Effective communication is essential to establish a good doctor-patient/parent relationship and practice high quality medicine. It is indeed the key to build confidence, faith and trust of the parents to augment the process of healing. Most parental complaints of dissatisfaction and mismanagement originate due to lack of communication or because of abrasive, cold or callous attitude of the doctor or members of the health care team and not due to lack of knowledge and skills or unsatisfactory management of the patient. The patients and parents must feel all times that they are treated with respect and dignity. We should consider patients as our clients and handle them with due confidence, humility, concern and empathy. It is important to communicate with the parents by literally coming down to their level and by maintaining an eye-to-eye contact. We should not judge, belittle or argue with the parents and handle them with due courtesy and consideration. We should be careful, tactful and diplomatic in deciding not only "what to tell the parents" but also "how to tell it". The parents should be told about the condition of the child in a simple, easy-to-understand language without any medical jargons. We should be pragmatic but honest in communicating the true medical status of the child but nevertheless try to keep the hope alive which has tremendous healing capabilities. We should not allow the technology to further dehumanize medicine and try to resurrect the declining image of the medical profession. It is desirable that all the medical and nursing colleges in the country should initiate regular education programs in the fields of social and behavioral sciences, art of communication and medical ethics for graduate and postgraduate medical and nursing students.
Excessive digital gaming is emerging as a mental health disorder because youngsters are losing control of their lives by wasting their time by indulging in online multiplayer games. The popularity of the games can be gauged by the fact that India's online gaming market of US $360 million is expected to grow to $ 1 billion by 2021. Video gaming is an obsessive compulsive disorder. The players enjoy creating and building relationships with other online characters, which provides a virtual community feeling at the expense of one-to-one social interactions and real life bonding. In due course of time, the players are preoccupied or "hooked" to the games and display mood swings like irritability, restlessness, and aggressive behavior when they are denied the playing gadgets. Realizing the multifarious health hazards of digital gaming, WHO has recently classified it as a mental health disorder in the 11th revision of its International Classification of Diseases (ICD-11) so that it is accorded the state health benefits for its prevention and treatment. The technology is both a boon as well as a bane, the option is with us. It is important to avoid all obsessions or compulsions in life in order to follow the philosophy of "middle path".
Uveal melanoma is the most common primary intraocular malignancy in adults. It is associated with a high rate of distant tumor spread and consequent mortality. Unlike retinoblastoma, for which treatment advances over the last few decades have resulted in a dramatic improvement in survival, outcomes for patients with uveal melanoma remain unchanged. Despite improvement in local control of this tumor, roughly 50% of patients develop metastatic disease within 15 years. Delays in diagnosis and marked vascularity of this tumor may underlie that situation. Tumor size, location, histopathologic appearance, cytogenetic abnormalities, and molecular profiling are used in prognostication. The revised 7th edition of the American Joint Committee on Cancer (AJCC) manual has presented new information that may improve that process as well. Herein, we review current knowledge on uveal melanoma.
Intolerance and grouse against doctors is a global phenomenon but India seems to lead the world in violence against doctors. According to World Health Organization, about 8-38% healthcare workers suffer physical violence at some point in their careers. Many more are verbally abused or threatened. Public is almost behaving like health sector terrorists. The spate of increasing attacks on doctors by damaging their property and causing physical injury is not acceptable by any civilized society. The public is becoming increasingly intolerant to a large number of social issues because of poor governance and vote bank politics. There is a need to arrest the development of further distrust between doctors and their patients/relatives, otherwise it will compromise all achievements of medical science and adversely affect healing capabilities of doctors. Rude and aggressive behavior of the patients or their family members, and arrogant and lackadaisical approach of the doctor, adversely affects the doctor-patient relationship and the outcome of the patient. The doctors, hospital administration and government must exercise "zero tolerance" with respect to acts of violence against healthcare professionals. It is possible to reduce the incidence of intolerance against doctors but difficult to eliminate it completely. The healthcare providers should demonstrate greater compassion and empathy with improved communication skills. The hospitals must have adequate infrastructure, facilities and staff to handle emergencies without delay and with due confidence and skills. The security of healthcare providers, especially in sensitive areas, should be improved by having adequate number of security guards, frisking facilities, extensive CCTV network and availability of "Quick response team" to handle unruly mob. In case of any grievances for alleged mismanagement, the public should handle the situation in a civilized manner and seek redressal through Medical Protection Act and legal avenues. Laws to prevent violence against doctors do exist but they need to be made more stringent and implemented properly.
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