sector has created waves across the world with its enticing medical tourism venture. This and a steadily rising economy have been the two factors that have made the Indian healthcare industry a serious contender to global healthcare leadership. Despite these developments, the health status of millions of its citizens remains below standard. Utter ignorance in the rural areas and the blatant misuse of people’s money by those in power has brought about a vast difference of healthcare status between the rich and the poor.

The Indian healthcare industry is a conundrum.

The state-of-the-art healthcare institutions in the public sector cater only to the few that make it to the privileged list. The few mentionable exceptions are just a handful. Most of these so-called centers of healing are very poorly equipped in terms of manpower, medical equipments, and resources. The input from the government coffers for these institutions is quite less compared to the population it has to cover, but misuse of resources have made an indelible mark in the Indian public healthcare sector making the scenario worse. Surprisingly, only 0.9 percent of the country’s GDP is dedicated to the public healthcare which is a gross understatement. There is much to be done to recover the lost glory of these government-owned institutions, and most people are much too disillusioned to try anything new. The healthcare education provided by many of these institutions is also below par and need overhauling.

With regard to the private sector, the monetary aspect is ingrained deeply, and most of these institutions cater to the high and mighty. Exceptions are few and far between where healthcare is provided without this distinction. Charitable institutions worth mentioning are few. About 4.2 percent of India’s GDP lies in the private health sector. This makes healthcare costs reasonably high, driving most of its own citizens to the doors of dilapidated government institutions which merely exist. The investment made by these private institutions is recovered by a steady flow of medical tourists from across the globe. The comparatively lesser cost in these high-end institutions is a boon to the medical tourists who avail the same treatment at a fraction of the cost they would have incurred abroad. An estimate that a mitral valve repair surgery in India would cost only around $ 7000 compared to the $ 200,000 in some of the hospitals abroad is just the tip of the iceberg. This is just one example of the cost-benefit aspect for foreign medical tourists. The healthcare standards in these institutions are comparable to those abroad and hence are a low-cost, affordable option to foreigners. Qualified and experienced specialists in different medical and surgical specialties, excellent nursing and paramedical staff, and affordable charges make these institutions successful and popular.

Medical Tourism Can Provide Much Needed Capital.

Having stated these differences, there is hardly a reason why one should not consider options elsewhere when healthcare costs are high. Numerous other countries have made inroads in the medical tourism industry making billions in the process. Medical tourism has rooted itself deeper due to the current depression in the world economy forcing people to look for viable options. India is a rapidly growing economy and would look at medical tourism seriously if it ever thought of making a mark in the global market.

1. To give the readers of a medical blogger a clear idea of the standards by which the blog is maintained.
2. To give bloggers (especially anonymous ones) a clear set of guidelines they can show employers, patients, or other concerned parties as to the nature of the blogging.

The Code

1. Clear representation of perspective – readers must understand the training and overall perspective of the author of a blog. Certainly bloggers can have opinions on subjects outside of their training, and these opinions may be true, but readers must have a place to look on a blog to get an idea of where this author is coming from. This also encompasses the idea of the distinction between advertisement and content. This does not preclude anonymous blogging, but it asks that even anonymous bloggers share the professional perspective from which they are blogging.
2. Confidentiality – Bloggers must respect the nature of the relationship between patient and medical professionals and the clear need for confidentiality. All discussions of patients must be done in a way in which patients’ identity cannot be inferred. A patient’s name can only be revealed in a way that is in keeping with the laws that govern that practice (HIPPA, Informed Consent).
3. Commercial Disclosure – the presence or absence of commercial ties of the author must be made clear for the readers. If the author is using their blog to pitch a product, it must be clear that they are doing that. Any ties to device manufacturer and/or pharmaceutical company ties must be clearly stated.
4. Reliability of Information – citing sources when appropriate and changing inaccuracies when they are pointed out
5. Courtesy – Bloggers should not engage in personal attacks, nor should they allow their commenters to do so. Debate and discussion of ideas is one of the major purposes of blogging. While the ideas people hold should be criticized and even confronted, the overall purpose is a discussion of ideas, not those who hold ideas.

Conclusion

KevinMD gives in elaborate detail the happenings that landed the 2 bloggers in a soup. There are various opinions on the discussion in a follow-up post. The final answer lies in discerning what is private and what is public domain. Sensitive info about the patient is to be held diligently in high regard. Invasion of privacy other than for direct patient care in the medical setting is a crime by itself and should be shunned by all. The legal eagle has become a complex jumbo. A nexus between legal enforcers and any distraught patient is dynamite. Avoid it at all costs!

In developing countries like India, the scenario is slightly different – but things are catching on at a fast pace. We, healthcare bloggers must be on our toes trying to adhere to certain ethical principles. “The Code” at MedBloggerCode is a definitive starting point.

Medical education in India encompasses allopathic medicine and other indigenous systems of medicine. Allopathic medicine is by far the most favored of all systems because of its wider acceptability and global recognition. This article deals only with allopathic medicine.

Like in the US, medical education in India involves a lengthy and arduous process.

Pre-University Course or HSSLC: It consists of pre-university studies or Higher Secondary School Leaving Certification (HSSLC) in the Basic Sciences with Physics, Chemistry and Biology as its major subjects for 2 years. A prospective medical student should have attained an average of 50 percent of the marks to qualify for medical education. A prospective medical student should apply for various competitive exams to attain a seat at any of the medical colleges or universities across the country. In the US, this stage is termed undergraduate education and consists of 4 years.

The Medical College: A medical college is a medical institution approved by the Medical Council of India (MCI) to train medical students and confer them the MBBS degree, also called Bachelor of Medicine and Bachelor of Surgery. Medical colleges are state-owned, state-aided or private institutions.

Undergraduate Medical Education: Five years of meticulous study of preclinical, paraclinical, and clinical subjects prepare the medical student to appear for four quality assured professional exams through the years of study. The preclinical study consists of one year study of Basic sciences like Human Anatomy, Human Physiology and Human Biochemistry. This prepares the way to a more thorough and in-depth overview of paraclinical subjects of Pathology, Pharmacology, Microbiology and Forensic Medicine for two years. This is accompanied by an introduction to the clinical sciences and learning in the clinical setup. The next one year covers Community Medicine, Ophthalmology and Otorhinolaryngology with clinical insinuation and glimpses of the practices of medical and surgical specialties. The last one year is dedicated to the clinical subjects of Medicine, Surgery, Orthopedics, Obstetrics and Gynecology and Pediatrics with all the sub-specialties. Having cleared the Final Professional examination, a medical graduate is required to complete one year of internship covering various specialties.

Internship Program: It consists of one year of rotating internship in various specialties. Only on completion of the internship is a medical graduate awarded the MBBS degree and a license to practice medicine anywhere in the country as a General Practitioner or Medical Officer. He is also prescribed the title Doctor. Permanent Medical Registration is required either in the Indian Medical Council or State Medical Council to practice. This is in contrast to the 3 to 7 years residency program required to practice in the US.

Post-Graduate Medical Education: This equates to the residency program in the US. Entrance to a Post-graduate degree program is through competitive exams conducted by the concerned college or university. It consists of 3 years of study to achieve an MS or MD degree in any surgical or medical specialty respectively. Following this a Doctor in India can practice in that said specialty as a medical or surgical specialist. There are also post-graduate diploma programs and Diplomate of National Board (DNB) programs for furtherance of medical education. Fellowship programs in various specialties can also be pursued.

Super-Specialty or Sub-Specialty Medical Education: A doctor who has attained a specialty post-graduate degree is qualified to pursue super-specialty or subspecialty education in their field of interest.

A medical graduate in India has the license to practice the broad specialties of Medicine and Surgery but is required to refer patients to a specialist to handle problems that require a particular expertise. Thus, it can be a long journey for the Indian medical graduate before he can settle down, unless he/she is satisfied to practice as a general practitioner.

The CEO of a large HMO dies and goes to heaven.

St. Peter shows him to a lovely villa, wonderful music, great views, full staff of servants, gourmet meals, etc.

The CEO says, “This is terrific!”

“Don’t get too comfortable,” says St. Peter. “You’re only approved for a three-day stay.”