Emedinews:Insights on Medicolegal Issues:Exhumation of corpse – America

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

In America corpses are exhumed when there is a need to identify a body or to establish cause of death like in the case of suspected homicide.

• The remains of President Zachary Taylor were exhumed in 1991 to determine whether or not he had been poisoned, and the famous outlaw Jesse James’s grave was excavated to prove that it was his body in the coffin. In addition, archaeological investigations often involve exhumation.
• Under modern law, courts usually do not allow exhumation unless there are substantial and compelling reasons to do so.
• In a landmark U.S. Supreme Court decision Justice Cardozo stated, "The dead are to rest where they have been lain unless reason of substance is brought forward for disturbing their repose."
• Three general principles govern the law of disinterment in the United States. First, it is presumed that a "decently buried" body should remain undisturbed where it was placed unless good reason is given to do so. Second, disinterment is considered the private concern of the immediate family and the cemetery. Third, if there is disagreement among the close relatives regarding a proposal for exhumation the matter is adjudicated by a court of equity. The court considers (in order of importance) the wishes and religious beliefs of the deceased (if these can be determined), the wishes of the spouse of the deceased, the opinions of other close relatives, and the policies and regulations of the cemetery when determining if exhumation should be allowed.
• California Labor Code stipulates that if it is suspected that a person has died as a result of injuries sustained in the course of his employment, the investigating appeals board may require an autopsy and, if necessary, the exhumation of the body for the purposes of autopsy. However, in accordance with the rules of equity, the close relatives can, if they wish, prevent the state (i.e., California) from either exhuming the body or performing the autopsy.

Emedinews:Makesure:An 18-year-old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.

Situation: An 18-year-old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin 500 mg twice-daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

Emedinews: Inspiration:The lucky starfish

An Inspirational Story
(Ms Ritu Sinha)

Once a man was walking along a beach. The sun was shining and it was a beautiful day. Off in the distance he could see a person going back and forth between the surf's edge and the beach. Back and forth this person went. As the man approached, he could see that there were hundreds of starfish stranded on the sand as the result of the natural action of the tide. 

The man was stuck by the apparent futility of the task. There were far too many starfish. Many of them were sure to perish. As he approached, the person continued the task of picking up starfish one by one and throwing them into the surf.

As he came up to the person, he said: "You must be crazy. There are thousands of miles of beach covered with starfish. You can't possibly make a difference."

The person looked at the man. He then stooped down and picked up one more starfish and threw it back into the ocean.

He turned back to the man and said: “It sure made a difference to that one!”

Emedinews:Insights on MEdicolegal Issues:Autopsy in death due to adverse events following immunization (AEFI)

Autopsy in death due to adverse events following immunization (AEFI)

The doctor conducting the autopsy is duty bound to take samples for toxicological screening and send them to Forensic Laboratory for toxicological/chemical examination

• The injection site and the tissues underneath up to 2–3 cms (button size) with dermis and epidermis of the sight of injection prick should be excised out. It should be preserved in a glass jar which should be filled two–thirds with saturated saline water. The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further toxicological/chemical examination.
• Viscera for toxicological/chemical examination: The following viscera specimen/biological samples should be collected for toxicological/chemical examination (80-100 gms of liver, 80-100 gms of brain with meninges, whole of the stomach with gastric contents (If no gastric contents, a section of stomach should be sent), upper part of small intestine about 30cm long with its contents, fragments from both adrenal glands, half of transverse section of kidneys, half of spleen, blood (100 ml ideal/minimum 10 ml) and urine (100 ml/minimum 10 ml).
• All the visceral specimens should be collected in separate container a wide-mouthed bottle as prescribed and saturated saline should be added as preservatives. The quantitative of the saline should be sufficient to cover all the pieces of specimen viscera in bottle.
• The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further chemical examination in a forensic lab.

Emedinews:Makesure:A patient on ACE inhibitor developed angioneurotic edema.

Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).

Emedinews:Inspiration:The power of determination (A true story)

An Inspirational Story (Ms Ritu Sinha)


 A true story about athlete Glenn Cunningham who was horribly burned in a schoolhouse fire at the age of 8 … Doctors predicted he would never walk again. Determined to walk, Glenn would throw himself off his wheelchair and pull his body across the yard and along a fence. Twenty-two months later, he took his first steps and through sheer determination, learned to run despite the pain… The little country schoolhouse was heated by an old-fashioned, pot-bellied coal stove. A little boy had the job of coming to school early each day to start the fire and warm the room before his teacher and his classmates arrived. One morning they arrived to find the schoolhouse engulfed in flames. They dragged the unconscious little boy out of the flaming building, more dead than alive. He had major burns over the lower half of his body and was taken to a nearby county hospital. From his bed the dreadfully burned, semi-conscious little boy faintly heard the doctor talking to his mother. The doctor told his mother that her son would surely die – which was for the best, really – for the terrible fire had devastated the lower half of his body. But the brave boy didn’t want to die. He made up his mind that he would survive. Somehow, to the amazement of the physician, he did survive. When the mortal danger was past, he again heard the doctor and his mother speaking quietly. The mother was told that since the fire had destroyed so much flesh in the lower part of his body, it would almost be better if he had died, since he was doomed to be a lifetime cripple with no use at all of his lower limbs. Once more the brave boy made up his mind. He would not be a cripple. He would walk. But unfortunately from the waist down, he had no motor ability. His thin legs just dangled there, all but lifeless. Ultimately he was released from the hospital. Every day his mother would massage his little legs, but there was no feeling, no control, nothing. Yet his determination that he would walk was as strong as ever. When he wasn’t in bed, he was confined to a wheelchair. One sunny day his mother wheeled him out into the yard to get some fresh air. This day, instead of sitting there, he threw himself from the chair. He pulled himself across the grass, dragging his legs behind him. He worked his way to the white picket fence bordering their lot. With great effort, he raised himself up on the fence. Then, stake by stake, he began dragging himself along the fence, resolved that he would walk. He started to do this every day until he wore a smooth path all around the yard beside the fence. There was nothing he wanted more than to develop life in those legs. Ultimately through his daily massages, his iron persistence and his resolute determination, he did develop the ability to stand up, then to walk haltingly, then to walk by himself – and then – to run. He began to walk to school, then to run to school, to run for the sheer joy of running. Later in college he made the track team. Still later in Madison Square Garden this young man who was not expected to survive, who would surely never walk, who could never hope to run – this determined young man, Dr. Glenn Cunningham, ran the world’s fastest mile*! *On June 16, 1934, Glenn Cunningham ran the mile in 4:06.8 minutes, breaking the world’s record. His effort portrays that whatever you want to create in your life is yours for the making. As long as you desire it enough and allow your will to guide you, you can have and be whatever your heart desires. The only one that can put limits on our personal will is ourselves. Develop and encourage your will to create and all the forces of nature within and without will help you bring your desire to pass. Source: http://academictips.org/blogs/the-power-of-determination-true-story/

Emedinews:Insights on MEdicolegal Issues:Postmortem examination: Ideal containers/preservative for viscera

For preservation of viscera, clean, wide-mouthed glass bottles fitted with glass stoppers of one liter capacity should be used. Rubber inserts under caps should preferably not be used. • 20–30 ml of blood taken from femoral artery or vein by skin puncture should be collected in 60ml screw–capped bottles or in plastic capped tubes/10 mg of sodium or potassium fluoride per ml of blood should be added in blood for preserving blood. • 20–30 ml of urine is obtained from direct puncture of the bladder during the postmortem examination with a syringe and needle and should be collected in 60 ml screw–capped bottles or in plastic capped tubes and 20–30mg of thymol blue or boric acid or acetic acid should be added as preservative. • Saturated sodium chloride solution (common salt) for all the visceral samples for chemical/toxicological examination. • If there is an associated history of death due to acid intoxication then all the samples should be preserved in rectified spirit.

Emedinews:Makesure:A patient with asymptomatic sinus bradycardia after permanent pacemaker implantation developed lead infection.

Situation: A patient with asymptomatic sinus bradycardia after permanent pacemaker implantation developed lead infection. Reaction: Oh my God! Why was PPI (Permanent pacemaker implantation) done? Lesson: Make sure that PPI is not implanted in patients with sinus bradycardia without significant symptoms, Sinoatrial block or sinus arrest without significant symptoms, Asymptomatic prolonged RR intervals with atrial fibrillation or other causes of transient ventricular pause and asymptomatic bradycardia during sleep.

Emedinews:Inspiration:Growing deep and strong!

An Inspirational Story (Ms Ritu Sinha) One day, my mother and I were working together in the garden where we were transplanting plants for the third time. Grown from seed in a small container, the plants had been transferred to a larger container; then transplanted into the garden. Now, because I was moving, we were transplanting them once again. Inexperienced as a gardener, I turned to my green-thumbed mother. “Isn’t this bad for them?” I asked, as we dug them up and shook the dirt from the roots. “Won’t it hurt these plants, being uprooted and transplanted so many times?” “Oh” my mother replied. “Transplanting doesn’t hurt them. In fact, it’s good for the ones that survive. That’s how their roots grow strong. Their roots will grow deep, and they will make strong plants”. Often, I’ve felt like those small plants – uprooted and turned upside. Sometimes I’ve endured the change willingly, sometimes reluctantly, but usually my reaction has been a combination. Won’t this be hard on me? I ask. Wouldn’t things be better if things remained the same? That’s when I remember my mother’s words: That’s how the roots grow deep and strong. Source: http://academictips.org/blogs/growing-deep-and-strong/

Emedinews:Insights on Medicolegal Issues:Death of a person admitted as medicolegal case

The following are the Dos and Don’ts in case a person admitted as a medicolegal case dies. • A water proof identity slip must be tagged carefully on deceased body. • Inform the police immediately. • Send the body to the hospital mortuary for preservation, till the legal formalities are completed and the police releases the body to the lawful heirs. • Request a medicolegal postmortem examination. • Do not issue a death certificate even if the patient was admitted. Make a death summary for postmortem surgeon. • The dead body should never be released to the relatives; it should only be handed over to the police.

Emedinews:Makesure:A patient with suspected pneumonia and normal x–ray died 12 hours after admission.

Situation: A patient with suspected pneumonia and normal x–ray died 12 hours after admission.
Reaction: Oh my God! Why were antibiotics not started?
 Lesson: Make sure that all patients with suspected pneumonia are given antibiotic at the first suspicion as x–ray can be normal in the first 24 hours.

Emedinews:Inspiration:Sunflowers

An Inspirational Story

Sunflowers  always  face  the  sun.   In  the  morning, they face east.  By evening,  they  have  turned  west.  They follow the sun as it crosses each day's  sky,  so they can gather in as much sun as possible.  We can be like sunflowers,  and  turn to the SON, Jesus Christ, and gather spiritual light from him.

A sunflower's seed will grow almost anywhere.  You, too, can bloom and grow where  you  are  planted.   By  desiring  to  believe  and  by studying the scriptures prayerfully, you will nurture your personal gospel seed.

As  the  sunflower  grows,  small birds soon appear, surround by protecting leaves.  Like those leaves, your parents,  leaders, and teachers surround  you,  and  love  you,  and  protect  you,  and  help your budding 
testimony grow.

As  a  sunflower grows taller, its stalk grows thicker, for it must support the  large flower that will soon be full of seeds.  So your spiritual stalk must  grow,  and  your testimony will grow stronger as you prayerfully read the scriptures that teach of Jesus Christ and strive to become like him.

When  the  sunflower  bud  opens,  bright  yellow petals form, and its head becomes a golden crown.  The blessings of its growth at last begin to show.  And,  having  been  born  of  a seed, it now produces seeds of its own that nourish  people,  animals  and birds.  Your testimony will likewise produce its own new seeds, and you will nourish family, friends and others who will see  the  Son  reflected,  like a golden crown, in you, for you have become like Him.

So  turn  to  the  Son.  Open your heart to His light.  Seek it first thing each morning.  Follow its warmth across each day's sky, and let its comfort be  the  last  thing  you  feel each night.  Then, when the evening of your life's  last  setting  comes,  you will arise to a glorious new morning and turn again to Him and he will see His image in your countenance.

Emedinews:Insights on MEdicolegal Issues:No Narcoanalysis without valid consent, rules Supreme Court of India

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


The most exhausting/frustrating and laborious parts of a criminal investigation are extracting information from uncooperative accused persons and suspects by investigators in India as well as abroad. Since no individual should be forcibly subjected to any of these techniques of interrogation in question, whether in the context of investigation in any criminal cases or otherwise. The narcoanalysis test began to be used with a presumption that it provides a simply, nonviolent method of finding out the truth. In a world where until quite recently, torture was employed in criminal cases, perhaps narcoanalysis is a simple, civilized way of conducting criminal investigation. • The Supreme Court of India said that so–called narcoanalysis, brain mapping and polygraph tests cannot be conducted on any person without their consent. • The apex court further said the confession of guilt during the course of the tests can’t be treated as evidence in court.

Emedinews:Makesure:An elderly patient with unstable angina presented with URTI and was found to be positive for C. pneumoniae infection.

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for C. pneumoniae infection. Reaction: Remember to start macrolides immediately. Lesson: Make sure to remember that erythromycin 2 g/day for 10-14 days reverses the increased risk of atherosclerosis. Sero-epidemiological studies have shown a strong association between C. pneumoniae infection and atherosclerosis in patients with cardiovascular disease.

Emedinews:Inspiration: The cockroach theory for self-development response vs reaction

An Inspirational Story (Dr GM Singh) At a restaurant, a cockroach suddenly flew from somewhere and sat on a lady. She started screaming out of fear. With a panic stricken face and trembling voice, she started jumping, with both her hands desperately trying to get rid of the cockroach. Her reaction was contagious, as everyone in her group also got panicky. The lady finally managed to push the cockroach away but ...it landed on another lady in the group. Now, it was the turn of the other lady in the group to continue the drama. The waiter rushed forward to their rescue. In the relay of throwing, the cockroach next fell upon the waiter. The waiter stood firm, composed himself and observed the behavior of the cockroach on his shirt. When he was confident enough, he grabbed it with his fingers and threw it out of the restaurant. Sipping my coffee and watching the amusement, the antenna of my mind picked up a few thoughts and started wondering, was the cockroach responsible for their histrionic behavior? If so, then why was the waiter not disturbed? He handled it near to perfection, without any chaos. It is not the cockroach, but the inability of the ladies to handle the disturbance caused by the cockroach that disturbed the ladies. I realized that, it is not the shouting of my father or my boss or my wife that disturbs me, but it's my inability to handle the disturbances caused by their shouting that disturbs me. It's not the traffic jams on the road that disturbs me, but my inability to handle the disturbance caused by the traffic jam that disturbs me. More than the problem, it's my reaction to the problem that creates chaos in my life. Lessons learnt from the story: I understood, I should not react in life. I should always respond. The women reacted, whereas the waiter responded. Reactions are always instinctive whereas responses are always well thought of, just and right to save a situation from going out of hand, to avoid cracks in relationship, to avoid taking decisions in anger, anxiety, stress or hurry.

Emedinews:Insights on Medicolegal Issues:What is the August 5, 2005 Supreme Court judgment on medical negligence?

Recently, cases of doctors being subjected to criminal prosecution are on an increase. Sometimes such prosecutions are filed by private complainants and sometimes by police on an FIR being lodged and cognizance taken.

·         The investigating officer and the private complainant cannot always be supposed to have knowledge of medical science so as to determine whether the act of the accused medical professional amounts to rash or negligent act within the domain of criminal law under Section 304–A of IPC.

·         The criminal process once initiated subjects the medical professional to serious embarrassment and sometimes harassment.

·         He has to seek bail to escape arrest, which may or may not be granted to him.

·         At the end he may be exonerated by acquittal or discharge but the loss which he has suffered in his reputation cannot be compensated by any standards.

·         We may not be understood as holding that doctors can never be prosecuted for an offence of which rashness or negligence is an essential ingredient.

·         All that we are doing is emphasizing the need for care and caution in the interest of society; for, the service which the medical profession renders to human beings is probably the noblest of all, and hence there is a need for protecting doctors from frivolous or unjust prosecutions.

·         Many a complainant prefer recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against.

Emedinews:Makesure:A patient with dengue died.

Situation: A patient with dengue died.
Reaction: Oh my God, why was he not given adequate fluids?
Lesson: Make sure that all patients with dengue are given fluids to correct intravascular dehydration.

Emedinews:Inspiration:What did you do today?

One afternoon a man came home from work to find total mayhem in his house. His three children were outside, still in their pajamas playing in the mud, with empty food boxes and wrappers strewn all round the front yard. The door of his wife's car was open, as was the front door to the house.

Proceeding into the entry, he found an even bigger mess. A lamp had been knocked over, and the throw rug was wadded against one wall.

In the front room the TV was loudly blaring a cartoon channel, and the family room was strewn with toys and various items of clothing.

In the kitchen, dishes filled the sink, breakfast food was spilled on the counter, dog food was spilled on the floor, a broken glass lay under the table, and a small pile of sand was spread by the back door.

He quickly headed up the stairs, stepping over toys and more piles of clothes, looking for his wife. He was worried she may be ill, or that something serious had happened. He found her lounging in the bedroom, still curled in the bed in her pajamas, reading a novel.

She looked up at him, smiled, and asked how his day went. He looked at her bewildered and asked, "What happened here today?"

She again smiled and answered, "You know every day when you come home from work and ask me what in the world I did today?"

"Yes," was his incredulous reply.

She answered, "Well, today I didn't do it." 

Emedinews:Insights on MEdicolegal Issues:Medical Negligence

Medical Negligence

Government of India/Medical Council of India should give Statutory Rules or Executive Instructions on medical negligence – Supreme Court of India

• The Honorable Apex Court said that so long as it is not done we propose to lay down certain guidelines for the future which should govern the prosecution of doctors for offences of which criminal rashness or criminal negligence is an ingredient.
• A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor.
• The investigating officer should, before proceeding against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice That doctor can normally be expected to give an impartial and unbiased opinion applying Bolam’s test to the facts collected in the investigation.
• A doctor accused of rashness or negligence, may not be arrested in a routine manner simply because a charge has been leveled against him
• The doctor should never be arrested in case of medical negligence since the basic rule of mens rea means any criminality to harm the patient always remain absent
• The exceptional ground and necessity of arrest of doctor is required to be deliberated must be transparent/well justified before the police if unavoidable for furthering the investigation or for collecting the evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make him available to face the prosecution unless arrested, the arrest may be withheld.

Emedinews:Makesure:A patient with Chikungunya had persistent joint pains.

Situation: A patient with Chikungunya had persistent joint pains.
Reaction: Oh my God! Why was a trial of hydroxychloroquinine not given?
Lesson: Make sure that all patients of Chikungunya fever with persistent joint pains are given a trial of hydroxychloroquinine.

Emedinews:Inspiration:The pearls

An Inspirational Story

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 loved her pearls. They made her feel dressed up and grown up. She wore them everywhere-Sunday school, kindergarten, even to bed. The only time she took them off was when she went swimming or had a bubble bath. Mother said if they got wet, they might turn her neck green.

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. A few nights later when her daddy came in, Jenny was sitting on her bed with her legs crossed Indian-style.

As he came close, He noticed her chin was trembling and one silent tear rolled down her cheek. "What is it, Jenny? What's the matter?"

Jenny didn't say anything but lifted her little hand up to her daddy. And when she opened it, there was her little pearl necklace. With a little quiver, she finally said, "Here, Daddy. It's for you." 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 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 like our Heavenly Father. Wonder what we're hanging on to... 

Emedinews:Insights on Medicolegal Issues:What is Sec 314 of the IPC?

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

Sec. 314 IPC provides that whoever, with intent to cause the miscarriage of the woman with child, does any act that causes the death of such woman, shall be punished with imprisonment of either description of a term which may extend to ten years or shall also be liable to fine. If the act is done without the consent of the woman, shall be punished with imprisonment for life or with punishment above mentioned.

• The explanation to this section says that it is not essential to this offence that the offender should know that the act is likely to cause death.
• A person who attempted to cause miscarriage of a pregnant woman but was unsuccessful in the process and when pregnant girl died several weeks later having developed septicemia without it having been established that the person was responsible for septicemia, the person cannot be held guilty under Sec 314 of IPC.

(Ref: Vatchalabai Maruti Kgar v. State of Maharashtra, 1993 Cri LJ 702 (Bom)

Emedinews:Makesure:A patient on binasal oxygen developed nasal mucosal damage

Situation: A patient on binasal oxygen developed nasal mucosal damage.
Reaction: Oh my God! Why was the oxygen given at 4 liter per minute?
 Lesson: Make sure that oxygen via nasal catheter is not given at a rate of more than 3 liter per minute.

Emedinews:Inspiration:Talk to Me

An Inspirational Story Talk to Me As you got up this morning, I watched you, and hoped you would talk to me, even if it was just a few words, asking my opinion or thanking me for something good that happened in your life yesterday. But I noticed you were too busy, trying to find the right outfit to wear. When you ran around the house getting ready, I knew there would be a few minutes for you to stop and say hello, but you were to busy. At one point, you had to wait fifteen minutes with nothing to do except sit in a chair. Then I saw you spring to your feet. I thought you wanted to talk to me but you ran to the phone and called a friend to get the latest gossip instead. I watched patiently all day long. With all your activities, I guess you were too busy to say anything to me. I noticed that before lunch you looked around, maybe you felt embarrassed to talk to me, that is why you didn't bow your head. You glanced three or four tables over and you noticed some of your friends talking to me briefly before they ate, but you didn't. That's okay. There is still more time left, and I hope that you will talk to me yet. You went home and it seems as if ! you had lots of things to do. After a few of them were done, you turned on the TV. I don't know if you like TV or not, just about anything goes there and you spend a lot of time each day in front of it not thinking about anything, just enjoying the show. I waited patiently again as you watched the TV and ate your meal, but again you didn't talk to me. Bedtime I guess you felt too tired. After you said goodnight to your family, you plopped into bed and fell asleep in no time. That's okay because you may not realize that I am always there for you. I've got patience, more than you will ever know. I even want to teach you how to be patient with others as well. I love you so much that I wait everyday for a nod, prayer or thought or a thankful part of your heart. It is hard to have a one-sided conversation. Well, you are getting up once again. And once again I will wait, with nothing but love for you. Hoping that today you will give me some time. Have a nice day!

Emedinews:Insights on Medicolegal Issues:What is murder?

Medicolegal Update (Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS) Murder is the act of killing another human being with malice, traditionally called "malice aforethought." Malice is defined as the intent to kill or to inflict bodily injury, either express or implied. If a deadly weapon is used, intent to kill will necessarily be implied by a court of law. The presumption is that if the assailant brought a deadly weapon with him/her there was intent to use the weapon. If the assailant picked up a weapon at the scene of the crime in an act of defense or in a provoked fit of rage, there might not be malice. Murder, as defined in common law countries, is the unlawful killing of another human being with intent or malice aforethought and generally this state of mind distinguishes murder from other forms of unlawful homicide • Manslaughter means unlawful premeditated killing of a human being by a human being. • In the United States, the principle of dual sovereignty applies to homicide, as to other crimes. If murder is committed within the borders of a state, that state has jurisdiction. • According to the modern Russian Criminal Code, only intentional killing of another human considered as a murder. • In Sweden, Murder (Mord) is defined as a planned taking of life of another and is punishable with imprisonment between 10 to 18 years or life imprisonment. • However, according to the Romanian Penal Code, a person can face a penalty ranging from 10 to 25 years or life imprisonment for murder. • In Norway, an act of murder (mord or drap) may be either planned murder, intentional murder or murder as a result of neglect. • Murder is defined in the New South Wales Crimes Act 1900 as follows: o Under NSW law, the maximum penalty for murder is life imprisonment with a standard non–parole period of 20 years, or o 25 years for the murder of a child under the age of 18 years, or police official • In Finland, murder is defined as homicide with at least one of four aggravating factors: deliberate intent/Exceptional brutality or cruelty significantly endangering public safety Committed against a public official engaged in enforcing the law.

Emedinews:Makesure:A diabetic patient died of flu pneumonia.

Situation: A diabetic patient died of flu pneumonia. Reaction: Oh my God! Why was flu vaccine not given? Lesson: Make sure that all diabetics are given flu vaccine every year.

Emedinews:Inspiration:The rose

An Inspirational Story A certain man planted a rose and watered it faithfully, and before it blossomed, he examined it. He saw the bud that would soon blossom and also the thorns. And he thought, "How can any beautiful flower come from a plant burdened with so many sharp thorns?" Saddened by this thought, he neglected to water the rose, and before it was ready to bloom, it died. So it is with many people. Within every soul there is a rose. The God-like qualities planted in us at birth grow amid the thorns of our faults. Many of us look at ourselves and see only the thorns, the defects. We despair, thinking that nothing good can possibly come from us. We neglect to water the good within us, and eventually it dies. We never realize our potential. Some people do not see the rose within themselves; someone else must show it to them. One of the greatest gifts a person can possess is to be able to reach past the thorns and find the rose within others. This is the characteristic of love, to look at a person, and knowing his faults, recognize the nobility in his soul, and help him realize that he can overcome his faults. If we show him the rose, he will conquer the thorns. Then will he blossom, blooming forth thirty, sixty, a hundred-fold as it is given to him. Our duty in this world is to help others by showing them their roses and not their thorns. Only then can we achieve the love we should feel for each other; only then can we bloom in our own garden.

Emedinews:Insights on Medicolegal Issues:Medicolegal cases & injury, assault and hurt in Indian law

The words injury, assault and hurt are invariably used by doctor in hospital practice and are used as synonymous. But all three have a different meaning as per law. It is defined by the Indian Penal Code as below: • Injury: Section 44 of IPC defines injury as any harm whatever illegally caused to any person in body, mind, reputation or property. • Assault: Section 351 of IPC defines assault as an offer or threat or attempt to apply force on body of another in a hostile manner. It may be a common/simple assault or an intention to murder. • Hurt: Section 319 of IPC defines hurt as whoever causes bodily pain, disease or infirmity to any person is said to cause hurt. When we as doctors deal with cases of Hurt/body injury, it means bodily pain, wound, disease or infirmity voluntarily caused to any person in medicolegal cases. These would include abrasions, contusions, lacerations, stab wounds, electric shock, firearm or ligatures etc resulting in human body injury. The doctor who is certifying an injury report should keep in mind the Penal provisions required by police to book the case i.e. • Simple injury: IPC Section 323 • Simple injury caused by dangerous weapons: IPC Section 324 • Grievous injury: IPC Section 325 • Grievous injury caused by dangerous weapons: IPC Section 326 • Dangerous injury: IPC Section 307 • Injury likely to cause death: IPC Section 304 • Injury sufficient to cause death: IPC Section 302 • Causing hurt by means of poison: IPC Section 328

Emedinews:Makesure:A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI.

Situation: A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI. Reaction: Oh my God! Why was a statin not started earlier? Lesson: Make sure that all patients with even normal cholesterol are considered for statins if the hsCRP is high.

Emedinews:Inspiration:Your heart's desire

An Inspirational Story One night, a young woman dreamed she was walking in the mall and noticed a shop on the second floor she hadn't seen before. The name over the door said, "Your Heart's Desire". She crossed the store's threshold and was enveloped in a charming fragrance. The store had a homey feeling, with shelves full of fascinating items. A short, smiling dumpling of a lady was behind the counter. "What is it your shop sells?" asked the young lady. "Just as the name implies, everything your heart desires!" came the purring answer. "Oh! I know what I want!" exclaimed the girl, "Peace, happiness, love for everyone, and..." "Wait a minute," giggled the cashier. "You don't quite understand. We sell whatever your heart desires. But we don't sell the finished product, we sell the seeds -- and you have to choose the ones you want to plant." http://www.christysclipart.com/inspirational_stories.htm

Emedinews:Insights on Medicolegal Issues:Sudden Cardiac arrest

Some people confuse sudden cardiac arrest (SCA) with a heart attack. They are by no means the same. • Nineteen cases of SCA have been examined and certified by me in AIIMS in the year 2010 where a defibrillator was not used prior to fatality. • During a heart attack, caused by blockage of the arteries, the victim has severe chest pain but almost always remains conscious. Whereas, victims of SCA will always lose consciousness. SCA is the result of a "ventricular fibrillation" a quivering of the heart which prevents the heart muscle from pumping blood to the body. To overcome this condition, the victim will need various forms of help in order to survive. • The most important is the assistance of a defibrillator. • Each minute that passes without defibrillation decreases the victim’s survival chances by 10–20%. • When a defibrillator is used, it in effect kicks the heart muscle into action again, causing it to resume sending blood throughout the body. • A defibrillator is a machine used to shock the victim’s heart and restore the heart’s normal rhythmic patterns.

Emedinews:Makesure:A patient with hiatus hernia developed severe symptoms after eating a ‘Paan’.

Situation: A patient with hiatus hernia developed severe symptoms after eating a ‘Paan’. Reaction: Oh my God! Why was he given a peppermint? Lesson: Make sure patients with reflex esophagitis are not given any food which can relax GI sphincter.

Emedinews:Inspiration:Never underestimate the Power of God!

Dwight Nelson recently told a true story about the pastor of his church. He had a kitten that climbed up a tree in his backyard and was then afraid to come down. The pastor coaxed, offered warm milk, etc. The kitty would not come down. The tree was not sturdy enough to climb, so the pastor decided that if he tied a rope to his car he could bend the tree down enough to get the kitten. He did all this, checking his progress frequently. But as he moved the car a little further forward, the rope broke. The tree went "boing!" and the kitten instantly sailed through the air-out of sight. The pastor felt terrible. He walked all over the neighborhood asking people if they'd seen a little kitten. No. Nobody had seen a stray kitten. So he prayed, "Lord, I just commit this kitten to your keeping," and went on about his business. A few days later he was at the grocery store, and met one of his church members. He was amazed to see she was buying cat food. Now this woman was a cat hater and everyone knew it, so he asked her, "Why are you buying cat food when you hate cats so much?" She replied, "You won't believe this," and told him how her little girl had been begging her for a cat, but she kept refusing. Then a few days before, the child had begged again, so the Mom finally told her little girl, "Well if God gives you a cat, I'll let you keep it." She told the pastor, "I watched my child go out in the yard, get on her knees, and ask God for a cat. And really, Pastor, you won't believe this, but I saw it with my own eyes. A kitten suddenly came flying out of the blue sky, with its paws outspread, and landed right in front of her." Never underestimate the Power of God! http://www.christysclipart.com/inspirational_stories.htm

Emedinews:Insights on MEdicolegal Issues:Delusions of grandeur

Also termed as delusion of exaltation • This is a delusion of pleasant belief or feeling. The sufferer remains in a state of feeling of greatness, power and wealth. He may be extravagant in his thinking and action and may commit some crime in such a state of mind or may ruin his money or property. • Erotomania is a type of delusion of grandeur, where the sufferer believes that a person of very high rank or social status loves him/her. The sufferer also believes that the imaginary person communicates his love in some manner or other, by posture or by communication in a secret or symbolic way. • When a person suffering from delusion of grandeur, believes that he will be killed by another person for the huge property he possesses and if as remedial step he kills that person then he will have diminished responsibility for the commission of the act because though in this case there are elements of fear and apprehension about his own life and to safeguard his life he has killed the person, yet he is not fully absolved from the act he has committed because in such a case he could have tried lawful protective steps for his life i.e., he could have sought for the help of the police…

Emedinews:Inspiration:No regrets about today

If I knew it would be the last time that I'd see you fall asleep, I would tuck you in more tightly, and pray the Lord, your soul to keep. If I knew it would be the last time that I see you walk out the door, I would give you a hug and kiss, and call you back for one more. If I knew it would be the last time I'd hear your voice lifted up in praise, I would video tape each word, so I could play them back day after day. If I knew it would be the last time, I could spare an extra minute or two to stop and say "I love you," instead of assuming you would KNOW I do. If I knew it would be the last time, I would be there to share your day, well I'm sure you'll have so many more, so I can let just this one slip away. For surely there's always tomorrow to make up for an oversight, and we always get a second chance to make everything right. There will always be another day to say our "I love you," And certainly there's another chance to say our "Anything I can do?" But just in case I might be wrong, and today is all I get, I'd like to say how much I love you and I hope we never forget. Tomorrow is not promised to anyone, young or old alike And today may be the last chance you get to hold your loved one tight... So if you're waiting for tomorrow, why not do it today? For if tomorrow never comes, you'll surely regret the day, That you didn't take that extra time for a smile, a hug, or a kiss and you were too busy to grant someone, what turned out to be their one last wish. So hold your loved ones close today, whisper in their ear, Tell them how much you love them and that you'll always hold them dear. Take time to say "I'm sorry," "please forgive me." "thank you" or "it's okay." And if tomorrow never comes, you'll have no regrets about today. She has been there, and done that. Source: http://www.inspirationalstories.com/10/1048.html

Emedinews:Makesure:A patient on ACE inhibitor developed angioneurotic edema.

Situation: A patient on ACE inhibitor developed angioneurotic edema. Reaction: Oh my God! Why was ACE inhibitor continued? Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).

Emedinews:Insights on Medicolegal Issues:Doctors should avoid special efforts to “cover up” any medical fact

The media and general public are vastly becoming informed and law conscious. There is awareness of modern diagnostic/therapeutic methods. The standard of doctors/hospital, its opinion and method of medical/surgical interventions are being scrutinized from time to time in public as well as Court of law and media. The doctor should not avoid talking to the media but definitely not too much and too soon. Prejudicial and sensational statements should not be made by doctor prior to trial. It is incumbent upon doctors to have good knowledge of the law governing their profession, in order not to transgress the law. • Doctors should totally avoid special efforts to “cover up” alleged medical negligence or unintentional wrong doing or inevitable medical accident. • It is a standard accepted universal fact that “Medicine is not mathematics but is a science of uncertainty and an art of probability. One thing that makes medicine so difficult is that there is no such thing as the average man can understand the intricacies. We can only say the reading is ‘within the range of normal’. Medicine is a biological science with the variability inherent in body physiology with the variability inherent in biological matters. • Forensic medicine is not an exact science as a mathematical calculation hence while making a forensic opinion it is required to deliberate that unexpected results are produced due to biological variations in case to case, there is an element of uncertainty and absolute proof is a rarity in any medical care delivery. • Doctors should bear in mind the essential difference between probability and proof. They should be reasonable in their opinions and should not overstate the likelihood of a relationship between cause and effect. • The doctor should be ready to defend every finding and conclusion on the report on clinical and scientific grounds in the court of law. He should be aware of professional and scientific viewpoints which might differ from his, and should be familiar with the latest scientific literature in relation to the subject involved. • The doctor in the Court of law may clarifying his testimony by means of photographs, maps, diagrams, charts, X-rays, skeletons, models, slides, films, tapes, etc., when they are properly verified.

Emedinews:Makesure:A patient with LBBB in ECG developed acute pulmonary edema.

Situation: A patient with LBBB in ECG developed acute pulmonary edema. Reaction: Oh my God! Why was underlying low cardiac functions not suspected? Lesson: Make sure all patients with LBB undergo echo to rule out ejection fraction. This may not be true for RBBB.

Emedinews:An Inspirational Story

Many years ago, when I worked as a volunteer at a hospital, I got to know a little girl named Liz who was suffering from a rare and serious disease. Her only chance of recovery appeared to be a blood transfusion from her 5-year-old brother, who had miraculously survived the same disease and had developed the antibodies needed to combat the illness. The doctor explained the situation to her little brother, and asked the little boy if he would be willing to give his blood to his sister. I saw him hesitate for only a moment before taking a deep breath and saying, “Yes, I’ll do it if it will save her.” As the transfusion progressed, he lay in bed next to his sister and smiled, as we all did, seeing the color returning to her cheeks. Then his face grew pale and his smile faded. He looked up at the doctor and asked with a trembling voice, “Will I start to die right away?” Being young, the little boy had misunderstood the doctor; he thought he was going to have to give his sister all of his blood in order to save her. Source: http://great-motivational-stories.blogspot.in/

Emedinews:Insights on Medicolegal Issues:How was death defined by scientist in past?

In the fatal automobile accident of Smith v/s Smith both husband and wife sustained injury. Husband died on the spot and the wife was taken to the hospital where she remained unconscious for 17 days and then died. The petitioner argued that the deaths were simultaneous, since there was no evidence of brain activity after accident. The inference was that resuscitative efforts were maintaining the body in a state of animation although it could not be shown that life existed. The court did not accept the contention. They quoted Black’s definition of death and stated that "one who is breathing, though unconsciousness is not dead." The living body depends upon the integrity of three principal interdependent systems circulation, respiration and enervation. Failure of one of them will cause failure of the other two. This leads to the death of the individual. There are two phases of death: (i) Extinction of the personality is immediate sign of vital process: This is somatic death. (ii) Progressive disintegration of the body tissue: This is molecular death or cellular death that occurs sometimes later. Calne in 1970, gave a more practical definition that states when destruction of the brain has been established, the individual has died no matter what the state of the rest of his body, giving four signs for such a diagnosis: (i) Deep, irreversible coma with fixed, dilated pupils and absent cranial nerve reflexes (ii) No spontaneous respiration (iii) absence of electrical brain activity (iv) Cessation of circulation in the retinal vessels. Rantoul and Smith in 1973 defined death as complete and persistent cessation of respiration and circulation. (Ref: Dr. PC Dikshit Head (MAMC) MD LLB, Textbook of forensic medicine, Peepe Publisher)

Emedinews:Makesure:A child with sore throat and enlarged lymph nodes developed fever.

Situation: A child with sore throat and enlarged lymph nodes developed fever. Reaction: Oh my God! Why were antibiotics not given in time? Lesson: Make Sure that all children with sore throat and enlarged lymph nodes are given antibiotics as such sore throats are streptococcal unless proved otherwise.

Emedinews:Inspiration:It is the little things that make a big difference

An Inspirational Story There was a man taking a morning walk at or the beach. He saw that along with the morning tide came hundreds of starfish and when the tide receded, they were left behind and with the morning sun rays, they would die. The tide was fresh and the starfish were alive. The man took a few steps, picked one and threw it into the water. He did that repeatedly. Right behind him there was another person who couldn't understand what this man was doing. He caught up with him and asked, "What are you doing? There are hundreds of starfish. How many can you help? What difference does it make?" This man did not reply, took two more steps, picked up another one, threw it into the water, and said, "It makes a difference to this one." What difference are we making? Big or small, it does not matter. If everyone made a small difference, we'd end up with a big difference, wouldn't we? Source: http://great-motivational-stories.blogspot.in/

Emedinews:Insights on Medicolegal Issues:Most important advances in the arena of medical practice have been the use of technologies

• Medical professionals today rely on a number of different types of equipment every day, from heart defibrillators to IV pumps to CT scans to automated breathing apparatuses. When any of these devices fail, the results can be disastrous, resulting in the injury or death of a patient. • When the medical devices fail, as all machines generally have a tendency to do, the risks have major consequences and are dangerous for human health. • Medical equipment failure can result from both manufacturing defects or human error i.e. it was used incorrectly by the medical staffer involved and the concept of product liability develops. • Medical professionals should keep a constant eye on the equipment/s to ensure that it is working properly and be adequately trained to use the device safely. • A register of maintenance of medical equipment must be maintained with signature of all stake holders for record. Failure to do so is a form of negligence that places the hospital and its staff at liability.

Emedinews:Makesure:A 20–year–old college student complained of dysuria, frequency and pyuria.

Situation: A 20–year–old college student complained of dysuria, frequency and pyuria. Reaction: Oh my God! Why did you not advise macrolide? Lesson: Make sure to remember that macrolides are very effective against E. coli, S. saprophyticus and C. trachomatis infection.

Emedinews:Inspiration:Grandfather’s experience

An Inspirational Story (MS Ritu SInha) A grandfather talking to his grandson about a tragedy he witnessed: “I feel as if I have two wolves fighting in my heart. One is the vengeful, angry, violent one. The other wolf is the loving, compassionate one.” “Grandfather, which wolf will win the fight in your heart?” asked his Grandson. Grandfather answered, “The one I feed.”

Emedinews:Makesure:Reasons for false negative chemical analysis report of viscera

If the doctor conducting the autopsy has formed a conclusive opinion that the death is due to poisoning based on clinical evidence and after excluding other causes, he has all the authority to inform the investigating officer and mention his conclusive opinion in the postmortem report even if he is preserving the viscera for chemical analysis. A false negative test report may be due to: • Delay in chemical analysis • Improper preservation • Use of wrong analytical technique • Early disintegration of poison • Complete metabolism • Lack of suitable test for certain poison In accordance with a judicial pronouncement, the doctor who has conducted the postmortem examination can give his opinion as to the cause of death (due to poisoning) despite negative viscera report.

Emedinews:Makesure:A 28–year–old male presents with increased frequency and occasional blood in urine. Examination of urine shows sterile pyuria.

Situation: A 28–year–old male presents with increased frequency and occasional blood in urine. Examination of urine shows sterile pyuria. Reaction: Oh my God! Why didn’t you check for TB? Lesson: Make Sure to rule out TB in patients with frequency, dysuria, hematuria. Sterile pyuria is the first clue to diagnosis.

Emedinews:Inspiration: How the poor live

An Inspirational Story (MS Ritu SInha) One day, a father of a very wealthy family took his son on a trip to the country with the firm purpose of showing his son how poor people live. They spent a couple of days and nights on the farm of what would be considered a very poor family. On their return from their trip, the father asked his son, “How was the trip?” “It was great, Dad.” “Did you see how poor people live?” the father asked. “Oh yeah,” said the son. “So, tell me, what you learned from the trip?” asked the father. The son answered, “I saw that we have one dog and they had four. We have a pool that reaches to the middle of our garden, and they have a creek that has no end. We have imported lanterns in our garden, and they have the stars at night. Our patio reaches to the front yard, and they have the whole horizon. We have a small piece of land to live on, and they have fields that go beyond our sight. We have servants who serve us, but they serve others. We buy our food, but they grow theirs. We have walls around our property to protect us; they have friends to protect them.” The boy’s father was speechless. Then his son added, “Thanks, Dad, for showing me how poor we are.”

Emedinews:Insights on Medicolegal Issues:What is lucid interval?

Lucid interval is the period during which the mentally unsound person behaves very much like a normal person. During this period all the signs and symptoms of insanity are absent. The person is responsible for all his acts performed during the period of lucid interval.

Emedinews:Makesure:A patient with acid peptic disease was denied any painkiller for his distressing illness.

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness. Reaction: Oh, my God! Why did you not give him nimesulide? Lesson: Make Sure, to prescribe nimesulide as it is safe in acid peptic disease.

Emedinews:Inspiration:In reply to all Sardar Jokes It's true

An Inspirational Story (Dr GM Singh) We all love Sardar jokes. But do you know that Sikhs are one of the hardest working prosperous and diversified communities in the world. My friend told me about the following incident which I wish to share with you. It has had a deep impact on my thinking. During last vacation, his few friends came to Delhi. They rented a taxi for local sight-seeing. The driver was an old Sardar and boys being boys, these pals began cracking Sardarji jokes, just to tease the old man. But to their surprise, the fellow remained unperturbed. At the end of the sight-seeing, they paid the cab hire-charges. The Sardar returned the change, but he gave each one of them one rupee extra and said, ''Son, since morning you have been telling Sardarji jokes. I listened to them all and let me tell you, some of them were in bad taste. Still, I don't mind coz I know that you are young blood and are yet to see the world. But I have one request. I am giving you one rupee each. Give it to the first Sardar beggar that you come across in this or any other city.” My friend continued, “That one rupee coin is still with me. I couldn't find a single Sardar begging anywhere.” MORAL: The secret behind their universal success is their willingness to do any job with utmost dedication and pride. A Sardar will drive a truck or set up a roadside garage or a dhaba, put a fruit juice stall, take up small time carpentry, ... but he will never beg on the streets.

Emedinews:Insights on Medicoleagal Issues: What is medical fasting?

Medicolegal Update (Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS) • Various blood tests require a fasting of up to 12–16 hours so that a baseline normalcy of blood can be established. • The patient is asked to remain in a fasting state for medical reasons: surgery or other procedures of diagnostic or therapeutic intervention that require anesthetic. The presence of food in a person's system can cause complications when they are anesthetized; medical personnel strongly suggest that their patients fast for several hours before the procedure. • Some animal studies show that fasting every other day while eating double the normal amount of food on non–fasting days led to better insulin control, neuronal resistance to injury and health indicators similar to mice on calorie restricted diets. • Patient refusal of nutrition and hydration in terminal illness: "within the contexts of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill" and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria." • In homeopathic medicine, fasting is seen as a way of cleansing the body of toxins, dead or diseased tissues, and giving the gastrointestinal system a rest. During fasts, water, fruit and vegetable juices are usually taken on choice.

Emedinews:Makesure:A patient with cough of more than 4 weeks duration came with blood in his sputum.

Situation: A patient with cough of more than 4 weeks duration came with blood in his sputum. Reaction: Oh my God! Why was TB not suspected earlier? Lesson: Make sure that all patients with cough of more than 3 weeks duration are investigated for TB.

Emedinews:Inspiration:How much do you make an hour?

An Inspirational Story With a timid voice and idolizing eyes, the little boy greeted his father as he returned from work, “Daddy, how much do you make an hour?” Greatly surprised, but giving his boy a glaring look, the father said: “Look, son, not even your mother knows that. Don’t bother me now, I’m tired.” “But Daddy, just tell me please!? How much do you make an hour,” the boy insisted. The father finally giving up replied: “Twenty dollars per hour.” “Okay, Daddy? Could you loan me ten dollars?” the boy asked. Showing restlessness and positively disturbed, the father yelled: “So that was the reason you asked how much I earn, right?? Go to sleep and don’t bother me anymore!” It was already dark and the father was meditating on what he had said and was feeling guilty. Maybe he thought, his son wanted to buy something. Finally, trying to ease his mind, the father went to his son’s room. “Are you asleep son?” asked the father. “No, Daddy. Why?” replied the boy partially asleep. “Here’s the money you asked for earlier,” the father said. “Thanks, Daddy!” rejoiced the son, while putting his hand under his pillow and removing some money. “Now I have enough! Now I have twenty dollars!” the boy said to his father, who was gazing at his son, confused at what his son just said. “Daddy could you sell me one hour of your time?” - Author Unknown Source: http://www.motivationalwellbeing.com/motivational-stories-8.html

Emedinews:Insights on Medicolegal Issues:Cite the source of the evidence in medical literature

Medicolegal Update (Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS) Cite the source of the evidence in medical literature For a document to serve as legitimate evidence in a trial it must exist in the public domain and the degree to which a medical document/literature/book validates the point you are making depends upon the reliability of the document. The author of a document is a witness that you are calling upon to testify. • To constitute valid medical testimony, the witness must be identified. • Conventions for citing sources are somewhat dynamic. However, at a minimum you should identify the individual, institution, or publication that authored the document and the publication date. • When it is not otherwise evident, you ought to make quick reference to the qualifications of the author to lend an air of credibility to the document. Although it is not necessary to read additional information into the records, you must be prepared to provide a complete bibliographic citation if called upon to do so by the court of law or cross lawyer.

Emedinews:Makesure:A patient with large intestinal diarrhea developed sepsis after he was given antimotility drugs.

Situation: A patient with large intestinal diarrhea developed sepsis after he was given antimotility drugs. Reaction: Oh my God, Why was an antibiotic not given?
 Lesson: Make sure that if antimotility drug is given in a large intestinal diarrhea, it is always given with an antibiotic.

Emedinews:Inspiration:I loved those boys

An Inspirational Story
(Ms Ritu Sinha)

Years ago a Johns Hopkin’s professor gave a group of graduate students this assignment: Go to the slums. Take 200 boys, between the ages of 12 and 16, and investigate their background and environment. Then predict their chances for the future. The students, after consulting social statistics, talking to the boys, and compiling much data, concluded that 90 percent of the boys would spend some time in jail.

Twenty-five years later another group of graduate students was given the job of testing the prediction. They went back to the same area. Some of the boys – by then men – were still there, a few had died, some had moved away, but they got in touch with 180 of the original 200. They found that only four of the group had ever been sent to jail.

Why was it that these men, who had lived in a breeding place of crime, had such a surprisingly good record? The researchers were continually told: “Well, there was a teacher…” They pressed further, and found that in 75 percent of the cases it was the same woman.

The researchers went to this teacher, now living in a home for retired teachers. How had she exerted this remarkable influence over that group of children? Could she give them any reason why these boys should have remembered her? “No,” she said, “no I really couldn’t.” And then, thinking back over the years, she said amusingly, more to herself than to her questioners: “I loved those boys…”

- Author – Bits & Pieces

(Source: http://www.motivationalwellbeing.com/motivational-stories-9.html)

Emedinews:Insights on Medicolegal Issues:Facilitate cadaver organ retrieval for transplantation

In India, certain amendments to the Human Organ Transplant Act 1994 are required to enhance cadaver organ retrieval and transplantation to bridge the huge demand–supply gap. The pool of donors, including increasing the supply of organs by widening the definition of ‘near relatives’ by allowing organ swaps among needy families, as well as, simplifying cadaver transplant procedures. The paired matching should be permitted i.e. if patient A’s donor does not match A, and likewise for patient B, then donor switch should be allowed, if it results in a match. Swaps or exchanges between families unable to fulfill the need of their family member in need of a transplant.

Emedinews:Makesure:A patient with chest pain with normal ECG died half an hour later.

Situation: A patient with chest pain with normal ECG died half an hour later.
Reaction: Oh my God! Why was acute MI not suspected?
Lesson: Make sure all patients of chest pain are observed for 12 hours. ECG can be normal in acute heart attack for up to six hours.

Emedinews:Inspiration:Doctor’s Service!

An Inspirational Story
(Ms Ritu Sinha)

A doctor quickly entered the hospital after being called in for an urgent surgery. He changed his clothes and went directly to the surgery block. He saw the boy’s father walking back and forth in the hall waiting for the doctor.

Once seeing the doctor, the dad yelled: “Why did you take all this time to come? Don’t you know that my son’s life is in danger? Don’t you have the sense of responsibility?”

The doctor smiled and said: “I am sorry, I wasn’t in the hospital and I came the fastest I could… now, I wish you’d calm down so that I can do my work.” “Calm down?! What if your son was in this room right now, would you calm down? If your own son dies now what will you do?” said the father angrily.

The doctor smiled again and replied: “I will say what is said in the Holy Bible ‘From dust we came and to dust we return, blessed be the name of God.’ Doctors cannot prolong lives. Go and intercede for your son, we will do our best by God’s grace.”

“Giving advice when we’re not concerned is so easy” murmured the father. The surgery took some hours after which the doctor went out happy, “Thank God! Your son is saved!” And without waiting for the father’s reply he carried on his way running. “If you have any question, ask the nurse.”

“Why is he so arrogant? He couldn’t wait some minutes so that I ask about my son’s state?” commented the father when seeing the nurse minutes after the doctor left.

The nurse answered: “His son died yesterday in a road accident, he was in the burial when we called him for your son’s surgery.”

Emedinews:Insights on Medicolegal Issues:Immediate first aid may stop serious poisoning and may save life

In cases of poisoning, if breathing and the heart stop, the person will die within a few minutes unless first aid is given at once. Here is an action list. Each step is explained in more detail below the list. Start with the first step and follow each step in the order given. Act as quickly as you can, but stay calm.

• Check if the patient is conscious try to make the patient wake up. Shout "Are you all right?" and gently shake the shoulders, but take care not to make any injuries worse. Pinch the skin on the neck and watch the face. A patient who is just sleeping will wake up, but an unconscious patient will not.
• Open the airway. The airway is the tube through which air passes from the mouth and nose to the lungs. If it is blocked the patient cannot breathe and air cannot get into or out of the lungs. A patient who cannot breathe will die within four minutes. In an unconscious patient the tongue may block the throat and the airway. Make sure the airway is open and air can get down the throat. Place the patient on his or her back. Tilt the head back and lift the chin up with the finger and thumb of one hand on the bony part of the chin, while pressing the forehead back with the other hand. This will open the airway and stop the tongue blocking the throat.
• Check whether the patient is breathing after opening the airway; quickly check whether the patient is breathing. Look for the belly or the chest moving up and down. Feel the chest moving up and down. Feel the patient’s breathe on your cheek. Listen for breath sounds. Put your ear close to the patient’s mouth. Use all four checks. Remember that the chest may move up and down even when the throat is completely blocked and air cannot get to the lungs.

Emedinews:Makesure:A patient on amlodipine developed severe gum hypertrophy.

Situation: A patient on amlodipine developed severe gum hypertrophy.
Reaction: Oh my God! Why was amlodipine not stopped?
Lesson: Make sure that all patients on amlodipine are watched for gum hypertrophy as its side effect.

Emedinews:Inspiration:The goldfish bowl – cute!

An Inspirational Story
(Ms Ritu Sinha)

Have you ever been saved from embarrassment by a kindly soul who absorbs the ridicule? These are the kind of people who are friends for life. Check this story out.

There is a nine-year-old kid sitting at his desk and all of a sudden, there is a puddle between his feet and the front of his pants are wet. He thinks his heart is going to stop because he cannot possibly imagine how this has happened. It’s never happened before, and he knows that when the boys find out he will never hear the end of it. When the girls find out, they’ll never speak to him again as long as he lives.

The boy believes his heart is going to stop; he puts his head down and prays — “Dear God, this is an emergency! I need help now! Five minutes from now I’m dead meat.” He looks up from his prayer and here comes the teacher with a look in her eyes that says he has been discovered.

As the teacher is walking toward him, a classmate named Susie is carrying a goldfish bowl that is filled with water. Susie trips in front of the teacher and inexplicably dumps the bowl of water in the boy’s lap. The boy pretends to be angry, but all the while is saying to himself, “Thank you, Lord! Thank you, Lord!”

Now all of a sudden, instead of being the object of ridicule, the boy is the object of sympathy. The teacher rushes him downstairs and gives him gym shorts to put on while his pants dry out. All the other children are on their hands and knees cleaning up around his desk. The sympathy is wonderful. But as life would have it, the ridicule that should have been his has been transferred to someone else – Susie.

 She tries to help, but they tell her to get out. “You’ve done enough, you klutz!” Finally, at the end of the day, as they are waiting for the bus, the boy walks over to Susie and whispers, “You did that on purpose, didn’t you?” Susie whispers back, “I wet my pants once too.”

 May God help us see the opportunities that are always around us to do good.

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

A doctor should not be dogmatic about his opinion, and lawyers also should not expect him to be so. He should be reasonable in his opinions and should not overstate the likelihood of a relationship between cause and effect. The doctor should be ready to defend every finding and conclusion on the report on clinical and scientific grounds in the court of law. He should be aware of professional and scientific viewpoints which might differ from his, and should be familiar with the latest scientific literature in relation to the subject involved. For the purpose of illustrating and clarifying his testimony in the court of law, the medical expert may employ photographs, maps, diagrams, charts, X–rays, skeletons, models, slides, films, tapes, etc., when they are properly verified. The doctor should avoid talking too much, talking too soon, and talking to the wrong persons. Prejudicial and sensational statements should not be made prior to trial. Courts of law are open to the public and the junior doctors should attend the Courts, where they can follow the proceedings, hear the evidence given by their senior medical colleague as a witness, to familiarize themselves with the procedures of the court of law.

Emedinews:Makesure:A patient was brought to the ICU in cardiogenic shock.

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA? Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

Emedinews:Inspiration:How big is one?

An Inspirational Story
(Ms Ritu Sinha)

As a man walked a desolate beach one cold, gray morning he began to see another figure, far in the distance. Slowly the two approached each other, and he could make out a local native who kept leaning down, picking something up and throwing it out into the water. Time and again he hurled things into the ocean.

As the distance between them continued to narrow, the man could see that the native was picking up starfish that had been washed upon the beach and, one at a time, was throwing them back into the water. Puzzled, the man approached the native and asked what he was doing. “I’m throwing these starfish back into the ocean. You see its low tide right now and all of these starfish have been washed up onto the shore. If I don’t throw them back into the sea, they’ll die up here from lack of oxygen.”

 “But there must be thousands of starfish on this beach,” the man replied. “You can’t possibly get to all of them. There are just too many. And this same thing is probably happening on hundreds of beaches all up and down this coast. Can’t you see that you can’t possibly make a difference?”

 The local native smiled, bent down and picked up another starfish, and as he threw it back into the sea he replied, “Made a difference to that one!”

Each of us is but one person: limited, burdened with our own cares and responsibilities. We may feel there is so much to be done, and we have so little to give. We’re usually short of everything, especially time and money.

When we leave this shore, there will still be millions of starfish stranded on the beach. Maybe we can’t change the whole world, but there isn’t one of us who can’t help change one person’s whole world. One at a time. We can make a difference.

Emedinews:Insights on MEdicolegal Issues:Instruments for shooting, stabbing, cutting are dangerous weapons

• The doctor is not required to make speculation about weapon of offence in a MLC case.
• According to the Section 324 of IPC, any instrument for shooting, stabbing, cutting or any instrument used as a weapon of offence likely to cause death or by means of fire or any heated substance or by means of poison or any corrosive substance or by means of any explosive or by means of any substance which is deleterious to the human body to inhale, to swallow, or to receive into the blood or by means of any animal - are all considered as dangerous weapons.

The duty of the attending doctor is to record all the injuries, their dimensions as far as possible, and the body parts where the injuries are located, the nature of injury, whether simple or grievous, caused by sharp/blunt object, age or duration of injury along with the vital parameters like blood pressure, pulse, respiration and the mental status of the patient. When an investigating officer comes to the hospital, he needs some specific answers for his legal investigation and to book a case under law of the land.

• Are the injuries present self–inflicted or fabricated? If yes, please mention the forensic justification.
• Is there any sign, symptom or smell of alcohol or any drug intoxication? If yes, please opine about his mental status due the influence of intoxication; also preserve a blood sample.
• Please opine if the injured or intoxicated patient is fit to record his statement? If no, please give due reasons and an approximate time interval for medical evaluation for his/her fitness for statement.
• Is the condition of patient is critical, severe or serious? If so, the dying declaration must be recorded by the attending doctor in the presence of one or two witnesses.

Emedinews:Makesure:A diabetic patient with BP of 130/90 developed acute chest pain.

Make Sure
Situation: A diabetic patient with BP of 130/90 developed acute chest pain.
Reaction: Oh my God! Why was his BP not kept below 120/80?
Lesson: Make sure that all patients with diabetes should have a goal BP of less than 120/80.

Emedinews:Inspiration:Today's lesson

One day a farmer's donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the animal was old, and the well needed to be covered up anyway; it just wasn't worth it to retrieve the donkey. He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well.

At first, the donkey realized what was happening and cried horribly. Then, to everyone's amazement he quieted down. A few shovel loads later, the farmer finally looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey was doing something amazing. He would shake it off and take a step up. As the farmer's neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!

Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a stepping stone. We can get out of the deepest wells just by not stopping, never giving up!

Shake it off and take a step up.

Remember the five simple rules to be happy:

1. Free your heart from hatred - Forgive.

2. Free your mind from worries - Most never happen.

3. Live simply and appreciate what you have.

4. Give more.

5. Expect less

NOW .................................

Enough of that rubbish . . . The donkey later came back, and bit the farmer who had tried to bury him.

The gash from the bite got infected and the farmer eventually died in agony from septic shock.

When you do something wrong, and try to cover it up, it always comes back to bite you.