#aspiring doctors

How to spot signs and symptoms of Breast Cancer 

also you shouldn’t feel like your entire life is medicine at the moment, take some time to not think about it and the current events

Errors are a given in every field. It is unfortunate when they occur in medicine and cost harm or a life, but it’s important to learn from these errors. Physicians learn when they miss a diagnosis and the patient is diagnosed by someone else. No error is made wilfully and I am certain every medical health practitioner exerts due diligence to ensure this. In this country, where doctors handle probably more patients than anywhere else in the world, they need to be quick but also leave no room for error. A case published by the Cooperative of American Physicians earlier this year is worth reviewing. A woman, named AB, was a patient of a large practice of doctors. She was in Las Vegas when she was admitted for a food poisoning-like illness. She recovered and went back to her physician, who asked for all her reports from the Las Vegas hospital. The x-rays were obtained after multiple requests. The physician sent the x-rays to the radiologist for evaluation. The radiologist said AB had multiple gall stones, following which she was evaluated by a surgeon and in view of some upper abdominal discomfort from time to time, advised surgery to remove the gall stones. During surgery, they found no stone in the gall bladder. It turned out that the x–rays sent to the treating doctor from Las Vegas were of another patient of the same name but a different date of birth. The patient sued for the loss of her gall bladder on the grounds that the treating physician should have been aware that not only were the x-ray findings of a different patient but also that a clinical diagnosis had failed to substantiate those findings. An arbitration won the patient $600,000. The case offers many lessons. One, the need to verify a patient’s records vis-à-vis their age and the date the x-ray was taken. In case a clinical diagnosis does not match an x-ray’s findings, the easiest thing that a physician can do is opt for an ultrasound to ascertain this. In the case of AB, the physician erred by choosing to treat the reports rather than the patient. The possibility of silent gall stones could have been considered — autopsy studies show many patients with gall stones that were never symptomatic in life — and based on this, AB could have been given the choice of going for further treatment. In my own practice, I once had a colleague complain that a resident doctor inadvertently omitted a drug order for a serious infection. This is a drastic error but when I tried to rationalise what went wrong, it became obvious. A patient in a serious condition needs a large order of drugs, often 15-20 (oral and IV). A resident doctor who writes down the whole list day after day risks omission of a drug by oversight if he does not number his list. Numbering alone helps ascertain if a day’s order tallies with that of the previous day. A more sensible way of doing this is to list the orders on one page and subtract from or add to it each day. Imagine the fate of a busy resident doctor who has to write 20 orders for 20 patients. What time will he really get to evaluate patients? In a country where doctors are grossly overworked, errors will occur but we must make every attempt to minimise them. They are inadvertent and no one wants to deliberately hurt another person. In fact, good medicine is all about this. The dangers of overworked and sleep-deprived doctors in India are an endless problem. I know a colleague, who, after a hard day’s work, went to the hospital for a call and fell asleep at the wheel, but thankfully only ended up with a minor accident. There must be a physical and mental threshold after which a doctor cannot perform the way he wants to, and each must determine this for themselves.

Medicos face tricky choices while prescribing drugs, attending conferences and writing in journals. Their actions should be guided by patients’ needs alone. An article on conflict of interest published in the Journal of the American Medical Association (JAMA) was very interesting. Though it talked about instances in the practice of medicine, I think we encounter such situations in our everyday life. For instance, when you visit an appliance store, the attendants try to sell you a product that can earn them a bigger commission instead of recommending aproduct that fulfils your requirements more. Often, it’s the same story when you seek advice from a stockbroker. This what’s-in-it-for-me attitude is a representation of human greed — it’s a problem affecting trusting customers across the table. Concerns over this behaviour in the UK led to the birth of ‘Which?’ magazine, which provides detailed information (pros and cons) of products so consumers can make an informed choice. The publication, which has been around since 1957, refuses advertisement to ensure bias does not creep in, and is registered as a charity. It also offers advice on financial and legal services. In medicine, conflict of interest is seen in cases where unnecessary procedures are recommended or conducted for money. Sometimes patients with heart ailments or cancer directly approach surgeons, who may suggest different procedures, confusing them. Patients end up consulting multiple experts. Some are more prudent and check with their physician if a procedure is necessary. A good rule of thumb is to seek advice from a medical expert who is unlikely to benefit by recommending a particular line of treatment or therapy. Conflict of interest is also witnessed when articles are written about a specific procedure, device or drug. Though journals insist that they have made adequate disclosures about any potential conflicts of interest, some articles appear to have a tilt towards a medical product. An analysis by Triangle et al in the US revealed that around 48 per cent of physicians received some kind of payment from drug and medical-device firms in 2015, totalling $2.4 billion. Another study, by Larkin and his colleagues, compared physicians who restricted access of pharmaceutical company representatives with those didn’t. Medicines promoted by the representatives, known as detailed drugs, lost market share after hospitals adopted policies that regulated or limited the agents’ interactions with doctors. An article by William Stead on the complex and multifaceted aspects of conflicts of interest makes a very interesting read. Judgement and integrity, he says, are the hallmarks of professionalism. Conflict of interest, bias and dishonesty represent a spectrum of threats to judgement and integrity. I remember seeing a film about good clinical practices when I was conducting a trial with an international pharma company. The film highlighted lapses in a different trial of an asthma inhaler. The team of this study was clearly told that the inhaler should be tested for only mild asthmatic conditions to prevent complications and fatality. But the nurse inducted a severe asthmatic subject, who received a dummy inhaler (without medicine) in the randomised study. The patient suffered a severe asthma attack at home and tried using the dummy inhaler several times before being rushed to the emergency room. She died before doctors could do anything. This, in my opinion, is the most severe case of irresponsibility on part of the research team. Before the trial I was associated with began, it was clearly stated that such situations should never occur. Any harm to the patient should be prevented. This is also the first concern of any physician. There are major conflicts of interest in the practice of helping doctors update their knowledge. Many symposiums and conferences for doctors are funded by pharma companies. Junior doctors often ask me whether they should attend such events or not. I tell them they should after making it clear to the organisers that there would be no quid pro quo. Boycotting such sessions is not a solution because medical education is expensive in our country and you need some funding from pharma firms. The other option is that doctors pay from their own pockets and later recover the money from patients through consultation charges, which is not ideal. Physicians should remember that their primary objective is to serve patients and deliver best results at the most reasonable price. Conflict of interest should be avoided at all cost.

Among the various diseases that take a heavy physical and emotional toll on patients, cancer is the worst. I have seen it cause enormous pain and distress to patients. And cancer therapy can be expensive; in many instances, seemingly well-off patients saw their savings halve in size. Many people also pursue experimental therapies and follow the advice of phoney spiritual babas and priests, who make a living by promising magical remedies. My young secretary suffered from cancer. She was in her early thirties and held two jobs; her work day would begin at six in the morning and often stretch to eight in the night. She used to wake up at 4 am to fill water (the supply lasted only an hour), cook and get her children ready for school. She handled the roles of a working woman, a mother and a homemaker very well, and I admired her strength and resilience. One day, she requested a 10-day leave saying she needed to undergo a hernia operation. I was a little surprised because she had not mentioned the problem before or sought my medical advice. I still asked her if I could examine her. The check-up suggested that it was not a hernia but a nodule, and I insisted that she undergo a sonography before her planned surgery. She was eventually diagnosed with uterine cancer, which had already spread to other parts. The secretary was later operated upon and she also completed chemotherapy. Unfortunately, cancer returned after two months, leading to another round of surgery and chemo sessions. Her condition did not improve much and she passed away a few months ago. She fought the disease till her last breath. I feel sorry for her husband and their young children. Her case made me wonder about the incidence of serious ailments among young Indians. As a student, I was told that anyone below the age of 50 could not have heart disease or cancer. Two to three decades down the road, I see young patients suffering from cancer. What is worrying is that such cases have become increasingly common. People talk of poor gene pool, but it takes thousand of years to change the gene pool. I have my own views and I suspect pollution is a major trigger. Radiation from mobile towers and phones, and high levels of lead or arsenic in groundwater could be among the factors causing cancer and other chronic diseases. A colleague with whom I have worked very closely in Germany told me the story of her husband. She studied the effects of heavy metals, and once examined the blood and urine samples of her husband. She found high mercury content and asked him to undergo a detoxification programme. He refused, and years later, he was diagnosed with cancer of the pancreas. During the surgery, she took a piece of the pancreas for tests and found it to be loaded with mercury. He died shortly after. I would like devote this column to dietary options that could help prevent cancer. The World Cancer Research Fund and the American Institute of Cancer Research have conducted various studies. The first premise here is to prevent obesity. Obesity is responsible for liver, ovarian, prostate, stomach, colorectal, breast, gall bladder, kidney, esophageal, pancreatic and endometrial cancers. A diet rich in whole grain, vegetables, fruits and beans is highly recommended to keep the conditions at bay. If there are no complications, mothers should breastfeed their babies for the first six months. The breastfeeding should continue in combination with solid food for two years. One should always try to avoid processed and fast food and dishes which have high fat, starch or sugar content. It is advisable to limit red and processed meat, and sugary drinks. More importantly, one should avoid drinking alcohol and smoking or limit the two activities, which are known to cause health problems. Physical activity is highly recommended and it goes a long way in not only preventing cancer but also heart disease and various other chronic conditions. Experts also say that one should avoid high doses of dietary supplements and instead try to meet the body’s nutrition requirements through natural food. These suggestions on diet and lifestyle should also be followed by people who have been diagnosed with cancer. Till we understand more about cancer, it is better to adhere to the principles that can help us stay healthy.

Artist students can often receive educational scholarships for post-graduate work while oneself involves research into a distinct problem. This mind in reference to financial assistance is habitually in case by groups that are aggressively seeking a cure to a disease fur advocates who are attempting to start going awareness in regard to a health issue. Most of these programs require that a student submit a effect and well written sample proposal in contemplation of approval. Some scholarships pro rata that the results of the research go on presented to a particular group. Unessential programs might take some ownership as for an results such as actual medications that are developed. Research scholarships can pay for a large portion of post-graduate tuition and do up be there highly difficult to acquire.<\p>