Over the last several decades, there have been rapid advances in human information, knowledge, skills and wisdom. The advances have encompassed all fields: Science, commerce, communication, aesthetics and philosophy. In pre-modern times, irrespective of the profession one pursued, the focus was on the all-round development of personality, encompassing all the fields simultaneously. Thus many famous medical professionals of the past were also famous philosophers (Charaka, Hippocrates, Descartes, Galen, Avicenna, Carl Jung), poet/writers (Avicenna, Keats, Chekov), business (Kellogg, Pepsi Cola) and communicators (Osler, Benjamin Spock, Kubler-Ross). However, with the advent of specialisation, the emphasis has shifted towards greater information/details about the area of interest but with narrowing of perspective.
Translated into the medical field, this has led to doctors to relatively keeping pace with scientific inventions/skills, advances in business models but slacking in fields of communication, philosophy and aesthetics. Thus we are now encountering a new breed of doctors who are smart, know their subject but lack in the social element, may lack empathy, communication skills, and are unable to gather the broader perspective of patients and their disease but are concerned with superficialities and trivialities. This creates a huge mismatch between the expectations and actual healthcare delivery in the eyes of the lay public, recipe of disaster at a societal level. Medicine is not pure science, like engineering, physics or chemistry but social science, which is practised in a social context where issues of empathy, ethics are foremost and far exceed mere physical cure.
Can we do something about it? While the solution is in tackling each of these problems at an individual level, best results may be obtained when these strategies can be employed at the earliest level or at the initiation of the medical school, in other words when incorporated in the medical curriculum itself. The medical curriculum has been an evolving process and the scientific part is frequently updated to bring it abreast with the latest scientific advances. Over the past, several new topics have been included in the medical curriculum which was not previously present—genetics and immunology are some of the examples. However, in most places, especially the developing world, it has failed to keep pace with advances in other areas including communication, management theory, personality development, ethics and aesthetics. Thus there is a need to revisit the medical curriculum to attune it to the current social context otherwise gap between the expectations and actual delivery will keep widening.
Here are some of the suggestions towards improving medical curriculum:
Newer ideas in the curriculum of medical students:
- Professional Development
A) Empathy Development: Inderstanding emotional intelligence and learning the art and skill of empathic listening and action
B) Medical Communication: Understanding modern doctor-patient relation and developing doctor-patient communication particularly “therapeutic communication” with special emphasis on the lost art of “bedside manners.”
C) Personality Development: Understanding the requisite personality attributes to becoming a good doctor, training the budding doctors to incorporate these attributes in their personality.
D) Technique of Medicine: Developing patient-centred clinical methods, focusing on improving the art of history taking, quickly incorporating evidence in medical practice and particularly on patient safety.
- Management Proficiency
In current times besides professional skills developing management skills is also absolutely mandatory. The requisite management skills pertain to:
A) Individual and Interpersonal Dynamics
These skills involve:
i) Understanding the motivators and motivation in medicine and assuming an ethical approach towards market-place
ii) Developing an approach of balanced decision making and judgment and a proper attitude towards the clinical job
iii) Understanding inter-personal relationships and communication and developing skills; negotiation and conflict resolution especially in clinical settings, skills of crisis management especially when there is an impending threat of violence of property and personnel.
iv) Understanding in which situations there are chances of medical error, malpractice and negligence and how to avoid them.
B) Team and Unit Dynamics
Understanding the (big)5 personality traits of a leader, team norms and practices and the network of the organisation. Learning how to evolve into a leader and be able to coordinate medical teams/organisation.
C) Organisational Dynamics
There should be some discussion on organisational structure and design, organisational culture, change in management and inter-organisational relationships.
- Medical Humanities
A) Philosophy: There should be a basic introduction to various branches of philosophy particularly in context to medicine: epistemology, consequentialism and deontological Ethics with particular emphasis on medical ethics
B) Arts: Aesthetics is perhaps the most neglected part in medical curriculum although there is a close historical and psychological relation of art with medicine particularly in developing empathy, the most essential skill in any doctor.
- Art of Living
Doctors have among the highest risk of burnouts and suicides among all professions, especially “white-collared” ones. The reason is that since the beginning they are ‘taught’ to focus on gathering knowledge as also keeping ‘patient first’ even at the expense of self and family. This excessive focus on professional skills leads to neglect of self and interpersonal relationships. Thus these budding doctors need to be tutored into the art of living from the beginning. Particularly they should be informed about the benefits of outdoor, the need to be flexible about things and be able to change habits and coached on how to increase mental stamina and increase attention span.
The writer is from the Department of Cardiology of AIIMS, New Delhi.
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HIGHER COFFEE INTAKE PREVENTS DEVELOPMENT OF ALZHEIMER’S
If you are one of those people who can’t start their day without a cup of hot coffee, we have some good news for you. New research has found that drinking higher amounts of coffee can make you less likely to develop Alzheimer’s disease.
The findings of this research were published in the ‘Frontiers in Aging Neuroscience Journal’. As part of the Australian Imaging, Biomarkers and Lifestyle Study of Ageing, researchers from Edith Cowan University (ECU) investigated whether coffee intake affected the rate of cognitive decline of more than 200 Australians over a decade.
Lead investigator Dr Samantha Gardener said that the results showed an association between coffee and several important markers related to Alzheimer’s disease.
“We found participants with no memory impairments and with higher coffee consumption at the start of the study had a lower risk of transitioning to mild cognitive impairment – which often precedes Alzheimer’s disease – or developing Alzheimer’s disease over the course of the study,” she said.
Drinking more coffee gave positive results in relation to certain domains of cognitive function, specifically executive function which includes planning, self-control, and attention.
Higher coffee intake also seemed to be linked to slowing the accumulation of the amyloid protein in the brain, a key factor in the development of Alzheimer’s disease.
Dr Gardener said that although further research was needed, the study was encouraging as it indicated drinking coffee could be an easy way to help delay the onset of Alzheimer’s disease.
“It’s a simple thing that people can change,” she said.
It could be particularly useful for people who are at risk of cognitive decline but haven’t developed any symptoms.
“We might be able to develop some clear guidelines people can follow in middle age and hopefully it could then have a lasting effect,” she said.
If you only have allowed yourself one cup of coffee a day, the study indicated you might be better off treating yourself to an extra cup, although a maximum number of cups per day that provided a beneficial effect was not able to be established from the current study.
“If the average cup of coffee made at home is 240g, increasing to two cups a day could potentially lower cognitive decline by eight per cent after 18 months,” Dr Gardener said.“It could also see a five per cent decrease in amyloid accumulation in the brain over the same time period,” she added.
In Alzheimer’s disease, the amyloid clump together forming plaques that are toxic to the brain.
The study was unable to differentiate between caffeinated and decaffeinated coffee, nor the benefits or consequences of how it was prepared (brewing method, the presence of milk and/or sugar etc).
Dr Gardener said that the relationship between coffee and brain function was worth pursuing.“We need to evaluate whether coffee intake could one day be recommended as a lifestyle factor aimed at delaying the onset of Alzheimer’s disease,” she said.
Pairing fasting with exercise can boost health outcomes
A new study has found that exercising intensely at the start of a fast may help maximise the health benefits of temporarily foregoing food.
The findings of the study were published in the journal ‘Medicine & Science in Sports & Exercise’. “We really wanted to see if we could change the metabolism during the fast through exercise, especially how quickly the body enters ketosis and makes ketones,” said BYU PhD student Landon Deru, who helped design the study for his thesis.
Ketosis occurs when the body runs out of glucose — its first, preferred fuel — and begins breaking down stored fat for energy, producing chemicals called ketones as a byproduct. In addition to being a healthy energy source for the brain and heart, ketones combat diseases like diabetes, cancer, Parkinson’s and Alzheimer’s.
For the study, the researchers asked 20 healthy adults to complete two 36-hour fasts while staying hydrated. Each fast began after a standardised meal, the first fast starting without exercise and the other with a challenging treadmill workout. Every two hours while awake, the subjects completed hunger and mood assessments and recorded their levels of B-hydroxybutyrate (BHB), a ketone-like chemical.
Exercise made a big difference: when participants exercised, they reached ketosis on average three and a half hours earlier in the fast and produced 43 per cent more BHB. The theory is that the initial exercise burns through a substantial amount of the body’s glucose, prompting a quicker transition to ketosis. Without exercise, the participants hit ketosis about 20 to 24 hours into the fast.
“For me, the toughest time for fasting is that period between 20 and 24 hours, so if I can do something to stop fasting before 24 hours and get the same health outcomes, that’s beneficial. Or if I do fast for my usual 24 hours but start with exercise, I’ll get even more benefits,” said study co-author Bruce Bailey, a BYU exercise science professor.
There are a few caveats to the proposed strategy, however.
“If you carb load or eat a huge meal before you fast, you may not reach ketosis for days, even if you do exercise, so you should eat moderately before fasting,” Bailey said.
“We also don’t know the ideal frequency for fasting. There are definitely certain people who shouldn’t fast, such as those with Type 1 diabetes, and obviously, it’s detrimental to fast 24/7. But for most people it’s perfectly safe and healthy to fast once or even twice a week for 24 or more hours,” Bailey added.
The study, which required participants to run on a treadmill for an average of 45 to 50 minutes, also didn’t establish an ideal amount or type of exercise for every person. Overall, though, the researchers believe the more energy a person can burn, the better.
“You can get a pretty good estimation of how many calories you’re burning in most exercises, and the more carbohydrates you burn off (without overdoing it or injuring yourself), the better you set the stage for starting ketosis early in your fast,” Deru said.
Also important to note is that, according to the participants’ reports, exercise didn’t seem to aggravate hunger or affect moods during the fast.
“Everyone’s going to be a little grumpier when they fast, but we found that you aren’t going to feel worse with the intervention of exercise — with exercise, you can get these extra benefits and be the exact same amount of grumpy as you would be if you didn’t exercise,” concluded Deru.
HOW YOU CAN IMPROVE LUNG HEALTH DURING COVID TIMES
Managing and controlling chronic obstructive pulmonary disease (COPD) is always important, and especially given the pandemic in the backdrop individuals living with a chronic lung disease are at a higher risk of severe illness and complications from COVID-19. However, misinformation about COVID-19 has made it hard for people with chronic conditions to determine how to stay safe.
Here is what you should know. Patients with COPD are highly susceptible from respiratory exacerbations from viral respiratory tract infections. So, when the COVID pandemic took us by storm, these patients were said to be more at risk of COVID-19 pneumonia or COVID-19-related mortality. However, with the more than 20 months into the pandemic, researchers are yet to establish the adverse COVID-19 outcomes in COPD patients. Having said that, in our clinical experience, a diagnosis of COPD significantly increases the odds in patients with COVID. Therefore, it is important for all COPD patients be considered a high-risk group and advised preventative measures and aggressive treatment for COVID-19 including vaccination.
There are a few things you can do. The best way to avoid illness, regardless of age or health status, is avoiding exposure to the virus. This becomes even pressing for individuals living with COPD. Stringent adherence to the safety precautions is vital. This means staying home as much as possible and avoiding potential exposure to the virus. When in public, maintain social distance of at least six feet from people and wear a N-95 mask. Also, wash your hands often and clean, then disinfect frequently touched surfaces.
Also, vaccination is key. Vaccines are developed to help a person’s immune system recognize and protect the body against certain infections. Vaccination can help in building immunity and in controlling severe disease if infected with COVID. Apart from this, continue controller medications for COPD to maintain lung health. Don’t delay important visits or ignore flare-ups or new symptoms. COPD complications can become serious if left untreated. Moreover, taking medication correctly is a major component in successfully controlling chronic lung diseases. Nebulized therapy continues to be a safe and effective way to take inhaled medications at home during the pandemic.
Above all, eating a healthy diet and drinking plenty of water can also help to support the body and remove excess mucus from the lungs. Add more Vitamin C and adequate proteins to your diet, along with moderate exercise as tolerated. Avoid crowded places and don’t forget to wear a mask while venturing out. Remember, if you develop symptoms of COVID-19, call your doctor who will advise what to do.
The author is a consultant-Pulmonologist & Sleep Medicine Expert, Hiranandani Hospital, Vashi-A Fortis Network Hospital.
UNKOWN IRON DEFICIENCY SYMPTOMS MORE HARMUL
How often do you feel lethargic or feel exhausted? Can you barely make it up the stairs without getting winded even though you’re physically fit? If so, you might be lacking in iron.
Although many people don’t think of iron as being a nutrient, but it is an extremely important mineral for our body. Iron helps to transport oxygen throughout our body. It is an important component of hemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Hemoglobin represents about two-thirds of the body’s iron. If you don’t have enough iron, your body can’t make enough healthy oxygen-carrying red blood cells. A lack of red blood cells is called iron deficiency anemia.
IRON DEFICIENCY IN INDIA
Iron deficiency that results in anemia has been a major public health burden in India. The incidence of anemia is as much as 53.2 percent among women and 21.7% among men. Iron deficiency occurs when the body lacks adequate iron, which is essential to make haemoglobin, the protein in red blood cells enabling them to transfer oxygen around the body. Without enough oxygen in your blood, you may feel tired, weak, and experience shortness of breath. Your doctor will find out why your iron is low. Usually, you can treat iron deficiency anemia with supplements. Once your iron levels go up, you should start to feel better.
Some symptoms include: Fatigue or weakness; pale or yellow skin; hortness of breath; dizziness or lightheadedness; headaches; fast or irregular heartbeat; chest pain; cold feet and hands; brittle, cracked nails, spoon-shaped nails, hair loss, cracks near the side of your mouth, Pica (cravings for things that aren’t food, like dirt, starch, clay, or ice); sore and swollen tongue and restless legs syndrome (an urge to move your legs while you’re in bed)
How Much Iron Do You Need?
This depends on your age, gender, and overall health. Infants and toddlers need more iron than adults, in general, because their bodies are growing so quickly. In childhood, boys and girls need the same amount of iron — 10 milligrams daily from ages 4 to 8, and 8 mg daily from ages 9 to 13.
Women need more iron because they lose blood each month during their period. That’s why women from ages 19 to 50 need to get 18 mg of iron each day, while men the same age can get away with just 8 mg.
Moreover, you might need more iron, either from dietary sources or from an iron supplement, if you: are pregnant or breastfeeding; have kidney failure (especially if you are undergoing dialysis, which can remove iron from the body) have an ulcer, which can cause blood loss; have a gastrointestinal disorder that prevents your body from absorbing iron normally (such as celiac disease, Crohn’s disease, or ulcerative colitis); take too many antacids, which can prevent your body from absorbing iron; have had weight loss (bariatric) surgery; work out a lot (intense exercise can destroy red blood cells)
If you are a vegetarian or vegan, you may also need to take an iron supplement, because the body doesn’t absorb the type of iron found in plants as well as it absorbs the iron from meat.
FOOD ITEMS THAT CONTAIN IRON
You can easily supplement your child’s Iron needs through diet by including the below-mentioned food items: various kinds of meat like beef, lamb, pork, liver, chicken, turkey; legumes like chickpeas, lentils, dried peas, beans; vegetables like spinach, green peas, broccoli, brussel sprouts. Other food items such as Eggs, Fish, Grains and Cereals
By ensuring that children, women, and all adults consume Iron-rich food, you can guarantee healthy and normal growth.
The author is the Director of Haematology & BMT Dept., Fortis Hospital Mulund
Iron deficiency that results in anemia has been a major public health burden in India. The incidence of anemia is as much as 53.2 percent among women and 21.7% among men. Iron deficiency occurs when the body lacks adequate iron, which is essential to make haemoglobin, the protein in red blood cells enabling them to transfer oxygen around the body.
REPEATED CONCUSSIONS IN PROFESSIONAL RUGBY PLAYERS LINKED WITH POOR MENTAL HEALTH POST RETIREMENT
According to a study, professional rugby players are more likely to show signs of poor mental health, such as depression and anxiety compared to amateur ones and non-contact athletes.
The research has been published in the journal ‘Sports Medicine’. The retired elite rugby players in the study suffered more concussions during their playing days than those in other groups and the researchers said this could be linked to their poor mental health later in life.
Players who had suffered five or more concussions were almost twice as likely to report signs of depression, anxiety and irritability compared with players with fewer concussions. These players were also more likely to struggle with feelings of covert anger.
Signs of depression and irritability were also more common in the rugby players who had suffered three or more concussions in their playing career. One in two players with three or more concussions experienced these signs of poor mental health compared to one in three players who had suffered less than three concussions.
The retired elite rugby union and league players, who all played in the UK, were compared to amateur rugby players and non-contact athletes, such as cricketers and runners. The scientists said further research is needed to explore if there is a direct neurobiological connection between repeated concussions and longer-term psychological health and to investigate any possible links with the development of neurodegenerative disease. Lead author, Dr Karen Hind from the Department of Sport and Exercise Sciences, at Durham University, said, “Our study shows that elite level rugby players disclosed more adverse mental health issues following retirement from the sport, compared to those who had played amateur level rugby, or a non-contact sport. This was particularly the case for those players who had experienced three or more concussions.”
There were no differences in alcohol scores between the retired sports groups or in relation to concussion history. However, the study did find that the former professional rugby players were more likely (1.8 to 2.9 times more likely) to suffer from sleep disruption compared to the amateur rugby players and non-contact athletes.
One in five former elite rugby players said they would not seek help from anyone if they had a problem or were upset.
The researchers acknowledged that forced retirement due to injury also played a part in players’ well-being post-retirement.
They also stressed that while this study does not conclude cause and effect; the findings are important for player welfare and added to a growing body of evidence on the impact of repeated concussions.
STUDY FINDS ONLY ALCOHOL TRIGGERS HEART ARRYTHMIA
According to research at UC San Francisco, it was found out that while the common heart condition is triggered by caffeine, sleep deprivation and sleeping on the left side, alcohol is the only one that was associated with heart arrhythmia (improper beating of the heart, whether irregular, too fast or too slow).
The study has been published in the ‘JAMA Cardiology Journal’. The authors concluded that people might be able to reduce their risk of atrial fibrillation (AF) by avoiding certain triggers.
Researchers were surprised to find that although most of the things that participants thought would be related to their AF were not, those in the intervention group still experienced less arrhythmia than the people in a comparison group that was not self-monitoring.
“This suggests that those personalized assessments revealed actionable results,” said lead author Gregory Marcus, MD, professor of medicine in the Division of Cardiology at UCSF.
“Although caffeine was the most commonly selected trigger for testing, we found no evidence of a near-term relationship between caffeine consumption and atrial fibrillation. In contrast, alcohol consumption most consistently exhibited heightened risks of atrial fibrillation,” he added.
Atrial fibrillation contributed to more than 150,000 deaths in the United States each year, reported the federal Centers for Disease Control and Prevention, with the death rate on the rise for more than 20 years.
To learn more about what patients felt was especially important to study about the disease, researchers held a brainstorming session in 2014. Patients said researching individual triggers for AF was their top priority, giving rise to the I-STOP-AFib study, which enabled individuals to test any presumed AF trigger. About 450 people participated, more than half of whom (58 per cent) were men, and the overwhelming majority of who were white (92 per cent).
Participants in the randomized clinical trial utilized a mobile electrocardiogram recording device along with a phone app to log potential triggers like drinking alcohol and caffeine, sleeping on the left side or not getting enough sleep, eating a large meal, a cold drink, or sticking to a particular diet, engaging in exercise, or anything else they thought was relevant to their AF.
Although participants were most likely to select caffeine as a trigger, there was no association with AF. Recent research from UCSF has similarly failed to demonstrate a relationship between caffeine and arrhythmias — on the contrary, investigators found it may have a protective effect.
The new study demonstrated that consumption of alcohol was the only trigger that consistently resulted in significantly more self-reported AF episodes.
The individualized testing method, known as n-of-1, did not validate participant-selected triggers for AF. But trial participants did report fewer AF episodes than those in the control group, and the data suggest that behaviours like avoiding alcohol could lessen the chances of having an AF episode.
“This completely remote, siteless, mobile-app based study will hopefully pave the way for many investigators and patients to conduct similar personalized “n-of-1” experiments that can provide clinically relevant information specific to the individual,” said Marcus.
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