Indian journal of medical ethics最新文献

I read with great interest the editorial on the pharmaceutical company-healthcare relationship published in the April-June issue of this journal [1]. Clinical practice guidelines are increasingly used by physicians to guide treatment decisions, and the pharmaceutical industry focuses on influencing the authors of these guidelines. Almost one in four guideline writers with no disclosed ties may have potentially relevant undisclosed ties to pharmaceutical companies [2]. Doctors are in a fiduciary relationship with patients and expected to act in their best interests. The relationship with the industry influences doctors in several ways; they may obtain information about medicines, but this information has been provided with an intention of influencing prescribing and increasing sales of the medicine [3].

The article analyses the recent amendment by the National Medical Commission (NMC) in India, capping the number of undergraduate medical seats in high-performing states, which has sparked a debate. With a healthcare system catering to the diverse needs of 1.4 billion people, regional disparities in healthcare personnel distribution have emerged, especially among doctors. The advantages of the amendment include a focused approach on lagging states and the potential distribution of doctors to improve overall health indices. However, concerns arise over infringement of the autonomy of state governments, potential hindrance to high-performing states, and the impact on doctors' postgraduate choices. This commentary explores the complex factors influencing doctor distribution, including state policies, infrastructure and migration patterns. While emphasising the need for equitable healthcare access, and it also stresses the need for a balanced approach to address the challenges in doctor distribution to ensure both state and national healthcare needs are met effectively.

Telemedicine technology plays a crucial role in addressing healthcare challenges, particularly in countries like India, by mitigating physician shortages, reducing patient burden and costs, and aiding in disease prevention. The term telemedicine, meaning "healing at a distance," was coined in 1970 [1]. It encompasses the use of electronic, communication, and information technologies to deliver healthcare services remotely. To regulate telemedicine practice, the Government of India released telemedicine guidelines on March 25, 2020, during the Covid-19 pandemic [2]. The National Medical Commission (NMC) added the Telemedicine Practice Guidelines as Appendix-5 to the Professional Conduct (Etiquette and Ethics) Regulation 2002 of the erstwhile Medical Council of India (MCI) [3]. Additionally, on June 11, 2020, the Insurance Regulatory and Development Authority of India (IRDAI) recognised teleconsultation services for insurance claims [4], which led to a surge in telemedicine consultations and the proliferation of various apps and service providers.

Poetry is a powerful tool to promote communication, develop insight and empathy, examine ethical issues, and challenge assumptions. We have been using poetry in health professions education for many years and wished to capture its impact on healthcare learners and professionals, with a focus on competencies essential to healthcare providers. A three-hour poetry workshop was conducted during the National Conference for Health Professions Educators, 2022, for volunteers from the health professions. Poems were curated beforehand to highlight ethics concepts, and social and structural healthcare barriers. Participant responses suggested that they connected with the struggles depicted, noticed ethical issues, and experienced empathy. Online feedback from participants after the workshop revealed that the poems motivated self-reflection, gave voice to feelings, and helped understand patient perspectives. Our findings suggest that integrating poetry into the curriculum can improve educational competencies, enhance understanding of illness, and facilitate creativity, reflective learning, and discussions on self-care and burnout.

Background: Physician trainees need to have robust gender awareness for better professional relationships and patient outcomes. A cross-sectional study was conducted among undergraduate (UG) medical students (MBBS) of a medical college in Hyderabad, India, in November 2022, to assess their gender sensitivity (GS) and gender-role ideologies.

Methods: A pretested, structured English questionnaire was used for the study, to compute the Nijmegen Gender Awareness Scale in Medicine (N-GAMS) of the participants.

Results: The mean age of the students was 20.51 years, with the majority being women (112, 61.2%). The mean GS score was 3.11, while the mean scores for gender-role ideology towards patients (GRIP) and gender-role ideology towards doctors (GRID) were 2.56 and 2.56, respectively. In the adjusted analysis, a significantly better GS score was seen among medical students from urban backgrounds. Significantly more egalitarian GRIP was found among women, participants from urban backgrounds, and among those whose mothers were employed. Significantly more egalitarian GRID was found among women and participants whose mothers were employed. There was a significant negative, but low, correlation between the GS domain and the GRIP (r = - 0.241; p < 0.001) and GRID (r = - 0.192; p = 0.009) scores. There was a high, positive correlation between GRID and GRIP (r = 0.812; p < 0.001).

Conclusion: Gender awareness is relatively low among Indian medical students and lower still among male students. It was higher among women, particularly among those whose mothers were employed and those who were from urban areas.

The primary objective of any research, regardless of its domain such as health, technology, psychology, or any other subject, is to enhance the overall well-being of individuals. Rigorous processes are involved in conducting research ethically and in communicating its outcomes to society. However, as publishing research has become a mandatory requirement for career advancement and appointments, academics are resorting to several unethical practices to get substandard work published quickly. Consequently, predatory publishing markets have emerged, which publish data that is falsified and fabricated, along with plagiarised textual matter. The emergence of "paper mills" is a further step in the corruption of research, where a group of persons or automated systems generate papers for publication. Anyone desirous of publishing a paper can purchase one, akin to any desired fast-moving consumer product, with the added guarantee of publication in indexed journals. Therefore, paper mills and their unethical modus operandi are discussed in this paper in detail, with relevant examples. The article unfolds the consequences of publishing such fraudulent research papers and concludes with the challenges in combating paper mills.

Background: The curricula of Ayurveda programmes emphasise various theoretical constructs such as Tridosha (three factors determining the state of health), Agnibala (digestive strength), Samprapti (patho-physiology), among others. It is often argued that practitioners follow an individualised approach based on these principles while treating patients. Yet, dependable data on their real-world influence is lacking. The aim of this study was to record the extent to which these constructs drive decision-making among Ayurveda practitioners and to examine whether these constructs determine individualisation of the interventions.

Methods: We employed an emailed survey to record physicians' perceptions. Convenience sampling was chosen as the sampling method. Registered Ayurveda practitioners located across India with a minimum of five years of clinical experience were invited to participate. Five case-based scenarios depicting different clinical conditions were presented to the physicians. Questions that accompanied each case scenario asked the physicians to record clinical diagnoses, treatment plans, and the Ayurveda principles that determined their treatment.

Results: A total of 141 physicians responded, from whom we received 152 responses as seven physicians responded to more than one scenario. The results suggest a significant lack of consensus among physicians regarding clinical diagnoses, interventions, and their understanding of pathophysiology in the given clinical scenarios. Many conflicting opinions were also noted.

Conclusion: Theoretical constructs do not appear to determine either prescriptions or individualisation uniformly. Two ethical questions arise: "Is this situation due to an inherently weak theoretical framework of Ayurveda?" and "How can one justify spending hundreds of hours teaching these theories?"

This is a reflection on the nature of language used by psychologists in the contexts of referrals and assessments. Through an example of a brief referral, I attempt to unpack the "clinical" language that may dehumanise and pathologise individuals. Further, I attempt to reframe it through a language, that is not just a shift from "deficits" to "strengths", rather a discourse respecting personhood. With a brief emphasis on neurodiversity and feminism, I reflect on the importance of incorporating affirmative language whether it is neuro-affirmative, queer-affirmative, age- or caste-affirmative, within and outside mental health practice.