Throat Inflation can initiate to Rheumatic Heart Disease

Throat Inflation can initiate to Rheumatic Heart Disease


In day-to-day life, one of the most commonly occurring contagions is a sore throat medically acknowledged as Pharyngitis or Streptococcal infection (strep throat). The cause is almost always by a bacterium called Group-A Beta-Hemolytic Streptococcus. The familiar symptoms are Discomfort or a prickly sensation in the throat, Dysphagia, scrambled voice. Generally, to overcome it many clinicians advise taking bed rest with a soft diet and plenty of fluids intake, in case severe unruly condition the prescribed medicine is antibiotics, analgesic, corticosteroids, and etc. The interesting doubt ascends i.e. why & how strep throat is it related to heart diseases? In general, the heart diseases are classified into various types such as atherosclerotic diseases, heart arrhythmias, cardiomyopathy, and congenital heart defects etc. Rheumatic Heart Disease is precisely triggered due to Rheumatic Fever.

Roughly 97-98 percent of the population can overcome to sore throat infection but for remaining, it can lead to Rheumatic Fever at post-sore-throat infection. This article mainly deals with a sore throat leading to Rheumatic fever. Which further may lead to chronic rheumatic heart disease, and comprises of numerous symptoms of this disease.

Initiation of Rheumatic Fever

Rheumatic fever is a non-contagious acute fever, marked as inflammation & pain in the joints. The word rheumatic generally termed as rheumatism which means inflammation and pain in the joints, muscles, or fibrous tissue stained by disease. And fever is an abnormal rise in body temperature.

All in all rheumatic fever caused to a very small percentage of the population, the prone individuals are children (5-15 years) and is rare after age 35 years. Rheumatic fever is an autoimmune inflammatory process that progresses as a corollary of streptococcal infection. The most significant complication of rheumatic fever is Rheumatic Heart Disease, which usually occurs after frequent bouts of severe illness.

Rheumatic Heart Disease

Initially, the human is attacked with Streptococcal Pharyngitis leading to Rheumatic Fever, typically occurs several weeks after Pharyngitis. Streptococcus cell membrane consists of a protein called M-Protein and the bacteria is highly antigenic to human. The immune system identifies the antigens through macrophages and counter attacks by producing antibodies against the M-protein cell membrane of Pharyngitis bacteria. But these antibodies also attack body own cells consist of M-protein which is similar to foreign body protein (this similarity is known as molecular mimicry) and finally leads to damage of body organs, which is known as the type-2 hypersensitivity reaction. The similar M-protein body cells or organs are myocardium of the heart, joints, subcutaneous layer (skin), Basal ganglia of the brain.

In rheumatic fever, there is a variety of clinical findings Jones’ criteria further classified as major and minor as follows


  • Fever: the Abnormal rise in body temperature.
  • Arthralgia: Pain in regular joints.
  • In blood, there is an increase in ESR/CRP.
  • The ECG shows a prolonged PR interval in heart-block.
  • Previous repetitive episodes of Rheumatic fever.


  • Migratory Polyarthritis: Multiple large joints Inflammation one after another in a symmetric way.
  • Subcutaneous nodules: These are firm lumps under the lining of the skin made of collagen which is painless and extensor.
  • Erythema marginatum: These are the reddish rash ring formed on trunk and arms.
  • Sydenham’s chorea: It is categorized by rapid or awkward jerking moment primary affecting face, hands, and feet caused by the destruction of basal ganglia of the brain.

The Carditis/Pancarditis caused by Rheumatic Fever

In the main, the heart is affected by auto-immune response during Rheumatic fever known as Rheumatic Heart Disease. This occurs when attacks of Rheumatic fever cause scarring and damage to the heart. Normally heart consists of three layers namely: pericardium, myocardium, and endocardium, these consist of M-protein in their tissue cells. But the antibodies released from immune system cause inflammation to the layers of heart leads to Carditis/Pancarditis. The inflammation is fibers type due to an accumulation of fibrin.


Inflammation of outer covering of heart is called Pericarditis, leading to sharp localized chest pain and reliefs on flexion of the spine (forward bending). On auscultation doctors can notice friction rub/pericardial rub in additional it weak heart sound is observed. When fever subsites there is no long-term pericarditis issue is seen in future.


Another effect of Rheumatic Heart Disease is Myocarditis, caused due to inflammation in Myocardium of heart. In Myocardium there is a formation of Aschoff body, it is very small pin head inflammatory lesions and these are the immune-mediated granuloma. It also contains large ribbon-like nucleated macrophages called Anitschkow cells. Myocarditis is the most dangerous and recorded most common cause mortality in children if it is untreated. The Myocardium becomes loose and flabby, unable to contract which may lead to other complications like congestive heart failure. This complication is not a long-term issue.


The serious and long-term complication is Endocarditis, inflammation of endocardium of heart and attacks specifically on valves of the heart. During fever, tachycardia occurs that leads to rapid closing and the opening of valves. Due to inflammation, there is a rupture or erosion of leaflets at valves. However, ruptures lead to deposition of platelets and fibrin which results in the formation of multiple small vegetation (sterile) on the valves. During post-fever healing occurs but this vegetation leads to fibrosis due to this the valves become fibrotic and distorted.

Above three conditions Pericarditis, Myocarditis, and Endocarditis usually leading light to Acute Rheumatic Heart Disease during Rheumatic fever in children. Whereas Endocarditis leads to severe complications like mitral stenosis, mitral regurgitation, and aortic stenosis and regurgitation in adults because of untreated recurrent episodes of Rheumatic fever which finally result in Chronic Rheumatic Heart Diseases.

General treatment

  • Take bed rest, Intravenous fluids and a healthy diet.
  • Conventional medications such as antibiotics (without carditis up to age 18/21 years, with carditis up to age 25/45 years), anti-inflammatory drugs.
  • In-take of Cardiac drugs on doctor’s prescription.
  • In severe, case surgical treatment of heart is required.


Rheumatic Fever




What is life if full of care!!
We have no time to stand and stare!!

These are my favorite lines. I feel those lines invariably especially after choosing
to be in the medical profession.
I had been totally unwary all throughout my medical journey which ended up being
an Anatomist. Repeating for getting into the medical profession and then for post-graduation
!! And then still the life is yet to settle!! But, I am always keeping the
hope to get a good opportunity. This reminds lines from the stalwart M. S.
Dhoni, “Kharagpur ki Government naukri mei phas gaya toh aghe kuch nahi ho
payega. Sirf 9 to 5 ki duty karte rehna padega.” (Meaning that,”If I join the
Government as a permanent employee as a ticket collector in the railways at
Kharagpur, then I will have to remain satisfied doing the 9 am to 5 pm duty. I will
be unable to satisfy my inner voice, be unable to fulfill the dream I cherish as a
And now we are not even able to get that. No satisfactory job nor salary!! Post PG
long wait; no result! MPSC was hope, but it was as if wanting to taste poisonous
honey!! It being preclinical subject is given last priority. Later on only to realize
that all preclinical vacancies are being directed to clinical subjects. I really fail to
understand why preclinical subjects are being looked down so much. To add on to
the existing struggle, MCI has reduced the requirement of staff members to be
recruited. Most of the time, pan India vacancies are available, but not where one
stays!! Ab kya pura India ghume? No family life.
But being a teacher, I encourage students. So how do I lose hope? Where there is
a will, there has to be a way. So, just need to keep patience and wait for the right
time to come.
And then by the grace of God a ray of hope is seen.
Job in a private college!! Everyone knows how it is!! Actually, it’s an open secret. But
sometimes to achieve something in life, some risks and compromises have to be
made. One needs to come out of the comfort zone as my husband puts it. It was slightly skirmished
for me. Not used to the local train travels, those fight to get
seats and phone calls to railway helpline numbers and many more. But, then I made
great lifetime friends in due course of time as well. Also, I got to learn a lot from
them. How everyone is struggling and yet so happy!!
I learned a lot as an Anatomist. I have my own innovative and unique style of
teaching. But at the same time, I am eager to learn from students as well. Although
it’s really funny to listen to their answers (entertainment time), it teaches lots
of lessons as well. For example, most of the time students are confused between
the lungs and liver. So, one can stress on this mistake. Thus, in future students can
avoid these errors. Also, if students are aware of the system wise different trays
kept in the examination, they can avoid mixture of two topics. In addition, one must be
aware that for dental students, knowledge on HNF is to be imbibed more.
Exercise science, Occupational therapy and Physiotherapy students, limb study is
to be focused. For MBBS students, mnemonics and stories help a lot to catch
their attention.
Ultimately, one has to choose a profession of our liking or like the one in which he
or she is into. I would like to reiterate on the winning statements of our beloved
MISS INDIA WORLD MANUSHI CHILLER, “Profession is not just about being
paid. It’s the respect and love one gets by doing whatever one has focused on.
Mothers’ life is full of sacrifice and doesn’t expect anything in return. And so that
is the highest paid profession.” And yes, of course, I could better understand
these words as I am because of the sacrifices and struggles of my mother and my
elder brother. Had they not been selfless, can’t even imagine my fate.
In the meantime, one has to be vigilant and look out for the opportunity. It does come
and in a special way unfolds the divine plan of God. Of course our efforts and hard
work matters!! And that opportunity did come thanks to the Modi government. Pan
India Central government is opening new medical colleges.
So, I am feeling positive and hopeful for the future. As Bob Hope rightly says, “I’ve
always been in the right place and time. Of course, I steered myself there.”




The hustle bustle, the chaos of the daily life, splattered blood on the floor and big blobs of Potassium Permanganate scattered all around –Yes this is the Emergency Room or fondly called the ER. The daily commotion of the ER and its speed of treating patients is what makes it the most critical yet exciting area of the hospital. It must sound preposterous to some, to call a Department or award with critically ill patients as ‘exciting’, but a Doctor’s point of view says much different. The thrill of cut and the joy of recovery – both are felt by the doctor at the same time, Blissful as I may call it. In the ER, you must work then and there –provide the patient with the first and foremost help required and as said by the book of Love and Bailey – ‘The Golden Period decides the quintessential treatment required by the patient  ’.  But is it really all that rosy and sparkly as it seems?  Every cloud might have a silver lining- but every cloud has a time when it bursts too. Same could be said with a doctor – A little delay of the seconds, a little inappropriately the body reacts and whoop- the case becomes critical than ever. How the doctor deals with the patient at that time, how he puts his extreme hard work of medical studies into actual treatment and how he manages to save the patients life is the real ball game. Unconscious, yet aware subconsciously how much pain the patient is going through – the doctors know it all. They might not be emotionally involved with everyone but yet the patient’s pain is their pain and the patient’s anguish is their anguish. And theoretically, everything is laid down on the books – which Medicine is first, which injection is second, when to push your chest for CPR and when to call time of death. And amongst all these battles with life – only one thing remains out of control of the patient –a deterration from the normal and even the abnormal. What if a patient reacts a way not mentioned in any Medicine books? What if the patient shows a symptom or sign never seen before –then what? Do we blatantly blame the doctor or feed our superstitious belief that God has planned so. Patients maybe mum at the time of crisis but the ones who love him/her are the real sufferers here. They want to do so much- and yet are helpless there. And there at that moment all their hopes, dreams, wishes lie on the doctor- and he is wilfully made the God. But also with that, lies the blame, the resentment, and the accusations – and if nature takes a call where the Doctor is unable to do anything even though he tried everything to his best of abilities –he is made a demon.
The ER has a million stories every day, millions of hopes and hues and cries of hurting people. It shows how the doctor rushes to the patients help, it shows what medicines are given during emergencies, it should how a person who has ingested poison can be saved – what it doesn’t show is the Pressure of the doctor,what it doesn’t show is the extreme burden of putting his treatment to use in a way that it shows results,the burden of handling a living human life in hand and most of all,the burden of letting down the patient and  above all –himself.
A doctor isn’t merely a white coat human with a stethoscope. A doctors experience is way more than words can explain. He wakes up early in the morning or possibly after only 2 hours of sleep after a night shift, then gets ready and on his toes for the next 10-12 hours. Crying, mourning and pain is what he sees every day. He doesn’t have a sunlight showing him joyous things all day long.  He doesn’t have flowers and butterflies and wall pictures. What he has is a solution- to heal people’s wounds. To make the best of his potential and treat that ulcer, and cure that chest pain. He works and works till the removes the word PAIN from patients’ dictionaries. He doesn’t mean harm – he only means well and truth. And the truth lies in the very basic fact that – LIFE AND DEATH ARE CONTROLLED BY SOME EXTERNAL FORCE THAT CANT BE ELUCIDATED and a doctor can trade his own life for the life of his patient but that’s all he can do. He can work and work and work harder to heal the pain, the sufferings the torture and turmoil born by the patient and his family – what he can’t do is compete against the undeciphered External Force of Nature and have a victory over it.
Lastly would like to quote – “The highest form of knowledge is empathy, for it requires us to suspend our egos and live in another world. It requires profound purpose, larger than the self-kind of understanding.”
-Bill Bullard.


A doctor is the one who referred as a god, he should be empathetic towards his patients rather than sympathetic. A patient is going to doctor with a lot of hopes and faith; even if the patient is suffering from tormenting pain with an incurable disease, a single heart filled kind word of doctor could give great relief to the patient rather than any palliative care. A doctor has a tremendous and valuable role in a patient’s life, in some cases patient will only trust the doctor than anyone else, the doctor is having the key to the happiness of patient. When a patient enters a doctor’s room, the doctor should receive him/her with a gentle and calm smile. Then try to gain the patient’s trust through friendly chat( by asking name, address, occupation, Hobbies etc) provide a comfortable zone for the patient, make such an environment that the patient will trust the doctor and the former feel open enough to share his /her (physical as well as psychological) issues to the doctor. Then only the doctor will get a proper and crisp history from the patient. After history taking doctor should arrive at a suitable diagnosis; Prescribe proper medicines, exercises, diets etc to the patient. If the patient should undergo a surgery, explain to him/her about the procedures (from anesthesia to suturing), complications, consequences etc. Provide the best post-operative care to the patient until the scar of sutures get mild and reduced. Inform the patient to visit the doctor, if any complications have occurred during this period. Moreover, a doctor should behave as a parent to his patient by providing love, empathy, care, and hopes. Corrupted doctors are increasing in number nowadays throughout the world. Before providing enough care to the patient, the doctor should be loyal to himself, then towards his patients and the world around him. He should follow The Hippocratic Oath until his last breath. Being a good doctor means being a good disciple of God, those doctors will be always close to the beat and breath of god and will be an idol in both earth and heaven.




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.

Story of Multiple Epiphyseal Dysplasia

Story of Multiple Epiphyseal Dysplasia


A very rare disease which you will misdiagnose most of the times.

Let’s me introduce you to this skeletal system disorder called Multiple Epiphyseal Dysplasia.

I have a Friend of mine who has a deformity in both of her legs and being a medic I had a very simple diagnosis in my mind which of course I never discussed with her. But suddenly a few days back she was very depressed and she wanted my help so she said to me. Hey, can you suggest me some simple ways to prevent it from getting more deteriorated?

That was the moment I was stunned and I started to go into the depth of my ignorance.

In a curious manner, I asked her what is the thing that you feel is getting worse. She replied to me that now she cannot sit on a motorbike because the distance between her legs was getting lesser with time and she has a waddling gait. She also said that she cannot even squat and many of the body postures which we do so subconsciously aren’t possible for her and is the reason for her depression. She added that her younger sister had even worse symptoms which also included pain along with postural defects and bowed legs.

Later I discovered that it was a disease which ran in her family and they inherited it from their mother who also had the same disease. So it was her mother and my friend with her younger sister and a younger brother who had the same condition known as Multiple Epiphyseal Dysplasia.

It is a rare disease so not many physicians know about it. People suffering from this disease have very fewer chances of getting a proper treatment in time as it is apparent only after 10-12 years that this becomes physically appreciable in the manner of bowing of legs towards outside and associated knock knees most of the times.

The diagnosis of this condition is very difficult as it requires sophisticated multidisciplinary setups with a facility of Genetic and Molecular Testing.

There are not many treatment options available as many it is claimed that the disease cannot be cured completely but only a few modifications can be made surgically to avoid the daily life problems related to sitting and posturing. Surgeries might include arthroplasty and joint replacement to correct the deformity.

The best approach is to reduce the effects of deformity by regular physiotherapy, weight control, and Psychological Counseling.



A 19-year-old male patient by name Mr. ECG presented to Dr. SMC (that’s my college) with chief complaints of an ambition to become a doctor since childhood. He was apparently asymptomatic before the thought, and the presenting complaint was sudden in onset after seeing, gradual in progression, with an ever-increasing severity since the past 2 years and was stimulating in character, aggravated by seeing the successful doctors, and relieved after enjoying with the non-medical friends.

His past history – No similar complaints in the past. He is not a known ‘ratta’ master. There were no similar complaints from the other members of the family. On general examination, he was conscious, coherent, cooperative, well oriented to time, space and person, but is little disturbed. Higher functions – normal. Attitude – ambitious. No abnormality was detected on clinical examination. He was admitted, for observation to relieve his complaint, and was subjected to a battery of investigations spanning over a 5 and a half years, involving all the senior members of the college.

At first, he was reluctant to get treated (ragging) but gradually was cooperative. He was put under tremendous pressure in the latter part of the first year. Complained of palpitations and nausea the day before the exam. Was not prescribed anything. He ultimately cleared the first year exam. This phenomenon continued until the third year, and a good response was noted as his chief complaint started to show some sort of improvement. All of his engineering friends were well settled. He was aging. He was feeling insecure. Somehow, by God’s grace, he was able to clear the final MBBS exam. BUT, that journey– was filled with a lot of pressure, tension, insecurity, etc. He became tired of the investigations and even questioned his mind during the announcement of results. He did not have any previous experience of doing this. Ultimately he did it.

Today he doubts, he doubts of his intellectual curiosity, whether he really needed this. He is even more confused than before about his ambition. He wants to achieve and prove it to the world that he is something in the world. He realizes that the journey which he faced is just a preview of the future. Digging his own road, he found himself landed nowhere. Now he wants to go back to that every time, and then change everything, but then he is confused again as what to change. The treatment and investigations the college gave were too much for him. And suddenly he realizes one thing. … it is this journey which makes him unique. it is this very journey that makes a man out of you, that gives you all the stress needed in the world, and top of all the individuality which is also a by-product of this arduous journey. He did a bit of soul searching and realized that this is the way life here is and hence his complaint grew in terms of severity. He realized that every person who joins medicine and is ambitious in finishing the journey is a successful person. Every doctor represents a success story. There is nothing like an unsuccessful or a successful practitioner. A physician is always a physician. This chap now realizes that he was just ground mentally and physically, and finally, he became a doctor, without realizing.


but it is after your MBBS life starts part of which is an awful lacuna which gets filled up with joy when you get through your entrances and embark towards your final destination.

Post-graduation begins with a new story…….

What People in India think about Doctors !!

What People in India think about Doctors !!

Well you may be wondering that this article may highlight the glorious history of Indian medicine and how people in India should appreciate  that. But well lets just say thats not the scenario presently. Lets just say it is one of the most respected career options available in India. People are trying hard to crack the entrance exams to be in this. But the weird thing is that very parent who is actually criticising the doctors admits his/her child in the best coaching institute so that entering into that very profession becomes easy. So you can say a lot of bad things but at the end of the day you unknowingly admit that they are still the saviours of the society. That means people do not actually think that way but they are made to believe certain things by some group of people. now lets think about the so called “Group of People” who are spreading a poison in our profession.

Is it the biased media who considers themselves greater than any doctor and apparently end up channeling an artery?

or is it the fake doctors who are practicing in reputed institutions 

Or is it the local goons who just waits for a moment to take out their frustration on Doctors maybe because he was unable to save an 80 yr old chronic alcoholic with liver cirrhosis . ?

Or is it our very own system who actually makes a doctor work for 10-20 hours continuously ?


All these poisons have actually misguided people about us. We still do work as hard as possible. We sacrifice our own lives for the betterment of society. So lets hope for a day when people will again start admitting that they do respect us and more importantly they need us when their mind will be free from all the influences . Then will be a time when you actually wont be hearing people mumbling behind our backs…you wont actually feel the need for greater security during a night duty… will finally be happy after seeing “That Smile” in the innocent face of a child who will actually admire you after you had treated him .

Lets hope for a better future…

Average salary of a doctor in India – Recent Study

Average salary of a doctor in India – Recent Study

Some killer facts about salary of a Indian Doctors, how much the doctors earn in India. Doctors are the most respected persons in a society. These noble persons are regarded as “The living God”.  They are some most paid professionals with high salary compared to other professionals. Salary of doctor in India or monthly income varies from Rs.30,000 to Rs.50 lakhs per month. There are doctors with highest tax payers to poor doctors supported by parents for a living. So, there are no fixed salary for a medical professional in India.  These are some general queries about salary of doctor in India often asked by general people to growing baby doctors. Here everything will be discussed about salary of doctors in India. Definitely as a developing country with low GDP, PPP Indian Doctors get low salary compared to USA medical professionals. Salary of doctor in India varies depending upon several factors like Country, Place of work, Type of Specialization, Type of sector – government or private , Skills of the doctor , Experience, Strategies with Personal setup and others.

Some facts about salary of doctor in india –

  1. There are only one doctor present for serving One thousand five hundred people.
  2. 48,180 hours are needed to be a doctor to earn 48K per month.
  3. A Intern can work continuously for 68hours.
  4. A MBBS doctor works 18hrs a day.
  5. The highest paid interns earn 50 paisa per second that is 30 Rupees a hour.
  6. If a doctor start a nursing home he can buy a new BMW every month.
  7. Government spent 24 lakhs to produce one MBBS doctor.
  8. Sometime, A medical seat in private medical college costs 5 cr.

Here I will mainly discuss about the salary of doctor in India with several dependencies.

Time table for a doctor to earn 60K+ in a month – A doctor who has spent 5.5 years for a MBBS degree. If he is too lucky, hardworking and brilliant and passes the Postgraduate entrance in one attempt then he has to give 3 years for MD and let us assume 5 years for experience. So, he has to give 13.5 years of life to earn 60,000 rupees per month – salary of doctor in India who has passed MD.

MBBS Course – 4.5 years.

Internship – 1 year.

MD – 3 years.

Experience – 5 years.

Total – 13.5 years

Number of doctors present in India – Number of doctors present in India are very low compared to other countries like it’s neighbor China. There are 1.9 doctors present for 1000 Chinese but for India it is 0.7 doctors for one thousand people of India. It means there are 7 doctors for 10000 Indians. So, statistics said that 1450 Indians are dependent on one doctor. It is clear picture of India’s poor health service. If you consider United Kingdom and United States the ratio of Doctor and Patient is quite high compared to India. Spain has an absolutely high Doctor to Patient Ratio. DP ratio of Spain is 4.9. Spain has one doctor serving 200 citizens of the country.

Doctor and Patient Ratio in different parts of the world:

Country: India

Doctor : Patient Ratio = 0.7

Patient dependent on One Doctor = 1450

Country: China

Doctor : Patient Ratio = 1.88

Patient dependent on One Doctor = 550

Country: United State

Doctor : Patient Ratio = 2.52

Patient dependent on One Doctor = 400

Country: United Kingdom

Doctor: Patient Ratio = 2.92

Patient dependent on One Doctor = 350

Country: Spain

Doctor: Patient Ratio = 4.87

Patient dependent on One Doctor = 200


Salary of intern doctors in different states of India

Assam – ₹14,000 per month

Andhra Pradesh – ₹10,000 per month

Bihar – ₹14,000 per month

Bengal – ₹18,000 per month

Chhattisgarh – ₹10,000 per month

Delhi – ₹15,000 per month

Gujrat – ₹9,500 per month

Himachal Pradesh – ₹12,000 per month

Jammu – ₹7,000 per month

Karnataka – ₹ 22,000 per month

Maharashtra – ₹8,500 per month

Madhya Pradesh – ₹8,000 per month

Orissa – ₹15,500 per month

Punjab – ₹10,000 per month

Rajasthan – ₹7,000 per month

Tripura – ₹10,500 per month

Uttar Pradesh – ₹9,500 per month


Post MBBS- Rs. 10,000 to 40,000/month (5.5 years of training)

Post MD/MS – Rs. 30,000 to 2,00,000/ month ( 9-12years of training)

Post DM/Mch/Fellowship – Rs. 50,000 to 3,00,000/month. (12-15 years of training)


Radiologists 1.5 -3.5 lakhs.

Gynecologist 1 – 2.5 lakhs

Pediatrician 1 – 2  lakhs

Orthopaedician 1 – 2 lakhs

Orthopaedician  surgeon– 1.5 to 26 lakhs

Anesthesia 1 – 2 lakhs

General Physician 1 – 2  lakhs

General Surgery  1 – 1.75 lakhs

Ophthalmologist – 80k – 1.75 lakhs

Pathologist doctor – 9.0 to 10.0 lakhs

Dermatologist doctor – 9.0 to 10.0 lakhs

Microbiologist doctor – 4.0 to 5.0 lakhs



Cardiology 3.5 – 7 lakhs / month

Neurology 2.5 – 6.5 lakhs / month

Urology 1.7 – 5.5 lakhs / month


Related Posts:

  1. Physiotherapist doctor surgeon fresher salary – 1.5 to 5 lakhs
  2. Staff Nurse fresher salary – 1.0 to 5 lakhs
  3. Pharmacist fresher salary – 1.5 to 7.00 lakh
  4. Dentist doctor fresher salary – 1.5 to 18.00 lakh
  5. Biomedical Engineer fresher salary – 1.0 to 5.00 lakh
  6. Medical Transcriptionist fresher salary – 1.0 to 2.0 lakhs
  7. Medical Coder fresher salary – 1.0 to 2.0 lakhs
  8. Medical Writer fresher salary – 1.0 to 2.0 lakhs
  9. Accounts Receivable Analyst fresher salary – 1.0 to 2.0 lakhs
  10. Medical Biller fresher salary – 1.0 to 1.5 lakhs


Strategies with personal setup:

The following strategies can make a doctor earn money quickly and effieciently.

Private Practice – Private practicing is the way most of the doctors earn a lot.

Commission from pharmacy and labs – Doctors earn by getting commission from different pharmacy and laboratory.

Investment – If you invest some penny in your business you are the winner.

Private setup – Setting up a private nursing home gives you the choice to have a new car every 3 weeks.

Marketing skills – Your marketing skill will help you make a comfortable zone to have good no of customer.

Professional skill – Finally your professional skill is the thing you can really sell to earn a lot of money



Eye Surgeon: 15,000-30,000 Yuan a month.

Heart Surgeon: (Cardiology): 20,000 to 50,000 Yuan a month.

Regular Doctor: At least 5,000 Yuan a month.

Other Doctor Professions: 5,000 to 10,000 Yuan a month


Story of poor doctors:

The story of Hemang Sanghvi, a gold medallist plastic surgeon of Bangalore Medical College is demoralizing for the society of baby doctors and aspirants. The doctor has to work for 18 hours a day to get a salary of 30,000 per month. He is unable to afford a home and the institution has not provided a house for him. He has to live in the Men boy’s hostel of the Medical College. This is same story of 300 other doctors.


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