India has too few post graduate specialists

Post graduates seats in India are much less than in the US. The distribution is Cardiology 250 (US 781); Diabetology/Endocrinology 50 (US 251); Gastroenterology 93 (US 433); Hematology 13 (US 523); Nephrology 84 (US 416); Neurology 159 (US 592) and Oncology 48 (508).

Only 250 new cardiologists are added to the pool in India with largest number of heart patients in the world.

It's worse for diabetics. Even when the country is heading towards becoming the diabetes capital of the world, we have only 50 PG seats in endocrinology. The US, on the other hand, has 250 PG seats in this subject.

Tuberculosis is the sixth highest contributor to the number of deaths in India but the country has only 307 specialized doctors graduating in pulmonary medicine every year. 

Cancer the most feared disease has only 47 seats in India. In contrast, the US has 508 seats.

While a mother dies every 10 minutes in India, we have only around 1,400 obstetrics and gynaecology seats. There are about 93 seats in gastroenterology, as against 433 in the US, even when diarrhoeal diseases are the second highest contributor to deaths in India.

On the other hand, there are 5,833 para-clinical PG seats in the country. Pathology tops with 1,201 MD seats, microbiology has 724 and community medicine 736, biochemistry has been allotted 481 seats and physiology 672.

Doctors say every unit in a medical college in the country can accommodate up to five PG students, according to MCI norms. If that's the case, the number of PG seats can go up to 38,390 in the current scenario, but will that happen? (Source TOI).

Use copper based kitchen and toilet accessories

Copper, pure or alloy, used in door knobs or other bathroom or kitchen accessories prevent infection. I casually asked this question to one of the builders why in a house he uses steel based accessories and not copper based. 

He said that copper accessories are costly. When asked how much costly he said it may amount to spending extra 50,000/-. A person can buy a flat for Rs.2.5 crores but when it comes to renovation he wants to save Rs.50000/- and compromise on the quality. 

 My end answer is never negotiate or bargain when it comes to eatables and healthcare. In healthcare never negotiate when it comes to implants. For example you need a heart stent and you end up negotiating a discount of Rs.20000/-. 

The hospital will never reduce its margin of profit but install in you a 20,000/- cheaper stent. The very purpose of your getting treatment in a private hospital is to get the best and not the costliest treatment with cheapest consumables and implants.

Do not ask for concessions when buying food

 A few days back I was delivering a lecture in Friends Club organized by All India Vaish Federation. There were many people who owned a car worth over 25 lakhs. 

When asked how much they spend on the car, the answer was on an average 3 lakhs per annum which included 60000/- for insurance, 2 lakhs for driver and the rest on annual maintenance. It amounts to over 10% of the car value being spent to look after its maintenance. 

When asked how much they spend on their body, the answer was less than 25,000/- per annum. The worth of the body from the above calculation comes out to be less than 2.5 lakhs. I called the chief hotel chef and asked him how was the food prepared? He said the food was prepared in soybean oil and the sweet dish in vanaspati ghee. 

When asked why did he chose them he said that oils like olive oil and desi ghee are costly. This means a chef whose income is less than Rs.25,000/- per month has a perception that people who own a car worth over Rs.25 lakh cannot afford food which is costly, and therefore by default he has to make food using tin based cheapest soybean oil or panghat ghee which is the trans-fat full vanaspati ghee. When asked how he presumed that these people could not afford he said that every day he has been watching people coming and negotiating about the prices of food when they book for any evening. 

These people who book do not realize that the hotel will pass on any concessions to the people by supplying cheaper oil and other ingredient of the food. They will never reduce their personal margin. So next time you go to a restaurant or a hotel and ask for concessions you will get it but at the cost of inferior material. When you eat out you pay double or triple the amount you would have spent if the food was made at home then why compromise on the quality.

Do not compromise on your health

Last week I interviewed 25 domestic helps working in highly educated, financially affluent class of the society. When asked what they fear the most, they said “a firing from the Madam (owner of the house) for wasting oil or soap”.

All of them were given one soap for their personal use to be used for 3 to 4 weeks. If by mistake, they lost the soap before then to avoid a snub from the lady of the house, they preferred not to tell her and continue working in the house without using the soap even after their morning evacuation, which may lead to a serious health hazard. For servants, it does not matter as prior to their job, they never realized the importance of soap as they have been cleaning their hands with mud or the ash in their respective villages. 

It is our duty to see that our servants are taken care of and their personal hygiene is important. They should be given adequate supply of soaps, oil for their personal use, clean undergarments and outer clothes and hygienic food. Another situation is when we book for a catering of a large function like a marriage. We often hire Maharajs to cook food, but we forget to give them a place to sleep, toilet to use, clean water to drink and adequate water to wash their hands and feet after the morning evacuation. 

 They defecate in the nearby open area and bathe and wash hands with the same water used for cooking food. If they are not provided with soaps, they will wash their hands with fire ash collected from cooking place. The same people are not given gloves to wear when they are serving golgappas. Next time when you do that make sure you treat your servants hygienically in the same way as you treat yourself or your kids.

Internists Choosing Wisely: No Checkups for Asymptomatic Healthy Adults

The Society of General Internal Medicine has recommended that internists avoid 5 common, but not always necessary, tests or procedures. The evidence-based recommendations, which are part of the Choosing Wisely campaign, are:

1. "Don't recommend daily home finger glucose testing in patients with type 2 diabetes mellitus not using insulin.

2. Don't perform routine general health checks for asymptomatic adults.

3. Don't perform routine pre-operative testing before low-risk surgical procedures.

4. Don't recommend cancer screening in adults with life expectancy of less than 10 years.

5. Don't place, or leave in place, peripherally inserted central catheters for patient or provider convenience."

All will not benefit by reducing sodium

A new analysis from the large international PURE trial has reopened the debate over the link between sodium and blood pressure. Presenting PURE SODIUM here at the European Society of Cardiology 2013 Congress, Dr Andrew Mente (McMaster University, Hamilton, ON) and colleagues found that only certain subgroups will actually experience blood-pressure benefits from restricting their sodium consumption. 

Ayurveda has been talking about it for some time. People with Kapha and pitta personalities will benefit and not those with vata personality. 

A new test to rule out heart attack

Suspected acute coronary syndrome patients with a negative troponin test and a negative copeptin test (Brahms, Thermo Scientific) can be safely discharged from the hospital without further testing, according to the results of a new study presented at the European Society of Cardiology 2013 Congress.