Dear Editor,

The government fails to come to the table at its peril.

Having supported junior colleagues on picket lines in 2016 and 2023, it is obvious that the public are very much on the doctors' side this time round.

I have observed more pipping, tinging, smiling, thumbs up, power salutes, clapping and waving than in 2016. There are more positive comments and fewer snide ones. People have been dropping off refreshments that they are donating. Groups who are not supposed to toot their horns, such as the police, have told us that they still support the action.

These are the folks who will be voting in forthcoming local and general elections. Those currently in power need to buck their ideas up if they want to stay that way.

Dear Editor

Here is one of the multiple scenarios that happen in India. A patient becomes sick in a small nursing home/ hospital, where the patient’s attendant creates chaos, threats, abuses, and sometimes manhandles the treating doctors. Strict law is rarely enforced. Unfortunately, the mob ransacks the smaller nursing home or hospital if the patient dies. The patient's attendants protest on the roads and attract media attention. The case is filed under section CrPC 174, but there are certain circumstances, like Dr. Archana Sharma, who was charged with IPC 302 (murder) without a medical team expert opinion.

Rarely are there instances where attendants influence district collectors to instruct the local medical college deans and the forensic department to find medical negligence. Whole-body CT scans, X-rays of the deceased body, and VIDEO recordings of the postmortem are done to find the cause, which happens only in rare situations. Indian doctors have been harassed to a maximum extent that all laws in India will be used to find a cause to make them medically negligent, even if not.

In recent times India has witnessed the unethical and atrocious behavior of a few journalists, papers, and online media where the nursing home/ hospital and the treating doctors are named in their news without evaluating the truth and waiting for the medical expert committee's opinion. This flares more wrong information and false impressions about the Indian doctors and the hospital to the common man’s perception. There is no control over this now.

There are windows for the attendants where a criminal complaint can be made to the police commissioner, DIG, and the local police station, repeatedly pressuring them to recharge the complaint 174 to IPC section 302. Higher up on the ladder, the patient’s attendant complains to the state health minister and health secretary. India has no proper protocol and system where the medical grievances redressal mechanism functions and addresses the calls.

Further, in a democratic country, courts are always the savior. The patient’s attendants file many petitions under different constitutional powers masking the truth and demanding the arrest of the treating doctors under section 302. Also, there are various forums, such as the state medical council, Director of health services, and family and rural health services, where the petitioner can make a complaint. The doctors and the hospital face enquiry in all these forums for the petitioner's complaint.

In some situations, a state medical council clears the doctor and team of no negligence. Still, the case is being held in the criminal courts, state health, and rural service departments without being aware of the medical expert team's opinion of the medical council. The Joint directors or directorate of the state should be educated about medical negligence and errors of judgment. Error in judgment is not medical negligence. They should be unbiased, bold, and informative in dealing the medical negligence cases. A prompt inquiry by a medical expert team and a timely decision save the doctor from harassment, abuse, mental unwellness, and despondence. The complications, untoward incidents during surgery or after, not conducting a few tests, finding faults in clerical errors, and expecting the imaginary best healthcare are not medical negligence.

The saviors and frontline warriors of dreadful COVID-19 cannot be portrayed as criminals in untoward incidents. India needs a renaissance and a colossal change in handling medical negligence, and I pray through this letter that justice prevails for doctors. Pushing them to halt the minds of saving the patients because of harassment will be a national loss; no doctor will take any risk. This will bring a monumental catastrophe to Indian healthcare.

Dear Editor,

Dr Rammya clearly illustrates the sense of over-whelm most clinicians feel when consulting with real world patients, who often have many complex conditions and bring both physical and social issues to a long-awaited but short consultation.

When guidelines are viewed in totality, it is very clear that we have lost the wood for the trees, have forgotten the person behind the disease and are failing to address the root causes of the symptoms we are seeing.

Basic science is now painting a clearer picture of a common underlying pathology to all these long-term conditions from cancer to neurological disease, autoimmunity and metabolic disease; that of immune dysregulation resulting in chronic systemic inflammation. The key driver of this dysfunction is often environmental and lifestyle factors influencing gene expression and our microbiome amongst others.

Our current medical model is based on a dated, reductionist and deterministic view of disease that stems from the era of genetic discoveries, this has fostered a pervasive belief that diseases exist in isolation and we are powerless victims without medicine and medications.

This is not the case, if we take a step back from the relentless assessment, quantification and labelling of disease and spend more time addressing their root causes, we may be able to support people to reverse or at least improve or delay these conditions. For example, this can be done through supporting better nutrition, sleep, social connection, increased activity and so on.

What I and Dr Mathews are seeking is fewer guidelines and assessments for more Public Health measures outside the consulting room and more Lifestyle Medicine approaches in it. Lifestyle Medicine is a discipline that is aware of the social drivers of behaviour, acknowledges the difficulties people might be facing and uses person-centered techniques that can support people to make lifestyle changes to improve health.

In my own practice as a GP with training in Lifestyle Medicine, I now ask people what matters most to them, where they would like to start and work with them to address the root causes of their symptoms. With patients agreements, we often stop medications and I’ve seen reversal of Type-2 diabetes and hypertension many times now.

This approach isn’t new, nor is it controversial - being the first step in all major long-term condition guidelines. But it is neglected, the funds for creating good quality education and evidence-base, are sorely lacking and need a mind-set and policy level change. The hardest behaviour to change however, is not that of our patients but that within medicine itself.

Dear Editor,

The leader of the World Health Organization stated on Mar 17th that he expects the organization to declare an end to the COVID-19 pandemic later this year [1]. However, a week later, three Chinese doctors published a correspondence letter to describe the situation of Chinese medical staff after the COVID-19 pandemic. The letter was soon retracted [2], once again, following the retraction of a letter requesting international assistance from two nurses at the beginning of the pandemic [3].

During the past three years of the COVID-19 pandemic, Chinese medical staff have faced unprecedented pressures, including unfulfilled medical needs, contagion risks, pandemic prevention measures, and lack of public support, as the Chinese government adhered to the “zero covid” policy. The physical exhaustion and mental health burnout resulting from this policy caused significant impairment, and Chinese medical staff experienced higher rates of burnout than medical staff in developed countries [4]. However, this issue has received little attention from the international community. Despite the language barrier confronting the authors who may be interested in knowing more [5], the difficult situation faced by Chinese medical staff is an undeniable fact. While the world has seen doctors in the UK, US, or Germany striking for their professional wellbeing, few voices have emerged from China, and it seems that these voices are being further silenced. When communication with the international community is blocked, the situation of medical staff will undoubtedly become even more challenging.

As other countries and governments start to summarize the lessons learned and move forward at the dawn of the end of the global pandemic, the Chinese government is trying to forget and erase the vestiges of the "zero covid" policy [6], which has irreversibly affected millions of people's lives. However, we must not forget the wellbeing of Chinese medical staff and ensure that it remains a critical priority, and their voice not to be silenced.

REFERENCES
1 Virtual press conference on COVID-19 & Other Global Health Emergencies 2023. Available at: https://www.who.int/publications/m/item/virtual-press-conference-on-covi... Accessed April 12, 2023.
2 Sun L, Jia H, Yang T. Chinese medical personnel after the COVID-19 pandemic. The Lancet 2023;401(10381):1000. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736 (23)00394-X/fulltext#back-bib1.
3 Zeng Y, Zhen Y. Chinese medical staff request international medical assistance in fighting against COVID-19. The Lancet Global Health 2020;0(0). doi:10.1016/S2214-109X(20)30065-6 [published Online First: 24 February 2020].
4 Zheng Q, Yang K, Zhao R-J, et al. Burnout among doctors in China through 2020: A systematic review and meta-analysis. Heliyon 2022;8(7):e09821. doi:10.1016/j.heliyon.2022.e09821 [published Online First: 28 June 2022].
5 "I really want to know what the medical staff think when the zero-covid is released"？(in Chinese) - Zhi Hu 2023. Available at: https://www.zhihu.com/question/572523606 Accessed April 12, 2023.
6 Hong N, Wang Z (2023). China Moves to Erase the Vestiges of ‘Zero Covid’ to Deter Dissent. The New York Times, 28 February 2023. Available at: https://www.nytimes.com/2023/02/28/world/asia/china-covid-lab-leak.html Accessed April 12, 2023.