Evidence Based Medicine some ramblings

Medical profession is always regarded as one of the best and noble professions of human civilization. Does it still hold the respect and regard which it accrued over a century? Is it worth considering medical profession as a job in the wake of new Evidence based medicine practice? Does studying for almost a decade in the med school and spending the most of your lively 20-30 in libraries get any better for your miserable life?

I will try to examine the present situation of med practice around the globe. Typically a student who is aspiring for joining a med school starts his preparation by spending on average 2-3 years at premed and performing very well in the MCAT exam. He will take a deep sigh in getting a great score and spends some time in different kind of volunteer and social activities apart from his pre med grades. He competes with his fellow nerds to gain entry into med school and starts his dream MD program. Here starts a huge drama of med school. You are supposed to do your best in the school by memorizing and mugging up the complicated text books. It doesn’t end there. As you complete your third year of med school, you will start preparing for the licensing exams. So, again another round of freaking tests for getting into residencies. You really need to toil down to get great scores. Finally you end up in a residency program which takes on an average 3-4 years and takes most of your quality time and ties you to either library or ICU rotations. Once you survive the hardship of studying for years your brain is literally exhausted. You are ready to take up a job. I am not following with the debt you incurred all along this path. It’s around 100-150 grand depending upon where you completed the MD program. Naturally one looks for the best hospital or a corporate entity where he looks for maximum compensation, to take care of his educational loan. How would a corporate company would practice? I guess you know the answer. It tries to squeeze as much as it could from the insurance companies to run its company, pay the physicians. So, your compensation will be based on the number of patients you would see every day and the dynamic targets you reach each and every day. There is no scope for you to understand the clinical case with the expertise you have learned all along the way for ten years by mugging dozens of text books. You are concerned with the patients out come with the maximum technology you can use. The maximum technology utilization leads to higher profits and eventually your compensation. Your compensation is directly proportional to the use of very high end diagnostic tests. Medical professionals have given a fancy name for this kind of camouflage relationship, “Evidence based medicine”. In this process your practice evidence based medicine concepts and loads of material you read and relished for long time slowly sneaks away from your grey matter. Down the lane what you remember is a hand book of medicine with different testing and prescription options. Well those things are also not have to be remembered by you since we have now high tech software programs and infinite memory disks flooded in the market to store and think about the ways as you perform. So, bottom line is you end up a clerical job clicking some screens and giving pills. You will never realize the fact that you are doing such kind of a no exciting work after toiling 10 years of your life. Who is benefited here? You?

Patient? Corporate entity? Or Insurance companies? Let me put the question in another way, who is most affected with this paradox? Straight answer is Patient and Insurance payers. Paying insurance is an insensible loss of income for most of us who are having a job. It’s a burden for who are jobless. How to correct the problems associated with it? It’s not of scope of my understanding and nor I would take stand on any side. My only frustration is about making physicians dumb and degrades their job profile to a clerical job. If that’s the case, the whole program should be revamped and there should be actually two kinds of jobs. One who just complete an undergrad program like stuff where he solely concentrates on learning the hand books of medicine and learning some standard surgical techniques. It reduces a lot of reading and happy years for the students. This would encourage more students to pursue the course and we can get more number of doctors. This in turn would reduce the MD/patient ratio. Another course of study would focus on more of medical research and design of new protocols which can be incorporated into the hand books for the other group of students. This curriculum can be little bit rigorous and intake should be limited making it competitive. This gives us the best designers of the programs of medicine.

What do you think? I guess it might work if I am a decision maker!!!!!! Well I am not...These are just ramblings….Do comment on parts you think are simply out of the way…..

Rest in Peace Venugopal Reddy

I am moved by the act of deceased venu. He charred his body with kerosene. What a ghastly and brutal punishment one could impose to his own body. I am really sorry for his family and friends. It’s painful for me to digest the fact that someone can actually do a self sacrifice for the cause of “Telangana”. It’s a very pathetic decision taken by him. We know that no one is getting a benefit out of his insane act. What it would reward him if he is dead? If state is formed or not...Does that really matter for his soul? People who acknowledge there insane acts as martyrdom would cause repetition of these cases. What happened to Srikanth who has taken his life for the cause of agitation? He is dead...his family is in an ocean of grief. Don’t be in state of mind that we could achieve our goal of statehood of Telangana with these attempts. Students and any other telangana activists should remember that we have only one life. We have every right to live up to the fuller extent as it permits. Don’t get emotional and carried away. Carry out the momentum for protection of your rights in a peaceful and non-violent way. Please don’t resort to any such kind of suicide attempts again. I request everyone to pray for the soul of Venu and we hope this kind of acts won’t repeat again in future.

Why Telangana?

This is not my original work. I have collected some information from the various websites. Facts stated are here in are unverified and I feel may be true to the content.

Thanks and happy reading.

Whenever the topic of Telangana is raised, many of us blindly support Andhra or Telangana based on where we come from. Not sure how many really think of why the demand for separate state has been there for such a long time. The 2 major reasons why the demand has been pending for so many years is WATER AND HYDERABAD. People around the state have earned and invested in and around Hyderabad so there is a concerns about the safety of the investment if the state is separated while both the major rivers in our state flow mostly through Telangana. Below are some facts that are few reasons for the demand. Sentiments can be foolish but not facts.



a. There are 10 districts in Telangana, 9 in Andhra and 4 in Rayalaseema. Out of these 7 districts in Telangana, 3 in Andhra and 1 in Rayalaseema are considered severely backward districts which means 70% of districts in Telangana are backward while in Andhra it is 35% and in Rayalaseema it is 25%. Apart from these there are some areas in all parts of the state which are also backward.

b. 45% of the state income comes from Telangana region. When it comes to utilization of funds, the share of Telangana is only 28%.

c. Normally canals are dug to supply water to the crops from rivers for cultivation. The amount of land cultivated through canals in just Guntur district is more than the land cultivated with canals in entire Telangana region.

d. Nagarjuna sagar dam is built in Nalgonda district which is in Telangana but majority of the water from the dam is used for Krishna and Guntur district. The original dam was supposed to be build much ahead of its present location but the location was changed so that it falls in the Telangana region. Due to the construction of the dam several hectares of Lime stone mines vanished as part of the dam back waters. Everyone know that lime stone is used for producing cement. Even the natural resources were not allowed to remain.

e. Fluorinated water problem is only in Nalgonda district which has not been resolved since decades.

f. Two major rivers Krishna and Tungabhadra enter the state of AP in the district of Mahaboobnagar(the biggest district in Telangana) but the district always remains the worst draught hit areas along with Anantapur because there is no project and process with which the water can be utilized. The plans for utilization has been pending for decades.

g. RDS (Rajolibanda Diversion Scheme) is build in Mahaboobnagar to provide water to 85000 hectares of land in the district. The leaders of Rayalaseems blasted the gates of RDS and water is supplied to KC (Kurnool-Cudapah) canal while only remaining water, if any, is supplied to the lands in Mahaboobnagar.

h. 3 TMC of water from Gandipet is sufficient to supply drinking water to our city. Every year 1700 TMC of water is wasted and is flown into Bay of Bengal from river Godavari. Starting from Nizambad to Bay of Bengal there is no project allowed to build on Godavari. If it is built leaders in Godavari districts fear that the fertile lands in the area may fall short of water. If the Godavari water is utilized properly, there will be no scarcity for food grains in our state.

i. In Telangana regions, only few areas cultivate one crop a year and very rarely two crops a year while most of the land doesn’t even cultivate single crop. In both the Godavari districts, Krishna and Guntur district, two crops a year is common and there are times where even 3 crops a year are cultivated. The only reason is WATER.

j. Government issue G.O.’s for implicating its decisions. G.O number 610 is the longest non implicated G.O in the history of AP. The G.O was issued in 1986 by late NTR who was then the CM of AP, which is not yet implicated. The G.O speaks about the share of Telangana employees in Government jobs in Telangana region.

k. 33% of the population in Mahaboobnagar district have left the district for livelihood to different parts of the state due to draught and majority of them are working as daily labour. No other district has so many people who fled the home place due to lack of livelihood and working as daily labour.

l. There are 25 plus government degree colleges in Krishna, Kadapa and Guntur district while there is not even a single government degree college in Ranga Reddy district.

m. Dairy development corporation of AP purchases milk from farmers across the state for distribution. For the same milk, in Andhra, the government pay Rs. 24 to the farmers and in Telangana they pay Rs. 22 per litre. Partiality is shown even in milk J

n. In between 2005-2008 government sold lands worth Rs. 20000 crores in and around Hyderabad which was utilized to build projects in Rayalaseema and Andhra.

o. Not even a single project was completed in Telangana in the last 5 years while several projects were completed in Andhra and Rayalaseema.