About Court Case in Karnataka

PG Aspirants: Fight for our righte - Merit Vs Might: "Post Graduate Aspirants Group: Karnataka State Junior Doctors' Association (KSJDA)

Other GO (Govt Orders) for CL (Casual Leave)

See Casual Leave as per FR (Fundamental Rules) for more information

1. Casual leave (CL) should not be combined with E.L.(Earned Leave) or U.E.L. (Unearned Leave)
2. Advance Application of CL need not contain the purpose for which the CL is required - G.O. Ms No 1410 P & AR dated 02.12.1977
3. Application for leave (or extension of leave) should be given either before availing the leave or at the time of joining duty - G.O. Ms No 1410 P & AR dated 02.12.1977
4. Employees irrespective of the office hours are eligible for 12 days CL - Govt Lr. No 109257- A/85 P & AR dated 31.12.1983
5. When CL is not available at the credit, they may take EL for short spells by sending advance intimation - Ruling (3) under FR 67
6. Contigent employees are also eligible for C.L if they have completed 30 days of duty - G.O. Ms No 1180 P & AR dated 15.12.1986

See Casual Leave as per FR (Fundamental Rules) for more information

Casual Leave as per FR (Fundamental Rules)

See
Other GO (Govt Orders) for CL (Casual Leave) for more information

ANNEXURE VII.
Executive Instructions regarding Casual Leave.
[See ruling (3) under Rule 85 of the Fundamental Rules of the Tamil Nadu Government
- Appendix I - Section VII.]
ORDINARY CASUAL LEAVE.
1. Casual leave is not provided for in the Fundamental Rules and is a concession to enable
Government servants in special circumstances to be absent from duty for short periods without such
absence being treated as leave under the Fundamental Rules or the Tamil Nadu Leave Rules, 1933.
2. No Government servant may, in any case, be absent on casual leave for more than @twelve
days in the course of one calendar year. Casual leave may be combined with compensatory leave,
Sundays, or other authorized holidays provided that the resulting period of absence from duty does
not exceed ten days. The fact that a maximum has been fixed for the amount of casual leave which
may be taken within a year, does not mean that an officer is entitled to take the full amount of casual
leave as a matter of course. †If the eleventh and subsequent days are incidentally declared as
holidays on account of natural calamities, death of national leaders, bandhs, strikes, a change in the
date of the festival as per the announcements made by religious heads during religious occasions,
etc., a Government servant who is on casual leave or compensatory leave may avail himself of those
days also eventhough the period of absence exceeds ten days.
@[G.O. Ms. No. 704, P. & A.R. (FR 3), Dept., dt 8-7-1985, w.e.f. 1-6-1985.]
†[G.O. Ms. No. 309, P. & A.R. (DO II) Dept., dt. 16-8-1993.]
Note (1).—In the case of Government servants appointed under emergency provision and who are
likely to be ousted at any time, their eligibility for casual leave shall be calculated with reference to the
period actually spent on duty and shall be Proportionately limited. As a working principle, they may be
granted two days casual leave for every two months service and such leave may be combined with
holidays subject to the maximum prescribed in the above instructions.
(G.O. Ms. No. 1122, Finance, dated 26th November 1959.)
Note (2).—Casual leave may be granted for half-a-day at a time on application. In such cases, the
half-a-day period should be either three hours from the commencement or before the closure of office
hours.
(G.O. Ms. No. 907, Finance, dated 21st July 1970.)
3. Heads of departments should intimate their intension or taking casual leave to Government in
the department concerned.
4. A register of casual leave taken should be maintained in every office.
5. Omitted.
6. Omitted.
[G.O. Ms. No. 802, P. & A.R. (FR. 3), Dept., dt. 14-8-85.]

See
Other GO (Govt Orders) for CL (Casual Leave) for more information

St John’s Medical College to fill up mgmt seats

From http://deccanherald.com/deccanherald/nov112005/state19185220051110.asp
St John’s Medical College to fill up mgmt seats : by DH News Service Bangalore:

The Karnataka High Court on Thursday declared that Bangalore-based St John’s Medical College is free to fill up all the seats in the post-graduate medical courses under the management quota. This order, however, would be effective from the next academy year.

Meanwhile, the court granted relief to the students admitted to the college under the Government quota during the academic years 2004-05 and 2005-06 by not disturbing their admissions.

A division bench comprising Justice B Padmaraj and Justice V Jagannathan delivered the verdict on the petitions filed by the students and the college management.

Government quota : Students, admitted under the Government quota had questioned denial of admission by the college. On the other hand, the college, claiming autonomous status on being a minority institution, had questioned government’s power to allot students.

More students : By virtue of this judgement, the college, which has been permitted by the Medical Council of India to admit only 56 students for both the PG degree and diploma courses in an academic year, will have to accommodate 82 students. Both the MCI and the Rajiv Gandhi University of Health Sciences have to approve these admissions.

The college, contending that it had the right to fill up all the seats, had admitted 56 students during last two academic years. On the contrary, the Government had refused the contention of the college and had allotted 26 students in each academic year under its quota.

No power : While relaying upon the recent verdicts of the Apex Court, the division bench held that the Government can not force the college, which is a minority autonomous institution, to surrender 50 per cent of its seats to the Government’s seat sharing and reservation policies. “Forcing the institution for government quota in the form of any Act or the Rules or the regulations by the Medical Council of India would be violative of Article 30 of the Constitution”, the court held.

However, the bench said that the admissions already made under the Government quota can not be disturbed at this stage. The Court approved the admission of all 82 students saying that all of them were meritorious, selected as per the norms and admitted by virtue of various interim orders passed by the High Court and the Supreme Court. The Court also directed the college to allow all the students, who are pursuing various courses, to complete their courses.

College warned : Meanwhile, the division bench warned the college to be careful in future and always respect the law. The bench made this observation while dismissing a contempt of court petition filed by some of the students against Principal of the college for denying admissions to them despite interim orders of the court.

Ethical dilemmas.

Ethical dilemmas.

From Journal of Post Graduate Medicine
www.jpgmonline.com

Pandya SK
Department of Neurosurgery, Seth GS Medical College, Parel, Bombay.

Correspondence Address:
Department of Neurosurgery, Seth GS Medical College, Parel, Bombay.



How to cite this article:
Pandya SK. Ethical dilemmas. J Postgrad Med 1997;43:1-3


How to cite this URL:
Pandya SK. Ethical dilemmas. J Postgrad Med [serial online] 1997 [cited 2005 Nov 9];43:1-3. Available from: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1997;volume=43;issue=1;spage=1;epage=3;aulast=Pandya




:: Introduction Top

Dilemma: difficulty, impasse, perplexity, predicament, quandary.
All medical doctors face situations from time to time, where the proper course of action is not clear. We are tempted, then, to paraphase Hamlet: “To do, or not to do - that is the question ...”

Take the case of a patient with confirmed malignant cancer of the breast whose chest x-ray film shows a rounded metastatic deposit. She now presents with a history of a recent focal epileptic fit but without any neurological abnormality on examination. Computerised tomographic scan shows what is most probably a metastasis in the left parietal lobe over the motor strip. Are we justified in advising excision of the tumour, knowing that it might leave her hemiplegic and when her general prognosis as regards long-term survival is grim?
Under such circumstances, how do we arrive at a decision? What do we navigate by?

:: Guiding principles Top

Four fundamental ethical principles have received universal acceptance by medical professionals:
* non-maleficence - ‘primum, non nocere’: first of all, do no harm
* beneficence - whatever we do must be for the benefit of the patient;
* respect for autonomy - the patient has an absolute right to make decisions concerning his own well-being, on any test or therapy proposed for him and on measures for resuscitation, prolonged maintenance on a ventilator and other such events.
In order to make such decisions, the patient - and family - need to be adequately informed on the pros and cons of each step. It is the communication of such details, in a manner that is clearly understood, that forms the basis of informed consent.
Justice as with reference to fair distribution of scarce resources; respect for the rights of the patient and family in the context of the rights of society at large; the use of the least expensive means in investigation and therapy; and respect for morally acceptable laws. It also implies the overcoming of personal prejudices - as against homosexuals or chronic alcoholics.
Thoughtful application of these principles to specific instances often helps resolve dilemmas.

:: Some common ethical dilemmas Top

Let us take examples from either end of the spectrum of life.
The treatment of infertility:
In a country where untold numbers of orphaned or discarded infants and children languish in unfeeling institutions where they are denied the attentions of parents and the company of siblings, is it fair for us to embark on such expensive techniques as in vitro fertilization?
On the other hand we have the plea of the barren wife who is willing to sacrifice almost everything to achieve the status of mother.
Possible resolution of dilemma:
Since it is the mother who comes to the doctor seeking treatment and since she has the right to decide on what should be done to and for her, the position of the orphaned children should not be allowed to intrude on the management of her problem.
Abortion:
Those in favour point to the legal sanction afforded to the termination of the life of the unborn foetus. Some have gone so far as to say that this is a welcome means for controlling our mushrooming population. Others have used it to get rid of female foetuses in their quest for the male child.
Many, however, remain troubled. Is this law morally acceptable? Are we ever justified in snuffing out life?
Possible resolution of dilemma:
This will depend on the beliefs and values cherished by the individual doctor. The doctor who holds life, as a sacred boon granted to an individual must refuse to perform or advice an abortion except in the specific instance where continuation of pregnancy may kill the mother. (Here, the operative principle is that the life of the mother is of greater concern than the life of the unborn foetus.)
Must we always strive to keep every baby alive, irrespective of costs?
Take two examples:
A premature newborn weighing 600 grams. Left to itself, it will perish. We can make extraordinary attempts to help it survive. In the process we may lead to a situation where the family is saddled with a severely handicapped individual with poor mental abilities.
A baby is born with meningomyelocele, paraplegia, incontinence of urine and severe hydrocephalus. A light applied to the head shows brilliant transillumination of the intracranial contents suggesting a paper-thin brain. It is possible to repair the skin over the exposed and damaged spinal cord and insert a shunt to drain the accumulated cerebrospinal fluid into the peritoneum. Survival is now assured but the family will bear the burden of looking after a mindless person who unknowingly passes urine and stools reflexly and will never understand, appreciate or communicate.
Possible resolution of dilemma:
The doctor must place the pros and cons of treatment in either instance before the parents. The doctor sympathetic to the social milieu in which the family exists and of the precarious economic circumstances of a particular family will emphasize the liabilities to the parents should treatment be preferred. I have, at times, gone a step further and told the parents that were the child in question mine, I would have decided against treatment.
If it is decided not to treat, should the patient’s life be terminated by a fatal dose of a drug? Some advocate stopping all feeds and supplying only water to take away thirst. The logic offered is that by this means we are not taking away life but allowing nature to take its own course. Is starvation to death not more cruel than instant death?
Possible resolution of dilemma:
Here, as often is the case with ethical dilemmas, the individual doctor’s conscience must dictate the course of action. Such a decision, however, must take into account the fact that the law of the land does not permit any doctor to kill the patient by any act of commission.
Admission to an intensive care unit:
The intensive care unit is already full of seriously ill patients, each of whom needs the special attention afforded in it. A fresh patient is brought to the clinic who also needs this specialized care. There is no other nearby centre that can take him. What is to be done?
Do we continue to treat existing patients and place this patient in a room or ward without special facilities for monitoring and treatment and, in the process, lose this patient? Do we shift the ‘least seriously ill patient’ out of the unit to make way for the new arrival and, in doing so, jeopardize the life of someone who may be on the way to recovery?
What if the new arrival is a ‘V.I.P.’?
A similar dilemma is posed when one has to select which of two patients is to be provided the only available ventilator.
Possible resolution of dilemma:
A new patient presenting to a clinic or hospital has not yet established the doctor-patient relationship with the consultant. Existing patients in the intensive care unit are already under his treatment and he is responsible for their welfare. His primary concern, then, must be for patients already in the unit. If, however, there if definite evidence that one of them can, without any risk, moved out of the intensive care unit to the half-way house of the semi-intensive care ward, such a transfer can be affected so as to take in the new patient.
Demand for euthanasia by a terminally ill patient in unremitting agony:
A patient with widespread cancer is in severe agony, which persists despite use of the maximal therapeutic doses of powerful drugs such as morphine. He begs to be relieved of pain and asks for the use of much larger doses, knowing that such doses will be fatal. Should one oblige?
Possible resolution of dilemma:
Here, as often is the case with ethical dilemmas, the individual doctor’s conscience must dictate the course of action. Such a decision, however, must take into account the fact that the law of the land does not permit any doctor to kill the patient by any act of commission.
Shutting off the ventilator:
The law, as it stands, does not allow one to take a brain-dead patient off the ventilator unless this patient is a donor of an organ such as the heart. What about the patient who is not suitable to offer an organ but whose relatives can no more afford the cost of an intensive care unit?
Should we insist on following the letter of the law so that we are not subject to prosecution under the Consumer Protection Act or the Indian Penal Code?
Possible resolution of dilemma:
The law, in this instance, is faulty. It is illogical to permit removal of the heart, lungs, kidneys, pancreas and other organs for transplantation into another patient and not allow switching off the ventilator. Senior lawyers consulted by us inform us that judges would, in all probability, rule in favour of the doctor, provided the procedure for the diagnosis of brain death before switching off the ventilator was foolproof.

:: Some personal guidelines Top

I have found the following additional guidelines useful. I pass them on for your consideration.
* The golden rule: Do unto others, as you would have others to do unto you. I have often found it helpful to ask myself, “Were I the patient, what course of action would I have wished the doctor to follow?”
* The patient comes first. The raison d’etre of our profession is the patient. We are here to serve him. The sick patient, often in physical pain and always in mental distress, deserves our fullest attention and calls for the best qualities of our mind and heart. His interests and decisions must prevail above all else except when the patient is non compos mentis. In the latter instance, the decisions of his family must prevail.
* The poor patient deserves special consideration He has nowhere else to go. He does not possess the means to command or demand. In our milieu he is often reduced to seeking help with bowed head and hands folded together. And he is ill. Medically malpractice against this group is particularly abhorrent.
* Ensure that your decisions and actions are scientific, humane, effective and in the best interests of the patient and his family. Record them. Once this is done, you need fear no individual, administrator or tribunal.

Ayurveda Drugs - Danger to Life - Poison which kills

The flip side of Ayurveda.

Thatte UM, Rege NN, Phatak SD, Dahanukar SA
Dept. of Pharmacology, Seth GS Medical College & KEM Hospital, Parel, Bombay, Maharashtra.

From Journal of Post Graduate Medicine
www.jpgmonline.com

Correspondence Address:
Dept. of Pharmacology, Seth GS Medical College & KEM Hospital, Parel, Bombay, Maharashtra.



How to cite this article:
Thatte UM, Rege NN, Phatak SD, Dahanukar SA. The flip side of Ayurveda. J Postgrad Med 1993;39:179-82,182a


How to cite this URL:
Thatte UM, Rege NN, Phatak SD, Dahanukar SA. The flip side of Ayurveda. J Postgrad Med [serial online] 1993 [cited 2005 Nov 9];39:179-82,182a. Available from: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=1993;volume=39;issue=4;spage=179;epage=82,182a;aulast=Thatte



"A 62 year old male patient was brought to the casualty in an unconscious state. A detailed history from relatives revealed that he was a known diabetic whose hyperglycemia was well controlled with insulin and glibenclamide. Five days earlier he had started an ayurvedic drug for psoriasis. He developed giddiness following ingestion of the drug, but ignored it. Subsequently, he became unconscious. He was diagnosed to be in hypoglycemic coma to which he ultimately succumbed."
While investigating the causes for such sudden hypoglycemia, the attending physician would naturally question, "Could the ayurvedic drug be responsible for the hypoglycemia?". This case was referred to the Adverse Reactions (Ayurvedic drugs) Monitoring Cell of the Ayurveda Research Centre of King Edward Memorial Hospital. On scanning available ayurvedic literature, no reference could be found describing metabolic actions of any of the constituents of this medication. Subsequent animal studies revealed, however, that in occasional mice a significant hypoglycemia occurred, reiterating the fact that the adverse interaction in the patient could have been due to the inadvertent co-administration of the ayurvedic agent and powerful hypoglycemic agents.
This case dramatically illustrates the sequel of self-administering 'ayurvedie' drugs and emphasises the fact that there is indeed a flip side to Ayurveda. We present in this brief article, the other side of Ayurveda.
A question that will arise at the outset is why read about adverse effects of ayurvedic drugs (let alone their uses or benefits) if we do not practice Ayurveda? The answer to this question is simple: over 80% of our population takes ayurvedic medicines - either self-prescribed or through a ‘Vaidya’. These same patients expect to be treated by our medicines while simultaneously taking ayurvedic medicines often leading to interactions of the type described above.
Another point to note is that a large number of herbal preparations are in the market under the label 1 ayurvedic Drugs'. Due to aggressive salesmanship and over-the-counter (OTC) availability, these drugs are prescribed by doctors and consumed by patients widely.
Hence, it is obvious, that at least in our country, we have to be aware of salient beneficial and adverse effects of commonly used ayurvedic drugs as much as of allopathic agents.
Ayurvedic drugs that one is likely to encounter in practice can be discussed under two broad categories: a) the traditional formulations including for example kadhas (decoctions), arishthas (decoctions containing alcohol) or gutis (pills) and b) the so called ayurvedic formulations which are a combination of different herbal extracts (sometimes aqueous, sometimes alcoholic). These plants are prescribed individually or together for a particular condition in ayurvedic texts. However, their fixed dose combination, as marketed, may not be mentioned therein. These herbal medicines are prescribed for a wide variety of non-specific conditions like improving vitality, anti-stress effects, boosting immunity and increasing appetite or memory!
Since, in this article we are discussing adverse reactions, we shall for the moment assume efficacy of these herbal preparations. It is an old adage of pharmacology that teaches us that if a drug is effective it is most likely to produce a side effect [1].
In fact, standard text-books of Ayurveda mention that ayurvedic drugs, if improperly used can be toxic. Charaka[2] states in the Sutrasthana of the Charaka Sarnhita - "A potent poison also becomes the best drug on proper administration. On the contrary, even the best drug becomes a potent poison if used badly".
Ayurvedic texts classify toxic plants (See http://www.jpgmonline.com/viewimage.asp?img=jpgm_1993_39_4_179_598_1.jpg) into different categories depending on the part of the plant that is toxic. Subsequent research has revealed the exact chemical nature of the toxic alkaloid validating the knowledge laid down in ayurvedic texts.



In fact, in Ayurveda, there is a separate science which deals with toxicological aspects and is known as Vishagarvajrodhika tantra' (toxicology)[3].
There are enough grounds to conjecture that some knowledge regarding toxicity of plants was obtained through observation of behaviour of insects and animals towards these plants. Plants, which were never infested with insects, were considered dangerous: these were later shown to contain repellants like anthraquinone, naphthalene or nimbidine. Plants like vinca or nerium from which animals steer clear have later been shown to contain toxic materials. Aconitum does not allow any other plant in its vicinity! An interesting feature about ancient ayurvedic physicians worth noting, and perhaps emulating, is their ability to improvise on information they had, using whatever facilities were at hand. Thus, for example, when the physicians discovered that a particular plant was visciously toxic and perhaps fatal, they evolved ways by which the toxic components could be destroyed and converted them not only to safe but further therapeutically useful entities! The story of Aconitum heterophyllum is illustrative in this respect. The roots of this plant are considered toxic (they contain an alkaloid aconitine) and following ingestion of roots, the toxicity manifests in the form of tingling numbness of mouth and throat, abdominal pain, loss of muscle power, visual and auditory disturbances and finally clonic convulsions [4]. However, aconite forms an important constituent of ayurvedic formulations. The aconite used in the formulations is not a crude agent but one, which is processed. This processing involves boiling of roots with 2 parts of cow's urine (7 hours per day) for 2 consecutive days. The roots are then thoroughly washed with water and boiled with 2 parts of cow's milk for the same duration. These are washed again with lukewarm water, cut into pieces, dried and ground. It has been shown that aconite becomes safe only after this elaborate process and all the steps are 6 essential for complete detoxification[6],[7].
Besides toxicology, ayurvedic pharmacology describes in some detail the side effects that can occur with different therapeutically useful drugs. Further, it also describes ways (which also include manufacturing techniques) to minimise these side effects. Just like we, for example, would advise that NSAIDs should not be taken on an empty stomach, Ayurveda gives instructions regarding time of drug administration, the relationship with food, type of food which should be avoided/permitted with the drug etc. The do's and don'ts are clearly enunciated. For example, amalki (amla, Emblica officinalis) should be avoided at bedtime to prevent harmful effects on teeth [8]. Chyavanprash contains large quantities of Amla - one wonders whether the package insert with any Chyavanprash mentions this precaution! Similarly, pippali (Piper longum) used in asthma should be avoided in patients with peptic ulcer disease and should be consumed with milk [9].
Tribhuvankirti is a combination of several plants which is very commonly used to treat a "cold in the head" and fever. There are clear instructions in Ayurveda that because it contains aconite [Table - 1] it should be used cautiously. When used, it should be taken with tulsi (holy basil) juice, ginger juice or honey[8].
Guggul is derived from the resin of Commiphora mukul [11] and is used in a variety of diseases including hypercholestrolemia (in fact gugglulip has been introduced into the market for this condition) and arthritis[12]. Ayurveda specifies that guggul should be used cautiously in patients with peptic ulcer disease. While on guggul therapy the patient is advised to avoid sour food, alcohol and heavy exercise[13],[14].
The subject of teratogenecity also figures in Ayurveda. Thus, certain plants like Terminalia hebula (harda) are to be avoided in pregnancy. This is a constituent of a large number of OTC preparations. It is a powerful purgative and is supposed to stimulate GI motility and would therefore be contraindicated in pregnancy[15]! This fact is not sufficiently publicised.
Apart from plants, Ayurveda also includes metals in its formulary. Thus, several preparations containing metals like mercury, lead and copper are available readily in the market on OTC basis. These metals have to be deligently processed before they are suitable for human consumption and there is again a long list of do's and don'ts regarding their use. Unfortunately, there are no quality control methods to standardise such metal containing drugs and to find out whether processing of metal is done appropriately so as to render it nontoxic. This thus increases the probability of toxic effects.
The case history of a 70-year-old male patient referred to the ADR monitoring cell illustrates the relevance of being aware of these. This patient was taking a 'herbo-mineral' preparation 'Mahayograj Guggul' in the dose of 4 tablets three times a day, for the complaints of joint pains for well over two years. He got relief from the arthritis but developed symptoms of lead poisioning including severe anaemia with classic basophilic stippling of the RBCs. The case was referred to the ADR cell with the query whether Mahayograj Guggul could lead to this problem. As this preparation contains lead, our centre adviced immediate withdrawal of the preparation.
This particular preparation is prescribed for rheumatoid arthritis in ayurvedic texts[13] and contains several plants and metals as shown in http://www.jpgmonline.com/viewimage.asp?img=jpgm_1993_39_4_179_598_2.jpg .





Ayurvedic textbooks recommend a special pharmaceutical process to detoxify the metals. The lead in this preparation has to be processed by first heating over a fire till it glows. It should then be cooled by dipping into a mixture of sesame oil, buttermilk, cow's urine and a decoction of three plants, viz. amia (E.officinalis), beheda (T. bellerica) and harda (T. chebula). After repeating this procedure thrice, the lead is heated the fourth time following which it is dipped into a churna (powder) made of the rind of tamarind and Piper longum. This lead is then mixed with arsenic sulphide and wrapped in a betel leaf and warmed in a crucible to a fixed temperature. This process is repeated thirty times before nagabhasma or processed lead is ready for use[16]. In addition, in the doses that this patient was taking the drug he would have consumed a phenomenal 414 mg lead per day for more than 2 years leading to lead toxicity. There are two points to note in this case. Firstly, Ayurveda definitely reconimends Mahayogiraj Guggul for rheumatoid arthritis but has cautioned about duration of therapy, which was overlooked. Secondly, as there are no quality control procedures in existence, there is rio way to know whether the lead in this formulation had been processed in the complex way it should have been.
This brings us to the second group of the 'herbal' formulations marketed under the label 'Ayurvedic'. All doctors are aware that such preparations are available, many may be prescribing them and some will come across patients self-medicating themselves with these drugs. What exactly are these drugs and what do we know about them? Most doctors prescribe these agents, in spite of lack of sufficient clinical studies (using the randomised controlled clinical trial model) proving their efficacy in comparison to allopathic drugs, in the utopian misconception that "never mind if they are ineffective, they will be safe!"
What adverse effects can occur with such formulations? The most glaring are possible drug interactions with the usually co-administered allopathic drugs. Several plants have been shown to alter bio-availability of allopathic drugs[17].
Similarly when used in combination with allopathic drugs they may alter their pharmacodynamics. The example in the diabetic patient described earlier is illustrative. Further, such herbal preparations may produce toxicity, often unexpectedly, per se.
A very herbal remedy is the need to conduct safety studies on them. Protagonists for this believe that with the changing ecological environment, use of pesticides, new manufacturing techniques, modern formulations and combinations of herbs not prescribed in ayurvedic texts, the need for looking at ayurvedic herbal drugs as new drug entities cannot be ignored. This is being seriously considered by the office of the Drugs Controller of India and an amendment to the laws governing manufacture and sale of ayurvedic drugs is on the anvil.
Opponents feel however that herbal remedies are natural remedies and are beyond conventional toxicity studies. Further developmental costs would be formidable.
Is there a via media? Perhaps incorporation of any or all of the methods summarised in [Table:3] would optimise use of ayurvedic drugs.
The Adverse Drug Reaction monitoring cell for Ayurvedic Drugs has been set up at the Ayurveda Research Centre of King Edward Memorial Hospital, Mumbai with several aims. Alongwith documenting anecdotal case reports suggestive of adverse effects to ayurvedic drugs, (please see ADR reporting card) we also, where necessary conduct studies in animals to confirm or rule out the cause and effect relation between the drugs and side effects reported. Further we give information related to ayurvedic drugs.
In conclusion we can reiterate that in view of the fact that we are
a) not using ayurvedic drugs only in the form as described in standard texts,
b) making over-the-counter formulations without much heed to the need for individualisation,
c) giving ayurvedic drugs in combination with allopathic agents which have a narrow therapeutic margin,
d) using raw plant material that is possibly polluted by environmental and ecological devastation,
e) not having good quality control methodologies,
We must beware. We must not wait for a thalidomide- like tragedy in Ayurveda to shake us out of our complacence that ayurvedic drugs are safe!

:: References Top

1. Melmon KL, Morrelli HE. Drug Reactions. In: Clinical Pharmacology. Basic Principles in Therapeutics, 2nd ed. New York: Macrinillan Publ Co; 1978, pp 968. Back to cited text no. 1
2. Samhita C. Sutrasthanam In: Sharma PV, editor. Charak Samhita Varanasi: Chaukhamba Orientalia; 985; 1:126. Back to cited text no. 2
3. Dahanulkar SA, Thatte UM. Historical survey of the evolution of Ayurveda. In: Ayurveda Revisited. Mumbai: Popular Prakashana; 1989; 10-27. Back to cited text no. 3
4. Franklin CA, In: Modi's Medical Junspiudence and Toxicology, 21st ed. Mumbai: NM Tripathi Pvt. Ltd; 1988, pp 279. Back to cited text no. 4
5. Sastri A. In: Sri Vagbhatacharya’s Rasaratna Samuchchaya, 6th ed. Varansi: Chawkhamba Sanskrit Series office; 1978, pp 590. Back to cited text no. 5
6. Sen SP, Khosla RL. Effect of Sodhana on the toxicity of aconite (vatsnava). Current Med Pract 1968; 12:694. Back to cited text no. 6
7. Thorat S, Dahanulkar SA. Can we dispense with ayurvedic Somskaras? J Postgrad Med 1991; 37:157-159. Back to cited text no. 7
8. Gogate VM. Emblica officinalis. In: Drvyaguna Vigyan. 1st ed. Pune: Continental Prakashan; 1962, pp 350. Back to cited text no. 8
9. Swami B. Tribhuvankirti. In: Rasadarpan - part 1, 3rd ed. Patiyala: Swami Publication; 985, pp 393. Back to cited text no. 9
10. Sukh Dev. A modern look at an age old ayurvedic drug gugguiu. Science Age 5:13-18. Back to cited text no. 10
11. Satyavati GV. Gum guggul (Commiphora mukul) - the success story of an ancient insight leading to a modern discovery. Ind J Med Res 1988; 87:327-335. Back to cited text no. 11
12. Gogate VM. In: ayurvedic Materia Medica. Pune: Continental Prakashan; 1981, pp 289-290. Back to cited text no. 12
13. In: Bhavaprakash Nighantu Karpooradi vargu. Varanasi: Chaulkhamba Sanskrit Samsthan; 1969, pp 205. Back to cited text no. 13
14. Gogate VM. Terminalia chebula. In: Dravyaguna Vigyan, 1st ed. Pune: Continental Prakashan; 1982, pp 436 Back to cited text no. 14
15. Gune G. In: Ayurvediya Aushadhi Gunadharma Shastra, Siddhaushadhi, part IV, 2nd ed. Ahmadnagar: Mohan Mandir; 1934; 8-9. Back to cited text no. 15
16. Dahanulkar SA, Kapadia AB, Karandikar SM. Influence of trikatu on rifampicin bioavailability. Indian Drugs 1982; 271-273. Back to cited text no. 16
17. Back to cited text no. 17

Doctor bashing and why the Indian medical profession must evolve.

Doctor bashing and why the Indian medical profession must evolve.

Gandhi JS

From Journal of Post Graduate Medicine
www.jpgmonline.com

How to cite this article:
Gandhi JS. Doctor bashing and why the Indian medical profession must evolve. J Postgrad Med 2002;48:155-155

How to cite this URL:
Gandhi JS. Doctor bashing and why the Indian medical profession must evolve. J Postgrad Med [serial online] 2002 [cited 2005 Nov 9];48:155-155. Available from: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2002;volume=48;issue=2;spage=155;epage=155;aulast=Gandhi

Sir,
I read with interest the comments by Dr. Pandya on the harassment and violence inflicted on doctors in India.[1] Indeed, in one of the recent issues of the British Medical Journal a Pakistani doctor reports similar events in his country.[2] It is clear even in Britain that doctors no longer have the kudos that their predecessors commanded implicitly as part of their professional role. Certainly in the UK this loss of faith in the medical profession has resulted from large malpractice scandals incriminating senior doctors during the last decade. We saw over the nineties the Bristol paediatric cardiac surgery scandal, the Alder Hey revelations, the Dr Shipman affair, and an array of ignominious ends to otherwise admirable careers. It was undoubtedly the case in these instances that patient care had been substandard. The General Medical Council responded briskly by establishing new mechanisms to monitor the performance of consultants (who hitherto had worked with relative impunity) and by forming bodies such as the National Institute of Clinical Excellence to audit clinical practices. The British people also changed their view of doctors, and there is presently a rising trend of complaints against health professionals and the system of the National Health Service (NHS). For the time being in Britain we are only more aware of the medicolegal aspects of our practice (so that clinical care is improving), but it may be that soon we will work in the litigious culture found in North America.
The spate of aggression against doctors in the subcontinent must also prompt a timely reassessment of the doctor’s role in Indian society. As observed by Dr Pandya and others, frequently the anger and distrust expressed by patients and relatives against doctors stem from poor communication rather than negligence. Patients and relatives feel alienated and powerless. In Indopakistani culture, anger can easily be vented in a fanatic manner that involves injury or murder, and it seems that the current vogue is to channel this destructive force towards the medical profession. Although I suspect there may be political issues that have led to the persecution of individual Indian doctors, surely it is now up to the Indian profession as a whole to actively redeem itself in the eyes of the public. Unlike in Britain, the Indian state is unlikely to show interest in the plight of its doctors, and changes to improve patient care and restore public confidence must arise from within the profession.
As a symbolic step, undergraduate curricula in India must now include teaching on communication between doctor and patient in earnest. On speaking to doctors who have qualified in India and now work in the NHS, the recurrent opinion I encounter is that there is a gross lack of such training. Moreover, the importance of good communication needs to be reiterated throughout postgraduate training. Indian doctors must also now be provoked to create a system to handle complaints from patients and relatives that gives people dignity, and minimises the dishonesty and inefficiency that Indians themselves admit riddles their existing institutions. Control of the quality of patient care is warranted especially in India, where healthcare is primarily in the private sector and patients are potentially vulnerable to serious iatrogenic blunders. Cynics will quickly say that the corruption cannot be erased, but surely every effort will help in reducing the actual burden of dishonesty that is sparking frustration and violence. If there is no accountability or audit in the profession, then barbarism will persist and probably worsen. The minutiae of how such a system of audit can be conceived, formed, financed, and run is not a matter for a bystander such as myself to contemplate. And armchair analyses and cynicism will not suffice, because if the chair is kept too warm too long Indian doctors will inevitably attain the status given to unreliable politicians.

:: References

1. Pandya SK. Doctor patient relationships: The importance of the patient’s perceptions. J Postgrad Med 2001;47:3-7. Back to cited text no. 1
2. Shafqat S. New hazard of medicine. BMJ 2002;324:1045. Back to cited text no. 2

Compensatory Leave

To have a comprehensive Idea about COL (Compensatory Leave, please refer Revenue dept - District Office Manual - 1973 - Vol I - Page 150 Para 169)

The question asked

Subject : C.O.L. (DISREGARD EARLIER MESSAGE DUE TO AN ERROR)
MessageDate : 11/11/2005 12:09:32 AM
Posted By : vijay
Email : vijay_72@yahoo.co.in
Message : PLEASE DISREGARD EARLIER MESSAGE DUE TO AN ERROR...........Sir, Thanks for your kind reply. ……. I request your further clarification in this issue. An example: A person has credit of 2 days COL on 31.10.2005 for his attendance during govt. holiday on 02.10.2005 and 11.10.2005 ……. QUESTION NO. 1. In this situation, whether he can carry those 2 days COL till 01.04.2006 (i.e. six months from the date first worked) or whether those COL expires on 31.12.2005 (calendar year effect)…..QUESTION NO. 2: Whether any restrictions such that only 10 days COL can be availed during the period from 1.6. 2005 to 31.12.2005 (i.e. in half of a calendar year, maximum 10 days COL can be availed)…..…..QUESTION NO.3: Whether COL can be availed for Second Saturday, if worked? Your kind advise is appreciated.......thanks.

One of our replies

Please see

http://www.tnhealth.org/webboard/messageDetail.asp?MessageId=8731

2.The question of calendar year does not arise since eligibility of compensatory leave(Col) is six months from the date of such holiday work.

That answers your first question --> He can carry that COL till 01.04.2004 (or may be 31/03/2005 !!!!)

Coming to your second question,

NO restrictions.... For a person whose probation has been declared and service regularised , you can take a maximum of 10 days continous CL, COL, PL, W/o, Govt Holiday . YOu cannot take CL, COL etc for more than 10 continous days. However there is an exception if the 11th day is UNEXPECTEDLY declared an holiday (say floods along cauvery etc) as per G.O No 309, P & AR dated 16.8.93

Coming to your thrid question,

Yes... As per the following rule

1. Revenue dept - District Office Manual - 1973 - Vol I - Page 150 Para 169

2. G.O. Ms No 2218 (Misc) dated 14.12.81

3. Govt. Lr. No 16215/83-1/P & A.R. dated 27.04.83

4. Govt Lr. No 10 P & AR dept dated 28.11.2000

From http://www.tnhealth.org/webboard/messageDetail.asp?MessageId=8731

Subject : RE: C.O.L.
MessageDate : 11/10/2005 1:22:08 PM
Posted By : tnhealth.org
Email : feedback@tnhealth.org
Message : Dear Mr.Vijay,

1.Maximum compensation leave allowed in 20 days in a calendar year. Total availing of compensation Leave(COL) should not exceed 10 days at a time.

2.The question of calendar year does not arise since eligibility of compensatory leave(Col) is six months from the date of such holiday work.

For tnhealth.org

***---REPLIED TO MESSAGE BELOW---***
Sir, as far as I know, compensatory leave (COL) could be accumulated for six months from the date of work but total leave shouldn't exceed 20 days on credit at any time. Am I correct? NOW THE QUESTION IS: Whether COL on credit (for.eg.20 days) get lapsed at the end of December 31st or could be carried over for the next calander year with the main restrictions of 6 months from the date worked. In nutshell, whether calander year do any restrictions/nullifying the credit of COL? Request your advise.

From http://www.tnhealth.org/webboard/messageDetail.asp?MessageId=8695

MessageDate : 11/5/2005 6:02:55 PM
Posted By : doctor
Email : doctor@redff.com
Message : dear vijay .you are right .

1.compensatory off leavecan be carried over to the next calender year unlike casual leave which will lapse at the end of december 31st.
2.comp leave can be combined with c.l.but not with a week off either before or after a comp .leave.
3.casual leave can be combined with a week off before or after.
4.the total comp.leave and permission leave availed by an individual should not exceed 20 in a single year.
5.to credit a govt holiday for comp.leave the individual must work full time.8am to 5 pm at phc
6.if the govt holiday is not credited for cop.lave then 1/2 day duty is enough for that day .that is 8am to 1pm enough at phc if u dont credit the govt holiday for comp.leave


***---REPLIED TO MESSAGE BELOW---***
Sir, as far as I know, compensatory leave (COL) could be accumulated for six months from the date of work but total leave shouldn't exceed 20 days on credit at any time. Am I correct? NOW THE QUESTION IS: Whether COL on credit (for.eg.20 days) get lapsed at the end of December 31st or could be carried over for the next calander year with the main restrictions of 6 months from the date worked. In nutshell, whether calander year do any restrictions/nullifying the credit of COL? Request your advise.

Civil Surgeon

For your information, the following are earlier replies of DMS in the bulletin board, which may be useful to you

• Civil Surgeon - Dr.Sankararaman CML no. 5050 of 2002: CML no. 4084 of 2005,
• Senior Civil Surgeon-Dr.A.A.Sami CML no. 3175 of 2002: CML no. 2299 of 2005, and
• Sr.Asst.Surgeon 6708/2002 is the last CML Numbers declared as promotion in the respective category.

Approximately for 225 Senior Assistant Surgeons promotion will be given.
Presently preparation of promotion list for Sr.Civil Surgeon, Civil Surgeon and Sr.Asst.Surgeon are in progress at DMS as per their intimation. So, keep your finger crossed for your promotions.
Approximately,

• Sr.Civil Surgeon (general) promotion comes after 22 years,
• Civil Surgeons after 17 years,
• Sr.Asst.Surgeon after 15 years.

There were heavy recruitment during the year 1990 to 1991 amounts to approximately 1800 doctors (due 10A1 etc). Due to which 1990 batch onwards promotion chances will be in slower path. If you have any doubt, quote your CML No. and confirm the promotion opportunity with DMS. ( On completion of 10 years service, u will get Slection.Grade Asst which is the earliest promotion a Asst.Surgeon can expect than the Sr.Asst.Surgeon) Anyway wish you good luck for early promotions.