signs of a good doctor

1) Jo patient ko na loote

2) Jo hamesha patient ke bhalai ke bareme soche

3) Jo khudke benefit bareme km soche

4) 

PRESCRIPTION (P-DRUG)

 

Hypertension Treatment

• Country Differences:

  • In the USA: ACE inhibitors (e.g., Lisinopril) are often the first choice for hypertension due to high prevalence of comorbid conditions like diabetes.
  • In India: Calcium channel blockers (e.g., Amlodipine) are commonly preferred due to cost-effectiveness and better efficacy in salt-sensitive hypertension.

• Doctor Differences:

• A cardiologist may prefer beta-blockers (e.g., Metoprolol) for a patient with coexisting heart disease.
• A general practitioner might choose a diuretic (e.g., Hydrochlorothiazide) due to affordability and simplicity.

In contrast, countries relying on the WHO Model List of Essential Medicines may prefer Hydrochlorothiazide due to its inclusion as a cost-effective option.

Impact of Treatment Guidelines

Treatment guidelines provide evidence-based recommendations that directly influence P-drug selection.

• Example 3: Hypertension

• USA (ACC/AHA Guidelines): Recommends ACE inhibitors (Lisinopril) or ARBs (Losartan) as first-line P-drugs for hypertension, especially in patients with diabetes or chronic kidney disease.
• UK (NICE Guidelines): Suggests calcium channel blockers (Amlodipine) as the first choice for hypertension in older adults or Black patients.
• India: Diuretics (Hydrochlorothiazide) are often selected due to affordability and inclusion in national guidelines.

Understanding Clinical Guidelines

• Example 1: Hypertension Treatment

• Doctor A: Interprets the American Heart Association (AHA) guidelines and emphasizes ACE inhibitors (Lisinopril) for hypertension in diabetic patients due to their protective renal effects.
• Doctor B: Focuses on the same guidelines but prefers ARBs (Losartan) because they are equally effective and have a lower risk of cough as a side effect.

"All diseases need not to be treated with a drug."

• Example 1: Hypertension

  • Non-drug approach: Lifestyle modifications such as regular exercise, low-sodium diet, weight loss, and stress reduction can be effective in controlling mild hypertension.
  • Rationale: Drugs may not be immediately necessary, especially in borderline cases.

PDL MR COMMUNICATION

 

https://iris.who.int/bitstream/handle/10665/69177/WHO_EDM_PAR_2004.3_eng.pdf?sequence=1

Ethical criteria for medicinal drug promotion

https://iris.who.int/bitstream/handle/10665/38125/924154239X_eng.pdf?sequence=1&isAllowed=y

INDIAN MEDICAL COUNCIL (Professional Conduct, Etiquette and Ethics) Regulations, 2002

(AMENDED UPTO 8th OCTOBER 2016) 

https://www.nmc.org.in/wp-content/uploads/2017/10/Ethics-Regulations-2002.pdf

The Gazette of India

https://www.nmc.org.in/documents/e_Gazette_Amendments/Ethics%20-%2010.12.2009.pdf

Code of Medical Ethics Regulations, 2002

https://www.nmc.org.in/rules-regulations/code-of-medical-ethics-regulations-2002/

LOK SABHA UNSTARRED QUESTION NO.4422 TO BE ANSWERED ON 19TH JULY, 2019 UNETHICAL PRACTICES 4422. SHRI SYED IMTIAZ JALEEL: 

https://sansad.in/getFile/loksabhaquestions/annex/171/AU4422.pdf?source=pqals

Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 (Published in Part III, Section 4 of the Gazette of India, dated 6th April, 2002) MEDICAL COUNCIL OF INDIA NOTIFICATION New Delhi, dated 11th March, 2002

https://wbconsumers.gov.in/writereaddata/ACT%20&%20RULES/Relevant%20Act%20&%20Rules/Code%20of%20Medical%20Ethics%20Regulations.pdf

Shastri Bhawan, New Delhi March, 2024 Subject: Uniform Code for Pharmaceutical Marketing Practices (UCPMP) 2024 — reg. Sir / Madam,

*UCPMP 2024 for website_0.pdf 

नाहं कालस्य, अहमेव कालम|

 नाहं कालस्य, अहमेव कालम|

MAI AHAM NAHI HU

MAI AATMA HU

https://acharyaprashant.org/en/articles/naaham-kaalasya-ahamev-kaalam-1_593683c

Bhagavad Gita (Chapter – 4, Verse – 7)

Whenever there is rise in evil, whenever ignorance and arrogance rise, obviously the result is suffering. The Lord does not drop physically somewhere from the heavens. The metaphor must be understood. It does not mean when there will be people of certain kinds who would be behaving in evil ways then some avatar will descend from the skies. What it simply means is that whenever the ego inflates, the consequence is suffering and suffering itself calls for its cessation. You do not like to suffer. This call of cessation of suffering itself is the coming of the Lord.

The ego is caught in a quandary. It likes to be inflated but it does not like to suffer. But the natural consequence of its own inflation is suffering. It likes to be big, it likes to act powerful, but the more powerful it acts, the more it suffers and suffering is something it does not like. So the very inflation of the ego, the very rise of ego, the very increase of evil, is also a parallel increase in the urge to dissolve the evil, the suffering, the ego. The Lord doesn’t come from anywhere; the ego sees its own futility, its vanity and surrenders. 

 “Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth.” [Marcus Aurelius]

ETHICAL

 censure

‍ˈसे᠎̮न्‌श(र्‌)

written

verb

to tell somebody, in a strong and formal way, that he/she has done something wrong

अनुचित काम करने के लिए किसी की भर्त्सना करना

घोर निंदा, भर्त्सना

written

‍ˈरिट्‌न्‌

adjective

expressed on paper; not just spoken

लिखित रूप में व्‍यक्त (न कि मौखिक रूप में)

sober

‍ˈसोब(र्‌)

adjective

adjective: sober; comparative adjective: soberer; superlative adjective: soberest

1.

(of a person) not affected by alcohol

not funny; serious

मज़ाक़िया नहीं; गंभीर

(of a colour) not bright or likely to be noticed

(रंग) चमकीला या भड़कीला नहीं; सौम्‍य

solicit

सˈलिसिट्‌

verb

1.

formal

to ask somebody for money, help, support, etc.

धन, सहायता, समर्थन आदि माँगना

ethical

‍ए᠎̮थि़क्‌ल्‌

adjective

1.

connected with beliefs of what is right or wrong

उचित-अनुचित के विचार से संबंधित; नैतिक

That is an ethical problem.

That is an ethical problem.

2.

morally correct

नैतिक दृष्टि से उचित, नैतिकतापूर्ण

adjective. pertaining to or dealing with morals or the principles of morality; pertaining to right and wrong in conduct. being in accordance with the rules or standards for right conduct or practice, especially the standards of a profession: It was not considered ethical for physicians to advertise.

zooooooooooooot

Hum log zoot nahi bol skte yaar 

Lekin hum zoot sun skte hai but there is a skill to catch this zoot.

Hum silent log hai

We are not violent type people.

Kr Bhai bakwas jitni krni hai utni.

Kuchh log hote hai jo jhut nahi bol skte or 

Kuchh log hote hai jo sach bolna nahi chahte .

Hame kya Krna hai ?

MR ka zoot pakdna hai 

Q for the benefit of the patient.

Hum zoot bol nahi skte lekin aap sach bhi to nahi bol rhe ho

Hum sirf Sach bol skte hai.

Tn zoot bolnu nahi h pn 

w log tn yo zoot h yo (yo zoot nahi h) bol bol h.

Hunger is truth (sach m yar ghani bhuk lagi h)

You are hollow and empty is truth 

There is void in you (with whatever you try to fill it, it's not going to become full.) void=gap=emptiness=vacancy

Your senses are hungry for knowledge

RAM NAM SATYA HAI.

BAKI SAB MITHYA HAI.

Jo RAM KA NAHI WI KISI KAM KA NAHI.

YE TERA KAM HAI -- YE TERI DUTY HAI -- YE TERA DHARMA HAI. (RELIGION) RIGHTEOUSNESS 

EYE EXPERIMENT

 CILIARY MUSCLE CONTRACT FOR NEAR VISION

CILIARY MUSCLE RELAX FOR DISTANT VISION

Mechanism:

• Normal Accommodation: The ciliary muscle contracts temporarily to allow the lens to thicken for near focus and then relaxes to flatten the lens for distant focus.
• Spasm of Accommodation: Persistent contraction of the ciliary muscle keeps the lens in a rounded state, reducing the eye's ability to relax for distant vision.

Cycloplegia

Cycloplegia refers to the paralysis of the ciliary muscle, resulting in the loss of accommodation. This prevents the lens from changing shape to focus on near objects, effectively rendering the eye focused only for distance vision.

Medical Representatives

 

Examples of Unethical Behavior

• Offering expensive gifts, free vacations, or monetary incentives.
• Exaggerating drug benefits or omitting critical safety data.
• Using false pretexts (e.g., fake surveys) to gain access to HCPs.
• Criticizing competitors’ products without evidence.

MANDL'S THROAT PAINT

 

medicinal preparation containing iodine.

Mnemonic for Mechanism

"Ions Denature Membranes and DNA"

• Ions: Oxidation by iodine ions.
• Denature: Proteins and enzymes are denatured.
• Membranes: Lipid damage increases permeability.
• DNA: Direct damage halts replication.

Oxidation of Cellular Components

• Iodine acts as a strong oxidizing agent.
• It disrupts the sulfhydryl (-SH) groups in enzymes and proteins of microorganisms, leading to the inactivation of these vital components.
• Sulfhydryl (-SH) groups, present in the amino acid cysteine, play a critical role in the structure and function of enzymes and proteins in microorganisms.

Basic Information

• Symbol: I
• Atomic Number: 53
• Physical State: A shiny, purple-black solid at room temperature that sublimates into a violet gas.

 Forms of Iodine

• Elemental Iodine (I2): Used in antiseptics and laboratory settings.
• Povidone-Iodine: A stabilized form for medical applications.
• Potassium Iodide (KI): Used in supplements, radioprotection, and hyperthyroidism treatment.
• Lugol’s Solution: A mixture of iodine and potassium iodide for therapeutic uses.

Iodine (I₂) vs. Iodide (I⁻)

Iodine and iodide are two forms of the same element, but they differ in their chemical structure, properties, and uses. Here’s a comparison:

• Iodine (I₂):

  • Molecular form of iodine.
  • Exists as a diatomic molecule (I₂).
  • Neutral, non-ionized form.
  • Insoluble in water but soluble in organic solvents like alcohol.

• Iodide (I⁻):

• Ionic form of iodine.
• A negatively charged ion.
• Water-soluble due to its ionic nature.

Biological Role

• Iodine (I₂):

  • Not directly used in the body; must be converted to iodide (I⁻) to participate in physiological processes.

• Iodide (I⁻):

• Absorbed in the gastrointestinal tract.
• Taken up by the thyroid gland for the synthesis of thyroid hormones (T3 and T4).

5. Safety and Toxicity

• Iodine (I₂):

  • Direct exposure can irritate the skin, eyes, and respiratory tract.
  • Overuse in antiseptics may lead to iodism (toxicity).

• Iodide (I⁻):

• Safer for internal use.
• Chronic high doses can disrupt thyroid function (hyperthyroidism or hypothyroidism).

Mnemonic to Remember

"Iodine for Outside, Iodide for Inside":

• Iodine (I₂): Topical and external antiseptic.
• Iodide (I⁻): Internal use for thyroid and deficiency treatment.

Mnemonic for Lugol's Iodine Uses

"Thyroid, Topical, Test"

• Thyroid: Hyperthyroidism, thyroid storm, radioprotection.
• Topical: Antiseptic for wounds and infections.
• Test: Schiller’s test for cervical health.

Mnemonic to Remember

"Lugol for the Thyroid, Mandl for the Mouth"

How Iodine Penetrates Microorganisms Quickly

Iodine's rapid penetration into microorganisms is due to its unique chemical properties and mechanism of action. Here's an explanation:

 Molecular Size and Solubility

• Small Molecule: Iodine (I₂) is a small, non-polar molecule that can easily pass through cell membranes, especially lipid layers.
• Lipid Solubility: It dissolves well in the lipid bilayer of microbial membranes, facilitating quick entry into cells.

Oxidative Properties

• Iodine is a strong oxidizing agent.
• Once inside the microorganism:
  • It reacts with and disrupts sulfhydryl (-SH) groups in proteins.
  • It modifies nucleic acids, damaging DNA and RNA.
• These reactions occur rapidly, leading to microbial inactivation within seconds to minutes.

 Disruption of Cell Membranes

• Iodine interacts with the lipids in microbial membranes, compromising their structural integrity.
• This increases membrane permeability, allowing further penetration and leakage of cellular contents.

Iodide Conversion

• In solutions (e.g., Lugol’s iodine or povidone-iodine), iodine dissociates into free iodine (I₂) and iodide ions (I⁻):
  • Free Iodine (I₂): Penetrates rapidly due to its non-polar nature.
  • Iodide (I⁻): Provides sustained action by continuously releasing iodine.

---

5. Synergistic Effects

• Iodine attacks multiple cellular targets simultaneously (proteins, enzymes, nucleic acids), overwhelming the microorganism and accelerating its destruction.

Mnemonic for Oxidation

"LEO the lion says GER"

• Loss of Electrons is Oxidation.
• Gain of Electrons is Reduction.

 Why Iodine Is an Effective Oxidizing Agent

• Electronegativity: Iodine is sufficiently electronegative to accept electrons but less reactive than chlorine, making it safer for certain applications.
• Stability of Iodide ($I^-$): Once reduced, iodide ions are stable in aqueous solutions.

What Does "Electronegativity" Mean?

Electronegativity is the ability of an atom to attract shared electrons toward itself in a chemical bond. It is a fundamental concept in chemistry that explains how atoms interact in molecules.

Mnemonic for Periodic Trend

"FONCl BrISCH"

• Fluorine > Oxygen > Nitrogen > Clorine > Bromine > Iodine > Sulfur > Carbon > Hydrogen.

This is the order of decreasing electronegativity for commonly encountered elements.

CHARIOT

 उपनिषदों में कहा गया है कि 

एक रथ है, 

जिसे पाँच घोड़े खींच रहे हैं; 

घोड़ों के मुँह में लगाम है, 

जो सारथी के हाथ में है; 

रथ के पीछे एक यात्री बैठा है। 

आदर्श रूप से, यात्री को सारथी को निर्देश देना चाहिए, जो फिर लगाम को नियंत्रित करेगा और घोड़ों को सही दिशा में ले जाएगा। 

हालाँकि, इस मामले में, यात्री सो गया है, और इसलिए घोड़े नियंत्रण में हैं।

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