Dispensary

deBakey at 97

A surgery for dissection on the person who invented the surgery.

Whistleblowers in medicine

This is the story of radiologist who threatened to blow the whistle on the issue of unreported radiographs and was subsequently suspended and now fired by the trust hospital.

This Diagnostic Imaging report gives a feeling that there is more to this. I am not sure whether have unread radiographs is a crime in itself. Especially with ER and ICU related studies, often there is no time to read these, or the referring doctors have already done the needful. There is no question that the systems should be solid enough to prevent this issue, but often radiologists just don't have the incentive to do so, especially if they are salaried.

Blowing the whistle on something like this, needs to be looked at carefully, because it may also implicate your own colleagues, if you are proven right. Given that the issue itself does not seem to have the kind of magnitude that its being given, again I wonder if censure by your own colleagues is worth all this.

Like I said...I don't think all the facts are known, so its difficult to be more definitive here.

Maternal mortality

I really didn't know this, but this article by Kristof Nicholas in today's NY Times, brings into focus the problems that pregnant women face in many parts of the world (the example here is a small town in Cameroon), when delivery, with an estimated mortality rate of upto 1 in 20, for e.g. in Cameroon.

India has a maternal mortality rate of approx. 540 per 100,000, which is amazingly high. This means that. The lifetime mortality risk is 1:48.

The rates are obviously higher in rural and more importantly impoverished areas and we have the highest rate in South Asia.

Resurgence of tuberculosis

Drug-resistant tuberculosis (TB) with or without associated HIV, is making a tremendous resurgence in Africa, and Eastern Europe and Russia. These are all usually resistant to first-line medication and most are also resistant to second-line.

This is obviously a major socio-political issue, as we see in our daily practice. Not only is there an increase in the incidence of tuberculosis, the organ systems involved and the patterns of involvement have changed and become more complex. M. tuberculosus unfortunately does not read our text-books.

Diabetes

NY Times has done a large feature on diabetes in India, following up on their continuing features on this subject.

If 35 million people today have diabetes with a projected 75 million by 2020, that is a lot of work for a new generation of diabetologists. Each patient with diabetes does not just have to be looked after with respect to sugar control and advise, but also needs to be evaluated for possible neurologic, cardiac, renal, and peripheral vascular disease complications.

Being a diabetologist is not a bad thing in this scenario, especially since these patients are also usually affluent and can pay.

Most certainly, the insurance companies are going to shy away from reimbursing diabetes related disease, except possibly for the first episode.

Chikungunya

This disease has been creating waves...literally. From the Indian Ocean islands to Britain. Chikungunya is currently affecting hordes of people in the interiors of Maharashtra and in Andhra Pradesh.

It is diseases such as these that keep reminding us of our inability to control the vast majority of viral diseases.