Saturday 30 March 2013

Emedinews:Insights on MEdicolegal Issues:What is conduct money for doctors?


Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

In criminal cases, no fee is paid to any witness, including the doctor, at the time of serving the summons. The summoned doctor must attend the Court and give evidence because of the interest of the State in securing truth/justice, otherwise the doctor will be charged with contempt of Court. However, in criminal cases, conveyance charges and daily allowance can be claimed by the doctor according to Government rules.

Emedinews:Inspiration:Take the son




Years ago, there was a very wealthy man who, with his devoted young son, shared a passion for art collecting. Together they traveled around the world, adding only the finest art treasures to their collection. Priceless works by Picasso, Van Gogh, Monet, and many others adorned the walls of their family estate. The widowed elderly man looked on with satisfaction as his only child became an experienced art collector. The son's trained eye and sharp business mind caused his father to beam with pride as they dealt with art collectors around the world.

As winter approached, war engulfed their nation, and the young man left to serve his country. After only a few short weeks, the elderly man received a telegram that his beloved son was missing in action. The art collector anxiously awaited more news, fearing he would never see his son again. Within days his fears were confirmed. The young man had died while rushing a fellow soldier to a medic. Distraught and lonely, the old man faced the upcoming Christmas holidays with anguish and sadness.

The joy of the season-a season that he and his son had so looked forward to in the past-would visit his house no longer. On Christmas morning, a knock on the door awakened the depressed old man. As he walked to the door, the masterpieces of art on the walls only reminded him that his son was not coming home. He opened the door and was greeted by a soldier with a large package in his hand. The soldier introduced himself to the old man by saying, "I was a friend of your son. I was the one he was rescuing when he died. May I come in for a few moments? I have something to show you." As the two began to talk, the soldier told of how the man's son had told every one of his-and his father's-love of fine art work. "I'm also an artist," said the soldier, "and I want to give you this." As the old man began to unwrap the package, paper gave way to reveal a portrait of the man's son.

Though the world would never consider it a work of genius, the painting featured the young man's face in striking detail. Overcome with emotion, the old man thanked the soldier, promising to hang the portrait above the fireplace. A few hours later, after the soldier had departed, the old man set about his task. True to his word, the painting went above the fireplace, pushing aside thousands of dollars worth of paintings. And then the old man sat in his chair and spent Christmas gazing at the gift he had been given. During the days and weeks that followed, the man learned that his son had rescued dozens of wounded soldiers before a bullet stilled his caring heart. As the stories of his son's gallantry continued to reach him, fatherly pride and satisfaction began to ease his grief, as he realized that, although his son was no longer with him, the boy's life would live on because of those he had touched. The painting of his son soon became his most prized possession, far eclipsing any interest in the priceless pieces for which museums around the world clamored. He told his neighbors it was the greatest gift he had ever received. The following spring, the old man became ill and passed away. The art world was in anticipation, since, with the old man's passing, and his only son dead, those paintings would be sold at an auction. According to the will of the old man, all of the art works would be auctioned on Christmas Day, the way he had received his greatest gift.

The day finally arrived and art collectors from around the world gathered to bid on some of the world's most spectacular paintings. Dreams could be fulfilled this day; greatness could be achieved as some could say," I have the greatest collection." The auction began with a painting that was not on any museum list... It was the painting of the old man's son. The auctioneer asked for an opening bid, but the room was silent.

"Who will open the bidding with $100?" he asked. Moments passed as no one spoke. From the back of the room came, "Who cares about that painting? It's just a picture of his son. Let's forget it and get on to the good ones." More voices echoed in agreement. "No, we have to sell this one-first," replied the auctioneer. "Now who will take the son?" Finally, a friend of the old man spoke. "Will you take $10 for the painting? That's all I have. "Will anyone go higher?" called the auctioneer. After more silence he said, "Going once, going twice... Gone!" The gavel fell. Cheers filled the room and someone shouted; "Now we can get on with it and bid on these treasures!"

The auctioneer looked at the audience and announced that the auction was over. Stunned disbelief quieted the room. Then someone spoke up and asked, "What do you mean it's over? We didn't come here for a portrait of some old man's son! What about all of the other paintings? There are millions of dollars worth of art work here. We demand an explanation!" The auctioneer replied, "It's very simple. According to the will of the father, whoever takes the son...gets it all."
Just as the art collectors discovered on that day...The message is still the same...the love of the Father....a Father whose son gave his life for others...And because of that Father's love...Whoever takes the Son gets it all.

Emedinews:Insights on Medicolegal Issues:Medical Testimony of Doctor in the Court of Law



Do not misrepresent documents/medical literature in the Court of Law
When evidence is read into the record of a trial, only that portion of the document, which validates the information being discussed needs to be read aloud. One paragraph or even one part of a paragraph may be all that is necessary to substantiate the point you are making. Documents must be presented in the words of the author. When you paraphrase evidence, you argue in a circle. Reading the remainder of the document, even if it establishes a context for the evidence, is unnecessary and time–consuming. When a document is cut in a manner, which lends the quoted passage a meaning other than what would be derived from a more complete reading, you are misrepresenting the document. This does not mean, however, that you are responsible for drawing the same conclusions from information as the author of the document.

Drawing a contrary conclusion from passages accurately interpreted does not constitute misrepresentation. The fact that the author of the document reached a different conclusion from the information argues perhaps persuasively against your conclusion. However, you have not misused the evidence.

Emedinews:Inspiration:Why it is so hard to let go



The cheerful girl with bouncy golden curls was almost five. Waiting with her mother at the checkout stand, she saw them: a circle of glistening white pearls in a pink foil box.

"Oh please, Mommy. Can I have them? Please, Mommy, please?" Quickly the mother checked the back of the little foil box and then looked back into the pleading blue eyes of her little girl’s upturned face. "A dollar ninety–five. That’s almost $2.00. If you really want them, I’ll think of some extra chores for you and in no time you can save enough money to buy them for yourself. Your birthday’s only a week away and you might get another crisp dollar bill from Grandma." As soon as Jenny got home, she emptied her penny bank and counted out 17 pennies. After dinner, she did more than her share of chores and she went to the neighbor and asked Mrs. McJames if she could pick dandelions for ten cents.

On her birthday, Grandma did give her another new dollar bill and at last she had enough money to buy the necklace. Jenny had a very loving daddy and every night when she was ready for bed, he would stop whatever he was doing and come upstairs to read her a story. One night when he finished the story, he asked Jenny, "Do you love me?" "Oh yes, Daddy. You know that I love you." "Then give me your pearls." "Oh, Daddy, not my pearls. But you can have Princess – the white horse from my collection. The one with the pink tail. Remember, Daddy? The one you gave me. She’s my favorite." "That’s okay, Honey. Daddy loves you. Good night." And he brushed her cheek with a kiss.

About a week later, after the story time, Jenny’s daddy asked again, "Do you love me?" "Daddy, you know I love you." "Then give me your pearls." "Oh Daddy, not my pearls. But you can have my baby doll. The brand new one I got for my birthday. She is so beautiful and you can have the yellow blanket that matches her sleeper." "That’s okay. Sleep well. God bless you, little one. Daddy loves you" And as always, he brushed her cheek with a gentle kiss.

With tears gathering in his own eyes, Jenny’s kind daddy reached out with one hand to take the dime–store necklace, and with the other hand he reached into his pocket and pulled out a blue velvet case with a strand of genuine pearls and gave them to Jenny. He had them all the time. He was just waiting for her to give up the dime–store stuff so he could give her genuine treasure.

So it is with our Heavenly Father. He is waiting for us to give up the cheap things in our lives so that he can give us beautiful treasure. Isn’t God good?

Are you holding onto things which God wants you to let go of. Are you holding on to harmful or unnecessary partners, relationships, habits and activities which you have come so attached to that it seems impossible to let go? Sometimes it is so hard to see what is in the other hand but do believe this one thing……………

God will never take away something without giving you something better in…

Friday 29 March 2013

Emedinews:Insights on Medicolegal Issues:Test for establishing medical negligence


Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)
Bolam Vs. Friern Hospital Management Committee 1957

  • The doctor is required to exercise the ordinary skill of a competent doctor in his field. He must exercise this skill in accordance with a reasonable body of medical opinion skilled in the area of medicine.
  • According to the Bolam test, negligence is the genus of which rashness is the species.
  • The latest trend of prosecution of the doctors, the term criminal negligence has come to light, which means recklessly acting without reasonable caution, hurting another person at risk of injury or death by negligence.
  • This applies to a medical practitioner when he shows gross negligence in his treatment, boding to severe injury or even death. He should not be held liable criminally for the patient’s death unless his negligence shows such regard for the life and safety of the patient as to amount to a crime.
  • The most important criterion is the degree of negligence required to prosecute them under the charge of criminal negligence, which should be gross or even high degree.
  • The jurisprudential concept of negligence differs in civil and criminal law. Negligence which is neither gross nor of a high degree may provide a ground for action in civil law but cannot form the basis for prosecution in criminal law.

Emedinews:Inspiration:Teamwork Lesson


An Inspirational Story

When you see geese flying along in "V" formation, you might consider what science has discovered as to why they fly that way. As each bird flaps its wings, it creates an uplift for the bird immediately following. By flying in "V" formation, the whole flock adds at least 71 percent greater flying range than if each bird flew on its own. People who share a common direction and sense of community can get where they are going more quickly and easily because they are traveling on the thrust of one another.

When a goose falls out of formation, it suddenly feels the drag and resistance of trying to go it alone – and quickly gets back into formation to take advantage of the lifting power of the bird in front. If we have as much sense as a goose, we will stay in formation with those people who are headed the same way we are.

When the head goose gets tired, it rotates back in the wing and another goose flies point. It is sensible to take turns doing demanding jobs, whether with people or with geese flying south. Geese honk from behind to encourage those up front to keep up their speed.

What messages do we give when we honk from behind? Finally – and this is important – when a goose gets sick or is wounded by gunshot, and falls out of formation, two other geese fall out with that goose and follow it down to lend help and protection. They stay with the fallen goose until it is able to fly or until it dies, and only then do they launch out on their own, or with another formation to catch up with their group.

If we have the sense of a goose, we will stand by each other like that.

Source: http://academictips.org/blogs/the–goose–story–teamwork–lesson/

Thursday 28 March 2013

Emedinews:Insights on Medicolegal Issues:What is contributory medical Negligence?



The pregnant woman delivered a child with spina bifida however she failed to regularly attend the advised dates for antenatal ultrasounds that would have identified this problem. The patient was found to be 100% at fault."
  • In a medical malpractice/maloccurence case, medical negligence is the foremost ingredient to establish the liability of damage and dereliction in provided medical care. However, it is important to establish the difference between malpractice and contributory negligence when determining liability.
  • Contributory negligence means the patient/legal heirs/parties are partially to blame for the maloccurrence or medical untoward incident. For e.g., a patient is admitted to the emergency room for treatment and they fail to inform the doctor about a pre–existing condition e.g. any allergy to a drug. The patient is guilty of contributing to the negative outcome/damage of the treatment.
  • If the victim is found to be even one percent at fault, they will be unable to recover compensation for their injuries. However, comparative negligence is used to determine degree of liability of the doctor/medical care provider.
  • Contributory negligence will determine who will receive compensation for their losses and how much they may be entitled to receive in compensation for their injuries. Pure comparative negligence means that in case of an aggrieved patient, damages will be calculated and then reduced to reflect his or her contribution to the injury.
In India, the doctors take the defense against malpractice cases when determining how the parties involved are responsible. In US, 4 categories apply in compensation cases in many of its states: Pure Comparative Negligence/Pure Contributory Negligence/ Modified Comparative Negligence—50% Bar Rule and Modified Comparative Negligence—51% Bar Rule. Twenty–one states that recognize the 51% Bar rule which means that the party who is less than 51% liable can seek compensation; only 11 US states use the 50% Bar rule, which means that if the damaged party is less than 50% responsible, they can collect damages.

Emedinews:Inspiration:Why dogs live less than human!

Being a veterinarian, I had been called to examine a ten-year-old Irish Wolfhound named Belker. The dog’s owners, Ron, his wife, Lisa, and their little boy, Shane, were all very attached to Belker and they were hoping for a miracle. I examined Belker and found he was dying. I told the family we couldn’t do anything for Belker and offered to perform the euthanasia procedure for the old dog in their home. 

As we made arrangements, Ron and Lisa told me they thought it would be good for six-year-old Shane to observe the procedure. They felt as though Shane might learn something from the experience. The next day, I felt the familiar catch in my throat as Belker’s family surrounded him. Shane seemed so calm, petting the old dog for the last time, that I wondered if he understood what was going on. 

Within a few minutes, Belker slipped peacefully away. The little boy seemed to accept Belker’s transition without any difficulty or confusion. We sat together for a while after Belker’s death, wondering aloud about the sad fact that animal lives are shorter than human lives. Shane, who had been listening quietly, piped up, “I know why.” Startled, we all turned to him. What came out of his mouth next stunned me.

 I’d never heard a more comforting explanation. He said, “People are born so that they can learn how to live a good life — like loving everybody all the time and being nice, right?” The six-year-old continued, “Well, dogs already know how to do that, so they don’t have to stay as long.” Source: http://academictips.org/blogs/why-dogs-live-less-than-human/

Tuesday 26 March 2013

Emedinews:Inspiration:Patterned bruises



The extent and severity of violence or force used may be determined from the size and swelling of bruise
  • The examining doctor must document the dimension/shape/size of bruise in the medicolegal report as it may connect the victim and the object or weapon used in the specific case, e.g., chain, cane stick, rifle butt, boots, ligature, vehicle etc.
  • The age of injury can be detected by the status of color of bruise; the extent and severity of violence or force used may be determined from the size and swelling of bruise; character and manner of the injury may be known from its distribution over the body.
  • Bruising of the arm may indicate restraining of the victim.
  • Bruising of the shoulder blades indicates firm pressure on the body against the ground or other resisting surface.
  • In manual strangulation, the position and number of bruises and nail marks may indicate the method of attack and the position of the assailant.
  • Patterned bruises on chest/neck and mouth are very important in diagnosing resuscitative injury in medicolegal cases, which may be invariably misconstrued by the doctor as indicative of manual strangulation/smothering.
  • Patterned bruises are an important tool to diagnose torture injury and very commonly appreciated in sole/flexor aspect of hands/buttock and back of thighs by doctors.

Emedinews:Inspiration:The story of a woodcutter



Once upon a time, a very strong woodcutter asked for a job in a timber merchant and he got it. The pay was really good and so was the work condition. For those reasons, the woodcutter was determined to do his best.
His boss gave him an axe and showed him the area where he supposed to work. The first day, the woodcutter brought 18 trees. “Congratulations,” the boss said. “Go on that way!”
 Very motivated by these words, the woodcutter tried harder the next day, but he could only bring 15 trees. The third day he tried even harder, but he could only bring 10 trees. Day after day he was bringing less and less trees.
“I must be losing my strength”, the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on. “When was the last time you sharpened your axe?” the boss asked. “Sharpen? I had no time to sharpen my axe. I have been very busy trying to cut trees…”
 Reflection: Our lives are like that. We sometimes get so busy that we don’t take time to sharpen the “axe”. In today’s world, it seems that everyone is busier than ever, but less happy that ever.
 Why is that? Could it be that we have forgotten how to stay “sharp”? There’s nothing wrong with activity and hard work. But we should not get so busy that we neglect the truly important things in life, like our personal life, taking time to get close to our Creator, giving more time for our family, taking time to read etc.
 We all need time to relax, to think and meditate, to learn and grow. If we don’t take the time to sharpen the “axe”, we will become dull and lose our effectiveness.

Emedinews:Insights on Medicolegal Issues:Malpractice


Supreme Court of Georgia echoed the Illinois decision, albeit with somewhat different wording
  • Every person who enters into a learned profession undertakes to bring to the exercise of his profession a reasonable degree of care and skill. He does not undertake to use the highest possible degree of skill, for there may be persons who, for having enjoyed a better education and greater advantages, are possessed of greater skill in their profession; but he undertakes that he will bring a fair, reasonable, and competent degree of skill…He is not responsible for an error in judgment…if such error arises from the peculiar circumstance of the case, and not from the want of proper care or competent skill on his part.
  • Nearly a half–century later, a state of New York appeals court issued an opinion as to what constitutes the standard of care of a medical physician. Although the lawsuit did not involve radiology, the court decision could have well applied to radiologic interpretation
  • The law requires a physician to possess the skill and learning which is possessed by the average member of the medical profession…and to apply that skill and learning with ordinary reasonable care. He is not liable for a mere error in judgment, provided he does what he thinks is best after a careful examination. He does not guarantee a good result.

Emedinews:Inspiration:Buying an hour of daddy’s time


 The man came home from work late again, tired and irritated, to find his 5 year old son waiting for him at the door.
 “Daddy, may I ask you a question? “Yeah, sure, what is it?” – replied the man. “Daddy, how much money do you make an hour?” “That’s none of your business! What makes you ask such a thing?” – the man said angrily.
 “I just want to know. Please tell me, how much do you make an hour?” – pleaded the little boy. “If you must know, I make $20 an hour.” “Oh,” the little boy replied, head bowed. Looking up, he said, “Daddy, may I borrow $10 please?”
 The father was furious. “If the only reason you wanted to know how much money I make is just so you can borrow some to buy a silly toy or some other nonsense, then you march yourself straight to your room and go to bed. Think about why you’re being so selfish. I work long, hard hour’s everyday and don’t have time for such childish games.”
 The little boy quietly went to his room and shut the door. The man sat down and started to get even madder about the little boy’s questioning. How dare he ask such questions only to get some money.
 After an hour or so, the man had calmed down, and started to think he may have been a little hard on his son. Maybe there was something he really needed to buy with that $10 and he really didn’t ask for money very often. The man went to the door of the little boy’s room and opened the door.
 “Are you asleep son?” – he asked. “No daddy, I’m awake.” – replied the boy
 “I’ve been thinking, maybe I was too hard on you earlier.” – said the man. “It’s been a long day and I took my aggravation out on you. Here’s that $10 you asked for.”
 The little boy sat straight up, beaming. “Oh, thank you daddy!” he yelled. Then, reaching under his pillow, he pulled out some more crumpled up bills. The man, seeing the boy already had money, started to get angry again.
 The little boy slowly counted out his money, then looked up at the man. “Why did you want more money if you already had some?” the father grumbled.
 “Because I didn’t have enough, but now I do.” The little boy replied. “Daddy, I have $20 now. Can I buy an hour of your time? Please come home early tomorrow. I would like to have dinner with you.” The father was crushed and he put his arms around his little son.
 It’s just a short reminder to all of us working so hard in life. We should not let time slip through our fingers without having spent some time with those who really matter to us, those close to our hearts. Do remember to share that $20 worth of your time with someone you love.
 If we die tomorrow, the company that we are working for could easily replace us in a matter of hours. But the family & friends we leave behind will feel the loss for the rest of their lives.

Monday 25 March 2013

Emedinews:Insights on MEdicolegal Issues:Medical Testimony of Doctor in the Court of law



Medical literature/document produced as evidence in the court of law must be a published one. For a document to serve as legitimate evidence in a trial/debate, it must exist in the public domain i.e. the document must potentially be available to any debater researching the topic or lawyer/interested party of cross examining side. Unpublished documents are privileged information, and using such information gives the doctor an unfair advantage. Academic debate does not have a discovery rule. The only opportunity your opponents have to examine your documents prior to a trial/debate is to have found the documents during their own research. That they may not have taken the opportunity to do so, or did not discover a document, does not obviate the rule. The advent of the Internet has created a new form of publication – electronic documents like this e–medinews. Electronic documents are accepted as published if they are accessible by the general public. Thus, electronic files to which other debaters would be denied access are not published. However, files and documents which other debaters may access, even if they have no subscription to a commercial service to do so, satisfy the publication rule.

Emedinews:Inspiration: The 12 gifts of birth



Once upon a time, a long time ago, when princes and princesses lived in faraway kingdoms, royal children were given 12 special gifts when they were born. You may have heard the stories. Twelve wise women of the kingdom, or fairy godmothers as they were often called, traveled swiftly to the castle whenever a new prince or princess came into the world. Each fairy godmother pronounced a noble gift upon the royal baby.
As time went on, the wise women came to understand that the 12 royal gifts of birth belong to every child, born anywhere at any time. They yearned to proclaim the gifts to all children, but the customs of the land did not allow that.
One day when the wise women gathered together they made this prophecy:
Someday, all the children of the world will learn the truth about their noble inheritance. When that happens a miracle will unfold on the kingdom of Earth.
Some day is near. Here is the secret they want you to know.
At the wondrous moment you were born, as you took your first breath, a great celebration was held in the heavens and 12 magnificent gifts were granted to you.
1. Strength is the first gift. May you remember to call upon it whenever you need it.
2. Beauty is the second gift. May your deeds reflect its depth.
3. Courage is the third gift. May you speak and act with confidence and use courage to follow your own path.
4. Compassion is the fourth gift. May you be gentle with yourself and others. May you forgive those who hurt you and yourself when you make mistakes.
5. Hope is the fifth gift. Through each passage and season, may you trust the goodness of life.
6. Joy is the sixth gift. May it keep your heart open and filled with light.
7. Talent is the seventh gift. May you discover your own special abilities and contribute them toward a better world.
8. Imagination is the eighth gift. May it nourish your visions and dreams.
9. Reverence is the ninth gift. May you appreciate the wonder that you are and the miracle of all creation.
10. Wisdom is the tenth gift. Guiding your way, wisdom will lead you through knowledge to understanding. May you hear its soft voice.
11. Love is the eleventh gift. It will grow each time you give it away.
12. Faith is the twelfth gift. May you believe.
Now you know about your 12 gifts of birth. But there is more to the secret that the wise women knew. Use your gifts well and you will discover others, among them a gift that is uniquely you. See these noble gifts in other people. Share the truth and be ready for the miracle to unfold as the prophecy of the wise women comes true.

Saturday 23 March 2013

Emedinews:Insights on Medicolegal Issues:Issuance of death Certificate by Doctor



Coma is a clinical symptom and not a cause of death

The certificate of death is always issued by doctor as an honor/respect to the deceased person without any fee. In accordance with the Registration of Births and Deaths Act 1969, the registration of deaths is now compulsory throughout India. The doctor must write his registration number in the Death Certificate and a register for such information should be maintained with his clinic/hospital and a copy/information of death must/mandatorily be sent immediately to the birth and death registration office. It is essential that the cause of death must be documented/determined before lawful disposal of the deceased body by the doctor. The death certificate also provides the exact cause of death for statistical purposes. The cause of death is recorded according to international conventions; the sequence being that adopted by the World Health Organization. Thus, the international medical Certificate of the Cause of Death consists of two parts:
  • Part I: Records (a) the immediate cause, and (b) the morbid conditions, if any, giving rise to the immediate cause. Thus (a) must be due to (b). When (b) is due to other causes, it should be mentioned in (c). The basic pathological condition is that on the lower–most line and this is the one that is used for statistical purposes.
  • Part II: records any other significant condition contributing to death, but not related to the immediate cause of death. The underlying cause of death is defined as the disease, which initiated the train of morbid events leading directly to death for instance; a patient may die primarily from myocardial infraction due to coronary artery disease. These should be placed in parts (a) and (b) of part I as the myocardial infraction due to coronary artery disease (or coronary insufficiency). Similarly, it can be certified that the patient died of cerebral hemorrhage due to hypertension.
However, if the patient also suffers from diabetes, it should be entered in part II as it does not have a direct contributing role to the immediate cause of death. It is incorrect to write ‘heart failure ‘or ‘cardiac failure’ or’ cardiopulmonary arrest’ without mentioning the underlying pathological cause, which might be’ coronary artery disease’ or ‘rheumatic valve lesions’ or’ senile myocardial degeneration’. It should be remembered that everyone dies of ‘cardiopulmonary arrest’ or’ heart failure’ or ‘cardiac failure’, which simply means cessation of circulation and respiration leading to somatic death.

The modes of death, e.g., cardiorespiratory failure, or asphyxia should not be recorded as the cause of death, unless qualified as explained here, for instance, ‘coma’ is a clinical symptom and not a cause of death. It should be used with proper cause such as crush injury of head or meningitis etc.

The terms like angina, cancer, tumor apoplexy congestion’,’ debility’, ‘asthenia,’ organic disease toxemia, sepsis and hemorrhage are sign/symptoms of the disease and not a pathological condition. It is pertinent for medical professional to note that a death certificate requires the underlying pathological cause and not clinical manifestations or modes of death.

Emedinews:Inspiration:How elite people think?



Have you ever wondered how elite people think? Through a short, inspiring speech below, Jim Rohn leads us into the spirit world of highly successful entrepreneurs. Here to strengthen our spirit! Yes we can!! 
An enterprising person is one who comes across a pile of scrap metal and sees the making of a wonderful sculpture. An enterprising person is one who drives through an old decrepit part of town and sees a new housing development. An enterprising person is one who sees opportunity in all areas of life.
 To be enterprising is to keep your eyes open and your mind active. It’s to be skilled enough, confident enough, creative enough and disciplined enough to seize opportunities that present themselves… regardless of the economy.
 A person with an enterprising attitude says, “Find out what you can before action is taken.” Do your homework. Do the research. Be prepared. Be resourceful. Do all you can in preparation of what’s to come.
 Enterprising people always see the future in the present. Enterprising people always find a way to take advantage of a situation, not be burdened by it. And enterprising people aren’t lazy. They don’t wait for opportunities to come to them, they go after the opportunities. Enterprise means always finding a way to keep yourself actively working toward your ambition.
 Enterprise is two things. The first is creativity. You need creativity to see what’s out there and to shape it to your advantage. You need creativity to look at the world a little differently. You need creativity to take a different approach, to be different.
 What goes hand-in-hand with the creativity of enterprise is the second requirement: the courage to be creative. You need courage to see things differently, courage to go against the crowd, courage to take a different approach, courage to stand alone if you have to, courage to choose activity over inactivity.
 And lastly, being enterprising doesn’t just relate to the ability to make money. Being enterprising also means feeling good enough about yourself, having enough self worth to want to seek advantages and opportunities that will make a difference in your future. And by doing so you will increase your confidence, your courage, your creativity and your self-worth, your enterprising nature.

Emedinews:Insights on Medicolegal Issues:World Medical Association Declaration on Principle-Undergraduate Medical Education & faculty



Medicolegal Update
(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

The goal of medical education is to educate physicians who are entitled and consistent with their training to practice the profession without limitation. Medical Education leading to the first professional degree must be conducted by an organized faculty and the faculty must possess the appropriate academic qualifications that can only be achieved through formal training and experience.
The first professional degree should represent completion of a curriculum that qualifies the student for a spectrum of career choices, including patient care, public health, clinical or basic research or medical education. Each career choice will require additional education beyond that required for the first professional degree.
The research to advance medical knowledge and the provision of the highest quality of care must occur in academic settings to demonstrate the highest medical standards.
The content, format and evaluation of the educational experience provided are the responsibility of the faculty with participation of National Medical Associations.
The faculty is responsible for providing its own obligatory basic curriculum in an academic environment of freedom in which learning and inquiry can thrive in a maximal way.
Frequent reviews of the curriculum, allowing for the needs of the community and for input from practicing physicians should be conducted by the faculty,
The proper administrative structure and academic records must be maintained. When the necessary elements are available the clinical education of practitioner and specialist can be sponsored by either a university or a hospital.
(Adopted by the 39th World Medical Assembly Madrid Spain, October 1987)

eMedinews:Inspiration:Teen Mental Health




Being a teenager is hard. You're under stress to be liked, do well in school, get along with your family and make big decisions. You can't avoid most of these pressures, and worrying about them is normal. But feeling very sad, hopeless or worthless could be warning signs of a mental health problem.

Mental health problems are real, painful and sometimes severe. You might need help if you have the signs mentioned above, or if you
·         Often feel very angry or very worried
·         Feel grief for a long time after a loss or death
·         Think your mind is controlled or out of control
·         Use alcohol or drugs
·         Exercise, diet and/or binge-eat obsessively
·         Hurt other people or destroy property
·         Do reckless things that could harm you or others
·         Mental health problems can be treated. To find help, talk to your parents, school counselor or health care provider.

Friday 22 March 2013

Emedinews:Insights on MEdicolegal Issues:A Criminal Investigative model of FBI for lust murders



On the basis of various literature and experience of two decades, I endorse/feel that dead bodies do tell tales as to ‘how he/she has been killed/died"; what is required is a meticulous autopsy surgeon to hear/understand its language.
Lust murder may be organized or disorganized depending on the psychopathology of the offender and the same is manifested in the crime scene of the killings.
It is determined by very close observation/examination of the scene and corpse. In the case of a disorganized offender, the victim will be immediately rendered unconscious or dead by a "blitz–style" of attack and there will be evidence of symbolic and postmortem sexual activities.
In both instances, however, the cutting, mutilation and overkill type wound structures will be directed towards those parts of the body that the offender finds significant to him as per his fantasy and serve as a sexual stimulus.
The disorganized offender usually depersonalizes his victim by facial destruction or overkill type of wounds and it became a signature forensic component for crime detection.
Any sexually sadistic acts are performed postmortem. Mutilation to the genitalia in females, neck, throat and buttocks are performed because these parts of the body contain a strong sexual significance to him. Most cases of lust murder usually involve male perpetrators. However, accounts of female lust murderers do exist also.

Emedinews:Inspiration:Success depends upon maturity!




Maturity is many things. It is the ability to base a judgment on the big picture, the long haul. It means being able to resist the urge for immediate gratification and opt for the course of action that will pay off later.

One of the characteristics of the young is “I want it now.” Grown-up people can wait.
Maturity is perseverance–the ability to sweat out a project or a situation, in spite of heavy opposition and discouraging setbacks, and stick with it until it is finished.
The adult who is constantly changing friends and changing mates is immature. He/she cannot stick it out because he/she has not grown up.
Maturity is the ability to control anger and settle differences without violence or destruction. The mature person can face unpleasantness, frustration, discomfort and defeat without collapsing or complaining. He/she knows he cannot have everything his/her own way every time. He/she is able to defer to circumstances, to other people-and to time. He/she knows when to compromise and is not too proud to do so.
Maturity is humility. It is being big enough to say, “I was wrong.” And, when he/she is right, the mature person need not experience the satisfaction of saying, “I told you so.”
Maturity is the ability to live up to your responsibilities, and this means being dependable. It means keeping your word. Dependability is the hallmark of integrity. Do you mean what you say-and do you say what you mean? Unfortunately, the world is filled with people who cannot be counted on. When you need them most, they are among the missing. They never seem to come through in the clutches. They break promises and substitute alibis for performance. They show up late or not at all. They are confused and disorganized. Their lives are a chaotic maze of broken promises, former friends, unfinished business and good intentions that somehow never materialize. They are always a day late and a dollar short.
Maturity is the ability to make a decision and stand by it. Immature people spend their lives exploring endless possibilities and then doing nothing. Action requires courage. Without courage, little is accomplished.
Maturity is the ability to harness your abilities and your energies and do more than is expected. The mature person refuses to settle for mediocrity. He/she would rather aim high and miss the mark than low-and make it.
Maturity is the art of living in peace with that which cannot be changed, the courage to change that which should be changed, no matter what it takes, and the wisdom to know the difference.

Thursday 21 March 2013

Emedinews:Insights on Medicolegal Issues:The forensic analyst/doctor has a legal responsibility to retain untested biological specimen


The forensic analyst/doctor has a legal responsibility to retain untested biological specimen in legal cases so that another person can test it for an independent conclusion
When crimes like injury, sexual offences and murder are reported to a police station, the investigating officers are assigned to examine and investigate the case and collect the related evidences. The observation of scenes of crime, collection of human body fluids, weapons of the offence and medical examination of victim, accused, or both are required in any investigation of crime against human body.
The medical examination is carried out in emergency ward of hospitals and the doctor’s main attention should be the treatment of injured and dying patient. However, in cases of crime against human body, medical examination and collection of biological sample, its recognition, documentation, packaging and analysis has an important role and are required to be done by doctor very meticulously with the high standards of science and the law in mind.
The biological materials which are frequently required to be collected/recovered by doctor during medical examination as evidence in crime against human body are blood, seminal stains, vaginal smears/slides, gastric lavage, chemical substances, poison, hair, fiber, broken glasses, knives, blunt instruments/objects, fire arms, bullet, live and empty cartridge cases, wads, clothing etc..
This scientific biological evidence becomes legal evidence in prosecution/acquittal of a case, if collected properly by maintaining the scientific sanctity and analyzed by a competent expert.

Emedinews:Inspiration:The strength of group work



Once a US president went out to see the situation of the city. Somewhere a group of soldiers was trying to lift a large branch of a tree from their way.
The Corporal was standing by their side instructing them to work harder, but they were unable to move it.
A stranger was riding on his horse and he observed what was going on. He said to the Corporal – “if you help them they will be able to move it. Why don’t you help them? ”
The Corporal replied – “That is not my job, I am the Corporal. It is their work, they should do it.”
The stranger did not hesitate a moment, immediately he dismounted from his horse, and helped the group of the soldiers to move that log.
This additional strength helped them to move the log. After moving it, the stranger mounted his horse and said to the Corporal – “Next time you need to move some heavy thing and you need a help, call for the Commander-in Chief” and went away his way.
It was then that the men realized that the stranger was none other than George Washington – the first President of the United States, the Commander-in-Chief of the army.

Wednesday 20 March 2013

Emedinews:Insighst on Medicolegal Issues:What is the nature of bullet wounds of the head?



In most such cases, the bullet passes completely through the skull. As it enters the skull, it produces a clean cut hole in the outer table and a larger hole in the inner table. At the exit point, these conditions are reversed and the hole in the outer table is larger than the hole in the inner table. These facts are often of importance in determining the direction of fire in bullet injuries of the head. The track of a bullet through the brain tissues varies greatly, depending on the range and stability of the bullet. On the other hand, if it remains high velocity at the time of impact with the skull, there may be considerable damage from the cavitation effect within the skull.
  • Fissured fractures often radiate through the vault and base of the skull from the bullet entrance and exit holes.
  • In certain bullet injuries of the head, the bullet may fail to emerge from the skull and in these cases an area of bony comminuting is often found at the site of lodgment.
  • When a bullet strikes the head at a tangent, penetration of the skull may fail to occur, but the force of the bullet may be sufficient to fragment the inner table at the site of impact. Delayed pressure effects and cranial edema may be produced as a result of this.

Emedinews:Inspiration:The whale rescuing experience



A 50-foot female humpback whale became entangled in a spider web of crab traps and lines. The whale was weighted down by hundreds of pounds of traps that caused her to struggle to stay afloat. She also had hundreds of yards of line rope wrapped around her tail, her torso and a line tugging in her mouth.
A fisherman spotted her just east of the Farallone Islands (outside the Golden Gate) and radioed an environmental group for help. Within a few hours, the rescue team arrived and determined that she was so bad off, the only way to save her was to dive in and untangle her – a very dangerous proposition. One slap of the tail could kill a rescuer.
They worked for hours with curved knives and eventually freed her. When she was free, the divers say she swam in what seemed like joyous circles. She then came back to each and every diver, one at a time, and nudged them, pushed them gently around – she thanked them. Some said it was the most incredibly beautiful experience of their lives.
The guy who cut the rope out of her mouth says her eye was following him the whole time, and he will never be the same.
 May you, and all those you love, be so blessed and fortunate… to be surrounded by people who will help you get untangled from the things that are binding you.
And, may you always know the joy of giving and receiving gratitude.

Tuesday 19 March 2013

Emedinews:Insights on Medicolegal Issues:Right coronary artery supplying blood to the electrical area of heart is called artery of sudden death



  • The most common cause of sudden cardiac death in adults over the age of 40 has been coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in the mortuary of AIIMS.
  • The most common finding at postmortem examination is chronic high-grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply. A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
  • In 75 out of hundred cases, the clot was found in the right coronary artery supplying the electrical area of heart. Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall, which induces a ventricular arrhythmia/fibrillation and no changes in the myocardium are seen during postmortem examination.
  • The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
  • Chronic high–grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
  • Ventricular arrhythmias may arise from a myocardium which has been previously scarred by episodes of ischemia.

Emedinews:Inspiration:Money is yours but resources belong to society



This is about an Indian's experience in Germany. Please read it carefully.

Germany is a highly industrialized country. It produces top brands like Benz, BMW, Siemens etc. The nuclear reactor pump is made in a small town in this country. In such a country, many will think its people lead a luxurious life. At least that was my impression before my study trip.

When I arrived at Hamburg, my colleagues who work in Hamburg arranged a welcome party for me in a restaurant. As we walked into the restaurant, we noticed that a lot of tables were empty. There was a table where a young couple was having their meal. There were only two dishes and two cans of beer on the table. I wondered if such simple meal could be romantic, and whether the girl will leave this stingy guy.

There were a few old ladies on another table. When a dish is served, the waiter would distribute the food for them, and they would finish every bit of the food on their plates.

We did not pay much attention to them, as we were looking forward to the dishes we ordered. As we were hungry, our local colleague ordered more food for us.

As the restaurant was quiet, the food came quite fast. Since there were other activities arranged for us, we did not spend much time dining. When we left, there was still about one third of unconsumed food on the table.

When we were leaving the restaurant, we heard someone calling us. We noticed the old ladies in the restaurant were talking about us to the restaurant owner. When they spoke to us in English, we understood that they were unhappy about us wasting so much food. We immediately felt that they were really being too busybody. "We paid for our food, it is none of your business how much food we left behind," my colleague Guy told the old ladies.

The old ladies were furious. One of them immediately took her hand phone out and made a call to someone. After a while, a man in uniform claimed to be an officer from the Social Security Organisation arrived. Upon knowing what the dispute was, he issued us a 50 Mark fine. We all kept quiet. The local colleague took out a 50 Mark note and repeatedly apologised to the officer.

The officer told us in a stern voice, "Order what you can consume, money is yours but resources belong to the society. there are many others in the world who are facing shortage of resources. you have no reason to waste resources."

Our face turned red. We all agreed with him in our hearts. The mindset of people of this rich country put all of us to shame. WE REALLY NEED TO REFLECT ON THIS. We are from country which is not very rich in resources.
To save face, we order large quantity and also waste food when we give others a treat. This lesson taught us a lesson to think seriously about changing our bad habits.

My colleague photo copied the fine ticket and gave a copy to each of us as a souvenir. All of us kept it and pasted on our wall to remind us that we shall never be wasteful.

Monday 18 March 2013

Emedinews:Insights on Medicolegal Issues: What is postmortem discoloration?



The bluish color of postmortem discoloration does not have the same connotation as cyanosis produced during life
  • There is a gravitational pooling of blood in the veins and capillary beds of the dependent parts of the body occur since after death the body remains lying in a position and cessation of the circulation. The postmortem coloration helps a doctor to estimate the time since death.
  • The skin of deceased may show dark purple discoloration due to accumulated blood. The process begins immediately after the circulation stops, and in a person dying slowly with circulatory failure, it may be pronounced very shortly after death. Lividity is present in all bodies, although it may be inconspicuous in some and thus escape notice.
  • Postmortem lividity is first apparent about 20–30 minutes after death as dull red patches or blotches, which deepen in intensity and coalesce over the succeeding hours to form extensive areas.
  • Postmortem lividity is usually well marked in the earlobes and in the fingernail beds. In a supine corpse, there may be isolated areas of lividity over the front and sides of the neck resulting from incomplete emptying of superficial veins. If the head is slightly flexed on the neck, then lividity may have a linear distribution corresponding to the skin folds.
  • Fading of the primary pattern of lividity and development of a secondary pattern of lividity will be quicker and more complete if the body is moved.
  • Cyanide poisoning results in lividity which is described by different authors as pink, bright scarlet, and violet.

Emedinews:Inspiration:Two castle builders



 Hot sun. Salty air. Rhythmic waves.
 A little boy is on his knees scooping and packing the sand with plastic shovels into a bright blue bucket. Then he upends the bucket on the surface and lifts it. And, to the delight of the little architect, a castle tower is created.
 All afternoon he will work. Spooning out the moat. Packing the walls. Bottle tops will be sentries. Popsicle sticks will be bridges. A sandcastle will be built.
 Big city. Busy streets. Rumbling traffic.
 A man is in his office. At his desk he shuffles papers into stacks and delegates assignments. He cradles the phone on his shoulder and punches the keyboard with his fingers. Numbers are juggled and contracts are signed and much to the delight of the man, a profit is made.
 All his life he will work. Formulating the plans. Forecasting the future. Annuities will be sentries. Capital gains will be bridges. An empire will be built.
 Two builders of two castles. They have much in common. They shape granules into grandeurs. They see nothing and make something. They are diligent and determined. And for both the tide will rise and the end will come. Yet that is where the similarities cease. For the boy sees the end, while the man ignores it. Watch the boy as the dusk approaches.
 As the waves near, the wise child jumps to his feet and begins to clap. There is no sorrow. No fear. No regret. He knew this would happen. He is not surprised. And when the great breaker crashes into his castle and his masterpiece is sucked into the sea, he smiles. He smiles, picks up his tools, takes his father’s hand, and goes home.
 The grownup, however, is not so wise. As the wave of years collapses on his castle, he is terrified. He hovers over the sandy monument to protect it. He blocks the waves from the walls he has made. Salt-water soaked and shivering he snarls at the incoming tide.
 “It’s my castle,” he defies.
 The ocean need not respond. Both know to whom the sand belongs…
 I don’t know much about sandcastles. But children do. Watch them and learn. Go ahead and build, but build with a child’s heart. When the sun sets and the tides take – applaud. Salute the process of life and go home.

Saturday 16 March 2013

Emedinews:Insights on Medicolegal Issues:What is the treatment of poisonous bites and stings?



  • Antivenom should only be given in a hospital or medical center where resuscitation can be given, because the patient may develop an allergic reaction. Antivenin should be used, if there are signs of severe systemic envenoming. It should not be used when there are no signs of systemic envenoming. To decide whether venom has been injected, and how serious the poisoning is, look for these signs:
    • Swelling and local tissue injury at the site of the bite
    • Blood that does not clot, causing bleeding from gums, nose, wounds and injection sites
    • Shock caused by circulatory failure
    • Neurotoxic paralysis (ptosis, ophthalmoplegia, dysarthria, peripheral muscle weakness, respiratory distress)
    • Generalized muscle pain and local tissue damage
    • Kidney failure, red or black urine
    • Tender swollen lymph nodes near the bite site
  • To test clotting time of whole blood: Place 2–3 ml of whole venous blood in a clean, dry, glass test–tube and leave undisturbed for 20 minutes at room temperature. Normal blood should have clotted by this time. Tip the tube to see if the blood is still liquid.
  • If the wound becomes infected, treat as for any other local infection. Use antibiotics if needed.
  • If there is local tissue injury, do not cover the wound, instead leave it open.

Emedinews:Inspiration:Remembering Dad



When I was four years old: My daddy can do anything.

5 years old: My daddy knows a whole lot.

6 years old: My dad is smarter than your dad.

8 years old: my dad doesn’t know exactly everything.

10 years old: In the olden days, when my dad grew up, things were sure different.

12 years old: Oh, well, naturally, Dad doesn’t know anything about that, he is too old to remember his childhood.

14 years old: Don’t pay any attention to my dad, he is so old–fashioned.

21 years old: Him? My Lord, he’s hopelessly out of date.

25 years old: Dad knows about it, but then he should, because he has been around so long.

30 years old: Maybe we should ask Dad what he thinks, after all, he’s had a lot of experience.

35 years old: I’m not doing a single thing until I talk to Dad.

40 years old: I wonder how Dad would have handled it, he was so wise.

50 years old: I’d give anything if Dad were here now so I could talk this over with him.

Too bad I didn’t appreciate how smart he was, I could have learned a lot from him.