Changing times - Nepali Times

Before antibiotics came to the rescue, our job as physicians was mainly custodial: we tried to take good care of patients and provided them with love and sympathy. Whether the patient survived or not depended on the natural history of the disease.

Our Nepali patients knew this all too well. For example, typhoid fever was called "myadhe joro" (fever with a limited time span). Generally the fever lasted for three weeks and if you survived 20 to 25 days with fever, then you would be fine.

Physicians' lotions, potions, and pills made little difference. American physician, Lewis Thomas observed in 1937 that if being in a hospital bed made a difference it was mostly the difference produced by warmth, shelter, and food. But when antibiotics became widely available starting from the 1940s and 50s, methods of treatment changed forever.

There are now effective prevention and treatment measures for many infections and non- infectious illnesses. We have moved beyond treatment in a big way into the realm of evidence-based medicine. Many hospitals in the west especially in the United States are now run by administrators and nurses at various levels who make sure doctors follow rules and regulations set by the administration so that infection is under control.

For example in many US hospitals there are random camera monitors to ensure doctors follow rules (like wearing masks and head covers) while performing even minor procedures on patients so that infections are prevented. Even senior doctors are reprimanded if they are found disobeying these rules. Naturally many senior doctors have not been able to adapt well to these changes.

In addition, many doctors in the west are experiencing insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and fellow doctors bearing tattoos and thinking nothing of their behaviour.

By comparison, we Nepali physicians have it easy. We don't have to fill out long forms after every visit nor do we have to worry too much about malpractice litigation, although Nepali lawyers are clearly lurking in the background.

But surely we Nepali physicians have to ask ourselves if we are always working in the best interests of our patients (when we don't follow simple guidelines like washing hands with soap and water), even if in the US and other developed countries seemingly unnecessary hassles may be interfering with patient care.

1. Jeeves
Besides asking docs to wash hand, what is the point of this article?If that's the only message,it's muddled in a long and unnecessary preface which in itself is not necessarily related to the message.seems like the author was trying to beat a deadline without much in way of a solid topic to write about

Posted on: 12 AUG 2012 | 7:20 PM NST

2. Sanjay Gelal
Changing times Actually to say,most of diseases in our country occur due to poor sanitated households and poverty. And I dont find amusing about antibiotics and else, since it is common for us to surrender our life to death on the sake of diarrhoea and dyse,

Posted on: 12 AUG 2012 | 7:38 PM NST

3. Ram Babu
From his weekly writings it is clear Dr Basnyat does not always have a mission ie a message to pass on to readers. He often writes to just entertain. Jeeves should just enjoy himself without always looking for deep meanings. For example I found it amusing how the author starts out by saying that the many years ago the doctors duty was mainly custodial. I like the usage of the last word there and it is stuff like that brings me back to read his column besides the medical content.

Posted on: 13 AUG 2012 | 10:07 AM NST

4. platypus
I agree with Ram Babu. Dr. Basnyat has a knack for writing. The medical content is great too. Sometimes the topics may be mundane but that's maybe because he may have a lot on his plate. He is a medical practitioner right? Give the guy a break Jeeves Peeves.

Posted on: 13 AUG 2012 | 9:33 PM NST

5. A Nepali

Dr. Basnyat does have an important message to convey to his colleagues, "But surely we Nepali physicians have to ask ourselves if we are always working in the best interests of our patients (when we don't follow simple guidelines like washing hands with soap and water)..."

An ounce of prevention is better than a pound of cure. For why handwashing by health practitioneers is such an important topic, see the below WHO link and related excerpts from other sources:

http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

At a recent Global Consensus Conference, participants were charged with the overall purpose of achieving consensus on infection control practice across healthcare settings and international boundaries related to caring for patients with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). The conference provided a major opportunity for professionals and scientists in the infection and prevention control field to discuss trends and develop strategies for best practice. The aim was to examine the infection control problems associated with these antibiotic-resistant organisms (AROs) and to consider possible solutions.3 One estimate places the direct cost of nosocomial infections caused by six different strains of AROs to be minimally $1.3 billion (1992 dollars)/year in the US.4 According to the Center for Disease Control and Prevention (CDC), each year an alarming 2,400,000+ nosocomial infections occur in the US alone. They are estimated to cause directly 30,000 deaths and contribute to another 70,000 deaths each year. Nosocomial infections cost over $2,300 per incident and $4.5 billion annually in extended care and treatment.

The CDC (Centers for Disease Control, USA) has identified handwashing as the single most important means of preventing the spread of infection.

Posted on: 13 AUG 2012 | 11:37 PM NST