A Doctor’s View on Doctor – Patient Relationship

A Doctor’s View on Doctor – Patient Relationship

MBBS (Bachelor of medicine and bachelor of surgery ) the most inspiring and attractive word for me throughout my whole childhood. But it becomes toughest on 5th June 2015 when the first time I was successfully failed to get an eligible rank in my West Bengal joint entrance examination for medical. Though the word inspiring was existing in my life for MBBS. I desperately accumulate all my courage and restart my preparation to crack the same examination for the next year.  And that time I successfully able to get the entry in my childhood wish. I was started my journey as an MBBS student at the BURDWAN MEDICAL COLLEGE, WEST BENGAL and from the beginning of that, I was an active part of the world medical association.

‘Doctor Babu ‘when I heard the word indicating to me for the first time it was such a pleasure to feel that astounding feeling. In the first year one day I went to visit the hospital for the first time with my white apron. Then a short height, an unhygienic man came towards me and ask for ECG room. But at that time I was not able to help that man because I also didn’t know this. As a doctor, my duty was to help that man.

A healthy doctor patients relationship is the most important part of treatment. Healthy means professional. Some foremost characters should have to be developed to become a successful doctor. At first, a doctor must have to be helpful towards his patients but obvious within his professional limit. Secondly, justice with patients, equality among patients, and equal division of limited resources only and only based on priority need and next one is fidelity means the ability to truths about our each and every action because mistakes are forgiven but lies are strongly punishable. We must have to be understood that patients are not help-seeking rather we are the help provider.

Doctor patients relationships are of different types. One may be doctor-centric in which doctors are superior and patient must have to follow doctors advice and another one is patients centric in this doctors are flexible in their point of views and they give opportunities to his patients to choose their options.

A doctor can play different roles in appearance to influence his patients. We must have to be flexible in our behavior and it will be the strongest ladder to achieve effective care. The term ‘placebo’ is a substantial term conjoin with the medical profession. Sometimes we have to use strongly directive approach to make better treatment. Some pessimistic patients are not aware of their health so they ignore the treatment process. It is our duty to strongly put our advice and make the better health of the patient. But as besides this, it is also important to remember that the right to refuse is the personal choice of the patient. We can’t pressurize them in any aspect rather we can motivate them. As a good doctor, we have to use tremendous politeness and respect during the treatment of geriatric patients and it is an appropriate doctor-patient relationship.  Another one is protectively paternalistic approach and this is maximally used in pediatric treatment. A doctor can advise his patients by gathering kindness, protection, strength, and patience. Because pain is the fearest foe of a child and as a doctor, our responsibility is not to destroy the fear but to achieve the power to fight against it so that he can tolerate it in his upcoming life. Some other aspect is the supportively directive approach. In this type, doctors believe in patient’s choice along with providing reassurance and guidance. Another example of the perfect doctor-patient relationship is the relationship between doctor and female patients. Most of the female patients always choose female gynecologists for their treatment but as a male doctor also our duty is to provide equal safety and security to them so they can trust us . A doctor can play an active role in the treatment of terminally ill patients. As a doctor, our responsibility not only in cure purpose but also provide the hand in care. In the case of terminally ill patients, we can’t stop our treatment by accepting upcoming death but it is our duty to provide a peaceful death to our patients.

Relationship means the mutual connection between two peoples. So both sides effort is necessary to make a relationship healthy. Patients also have to believe in the doctor to make the relationship more trustworthy. Some people told that feel your patients as your family members but I think rather it is important to feel our family members as our patients when they suffer from disease because a professional relationship can handle effective treatment rather than a coherent relationship. As besides the importance of establishing relationships, it is also important to perfectly terminate our relationship with our patients because we can’t expose us as available and as sympathetic so that we become emotional during termination.

As a future doctor, I will definitely maintain these in my working phase and I wish my other co-workers who are reading this may also influence through my words.





  • Introduction: Nipah Virus is a newly emerging zoonosis that causes a severe disease in both Animals and Humans.
  • This may worsen into a state of a coma over a day or two.
  • Complication can include Encephalitis and Seizures.
  • This is a highly contagious and deadly virus.
  • What is Nipah Virus: The virus, a member of the family Paramyxoviridae (genus Henipavirus) is named after the Malaysian Village of Sungai Nipah, where many Pig farmers became ill.



  • Epidemiology: Nipah Virus was first isolated & identified about 2 decades ago in 1998-99 When Malaysian & Singaporean Pig farmers & others in close contact with the animals suffered from respiratory illness.


  • Outbreaks: Nipah Virus outbreaks have been reported in Malaysia, Singapore, Bangladesh, and India.
  • The Highest Mortality Rate has been reported about 2 decades ago in Bangladesh in 1999, where about 300 human cases of Nipah Virus were reported, including 100 deaths.


  • At that time, more than one million pigs were euthanized to contain the outbreaks.
  • In 2001, NiV was again identified and isolated as the causative agent in an outbreak of human disease occurring in Bangladesh.
  • Recent Outbreaks In India: Recently, Nipah Virus came into the limelight when there is 17 people have died due to this fatal contagious viral disease in the Indian State of Kerala, According to the Health Ministry Official.

The virus is more frequent in Bangladesh & India, where exposure to Nipah Virus has been associated with eating raw date palm sap with contact with infected Bats Or Human.

  • Transmission: Transmission of Nipah Virus to human may occur when one comes in direct contact with infected bats, infected pigs or infected people.


  • The recent outbreak of Nipah Virus in Kerala (May 2018), occurred when people consumed fruits bit by infected fruit bats, When bats carrying the virus bites into fruits, the virus enters the fruits and then infects the humans who consume it.


  • Bats shed the virus in their excrement and secretions which can infect humans, as well as animals such as pigs, dogs, cows, etc who come into contact with the droppings.
  • The “Hospital-Acquired Infections” – are a major path of human to human transmission.
  • The Nipah Virus is also suspected to get transmitted through coughing. This infection can also easily affect people who come in direct contact with contaminated bodies.
  • Incubation Period: The symptoms may take from 4 to 14 days to appear after a person gets infected.
  • Risks of Exposure: Consumption of raw date palm & contact with bats. Human to Human transmission has been documented & exposure to other Nipah infected individuals is also a risk factor is reported in India & Bangladesh.
  • Signs & Symptoms: NiV infection can progress silently in humans without showing any symptoms. However, people infected with this deadly virus may display Influenza-like symptoms.
  • The Sign & Symptoms of Nipah Virus include:
  • Acute Respiratory Infection, which can be mild to severe and cause interference in breathing.
  • Fever, Muscle Pain, Headaches, Nausea, Vomiting, Sore Throat.
  • Dizziness, Drowsiness, Mental Confusion & Disorientation, Atypical Pneumonia.
  • Brain Swelling or fatal encephalitis. Gradual progression to Coma within 24 to 48 hours.
  • People who survive the infection may suffer from long-term side effects such as Convulsion and Personality Changes.
  • Mortality Rates: The virus can kill between 40% to 100% of those infected by it. Surprisingly, more than 60% of this infection in humans comes from animals.
  • How is Nipah Virus Infection Is Diagnosed:


  1. Throat & Nasal Swabs.
  2. Blood Tests.
  3. Virus Isolation & Detection.
  4. CSF Analysis, Urine Tests.
  5. ELISA (IgG- IgM).
  6. Real-Time Polymerase Chain Reaction (RT-PCR).
  7. In Fatal Cases, immunohistochemistry on tissues collected during Autopsy may be the only way to confirm it.
  • What is the treatment for Nipah Virus Infection:

Currently, there is no vaccine or treatments available for Nipah Virus, Supportive Care and Prevention is the key to stop the spread and remain safe from this virus.

The drug Ribavirin has been shown to be effective against the virus in vitro, but the usefulness of Ribavirin remains uncertain.

  • How We Can Prevent The Nipah Virus Infection:
  1. People Should prevent the animals from eating fruits contaminated by Bats since the Fruits Bats are the Primary cause of Nipah Virus Infection.
  2. Stay away from consuming date palm for some time.
  3. Avoiding direct contact with Pigs, Bats, Human in Endemic.
  4. Health-Care Professionals to such patients should take precautionary measures such as Wearing Masks, Gloves etc.
  5. To avoid Hospital-Acquired Infections raise awareness about signs & symptoms & transmission to avoid human to human infection in such settings.











When you will see into a baby’s eyes, and you might notice sometime Babies rarely blink. As we know adults, blink about 15 times a minute, on average. But newborns and infants blink rarely — only a handful of times every minute, with some babies blinking as infrequently as once a minute. The average is two or three blinks That’s because blinking is regulated by the brain’s dopamine, one of the neurotransmitters that allow brain cells to communicate. So, blinking in babies could help us better understand how this important neurotransmitter operates in infants. We know the link between dopamine and blinking, as conditions or drugs that affect dopamine also change blinking rates. People with schizophrenia, which may be caused, in part, by too much dopamine, blink more frequently. As in Parkinson’s disease, which is caused by the death of dopamine-producing neurons, blinking is markedly decreased. Taking medicine to raise dopamine levels brings blinking rate back up. But dopamine also underlies a diverse set of other functions, from the control of movements and hormonal levels to learning and motivation. So, babies’ blinking rates may reveal something about the development of the dopamine system and perhaps even reflects individual differences in some aspects of babies’ nervous systems, there will potentially spontaneous blink What does this all mean for babies? Because one function of blinking is to keep the eyes lubricated, researchers have proposed that babies blink less than we do because their small eyes don’t need as much lubrication.. the reduced blinking rate in newborns is due to an underdeveloped dopamine system.




     Days passed by hearing the sudden death news of Celebrities like Michael Jackson, Sri Devi, Sema Lagoo, Om Puri due to Heart Disease. Heart disease can occur in 2 ways:  One by birth, family history, diabetes mellitus type 1. Second by cholesterol, lack of exercise, overweight, smoking, diabetes mellitus type 2.  Nowadays a heart attack by diabetes mellitus is getting worse. If we think twice or thrice, the common effect for this disease can be the mistakes and discipline of our daily life activities.

Recently, ‘diabetic heart disease’ is the highly ranked disease crawling among the adults with an age of 45 to 55. Sadly, this evil that will be been weaving around us at the youthful age. As laziness and unhealthy diet take a major place in your life, the art of heart disease gives birth in your body.

Every profession got its own way of stress, tension, sleepless tasks in simpler word ‘difficulties’ as an employee pressurized by the boss, as a boss stressed in maintaining company statistics, as a student tensed about career and future, a doctor diagnosing patients’ diseases we cannot blame anyone for this. But by these effects of stress, tensions, staying in a stationary position for extended periods of time, our body will be prone to chronic disease like diabetes. Diabetes mellitus type 2 is the most entertained disease in our body. How about the stress of the work which damages your nervous system, increases your blood pressure, constricts your blood vessels? Have you ever thought that not only the junk in your body but even the stress, fear, tension taken up during the work affects your body in a soothing way?

How Diabetes Mellitus type 2 starts?

You get to work and end up the day with an entire body filled with tiredness. All this time the brain helped in thinking, calculating, decision making; digestive system extracted some enzymes from food which helps the other organs to work in a proper way and energy distributed all over so that you may not faint in the middle of your work, but stress disturbed them. As tension and stress make your heart beats fast soon blood pumps fast and your blood vessels constrict by pressure, as the blood moves fast in your body the organs of your body attempts to work fast. This means the body is working more than needed. Eventually, the pituitary gland (master gland of the body) secretes hormones in large amount which means hyperfunction takes places in the organ. As concerned to the pancreas, sometimes it cannot be capable of secreting insulin and the glucose cannot be converted into glycogen that brings changes to the blood sugar level. By this, you will be affected by diabetes mellitus type 2.

Symptoms of Diabetes Mellitus type 2:

If you have diabetes mellitus type 2 you will have an Increased thirst and frequent urination (Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues), Increased hunger, Weight loss (Calories are lost as excess glucose is released into the urine), Fatigue, blurred vision (If blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus), Slow-healing sores or frequent infections, Areas of darkened skin (patches of dark, velvety skin in the folds and creases of their bodies — usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance). These symptoms of diabetes mellitus type 2 can affect your heart.


How Diabetes Mellitus type 2 affects your Heart?

By regular fast pumping of the heart, it can become weak and irregularity of heartbeat takes place, which may lead to arrhythmia (irregularity of heartbeat) or dilated cardiomyopathy (heart chambers become dilated because of heart muscle weakness and cannot pump blood properly) sometimes heart failure(insufficient supply of oxygen).

As a foodie, a chicken burger with extra cheese in right hand and a cola in the left hand or trying out new fast food seems to be a magic ‘mantra’ for after work stress-relief. You may enjoy that plate of delicious food and get back to sleep. What about the fat summed up in your body?  There is no way for the calories to burn up!

First, calories pile up and there will be no scope to run out of the body. These tiny calories turn and convert into a thick creamy unwanted layer of fat in the body. The unwanted fat slowly turns into cholesterol and lead to obesity. Some of the diluted fats go around the body and stays at a place like heart, bundles up into cholesterol, mostly in a coronary artery, one of the main arteries of the heart. This leads to improper pumping of the blood leading to coronary heart disease. Sometimes, myocardial infarction (heart attack) caused by a blood clot that develops in one of the coronary arteries and can also occur if an artery suddenly narrows or spasms occur.


Symptoms of Heart Disease:

You should be aware of what is happening in your body.

When you feel an unbearable pain that travels through the body (for example from the chest to the arms, neck, back, abdomen, or jaw) light-headedness and dizzy sensationsprofuse sweating nausea, and vomiting clearly shows that your heart is in trouble. It is not getting enough oxygen to pump up the blood. Immediately run to the hospital.


Medications for Heart Disease:

The main medications in use are statins (for lowering cholesterol), aspirin, clopidogrel, and warfarin, (for preventing blood clots), beta-blockers (for treating heart attack, heart failure, and high blood pressure), angiotensin-converting enzyme (ACE) inhibitors (for heart failure and high blood pressure). The doctor will work to find a medication that is safe and effective. They will also use medications to treat underlying conditions that can affect the heart, such as diabetes before they become problematic.


‘Prevention is better than cure’

The only way to get rid of the disease is proper diet and regular exercise. When you wake up a 5-minute meditation or yoga will give fresh start and calmness to your mind which controls your anxiety, stress, tension for the entire day, regular breakfast, minimum 30-minutes exercise per day, power naps, healthy diet, avoid smoking, avoiding or reducing junk food and soda will be helpful to get a good health. By this, you will be healthy and have a great immunity in your body.




I’ve dealt my experiences and knowledge with WHO’s this year theme Health for all

Let`s define Health for all-“Attainment of a level of health that will enable every individual to lead a socially and economically productive life”

When wealth is lost nothing is lost

When health is lost something is lost

When a character is lost everything is lost

Last year WHO stressed on the character aspect that too in individual level through the topic, ”Depression-Let’s talk”. This year we are dealing with the health aspect in community level and the wealth which is needed to establish the health system

“WHO was founded in 1948 to make health a human right and not as a privilege. We’ve crossed 70 years and still the conviction is as strong as ever”, these are the words of WHO director Dr.Tedros

As a third-year medical student, PSM is the subject which gave me the most joy as it dealt with health in community level. Health is something which is to be learned at a community level for the overall health promotion. Health is the only thing which is needed by the richest and also the poorest in the country without any compromise. It would be ruthless and barbaric to put an option like health or food/education/basic needs among the poor. That’s why this year WHO insisted on Health for all everyone everywhere

Now I’ll tell you my real life impact on community health during my 3rd-year ward posting. 8 year old female named Dhivya came to the pediatric OPD with chief complaints of respiratory distress. She is a known case of spastic cerebral palsy who had lost her mother during labor and father to an accident. She is now under the care of her grandmother. On head to foot examination, we found severe pediculosis affecting her scalp and eyebrows. We asked her caretaker to maintain proper hygiene by providing her regular bath and prescribed her ketoconazole shampoo to be bought outside (as it was not available in the hospital pharmacy). But she didn’t take the prescription and wept about her poor socioeconomic status to buy the shampoo which costs Rs.180. This patients history raised me questions in my mind. Why should the innocent girl suffer this? Is this any incurable medical condition like malignancy or AIDS? NO INDEED. Then there is no point in her suffering. The entire humanity should feel ashamed for her suffering as we are spending millions in finding and drug and testing it by clinical trials. Yet this Rs.180 made pushed the therapy to an unreachable altitude.

Sometimes I get inspired by watching medical series like HOUSE MD and got inspired by the American health care system. But after doing research regarding that I came to know that the health insurance companies only cover those people who are in good jobs. What about the homeless old man wandering in their streets? Does their insurance companies think that is a life not worthy of a medical care? We need a policy from our leaders which establishes equity among people. This year is the time to ask our leaders our basic right, OUR HEALTH.

For a good health care facility, we need people, services, products, finances and information and everything is needed especially in times of an outbreak. A good example of our health care system can be explained by the Nipah virus outbreak in Kerala. This is a deadly virus an too difficult to establish a diagnosis in index and primary cases. But our health care facility was able to tackle the situation and saved millions in spite of losing a few.

Here we are providing health care free of cost and health insurance also free of cost. As a medico from a government institution, I came across a lot of people from low socioeconomic class (as per modified Kuppusamy scale) seeking medical attention and they were given excellent care under free of cost. Few cost expensive services like MRI are covered under their insurance scheme. But still, we are not providing some advanced services like bone marrow transplantation, gene therapy, etc. which are provided by corporate hospitals. This is one milestone we need to achieve.

When we went to field trips to PHC, ICDS, Health sub-centre during field visits, I can see that at least essential health care is accessible to all individuals and families in an acceptable and affordable way with their full participation. We have launched a sustaining primary health care by formulating national policies, strategies, and plans of action as per Alma-Ata-conference. In spite of inequality among education, social status, economic status, etc, Healthcare is the only this we`ve tried to establish some equality and equity among people.

Regarding the inspiring 2018 theme of WHO I came to know that half of the world`s population don’t have access to a proper healthcare facility. Millions are pushed to poverty due to money spent on food. WHO insisted the need that No one should have to choose between health and food/education/shelter. Then what is the solution? The answer is to establish affordable health services for EVERYWHERE, EVERYONE. This universal health coverage can be achieved if and only if the political will is strong. WHO is calling leaders this year to make universal health coverage a reality for everyone, everywhere.

The very special 2 things in 2018 universal health coverage concept:

  • First, this stresses the importance of nurses and midwives in the health care system. Generally, they are underrated. They are the pillars of our health care system. I’ve seen a Nurses strike in my college. The whole hospital was stranded. They have the number and knowledge for our health infrastructure.
  • Second, universal health coverage stresses the importance of healthcare for older people. It considers their health issues in a novel approach. WHO does not want them to seek a doctor for their diabetes another doctor for arthritis and another doctor for hypertension. It wants them to have a health coverage in such a way that they can whatever the services they need in a single institution with their health-related data and treatment history being synchronized among different specialties.

Countries with universal health care include

Austria, Belarus, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, Malta, Moldova, the Netherlands, Norway, Portugal, Romania, Russia, Serbia, Spain, Sweden, Switzerland, Ukraine and the United Kingdom.

There is a very peculiar thing about this list of countries. Have you noticed any South East Asian county on the list? The answer is a big NO. In South East Asia over 800 million people don’t have full coverage of essential health services. 65 million people are pushed to poverty because of the health costs. We cannot accept or afford a world like this. Especially as a South Asian Country, India cannot accept this atrocious state of us and our neighborhood. That’s why we should make health services universal so that these people do not suffer from financial hardship. By tracking who is not getting health care and who is being improvised by health care, we can make policy to establish this system. This would pave a way for a fairer and healthier world.

Health is a human right. No one should get sick and die just because they are poor or because they cannot access the health services they need. 97 million deaths can be prevented worldwide when the global community makes the right investments in the right health care system. This is quite a big number. The SDG or Sustainable Development Goals insists on making the right investment in the next 15 years to prevent this death. The SDG price tag in 67 countries which has 75% of the world`s population is 3.9 trillion dollars for the 15 years. These countries don’t have the economic source to pay the price tag (India is not one of those countries we have enough resources). But most other countries have the fund to make an investment in these countries. By giving economic assistance is theoretically proven that SDG can be established worldwide. This could add 535 million extra years of healthy living to the world’s population.

People-centered care:

Recently a lot of money invested in health has been wasted due to unnecessary investigations etc. To avoid this year WHO insists on people-centered care. People-centered care means health services are ensured to people’s needs and provided in partnership with them rather than simply given to them. It means the care where people, community, and families were respected informed engaged and treated with dignity and compassion. This improves the trust, experience, and outcome from people and gives confidence and job satisfaction among professionals. This would also improve the quality and efficiency of the healthcare system

Let’s take a look at these facts by WHO:

  • 5 million people don’t receive treatment for TB
  • 17 million people do not receive treatment for HIV
  • 20 million infants are not vaccinated against DPT
  • 204 million women do not receive adequate family planning
  • 1.1 billion people are living with uncontrolled hypertension
  • 2.3 billion people lack basic sanitation

What do we infer from these points? All the above-mentioned care is available now that’s what we are thinking, isn’t it? What is the whole point in developing a care that is not reaching millions and billions of people? We have the good knowledge I accept but we need to make this knowledge useful to the community. Otherwise, all these knowledge are vain.

Social media and mass media: Boon or ban for HEALTH FOR ALL:

Everyone will think that social media and mass media will be useful in spreading knowledge and improving the concept of health for all. But my point is they are better in collapsing the health care system rather than promoting it.

A good example is the MMR vaccination program last year. It was a great program to prevent 3 deadly childhood diseases Mumps, Measles, and Rubella. But it was a failed program. Because of fake what’s app message telling about researches in which they’ve proven that this MMR has lots of ADR?

My cousin refused to vaccinate her child with MMR.

I’ve shown her the researches about the vaccine in PubMed and yet she insisted on that wapp message and ignored me. In the history, there were a lot of failure programs due to mass media also.

. Universal health coverage is more than just health insurance, more than just health care. It means people can get quality health services where and when they need them without suffering financial hardship. Half of the population have no access to healthcare and millions are pushed to poverty due to health expenses. Universal health coverage is the solution to all this problem. Evidence and experience show that all countries at all income levels can make progress with the resources they have also show us that there is no single path to Universal health coverage. All countries must find their own way in their own political social and economic circumstances. Let`s take Ghana and Rwanda as examples,

In Ghana, a remote household receives support from community healthcare workers. They help people to receive relevant health care. I’ve read an interesting story about a 16-year-old boy, Shaibu, who was found to have a deadly skin disease and was spotted during such visits. He was referred to hospital to get specialized quality care. Ghana`s National Health Insurance provides free health services for children under 18. Since 2003, this health insurance covered over 6000 patients.

In Rwanda, Dr.Olushayo Olu WHO representative in Rwanda really wanted to create a community where everybody has a good access to health care, basic services like water and sanitation. He developed a system in which financial barriers are removed. The main problem is lots of their people were working in the informal sector. Generally, health insurance schemes focus on people who are working. So the government decided to create different categories called “UBUDEHE”. This classified people according to socioeconomic status and to know who needs assistance and what level of assistance they need. And the Community based health insurance scheme was rolled out. Now they have a coverage of over 80% which by African standards and by any standards represent a great number and they are now progressing towards 100%.

In India, states like our Tamil Nadu have the glory of having a state government implemented a government insurance scheme. Now the central government also made an initiative, Ayshman Bharat which could be the world’s largest health insurance program.


Universal health coverage not only improves health. It reduces poverty, creates jobs, spares inclusive economic growth and increases gender equality. Strong healthcare systems based on the foundation of primary care are also the best defense against outbreaks and other health emergencies. Universal health coverage and health security are truly two sides of the same coin. Now it is the time for all countries to invest in universal health coverage.

It`s time to talk about the best ways to get health services to all.

Time to remind the world leaders “Health is a human right”

It’s time to have the Right care in Right time in the Right place.




It is often said that life imitates art. In that case, I couldn’t find a stronger case for that assertion other than the fact that IBM chose to name its state-of-the-art Artificial Intelligence Watson, an obvious reference to the sidekick of none other than Sherlock Holmes himself. In a surprising twist, that character too was named after another doctor, the eponymous Dr. James Watson. In fiction, Dr. Watson (MD) was depicted as an expert medical practitioner, but nevertheless was but a foil next to his best friend Sherlock, a literary device no doubt intended to accentuate the audience’s awe and admiration of the brilliant feats of deductive reasoning Sherlock performed on a regular basis.

However, the Watson created by the engineers and scientists at IBM proved to belie his name, for it displayed a superhuman and often astounding series of abilities to the world when it won the first prize in the game show Jeopardy, netting the machine no less than a million dollars, which it was unfortunately not programmed to spend!

In 2011, it was perhaps forgivable for a layman to think this a fluke, and not an example of the consistent march of progress that has been steadily bringing silicon chips and software within ever closer to parity with what has been since time immemorial the Gold Standard in intelligence and intellectual capability: The human brain.

And further proving the point, IBM set its creation back onto the road its namesakes once followed, the field of medicine itself. After several proof-of-concept tests, the Memorial Sloan Kettering Cancer Center in New York entered into a multi-million dollar contract with IBM to have Watson aid in performing utilization management for lung cancer cases, later stating that 90% of the nurses who have used Watson ended up consistently heeding its advice. In India, Manipal Hospitals has also partnered with IBM in the launch of IBM Watson for Oncology, a service that helps in providing personalized care to cancer patients, whilst also aiding doctors by providing accurate information even in rare and hard-to-diagnose cancers.

Now, in 2018, Artificial Intelligence, aided by its implementation through Machine Learning, is poised to take the medical world by storm, and it is in the interest of both doctor and patient to learn of its role, and how it is already, quietly but surely, revolutionizing healthcare.

A proper technical overview of all the factors that made AI software a marvel is far beyond the scope of this article, but nevertheless, I shall strive to explain the broad concepts behind its implementation, and also how to prepare for and hopefully embrace the changes it will produce in the field of medicine.

First, an explanation of the terminology:

Artificial Intelligence refers simply to any intelligence displayed by a machine, that is, any constructor system that was not ‘naturally’ formed. It can be as simple as the keyboard on your phone detecting spelling errors and correcting them so you can type faster, to the chess programs that soundly thrashed Grandmasters at the turn of this millennium, the handy little tools that let you tag your friends’ photos on Facebook, and even the self-driving cars that are constantly making the news!

Machine Learning is a way of creating artificial intelligence, using statistical techniques to make intelligent decisions even without a human explicitly programming it to do every single thing the machine eventually learns to do. Given enough time, processing power, and data, ML allows computers to do amazing things, such as learning how to convert human speech to words and then understand them, or to comb through mounds of old journals and medical data to make connections and deductions that would be simply beyond the ability of any human to find. It is the difference between a student rotely doing calculations to solve a math problem, and a teacher explaining how to solve problems, with the student then using their understanding to find answers even if the questions are not exactly the same as what they practiced on.

Reinforcement Learning is the step beyond the example given before. It is akin to a bright student trying to solve problems on their own, with the teacher only telling them if their answer is right or wrong until eventually the student exceeds the teacher and starts solving problems previously thought impossible! And yes, AI can do this, such as recently, when Google unleashed an AI called AlphaGo Zero, completely self-taught, but which still soundly thrashed all humans at the ancient game called Go, and even its ancestor, AlphaGo, which had just a few months back defeated the same masters. Go is considered a game of deceptive simplicity, but it is known to be even more complicated than chess, and thus even harder to develop the superhuman mastery shown by these AI.

So now we see how the AI is taught, let us move on to what it can do.

Of all the fields of medicine where AI and Machine Learning are being applied, Radiology is the first where these techniques are showing that they can both improve and somewhat exceed the abilities of a human doctor. Recently, scientists at Stanford displayed an AI that proved better at detecting Pneumonia than certified and well-trained radiologists! This was owing due to its superhuman attention to detail, and it being able to spot minute changes in the slide that humans simply cannot notice.

But do not fear, dear reader, for robots have not put doctors out of business yet. More importantly, these tools can be used by doctors to enhance their diagnosis, and reduce the amount of tedious busywork that has long been the norm in healthcare:

A large amount of a doctor’s time is spent in monitoring their patients, and AI has begun its rise in the field of Telemedicine, capable of doing that task and freeing up doctors and nurses to attend to other patients as well as do their real duty of treating and curing the ill.

Even the recent advances in AI’s ability to diagnose it is still another tool in the belt of a good clinician. With it aiding in diagnoses and combing through medical literature for obscure information, the doctor can take over the duty of prescribing medicine, and be applying his judgment, a factor still not superseded by machines. Much stress and effort can be relieved when it also aids him in spotting an error in the treatment protocol, such as rare interactions or genetic side-effects. With this new knowledge, the doctor can focus on the care of his patients, both increasing the number he can serve as well as the quality of service, whilst cutting costs so that even more people receive the blessings of modern medicine.

Machine learning and reinforcement learning will allow epidemiologists to churn through massive amounts of data, and by doing so find correlations and trends that let us identify and stop the next great epidemic before it takes root.

Interestingly, our attempts to make machines that are as smart as we have led us to create machines that think more like us. For example, as a way of implementing machine learning involves the use of Artificial Neural Networks, these systems are deliberately designed to mimic the way our own neurons work. They use the aforementioned network to learn from data and produce outputs in much the same way that our own brains work, albeit differing from real neurons in very significant ways.

At this moment, robotic surgery is a rather misleading term, with the name conjuring up the image of a robot cutting and slicing a patient with doctors standing bemused in the background. It is not so, for the surgical robots in current use, such as the Da Vinci are merely a more sophisticated instrument for a surgeon, allowing him or her to perform steady cuts with the precision needed for microsurgery. They more exotically allow doctors a great distance away to perform surgeries as if they were right in the operating theatre, another example of telemedicine.

Even so, advances in truly autonomous surgeries are actively ongoing. Recently, scientists displayed an AI that observed incisions made by many skilled surgeons and then used that knowledge to perform its own on a model specimen, namely the tissue of a pig. It displayed even greater consistency and accuracy than the doctors it learned from, leading to hopes that in the near future, simple procedures might be left to AI, with doctors stepping in to finish the more complicated aspects, or simply use existing means of telemedicine to finish the job from afar. Once again, surgeons are liberated, and are now free to use their hard-earned skill to perform challenging tasks, and attend to their patients. So we can see how the cost of surgeries can be significantly reduced, allowing even the neediest of patients a better opportunity for treatment, while expanding the umbrella of health services all around the world.

With this information in mind, let us imagine the near future, perhaps only as little as 10 years ahead:

The setting is immediately familiar to any medical professional today, a clean, sterile operating theatre which is suddenly the site of immense activity as a patient is wheeled in. This man, a poor farmer, was once incapable of affording anything near the costs of what his accident had inflicted on him, and perhaps would have died from the accident that cost him his leg, and now leaves him in critical condition. Belonging to an isolated rural community, even if he had been brought to the district health center, it is likely that they would neither have had the resources or expertise to take care of him. But today, long before he was brought to the hospital, preparations have been made and the staff is ready to heal him. A specialist, who would once have been much too far away in a major city just to be able to cater to enough patients to earn their bread, has been reviewing the case in the comfort of their own home, as nurses and assistants run IVs and prepare anesthesia. He or she needs not rush and is able to review the case, because AI of the medical robot is already preparing the patient, cutting away necrosed tissue, whilst other software admits just the right dose of necessary medication without careful monitoring by human nurses being needed. The nurses can then rush to the IPD or Emergency to attend to other patients, knowing that their ward is being monitored and they will be immediately summoned if vital parameters are judged to be abnormal, or even if there is an expected risk of complications arising. The doctor dons a virtual reality headset and is immediately in control of the robot. They now are in possession of data that modern surgeons can only dream of, for in front of their eyes they can see hidden anatomical features, such as hidden arteries or veins, even though dirt, blood and obscuring tissue, with the AI intelligently predicting and tracking relevant details through its advanced sensors. They can take control at any point, with the software compensating for tremors or micromovements that produce small errors in the motions of the doctor’s hand, allowing for pinpoint precision, or order the robot to perform procedures carefully and correctly. Ideally, this intervention would have saved the patient’s leg, but due to the delay in his arrival, we must settle for saving his life.

Once he is in the surgical ward, he is still safely under watch, medicine personalized in both dose and type is being provided, novel antibiotics produced as a response to the modern risk of antibiotic-resistant infections are at work. In fact, in all likelihood those drugs were invented by a pharmaceutical AI, that synthesized them after doing trillions of calculations and simulations to find a way to overcome bacterial adaptations, often in advance of them occurring. They were also deployed so quickly clinically because such AI can help skip the need for protracted drug testing and clinical trials, as well as help in follow-ups with the possibility of catching subtle effects in the future.

The benefits of AI will not cease even when the man is discharged, in our day, he might have had to settle for a crutch and the resulting disability for the rest of his life. However, the same advances in modern science that ensured that even a relatively backwater hospital could afford a surgical robot as well as the access to a specialist doctor now allow him to afford a prosthetic leg. It shares but the name to the clunky, and inferior models we use today. This one can be integrated into the patient’s body to a far greater degree, a relatively cheap device reads the electrical outputs of the neurons that once lead to his leg muscles, and AI uses that knowledge to ensure that moving it feels as natural and intuitive as his real leg did. He soon walks out of the hospital a healthy man, and thanks to both the surgeon and advances in medicine for securing his safety and good health.

This tale might sound fantastic, but I assure you, dear reader, that it is not. The techniques and technologies involved are very real and are already being deployed today. As with all technology, time will only make them cheaper, and accessible to all.

So now we come to the real issue, how do we, as doctors and aspiring doctors, prepare for this future? I will state a few points that are relevant:

  • Healthcare will become much cheaper, this will allow a much larger number of patients to be inducted into the systems already in place. Even though we might fear these AI taking our jobs, it must be admitted they are also increasing our total number of patients, and thus the need for doctors again!
  • Right now, individual clinical skill and bedside manner share equal importance for a doctor’s success. This might sound surprising, so I will refer you to the studies that discovered that how often a doctor gets sued for medical malpractice does not even depend on their skill and patient outcomes, but actually on their rapport with the patient! Even a below-average practitioner ultimately provides the most patient satisfaction by taking the time to get to know their patient, and by assuaging their concerns. Patient satisfaction is a concern that is sadly ignored much too often, to the detriment of many a doctor.
  • AI assistance will greatly decrease the skill gap between the best doctor in a given field, and the baseline. Right now, a doctor’s knowledge and experience can help him significantly exceed the performance of his peers. However, with AI catching the hundreds of tiny issues and esoteric bits of knowledge that an experienced clinician currently knows, that gap will be significantly reduced if not eliminated.
  • Thus, a young doctor today would be wise to pay more attention to their soft skills! It soon will become the most visible aspect of their practice, at least to the patient and the public.
  • Today, the driving pressure on doctors is to specialize in ever more niche fields, but AI will largely remove the need for such hyper-specialization. There is likely to be a massive rise in the demand for General Practitioners, but the rate of this change is sufficiently unclear that students should not just abandon their current MD courses!

Thus, we come to an end of this overview. I hope that I have convinced you that the future holds just as great an opportunity as it does risks and that these guidelines will prepare you for it. This has long since ceased to have been a matter of if but rather when. The mark of a great doctor is their ability to deal with rapid change and information overload, and our training will definitely be needed to weather the road ahead!

Salary of a Doctor in India

Salary of a Doctor in India

As a medical student I strongly believe that being a doctor is one of the nobel proffesion in India. Let’s talk about the salary of a doctor in India after MBBS. It varies from state to state and also the place of work. Here we catagorize the earning of a doctor by his speciality in work and experiences he gather.

Goverment vs Private sector– In general Govt hospital pay less money than a private sector. A MBBS doctor earn 30000/- to 50000/- from a Govt hospital and 40000/- to 70000/- from a Private hospital. Whereas a specialised doctor like MD or MS can earn about 50000/- to 120000/- from a Govt hospital and 70000/- to 300000/- from a private hospital. It seems that there is a huge difference there. Right? Yes, it is. As I have already said that earning by a doctor depends on their speciality, degrees and experiences. It may varies from 30000/- to 2-3 lakhs per day.

Note that– An ex-professor of AIIMS had been offered around 12 crore per annum from a big corporate hospital. That’s almost 3 lakh per day !

But after all an Average salay a doctor can make is described below

Post MBBS- Rs. 10,000 to 40,000/month
Post MD/MS – Rs. 30,000 to 2,50,000/ month
Post DM/Mch/Fellowship – Rs. 50,000 to 5,00,000/month.

A report has seen released by Medscape 2016-2017 on Annual earning of a doctor according to his/her speciality.


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