Something About Good Things

Manali to Leh: A Bicycle Tour

noreply@blogger.com (Unknown) — Sun, 14 Sep 2014 07:17:00 +0000

Manali to Leh is a dream route for most cycling enthusiast.The route presents challenges of high altitude, freezing temperatures, uncertain weather, and long stretches of winding roads. Despite all these and more known difficulties when we started to plan cycling on this route, five of us fellow cyclists decided to join, all from Bhuj Bicycling Club. Me, Dr. Devanand Parmar, Shreyas Negi, Mahendra Yadav and Bhavesh Dave committed for the job. We started to prepare about 3 months before the planned date of 22nd August. Our daily training included about 20-30 km of cycle riding in early morning and about 50 km of riding on Sundays. However we later realized that no training can prepare one for the rigours of the Manali Leh route. Anyway, soon this time passed and the day of journey arrived.

Starting from Bhuj, on 19th August

We had decided to go with a support vehicle, Innova, which we hired from Bhuj. Two of the bikes were kept on roof while 3 were hanged on hatch with a bicycle carrier. Me, Mahendra Yadav and Bhavesh Dave travelled in the Innova and reached Leh on 21st August after 3 days of tiring road journey. Where Dr. Devanand and Shreyas Negi were already waiting. We started our journey on next day.

Our bikes at Hotel Beas, Manali

Starting point: Hotel Beas, Manali

Day 1(22nd August), Manali to Marhi (34km): We started from Hotel Beas, a Himachal Pradesh tourism department undertaking. We found good smooth roads of the first day, however continuous 34 km of climb was not easy.

We reached Marhi after about 6 hours of riding. The same distance would have took about 1 hour on flat roads. Marhi is a small village made up of few dhabas serving tourists.

Bhaveshbhai with our driver Hiren

Weather at Marhi changed in the evening, clouds suddenly came down at land level, visibility was zero now and rain started pouring.

Marhi weather in evening

Dr. Devanand, Shreyas Negi and Bhavesh Dave at Marhi (from left to right)

I started to have headache, which was later joined by abdominal discomfort and nausea (early signs of altitude sickness due to low oxygen at high altitude). Marhi is located at 3300m altitude. However condition improved after taking one dose of Diamox (for altitude sickness) along with a pain killer. We had my BSNL phone working at Marhi, but only from top of a small temple there, which we all used to call home one by one.

Day 2 (Marhi to Sissu, via Rohtang Pass)(50km): We started early in the morning around 6:00 am. Roads upto Rohtang pass were mixed bag, with some good roads and few bad stretches. We face 18 km of continuous climb till we reached the top.

Marhi and Marhi Nala (lower one), photograph taken from Marhi Rohtang road

Apples were our preferred food on the go. Dr. Devanand

That's me

At Rohtang Pass: Shreyas Negi, Mahendra Yadav, Dr. Devanand and Bhavesh Dave (left to right)

We ate some food at dhabas on Rohtang pass. They serve meggi, parathas, eggs and tea mainly, which was going to be the only food available at most dhabas on the way. Roads downhill from Rohtang were mostly bad, tarmac was nonexistent, however there were no rains so we were saved from mud. Downhill ride was a great fun on our mountain bikes. I was first to reach Khoksar followed by Mahendrabhai and Bhaveshbhai. I decided to wait for the remaining two while Mahendrabhai and Bhaveshbhai continued towards Sissu. After waiting for about 45 minutes I decided to move towards Sissu.

One of the short cut on downhill from Rohtang to Khoksar

From Khoksar to Sissu roads were mostly flat (or slight downhill), road condition improved and tarmac was easy to find. At Sissu we all gathered (except Mahendrabhai who was first to reach there), and started to look for Mahendrabhai who already had found a nice hotel with attached bathroom and hot water (not common on this route). Except to BSNL postpaid phones (one with me and the other with Shreyas Negi) none of our mobile phones were working which was causing communication problems by now. Even BSNL connection was not available continuously.


Mahendra Yadav relaxing at Chandra River near Sissu

Day 3 Sissu to Jispa (56km): We started to move along the Chandra river going downhill till Tandi (8km), where it meets Bhaga River to form Chandra-Bhaga (Chenab). Tandi has a army transit camp and a Petrol pump (which will not be seen till 360 km now). Roads till Tandi were real bad, narrow at few places and risky.

Road condition near Tandi

After Tandi we started to climb upwards till Jispa. I was second to reach after Mahendrabhai, and search for him started again. Dr. Devanand arrived soon to aid in the search. At this time I received call from Mahendrabhai that he had reached Darcha, one stop ahead of our destination, as he was told by some that hotels in Jispa were closed. However we were able to find luxury accommodation in Jispa at Hotel Padma. Soon other arrived followed by our support vehicle, which was sent to retrieve Mahendrabhai.

Yak as seen near Hotel Padma, Jispa

Day 4 Jispa to Zing Zing Bar (39km steady climb): We had continuous climb today till zing zing bar as we were on the way to Barlachha La. Landscape changed as we enter the Ladakh district of J&K, after darcha. Green valleys of Himachal suddenly disappeared and dry mountains raised their heads.

Today was a tough day, as we had to climb continuously. We reached our destination at around 2 pm. On the way we found beautiful Deepak Tal before Patseo. There was nice bamboo dhaba there with accommodation available, however our destination was higher and we moved on after having tea there.


Beautiful Deepak Tal

On the way to Zing Zing Bar

Famous Zing Zing Bar

Zing zing bar was nothing but collection of few dhaba at small flat place on the way to Barlachha La. However at that time it felt like heaven. We booked 3 two person semi luxury tents with attached toilet (a pit with indian style toilet), however you have to carry water buckets yourself. We were tired of eating same food at every dhaba, so we cooked Khichadi, with rice and daal we were carrying with us, using dhaba owners equipments. In evening Bhaveshbhai started to have severe headache and soon were feeling breathless. Fortunately we were carrying diamox and mini oxygen cylinder, and that helped a lot, otherwise we would have been forced to descend at lower altitude.

Day 5 Zing zing bar to Brandy bridge via Barlachha La: Today was going to be a long day as we were planning to ride about 72km, so that we can reach brandy bridge, just before the start of infamous Gata Loops. We climbed about 15km before we reached the Barlachha La. The signboard at Barlachha La was being painted and we failed to identify that and started to descend. Roads downward were mostly good with few bad stretches. We soon reached Killing Sarai where descend stopped, and almost flat, straight (or mild downhill) roads with wind support started till Sarchu.

Flat roads near Sarchu

Beautiful sand structures near Sarchu

Sand Structures near Sarchu (more such structures are near Pang)

We reached sarchu at around 12:30, and decided to take lunch there. Everyone arrived soon however Mahendrabhai was last to reach about an hour late as he had tyre burst in his hybrid bike with thin tyres ( 700 x 32c), so he had to use support vehicle to reach Sarchu.

After lunch we started again to reach brandy nala, roads were good and we had good supporting wind till half way, after which road turned and remaining cycling of the day was against wind.

There was a flat place near river at brandy bridge where we were planning to use our tents. Mahendrabhai reached there first in support vehicle and had already found a nice flat section of road for tents. Me with help of Shreyasbhai and Bhaveshbhai pitched our two tents. Mahendrabhai changed his burst tyre and then as he was not feeling well, took rest in support vehicle. Wind was very strong in the evening, which made us worry about our tents, however they survived. In the evening I found that my rear tyre was flat, so we change the tube. We were carrying portable gas stove and ready to eat pack of Dal Makhani (that required only heating for few minutes) which we ate with bread we procured from a dhaba on the way.

Shreyasbhai working on tent at brandy bridge

At that night first time in my life I saw our milky way galaxy in the night sky. I tried to take a snap of the galaxy holding camera in my hand and seating on a rock, however to my surprise I was feeling breathless in that position, as air pressure was low at that altitude and my lung were not able to expand fully while seating with hands locked in a position. View was amazing but weather outside was very cold so we moved inside the tent very soon. After some breathing difficulties I was able to fall asleep late in the night.

Day 6 Brandy bridge to Whisky Nala via Gata Loops and Nakee La: We were planning to cross Nakee La and Lachulung La and reach Pang, however day turned out to be more tough then we thought. Gata loops are infamous 21 hairpin bends that take you from 4190mts to 4630mts of height in distance of eight kms. I took about two hours to cross gata loops at my relaxed pace, taking many photographs on the way. However climb didn't end here as we still has to climb upto Nakee La. There were many shortcuts at Gata loops, I tried one but climb was too steep, and I had to walk, I felt even more tired after the shortcut and avoided taking anymore. When I looked back I found Bhaveshbhai walking on one after one shortcuts, we tried to warn him however he preferred to walk.

Few loops of the infamous Gata Loops


Upper end of the Gata Loops

After Gata loops we were climbing the hills in circumferential manner so that we were not able to see what lies after the turn. Soon I was hoping to see Nakee La after every turn, however hopes turned out to be futile too many times before I reached Nakee La. Me, Shreyas Negi and Dr. Devanand reached almost together. Mahendrabhai were few turns behind and Bhaveshbhai were no where to be seen. We started to climb down soon as staying long at high altitude was not a good idea.

Shreyasbhai and Devanandbhai at Nakee La

We started climb down, and soon reached whisky nala (downhill is short as it doesn't go as low as we climbed). After waiting for about an hour, our support vehicle became visible on the downhill route carrying two bicycle. Both Mahendrabhai and Bhaveshbhai had climbed in the vehicle. As both of them were tired and not willing to ride anymore that day, we decided to halt at whisky nala. We booked one large tent with six beds on floor. There were two toilet areas at some distance, basically open pits covered by about 4 feet tall wooden sticks and cloth curtains.

Bob and Claire Rogers with their tandem bike

We met two other cyclist travelling in opposite direction (Leh to Manali), on their tandem bike. They are travelling around the world since last 25 years. This was first time I saw a tandem bike (except circus). However it was my lucky day as two more tandem bikes with four French and German cyclists arrived later on the day, followed by a Finnish geologist having a long beard on a regular touring bicycle. So the day was like having mini conference of cyclists at whisky nala. However this cheerfulness didn't last long as Bhaveshbhai soon announced that he is abandoning the trip as he wasn't able to ride anymore, which prompted Mahendrabhai to join him, after long efforts we were not able to convince them and they decided to leave next morning in whatever vehicle they get. At the height of 4750mts, whisky nala was our highest altitude night halt till now. I was not able to sleep till 1:00 am at night, during which I had move out of tent about 3 times to make water. Every time I came back in the tent I was shivering due to cold and was not feeling comfortable even under thick blanket, which itself was feeling cold. At that time I gave up and took Alprazolam (sleeping pill), which helped me to fall asleep soon.

Day 7 Whisky Nala to Pang via lachulungla, 30km: We are only three today as Bhaveshbhai and Mahendrabhai had decided to leave the tour, and go back. This was easy day (relatively), as we had only 7.5km climb till lachulungla followed by a descend till Pang. We faced some mild snowfall on the climb, which was not bothering at all. The highlight of the day were beautiful sand structures that we saw on the way to Pang. Mountains in this region are made of sand and few rocks, that creates various shapes due to rain and wind. We spent lots of time doing photography, and took almost five hours to reach Pang, even with most of route was going downhill.

(curtsy Shreyas Negi)

Beautiful sand-structures near Pang

When we were about to reach Pang we met few other cyclists who started from Sarchu in the morning. We were literally in shock that they arrived from Sarchu to Pang in almost same time that we took in crossing just from Whisky Nala. However we later found out that they were on an organized tour, and most of them crossed Gata Loops, Nakee La and Lalchulung La sitting in their support vehicle, and started to ride only after crossing all the climbs. At Pang we stayed at guest rooms in army transit camp. After passing night in tents at Whisky, this guest room felt like heaven, as we were pampered with room heater and comfy beds. However still there was no continuous water supply and we had to do with one bucket per head that they provided.

Day 8 Pang to Debring, via Morey Plaines, 47kms: Today we had 6km of climb followed by almost flat to mild downhill roads till debring. Before we start, I found my bicycle was having flat rear wheel. So we spent about 10 minutes in changing the rear tube, I choose an old tube that was repaired at a bike shop in Manali when we arrived there. After fixing rear wheel back in place we found that that the Schrader valve of the tube was without its core (may still be resting at the bike shop), so we were not able to fill the air. After another 10 minutes we change the tube, this time with brand new one. This was second puncture in the same tyre. Finally we started around 7 am, about an hour late that usual. Weather was not good, sky was fully covered by clouds, we even found clouds at land level for a while. As soon as we completed the initial climb snowfall started, which wasn't mild this time. We took a cover in the support vehicle for few minutes, before deciding to start again.

Snowfall at the beginning of Morey plains

Morey plains is a long stretch of flat area, which is quite unusual at this altitude. Weather soon cleared and we were able to click few beautiful photographs of the nature.

Few clicks at Morey Plaines

We witnessed one accident on the road, when one bullet rider while trying to cross army trucks from left side, skid from the road margin. We stopped there and give as much first aid we could with the medicines we were carrying in the support vehicle. The rider was soon transferred to army transit camp at Pang. After about 5 and a half hour we reached debring. After staying at the whisky nala, we were not willing to pass another night in a tent, so decided to go to Tso Kar village near Tso Kar lake. The route was diversion from our plan so we climbed in support vehicle this time. This was a good decision as we found another good accommodation on this visit, in addition to the opportunity to click few more beautiful photographs. Tso kar lake has salty soil, (reminds ocean?).

At Tso Kar Lake

Salty soil at Tso Kar Lake

Tso Kar, changing weather in the evening

After the photography session in the evening, I decided to check the bikes, and guess... I had a flat tyre, in the same rear wheel. This time I was too tired of changing tubes, so decided to ride with the same punctured tube.

Day 9 Debring to Upshi via THE Tanglang La , 87 km: The night had been very cold, and we couldn't start from Tso kar before about 6:30am. We climbed in the support vehicle and reached upto Debring. Here I filled air in the rear tyre of my bike and we started what was going to be the toughest day of this tour. We had to climb about 22km till the top of the Tanglang la. Weather was chilly, we even faced snowfalls for about an hour, but we continued our climb. Road condition remained worse, and we took little more than five hours to reach the top.

Frozen water on the way to Tanglang La

The Tanglang La, A feet we all will cherish whole life.

After spending about 15minutes on the top, we started to climb down. Roads were very good on this side. Even though it was simple going downhill without much efforts, 64km was quite a distance, and we all were greatly tired when we reached Upshi. For the record I had to fill air in the rear tire for four times in about nine hour long ride. Upshi is located at the meeting point of Zanskar river with the great Indus river. We had a comfortable stay here as we were at lower altitude (comparatively), and nights were not freeze cold.

Day 10 Upshi to Leh,50km: We had a easy day, as we had almost flat roads, lower altitude, and comfortable weather. I needed to fill air only once in the way after one morning fill. We passed Thicksey monastery and Shey palace on the way.

Thicksey Monastery

Shey Palace

My rear wheel had more bad luck then I imagined. I was struck by a Maruti van driver just about 3 km before Leh. This led to bent wheel and bent luggage carrier. I had a somersault in the air but luckily no injury. This effectively ended our journey as we all climbed in the support vehicle after this.

Bent rim of the rear wheel and bent luggage carrier

End of the tour.

Few more snaps...... (click to enlarge)

THE GOD: A pathologist's view

noreply@blogger.com (Unknown) — Sun, 29 Dec 2013 18:21:00 +0000

(Disclaimer: Following article is written in one go. It may lose flow, or may become difficult to understand. This article is not copied from anywhere and it is authors own genuine thinking. If you want to publish this article or part of the article somewhere else kindly give proper credit and information to the author.)

Our body is made of cells. Cells are considered as the smallest unit of the body that can survive outside human body if it's needs are fulfilled. To give an example we can keep cells in the donated blood alive for a month, and if we can transfuse these cells to other human, the cells in donated blood will survive. Nowadays we can even culture some of the human cells outside the human body.

The soul (or atma) of a human is said to be the life force. It is immortal and unbreakable. It changes body like body change clothes. Without soul body will be dead. That means without soul all the cells of the body will die.

If we combine above two paragraphs, we can find few controversies. When we remove red blood cells from a blood donor, do we remove part of his soul? If not, how these cells can survive without soul? When to transfuse these red cells to a recipient, do we transfuse cells with part of donor's soul? How can we culture human cells ( in culture we grow human cells, from one to many), if there is no soul or life force in those cells?

Explanation:

Above problem can be explained if we consider that every cell carries it's own life force or it's own soul. Like when we combine all the cells of the body, we make one human. When we combine all the life force of all cells we make soul of human. So soul of human is made by combining souls of all the cells. So when we remove cells from a donor we are removing life force of that cells to, so these cells can survive outside human body.

If one human soul or life force can be made of multiple life forces, we may further theorise that if we combine life forces of all the living organism, we make an ultimate life force, that can be called GOD.

By this theory The God is not a single being, but is made of all the life force this world has. So when majority of do something, to bring change in the world, if becomes The God's decision.

Purnamadah Purnamidam Purnat Purnmudachyate

Purnasya Purnmaday Purnmevmashisyati.

When we remove few red cells from a donor, we are not breaking soul or life force. The life forces of all the living organisms are connected with each other in the form of the God. And despite these every single cell, whether it is a cell from human, or it is a bacteria, is complete in it's self. Everyone is complete like the God.

The cells are made of various components like proteins, lipids, carbohydrates etc. These structures outside the cells cannot be considered as living. In other words they are without life force. However all these are made of atoms. And atoms are made of protons, electrons etc. If we think about atoms there is some kind of life force or energy in them. Otherwise electrons will not rotate around the protons. So we may now say that the cell is not the smallest unit of soul. But the atoms are the smallest unit. Well I am not sure of this. We will have to consider subatomic particles too!! And we may have to consider even smaller particles yet to be discovered. Is there any limit to the smallness of a particle. NO. There are limits to what we can see or even think, but the smallest particle may be infinite small. And that infinite small particle must carry it's own life force or atma.

Take a break here.

Now we are about to conclude that smallest unit of life force or atma is some infinite small particle. This particles are common to everything. Even rocks are made of these same particles. And that means everything in this worlds carries soul. Every rock, every mountain, every planet, every star, every galaxy. And when we combine life force or energy or soul of everything, we can call it the God.

We are still missing a point. Like we have discussed earlier, there is no limit to the smallness. So the smallest unit of the life force is the life force of the infinite small particle. Likewise the biggest unit of the life force is the God. And the point here is if there is no limit to the smallness, there can not be a limit to the bigness.

Inside a cell there are atoms, where electrons move around protons in the nucleus. When we combine cells we make a human or animal or some organism. Inside the universe there are galaxies where stars and planets rotate around some other stars. Here we are comparing a cell with the universe. Can we think universe as one unit of something much bigger, we are yet to discover. So that when we combine multiple universes we make some kind of living organism we are yet to discover.

In conclusion there are no limit to the smallness, or bigness. But still every unit is complete in it's self. All these units of life force they are connected with each other, very intimately then we can think of.

Purnamadah Purnamidam Purnat Purnmudachyate

Purnasya Purnmaday Purnmevmashisyati.

Bio disc party trick, How?

noreply@blogger.com (Unknown) — Wed, 06 Mar 2013 04:41:00 +0000

Click here to know
Just click above to check few videos about how the finger lifting party trick demonstrated by Bio disc salesman works.

GMC guidelines regarding Continuing Medical Education and Credit Hours

noreply@blogger.com (Unknown) — Sun, 06 Jan 2013 11:00:00 +0000

GUJARAT MEDICAL COUNCIL

CONTINUINGMEDICAL EDUCATION IN MODERN MEDICINE IN THE STATE OF GUJARAT

1. PREAMBLE

Medical Science is dynamic and it is essential for the doctor to become acquainted with the advances in medicine. This is in essence the concept of Continuing Medical Education (CME). Tremendous advances are taking place in the field of medical sciences, continuously changing the concept, approach to management and the outcome of several diseases. The rapid pace of these advances makes it mandatory for doctors to keep themselves updated so that they may apply this information to their practice & thus fortify his/her competence and knowledge by keeping abreast with the latest developments in the field.

The changing demographic profile of our country is also accompanied by changing disease patterns, education profile and health awareness. This has resulted in substantial increase in expenditure on health by individuals and also by Government. While the doctors to population ratio has been steadily improving due to the exponential growth of Medical Institutions, the rapid pace of technological and scientific advances, and the looming threat of new disease clearly mandate a system of continuing medical education to keep the medical personnel current in terms of knowledge and skills, thereby enhancing Medial Education and health care system to a global model.

Hence Continuing Medical Education is felt need to update the knowledge of all doctors. Imparting new knowledge and skills in medicine to the professional in a systematic manner is possible only through Continuing Medical Education Programme.

2. DURATION OF CONTINUNING MEDICAL EDUCATION PROGRAMME :

Gujarat Medical Council will give Credit hours to the registered Medical Practitioners as per the guidelines which is in existence at specific time. Any changes will be intimated to the members in due time.

A Physician should participate in professional meetings as part of Continuing Medical Education Programs and should earn 30 hours per year or 150 credit hours for every 5 years.

3. ORGANISATIONS / ACADEMIC ACTIVITES TO BE ACCREDITED FOR CME

To regulate and standardize the CMEs and also to avoid exploitation by non-accredited agencies, it is decided that the CMEs organized/sponsored/funded by the following organizations/institutions are approved by the Gujarat Medical Council for CME accreditation.

International Conference of Registered Professional bodies / Associations.
National Conference of Registered Professional bodies / Associations.
State Conference of Registered Professional bodies / Associations.
National, State, District & City level Scientific Programmes organized by Professional bodies / Associations.

( For No. 1 to 4 Qualification being approved by Medical Council & mentioned in the MCI Schedule)

National, State, District & City level Scientific programmes organized by Indian Medical Association & its Academic Wings.
CME / Workshop / training propgramme conducted by all Government & Private Medical Colleges.
All the Directors working under Department of Health & Medical Services, Govt. of Gujarat
Central Government & State Governments Hospitals (including Districts Hospitals) and training centres in health field including Ministry of Health and FW, Defense, Railways.
Multi-specialty Hospitals with accreditation and presently conducting Dip NB course. A copy of the order approving Dip NB course should be produced along with the application for accreditation of CME.
Government /U.G.C. recognized University.
Any other approved organization/association at the discretion of the Gujarat Medical Council.

04. GUIDELINES FOR CME ACCREDITATION

1. The power to award Accreditation / Credit hours will be the sole discretion of the Gujarat Medical Council.

2. The Credit hours will be awarded by Gujarat Medical Council depending upon the subject matter, status of the speaker, quality of the papers to be presented in the CME / Conference.

3. Any Associations/Organization/Institute want to hold CME, should apply for accreditation to the Gujarat Medical Council. The council after verifying the credentials of the organization will give certificate of accreditation.

4. The Association / Organization /All Govt. Medical Colleges/ Govt. Hospitals/ Organizing Secretary will apply to the Gujarat Medical Council on a stipulated Application Form. The application should be accompanied by the names & designation of the speakers along with their subject of speech, & the duration of the talk.

5. The organization like IMA/ Professional bodies holding regular monthly meeting will issue a CME Credit certificate at the end of every year to its members specifically stating how many credit hours were acquired by each members for that year. These certificates will be issued on the prescribed proforma approved by the Gujarat Medical Council.

6. Accredited bodies like IMA / Professional bodies which hold regular CME’s will have to inform the Gujarat Medical Council, the date of the CME, at least 15 days in advance, so that the Gujarat Medical Council can send the observer to the CME meeting.

7. Ordinarily the duration of CME should be more than 2 hours.

8. Minimum one credit hour will be granted to each CME of minimum two hours.

9. Association / organization should strictly issue the certificate to the delegate who has attended the CME. The certificate should be distributed only on the last day.

10. Associations / organizations will be duty bound to send the feedback of the delegates and the list of the delegates who have attended the CME / Conference. A separate list of the delegates belonging to state of Gujarat and delegates of the other states be submitted to the Gujarat Medical Council.

11. In case it is found that the certificate is false, than the issuing Association / Organization will be debarred for future accreditation.

12. Postgraduate diploma/certificate courses will be given credit hours in case the diploma/certificate issuing institute has awarded the credit hours and credit hours have been mentioned in the certificate of such diploma/certificate.

Gujarat Medical Council may depute one representative to attend the

CME’s as an observer and will be given certificate of attendance.

The observer deputed by Gujarat Medical Council will be treated as “Invited Registered Faculty”.

14. The list of the delegates who have attended the CME should be sent from the organizing secretary of the CME/Conference along a CD of the CME.

15. After the programme, a short report of the programme, with the exact time schedule of speeches and a list of participants who have attended the same with the mention of their Gujarat Medical Council registration number and their signature should reach the Registrar, Gujarat Medical Council within ten days. A specimen copy of the certificate issued by the Organizers should also be enclosed. The Organizing Secretary will be responsible for the authenticity of the data which will be counter-checked at the time of renewal of registration.

Credit hours to the CME/State/National/International Conference/Workshop organized will be credited on the basis of the quality of subject matter and the

status of the speakers delivering the lecture during the CME.

1. For each CME/State/National/International Conference/ Workshop will be awarded minimum credit hours as per the schedule of the conference.

Two hours CME 1 credit hours

Half day CME 2 credit hours

One day conference 4 credit hours

Two day conference 8 credit hours

Three day conference 12 credit hours

(In any one Scientific Programme, maximum 12 credit hours will be granted)

Doctors claiming the credit hours will be required to submit the Certificate of attendance.

2. The doctors may attend the International C.M.E.’s/Conference held overseas as delegate. On the production of the certificates of attendance, CME credit hours will be given on the same pattern as for National Conference.

3. Doctors working as medical teachers can claim 4 C.M.E. credit hours per year on production of certificate from their head of institution that they are taking under graduate/postgraduate classes and are engaged in post graduate research work in the institute.

4. Doctors doing post-Graduate course e.g. Diploma MD, MS, DNB, MCh., D.M., Fellowships/Diploma & Degree Courses approved by State Government & State Council etc. from recognized /reputed institutions in India or abroad will get 4 credit hour per year for the duration & the courses e.g. one year (4 credit hour) two year 4 credit hours, Three year 4 Credit hours as so as.

5. Any paper published in indexed state/national/international journal will entitle the author/co-author CME credit hours.

6. Any chapter published in a text book or update book published by professional bodies will entitle the author/co-authors for credit hours.

7. Speakers/Chairman/Co-chairman at any conference/CME/Workshop / training programme will be given one credit hour per talk in addition to the credit hours allotted for that particular academic activity.

8. Subscription of the indexed national/international journal will entitle the doctors to five (5) CME credit hours per year for each journal subject to a maximum of ten (10) hours per year. Member of professional bodies who receive journal as a part of their membership should give proof of membership of the professional bodies.

9. Paper presentation (Oral Poster) in International Conferences will be awarded 3 Credit hours, & in National Conferences will be awarded 2 Credit hours.

10. Doctors working in Govt. Sector/Private Sector undergoing refresher courses from time to time can claim credit hours on the recommendation of the head of institute ( in case of smaller units it will be immediate higher authorities ) as per the norms mention in clause 1.

11. Guidelines for issuing credit hours for Published Medical text book / Chapter in text book / Research Papers in International & National Index Medical Journals.

12. Satellite Scientific Programmes will also be accredited on a similar guidelines.

13. Credit hours given by Medscape – on online scientific accredited site will be approved by Gujarat Medical Council.

Sr. No.	Publication of Medical Text Book	Credit Hours
01.	Author/Editor of Published Medical Text Book	16 Hours
02.	Author of Chapter published in Medical Text Book	4 Hours

Sr. No.	Papers Published in International Index Journals	Credit Hours
01.	Original Article	12 Hours
02.	Case Report	6 Hours
03.	Letter to Editor	3 Hours

Sr. No.	Papers Published in National Index Journals	Credit Hours
01.	Original Article	8 Hours
02.	Case Report	4 Hours
03.	Letter to Editor	2 Hours

Sr. No.	Papers Published in State Index Journals	Credit Hours
01.	Original Article	4 Hours
02.	Case Report	2 Hours
03.	Letter to Editor	1 Hours

05. Continued Medical Education (CME) which will not be accredited.

1. The CME organized by a drug/equipment company for promotion of the drug / equipment will not be considered.

2. CME organized by the individual Nursing Homes/Hospitals/Persons for marketing purpose shall not be credited.

3. CME organized for self promotion/advertisement will not be credited.

4 CME/Conference organized by the G.M.C approved accredited Association/Professional body where the title of the programme is given on the name of the sponsors.

06. Implementation of Accreditation Programme In Modern Medicine In The State Of Gujarat.

Gujarat Medical Council will start implementation of Accreditation programme in modern medicine in the State of Gujarat from 1^st January 2012.

1. Organizations / Institutions competent to conduct Continuing Medical Education Progamme have to apply with in stipulated time to the Gujarat Medical Council in the prescribed form with necessary fees as decided by the council from time to time.

For Local programmes - 15 days

For State Programmes - 01 months

For National / International Programes - 03 months

2. A Monitoring committee for accreditation should be formed.

There should be three members. The members may be a present or past counc il members but the Chairman of the Committee must be from the present Council. Every year one member retires by rotation. He can be renominated. The tenure of the first committee should be of three years.

The committee with approval of the council will look after all the matters related to accreditation.

3. The organization like IMA / Professional bodies holding regular monthly meeting will issue a CME Credit Certificate at the end of every year to its members specifically stating how many credit hours were acquired by each member for that particular year. These certificates will be issued on the prescribed proforma approved by the Gujarat Medical Council.

The local Secretary has to maintain the passbook. This passbook shall be kept under Safe Custody. It is the responsibility of the doctor and organizing secretary of the CME to keep this passbook up-to-date.

PASS BOOK

Sr. No.	Date	Progamme Name / Venue	No. of Credit Hours	Signature of Organizing Secretary of CME

4. FEE STRUCTURE

The council will collect the fees as decided by time to time as processing charges for Accreditation. BY DEMAND DRAFT IN FAVOUR OF “REGISTRAR, GUJARAT MEDICAL COUNCIL” PAYABLE AT AHMEDABAD. (Nationalised Bank only)

	First Year	Renewal
Local IMA / Professional Branch	Rs. 2,000/-	Rs. 1,000/-
State IMA / Professional Branch	Rs. 5,000/-	Rs. 2,000/-
Govt. Medical College	Rs. 2,000/-	Rs. 1,000/-
Self Finance Medical College	Rs. 5,000/-	Rs. 2,000/-
Multi specialty Hospital with accreditation	Rs. 5,000/-	Rs. 2,000/-
Govt. Institutes & Depts.	Rs. 2,000/-	Rs. 1,000/-
Central & State Govt. Hospitals	Rs. 2,000/-	Rs. 1,000/-

Gujarat Medical Council has discriminatory power to wave off the prescribed processing charges for accreditation.

Additional fees to be collected if Institution / Association organizes International, National or State Conference / Seminar / Workshop etc.

State Conference Rs. 2,000/-

National Conference Seminar / Work Rs. 5,000/-

International Conference Rs. 10,000/-

5. The member registered with Gujarat Medical Council and completed 60 years of age will be exempted from obtaining the necessary credit hours.

6. Gujarat Medical Council will periodically review the norms and may updates them in the interest of patients and Doctors at large.

New Way to Look at Tissue Biopsies: Spatial Light Interference Microscopy

noreply@blogger.com (Unknown) — Sat, 10 Mar 2012 03:14:00 +0000

Pathologists would gain new tool to diagnose cancer faster and more accurately, based upon stain-free analysis of tissue
Reading tissue biopsies with a new stain-free method could eventually help pathologists achieve faster and less subjective cancer detection. Should this technology prove viable, it would also displace many of the longstanding tissue preparation methodologies used today in the histopathology laboratory.
Credit a research team from the Beckman Institute at the University of Illinois (UI) Christie Clinic and at the UI campuses in Urbana and Chicago, with developing this new technology.
They call the technique Spatial Light Interference Microscopy (SLIM). According to a story reported by Futurity.org, the technique uses two beams of light.
New Technology Could Help Pathologists Detect Cancer Earlier
In the Proceedings of the National Academy of Sciences, the scientists stated the new technology offers answers to some of the most elusive questions in contemporary biology: how cell growth is regulated and how cell size distributions are maintained. “SLIM can be so valuable for greatly improving the chances of early detection and treatment of cancer,” declared study leader Gabriel Popescu, Ph.D., Quantitative Light Imaging Laboratory, Department of Electrical and Computer Engineering at the Beckman Institute.
The reason for Popescu’s optimism is SLIM’s capabilities using optical interferometry, or interference patterns, to make accurate measurements of waves at the molecular level. This enables the technique to work with great sensitivity.

Shown above are multi-modal images of prostate biopsy slides of a 5+4 Gleason grade, or high grade tumor. The top row of images are done with standard histological staining. The bottom row of images are done with the stain-free Spatial Light Interference Microscopy (SLIM). (Credit: Shamira Sridharan of www.Futurity.org)

According to Mustafa Mir, a graduate student in Electrical Engineering and a first author of the project paper, SLIM is capable of measuring mass with a sensitivity of one femtogram, or one thousandth of the mass of a cubic micron of water.
“What that means is that only a small number of molecules arranged in a certain way are enough to give us the optical signal that something is going to happen here,” Popescu explained.
The technology works through a combination of phase-contrast microscopy and holography. It does not need staining or any other special preparation of the tissue to be analyzed. It is also completely non-invasive. This means that scientists can visualize nanoscale structures quantitatively and study ongoing cell function in situ.
“Ideally, we would like to detect cancer at the single-cell level,” Popescu stated. This would enable scientists to find a cell that looks abnormal early on, allowing treatment where the process is still reversible. “We know that the disease starts at the nanoscale, at the molecular level, and we think we have the proper tool to catch these early events,” he added.
With Current Staining Method, Pathologists Disagree 20% of the Time
SLIM offers revolutionary advantages over current staining technology. Its optical maps report morphological properties of tissues and cells that cannot be recovered by common stains, including hematoxylin and eosin, Futurity reported. This provides objective evaluations of structural data such as tumor margins that can be difficult for pathologists to assess with current methodologies.
“A significant advantage over existing methods is that we can measure all types of cells… while maintaining the sensitivity and the quantitative information that we get,” Mir stated in a story by MedGadget.
According to Popescu, use of SLIM technology, along with a fluorescent reporter, could have broader implications in understanding the effects of cancer treatments and other forms of therapy on the fundamental process of cell growth. “By using [the combined technologies], we were also able to differentiate how the cells regulate their growth in different stages of their lifecycle,” he stated.
“We think that the most important advantage of SLIM is that it provides quantitative, objective information,” Popescu observed in Futurity. “Right now, in the clinic, the diagnosis is subjective; it’s a human that does it. There are studies showing that two pathologists agree on a diagnosis only four out of five times.”
Popescu described the ability to actually predict information about the outcome of the patient as the Holy Grail of the research. As an example, he noted SLIM’s potential to help determine the likelihood of recurrence following surgery. “This, right now, is actually a 50/50 guess,” he observed.
According to Popescu, SLIM’s highly automatic procedure, together with the low cost and high-speed associated with the absence of staining, could make “a significant impact in pathology at a global scale.”
Of course, it will take years before tissue analysis solutions incorporating Spatial Light Interference Microscopy (SLIM) are ready for daily use by anatomic pathologists. Yet, it is the pipeline of transformative technologies like that which promise to give Clinical laboratory professionals new capabilities to diagnose disease more accurately and earlier. In turn, this improves the value that laboratory medicine brings to physicians, patients, and payers.

—Pamela Scherer McLeod

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Pathology Labs Replace Microscopes with Digital Imaging

noreply@blogger.com (Unknown) — Sun, 08 Jan 2012 07:45:00 +0000

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Non-US deployment of Aperio platform with image storage on a Hitachi platform. 400,000 glass slides annually at a rate of 300 TB of storage per year. Very cool. Look for more adoption overseas this year.

Microscopes are being replaced with digital imaging in pathology laboratories in the southern part of Sweden.

Traditional microscope glass slides are turned into digital images, which are then analyzed by pathologists directly from the computer screen, instead of using regular microscopes.

The revolution, which has already occurred in radiology, is now taking place in pathology. The contracted delivery not only digitizes the slides but also will completely renew IT support for all workflows of the pathology laboratories in the Skåne region.

Labvantage (Somerset, NJ, USA) will deliver a USD 4 million turnkey solution for digitizing the histopathological workflows in the whole region. The system will be possibly the largest such installation in the world and among the first of its kind in northern Europe. The digital slides will reside in Hitachi’s (Tokyo, Japan) Content Platform, which employs distributed object storage. All of the images will be kept well protected and duplicated across several physical discs. This makes the traditional backing up of data unnecessary.

Currently the four pathology laboratories run by Region Skåne produce about 400,000 histological microscope slides a year. The samples are prepared into microscope slides and are then physically distributed to pathologists. Slides are then analyzed using regular microscopes. There is currently limited IT support for the workflow, making it difficult to track the status of pending cases and to identify the bottlenecks in the production workflow.

The difficulties in this method are mostly related to physical slides, which can only reside–and be analyzed–in one place at a time. With the digital pathology in place, all pathologists from all laboratories of Skåne can gain access to all cases and related slides. Together with the introduction of digital pathology, another goal of Region Skåne is to introduce so-called LEAN workflows.

The digitizing will not only ease the distribution of slides for the pathologists’ viewing but will also solve the needs for storage. Swedish law requires Region Skåne to keep all slides for a minimum of 20 years, and today this requires a lot of physical space. It is also difficult to retrieve a particular case from the archive. In the digitized format, the annual production of about 400,000 glass slides will consume 300 terabytes of storage each year.

The unique changeover both in its scope and in scale is to be supplied by Software Point. A key component in the delivery is a new workflow management system, which will manage both the preanalytical and analytical stages of the laboratory process. An adapted version of Software Point’s (Espoo, Finland) C5 LIMS will be in total charge of managing the workflows and tracking all events within. It will maintain a real-time status of each sample, slide, and case, and will ease the work of both laboratory technicians and pathologists with advanced functionalities such as integration to laboratory automation, datamatrix labeling of all objects, and speech recognition for pathologists.

"This is an important milestone for us. Our workflow-centric C5 LIMS, complemented with the best of breed systems from Aperio (Vista, CA, USA) and Hitachi, make up a solution unlike anything else on the market. We see tremendous potential in digital pathology and this is one key element in our strategy for further expanding the position of our LIMS in the healthcare marketplace," comments Andrea Holmberg, CEO of Software Point.

Related Links:
Labvantage
Software Point
Aperio

INTERESTING ARTICLES: Damjibhai Anchorwala: Switching to Success

noreply@blogger.com (Unknown) — Thu, 03 Nov 2011 12:05:00 +0000

INTERESTING ARTICLES: Damjibhai Anchorwala: Switching to Success: Damjibhai Anchorwala may have dropped his entrepreneurial anchors by selling his Anchor Electricals Company to Panasonic, this Kutchi, in...

Do Doctor's need coach? MUST READ

noreply@blogger.com (Unknown) — Wed, 28 Sep 2011 14:06:00 +0000

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ANNALS OF MEDICINE

PERSONAL BEST

Top athletes and singers have coaches. Should you?

by Atul GawandeOCTOBER 3, 2011

No matter how well trained people are, few can sustain their best performance on their own. That’s where coaching comes in.

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KEYWORDS: Coaches;; Surgeons;; Teachers;; Education;; Tennis;; Atul Gawande;; Robert Osteen

I’ve been a surgeon for eight years. For the past couple of them, my performance in the operating room has reached a plateau. I’d like to think it’s a good thing—I’ve arrived at my professional peak. But mainly it seems as if I’ve just stopped getting better.

During the first two or three years in practice, your skills seem to improve almost daily. It’s not about hand-eye coördination—you have that down halfway through your residency. As one of my professors once explained, doing surgery is no more physically difficult than writing in cursive. Surgical mastery is about familiarity and judgment. You learn the problems that can occur during a particular procedure or with a particular condition, and you learn how to either prevent or respond to those problems.

Say you’ve got a patient who needs surgery for appendicitis. These days, surgeons will typically do a laparoscopic appendectomy. You slide a small camera—a laparoscope—into the abdomen through a quarter-inch incision near the belly button, insert a long grasper through an incision beneath the waistline, and push a device for stapling and cutting through an incision in the left lower abdomen. Use the grasper to pick up the finger-size appendix, fire the stapler across its base and across the vessels feeding it, drop the severed organ into a plastic bag, and pull it out. Close up, and you’re done. That’s how you like it to go, anyway. But often it doesn’t.

Even before you start, you need to make some judgments. Unusual anatomy, severe obesity, or internal scars from previous abdominal surgery could make it difficult to get the camera in safely; you don’t want to poke it into a loop of intestine. You have to decide which camera-insertion method to use—there’s a range of options—or whether to abandon the high-tech approach and do the operation the traditional way, with a wide-open incision that lets you see everything directly. If you do get your camera and instruments inside, you may have trouble grasping the appendix. Infection turns it into a fat, bloody, inflamed worm that sticks to everything around it—bowel, blood vessels, an ovary, the pelvic sidewall—and to free it you have to choose from a variety of tools and techniques. You can use a long cotton-tipped instrument to try to push the surrounding attachments away. You can use electrocautery, a hook, a pair of scissors, a sharp-tip dissector, a blunt-tip dissector, a right-angle dissector, or a suction device. You can adjust the operating table so that the patient’s head is down and his feet are up, allowing gravity to pull the viscera in the right direction. Or you can just grab whatever part of the appendix is visible and pull really hard.

Once you have the little organ in view, you may find that appendicitis was the wrong diagnosis. It might be a tumor of the appendix, Crohn’s disease, or an ovarian condition that happened to have inflamed the nearby appendix. Then you’d have to decide whether you need additional equipment or personnel—maybe it’s time to enlist another surgeon.

Over time, you learn how to head off problems, and, when you can’t, you arrive at solutions with less fumbling and more assurance. After eight years, I’ve performed more than two thousand operations. Three-quarters have involved my specialty, endocrine surgery—surgery for endocrine organs such as the thyroid, the parathyroid, and the adrenal glands. The rest have involved everything from simple biopsies to colon cancer. For my specialized cases, I’ve come to know most of the serious difficulties that could arise, and have worked out solutions. For the others, I’ve gained confidence in my ability to handle a wide range of situations, and to improvise when necessary.

As I went along, I compared my results against national data, and I began beating the averages. My rates of complications moved steadily lower and lower. And then, a couple of years ago, they didn’t. It started to seem that the only direction things could go from here was the wrong one.

Maybe this is what happens when you turn forty-five. Surgery is, at least, a relatively late-peaking career. It’s not like mathematics or baseball or pop music, where your best work is often behind you by the time you’re thirty. Jobs that involve the complexities of people or nature seem to take the longest to master: the average age at which S. & P. 500 chief executive officers are hired is fifty-two, and the age of maximum productivity for geologists, one study estimated, is around fifty-four. Surgeons apparently fall somewhere between the extremes, requiring both physical stamina and the judgment that comes with experience. Apparently, I’d arrived at that middle point.

It wouldn’t have been the first time I’d hit a plateau. I grew up in Ohio, and when I was in high school I hoped to become a serious tennis player. But I peaked at seventeen. That was the year that Danny Trevas and I climbed to the top tier for doubles in the Ohio Valley. I qualified to play singles in a couple of national tournaments, only to be smothered in the first round both times. The kids at that level were playing a different game than I was. At Stanford, where I went to college, the tennis team ranked No. 1 in the nation, and I had no chance of being picked. That meant spending the past twenty-five years trying to slow the steady decline of my game.

I still love getting out on the court on a warm summer day, swinging a racquet strung to fifty-six pounds of tension at a two-ounce felt-covered sphere, and trying for those increasingly elusive moments when my racquet feels like an extension of my arm, and my legs are putting me exactly where the ball is going to be. But I came to accept that I’d never be remotely as good as I was when I was seventeen. In the hope of not losing my game altogether, I play when I can. I often bring my racquet on trips, for instance, and look for time to squeeze in a match.

One July day a couple of years ago, when I was at a medical meeting in Nantucket, I had an afternoon free and went looking for someone to hit with. I found a local tennis club and asked if there was anyone who wanted to play. There wasn’t. I saw that there was a ball machine, and I asked the club pro if I could use it to practice ground strokes. He told me that it was for members only. But I could pay for a lesson and hit with him.

He was in his early twenties, a recent graduate who’d played on his college team. We hit back and forth for a while. He went easy on me at first, and then started running me around. I served a few points, and the tennis coach in him came out. You know, he said, you could get more power from your serve.

I was dubious. My serve had always been the best part of my game. But I listened. He had me pay attention to my feet as I served, and I gradually recognized that my legs weren’t really underneath me when I swung my racquet up into the air. My right leg dragged a few inches behind my body, reducing my power. With a few minutes of tinkering, he’d added at least ten miles an hour to my serve. I was serving harder than I ever had in my life.

Not long afterward, I watched Rafael Nadal play a tournament match on the Tennis Channel. The camera flashed to his coach, and the obvious struck me as interesting: even Rafael Nadal has a coach. Nearly every élite tennis player in the world does. Professional athletes use coaches to make sure they are as good as they can be.

But doctors don’t. I’d paid to have a kid just out of college look at my serve. So why did I find it inconceivable to pay someone to come into my operating room and coach me on my surgical technique?

What we think of as coaching was, sports historians say, a distinctly American development. During the nineteenth century, Britain had the more avid sporting culture; its leisure classes went in for games like cricket, golf, and soccer. But the aristocratic origins produced an ethos of amateurism: you didn’t want to seem to be trying too hard. For the Brits, coaching, even practicing, was, well, unsporting. In America, a more competitive and entrepreneurial spirit took hold. In 1875, Harvard and Yale played one of the nation’s first American-rules football games. Yale soon employed a head coach for the team, the legendary Walter Camp. He established position coaches for individual player development, maintained detailed performance records for each player, and pre-planned every game. Harvard preferred the British approach to sports. In those first three decades, it beat Yale only four times.

The concept of a coach is slippery. Coaches are not teachers, but they teach. They’re not your boss—in professional tennis, golf, and skating, the athlete hires and fires the coach—but they can be bossy. They don’t even have to be good at the sport. The famous Olympic gymnastics coach Bela Karolyi couldn’t do a split if his life depended on it. Mainly, they observe, they judge, and they guide.

Coaches are like editors, another slippery invention. Consider Maxwell Perkins, the great Scribner’s editor, who found, nurtured, and published such writers as F. Scott Fitzgerald, Ernest Hemingway, and Thomas Wolfe. “Perkins has the intangible faculty of giving you confidence in yourself and the book you are writing,” one of his writers said in a New Yorker Profile from 1944. “He never tells you what to do,” another writer said. “Instead, he suggests to you, in an extraordinarily inarticulate fashion, what you want to do yourself.”

The coaching model is different from the traditional conception of pedagogy, where there’s a presumption that, after a certain point, the student no longer needs instruction. You graduate. You’re done. You can go the rest of the way yourself. This is how élite musicians are taught. Barbara Lourie Sand’s book “Teaching Genius” describes the methods of the legendary Juilliard violin instructor Dorothy DeLay. DeLay was a Perkins-like figure who trained an amazing roster of late-twentieth-century virtuosos, including Itzhak Perlman, Nigel Kennedy, Midori, and Sarah Chang. They came to the Juilliard School at a young age—usually after they’d demonstrated talent but reached the limits of what local teachers could offer. They studied with DeLay for a number of years, and then they graduated, launched like ships leaving drydock. She saw her role as preparing them to make their way without her.

Itzhak Perlman, for instance, arrived at Juilliard, in 1959, at the age of thirteen, and studied there for eight years, working with both DeLay and Ivan Galamian, another revered instructor. Among the key things he learned were discipline, a broad repertoire, and the exigencies of technique. “All DeLay’s students, big or little, have to do their scales, their arpeggios, their études, their Bach, their concertos, and so on,” Sand writes. “By the time they reach their teens, they are expected to be practicing a minimum of five hours a day.” DeLay also taught them to try new and difficult things, to perform without fear. She expanded their sense of possibility. Perlman, disabled by polio, couldn’t play the violin standing, and DeLay was one of the few who were convinced that he could have a concert career. DeLay was, her biographer observed, “basically in the business of teaching her pupils how to think, and to trust their ability to do so effectively.” Musical expertise meant not needing to be coached.

Doctors understand expertise in the same way. Knowledge of disease and the science of treatment are always evolving. We have to keep developing our capabilities and avoid falling behind. So the training inculcates an ethic of perfectionism. Expertise is thought to be not a static condition but one that doctors must build and sustain for themselves.

Coaching in pro sports proceeds from a starkly different premise: it considers the teaching model naïve about our human capacity for self-perfection. It holds that, no matter how well prepared people are in their formative years, few can achieve and maintain their best performance on their own. One of these views, it seemed to me, had to be wrong. So I called Itzhak Perlman to find out what he thought.

I asked him why concert violinists didn’t have coaches, the way top athletes did. He said that he didn’t know, but that it had always seemed a mistake to him. He had enjoyed the services of a coach all along.

He had a coach? “I was very, very lucky,” Perlman said. His wife, Toby, whom he’d known at Juilliard, was a concert-level violinist, and he’d relied on her for the past forty years. “The great challenge in performing is listening to yourself,” he said. “Your physicality, the sensation that you have as you play the violin, interferes with your accuracy of listening.” What violinists perceive is often quite different from what audiences perceive.

“My wife always says that I don’t really know how I play,” he told me. “She is an extra ear.” She’d tell him if a passage was too fast or too tight or too mechanical—if there was something that needed fixing. Sometimes she has had to puzzle out what might be wrong, asking another expert to describe what she heard as he played.

Her ear provided external judgment. “She is very tough, and that’s what I like about it,” Perlman says. He doesn’t always trust his response when he listens to recordings of his performances. He might think something sounds awful, and then realize he was mistaken: “There is a variation in the ability to listen, as well, I’ve found.” He didn’t know if other instrumentalists relied on coaching, but he suspected that many find help like he did. Vocalists, he pointed out, employ voice coaches throughout their careers.

The professional singers I spoke to describe their coaches in nearly identical terms. “We refer to them as our ‘outside ears,’ ” the great soprano Renée Fleming told me. “The voice is so mysterious and fragile. It’s mostly involuntary muscles that fuel the instrument. What we hear as we are singing is not what the audience hears.” When she’s preparing for a concert, she practices with her vocal coach for ninety minutes or so several times a week. “Our voices are very limited in the amount of time we can use them,” she explains. After they’ve put in the hours to attain professional status, she said, singers have about twenty or thirty years to achieve something near their best, and then to sustain that level. For Fleming, “outside ears” have been invaluable at every point.

So outside ears, and eyes, are important for concert-calibre musicians and Olympic-level athletes. What about regular professionals, who just want to do what they do as well as they can? I talked to Jim Knight about this. He is the director of the Kansas Coaching Project, at the University of Kansas. He teaches coaching—for schoolteachers. For decades, research has confirmed that the big factor in determining how much students learn is not class size or the extent of standardized testing but the quality of their teachers. Policymakers have pushed mostly carrot-and-stick remedies: firing underperforming teachers, giving merit pay to high performers, penalizing schools with poor student test scores. People like Jim Knight think we should push coaching.

California researchers in the early nineteen-eighties conducted a five-year study of teacher-skill development in eighty schools, and noticed something interesting. Workshops led teachers to use new skills in the classroom only ten per cent of the time. Even when a practice session with demonstrations and personal feedback was added, fewer than twenty per cent made the change. But when coaching was introduced—when a colleague watched them try the new skills in their own classroom and provided suggestions—adoption rates passed ninety per cent. A spate of small randomized trials confirmed the effect. Coached teachers were more effective, and their students did better on tests.

Knight experienced it himself. Two decades ago, he was trying to teach writing to students at a community college in Toronto, and floundering. He studied techniques for teaching students how to write coherent sentences and organize their paragraphs. But he didn’t get anywhere until a colleague came into the classroom and coached him through the changes he was trying to make. He won an award for innovation in teaching, and eventually wrote a Ph.D. dissertation at the University of Kansas on measures to improve pedagogy. Then he got funding to train coaches for every school in Topeka, and he has been expanding his program ever since. Coaching programs have now spread to hundreds of school districts across the country.

There have been encouraging early results, but the data haven’t yet been analyzed on a large scale. One thing that seems clear, though, is that not all coaches are effective. I asked Knight to show me what makes for good coaching.

We met early one May morning at Leslie H. Walton Middle School, in Albemarle County, Virginia. In 2009, the Albemarle County public schools created an instructional-coaching program, based in part on Knight’s methods. It recruited twenty-four teacher coaches for the twenty-seven schools in the semi-rural district. (Charlottesville is the county seat, but it runs a separate school district.) Many teacher-coaching programs concentrate on newer teachers, and this one is no exception. All teachers in their first two years are required to accept a coach, but the program also offers coaching to any teacher who wants it.

Not everyone has. Researchers from the University of Virginia found that many teachers see no need for coaching. Others hate the idea of being observed in the classroom, or fear that using a coach makes them look incompetent, or are convinced, despite assurances, that the coaches are reporting their evaluations to the principal. And some are skeptical that the school’s particular coaches would be of any use.

To find its coaches, the program took applications from any teachers in the system who were willing to cross over to the back of the classroom for a couple of years and teach colleagues instead of students. They were selected for their skills with people, and they studied the methods developed by Knight and others. But they did not necessarily have any special expertise in a content area, like math or science. The coaches assigned to Walton Middle School were John Hobson, a bushy-bearded high-school history teacher who was just thirty-three years old when he started but had been a successful baseball and tennis coach, and Diane Harding, a teacher who had two decades of experience but had spent the previous seven years out of the classroom, serving as a technology specialist.

Nonetheless, many veteran teachers—including some of the best—signed up to let the outsiders in. Jennie Critzer, an eighth-grade math teacher, was one of those teachers, and we descended on her first-period algebra class as a small troupe—Jim Knight, me, and both coaches. (The school seemed eager to have me see what both do.)

After the students found their seats—some had to search a little, because Critzer had scrambled the assigned seating, as she often does, to “keep things fresh”—she got to work. She had been a math teacher at Walton Middle School for ten years. She taught three ninety-minute classes a day with anywhere from twenty to thirty students. And she had every class structured down to the minute.

Today, she said, they would be learning how to simplify radicals. She had already put a “Do Now” problem on the whiteboard: “Simplify √36 and √32.” She gave the kids three minutes to get as far as they could, and walked the rows of desks with a white egg timer in her hand as the students went at it. With her blond pigtails, purple striped sack dress, flip-flops, and painted toenails, each a different color, she looked like a graduate student headed to a beach party. But she carried herself with an air of easy command. The timer sounded.

For thirty seconds, she had the students compare their results with those of the partner next to them. Then she called on a student at random for the first problem, the simplified form of √36. “Six,” the girl said.

“Stand up if you got six,” Critzer said. Everyone stood up.

She turned to the harder problem of simplifying √32. No one got the answer, 4 √2. It was a middle-level algebra class; the kids didn’t have a lot of confidence when it came to math. Yet her job was to hold their attention and get them to grasp and apply three highly abstract concepts—the concepts of radicals, of perfect squares, and of factoring. In the course of one class, she did just that.

She set a clear goal, announcing that by the end of class the students would know how to write numbers like √32 in a simplified form without using a decimal or a fraction. Then she broke the task into steps. She had the students punch √32 into their calculators and see what number they got (5.66). She had them try explaining to their partner how whole numbers differed from decimals. (“Thirty seconds, everyone.”) She had them write down other numbers whose square root was a whole number. She made them visualize, verbalize, and write the idea. Soon, they’d figured out how to find the factors of the number under the radical sign, and then how to move factors from under the radical sign to outside the radical sign.

Toward the end, she had her students try simplifying √20. They had one minute. One of the boys who’d looked alternately baffled and distracted for the first half of class hunched over his notebook scratching out an answer with his pencil. “This is so easy now,” he announced.

I told the coaches that I didn’t see how Critzer could have done better. They said that every teacher has something to work on. It could involve student behavior, or class preparation, or time management, or any number of other things. The coaches let the teachers choose the direction for coaching. They usually know better than anyone what their difficulties are.

Critzer’s concern for the last quarter of the school year was whether her students were effectively engaged and learning the material they needed for the state tests. So that’s what her coaches focussed on. Knight teaches coaches to observe a few specifics: whether the teacher has an effective plan for instruction; how many students are engaged in the material; whether they interact respectfully; whether they engage in high-level conversations; whether they understand how they are progressing, or failing to progress.

Novice teachers often struggle with the basic behavioral issues. Hobson told me of one such teacher, whose students included a hugely disruptive boy. Hobson took her to observe the boy in another teacher’s classroom, where he behaved like a prince. Only then did the teacher see that her style was the problem. She let students speak—and shout, and interrupt—without raising their hands, and go to the bathroom without asking. Then she got angry when things got out of control.

Jennie Critzer had no trouble maintaining classroom discipline, and she skillfully used a variety of what teachers call “learning structures”—lecturing, problem-solving, coöperative learning, discussion. But the coaches weren’t convinced that she was getting the best results. Of twenty kids, they noticed, at least four seemed at sea.

Good coaches know how to break down performance into its critical individual components. In sports, coaches focus on mechanics, conditioning, and strategy, and have ways to break each of those down, in turn. The U.C.L.A. basketball coach John Wooden, at the first squad meeting each season, even had his players practice putting their socks on. He demonstrated just how to do it: he carefully rolled each sock over his toes, up his foot, around the heel, and pulled it up snug, then went back to his toes and smoothed out the material along the sock’s length, making sure there were no wrinkles or creases. He had two purposes in doing this. First, wrinkles cause blisters. Blisters cost games. Second, he wanted his players to learn how crucial seemingly trivial details could be. “Details create success” was the creed of a coach who won ten N.C.A.A. men’s basketball championships.

At Walton Middle School, Hobson and Harding thought that Critzer should pay close attention to the details of how she used coöperative learning. When she paired the kids off, they observed, most struggled with having a “math conversation.” The worst pairs had a girl with a boy. One boy-girl pair had been unable to talk at all.

Élite performers, researchers say, must engage in “deliberate practice”—sustained, mindful efforts to develop the full range of abilities that success requires. You have to work at what you’re not good at. In theory, people can do this themselves. But most people do not know where to start or how to proceed. Expertise, as the formula goes, requires going from unconscious incompetence to conscious incompetence to conscious competence and finally to unconscious competence. The coach provides the outside eyes and ears, and makes you aware of where you’re falling short. This is tricky. Human beings resist exposure and critique; our brains are well defended. So coaches use a variety of approaches—showing what other, respected colleagues do, for instance, or reviewing videos of the subject’s performance. The most common, however, is just conversation.

At lunchtime, Critzer and her coaches sat down at a table in the empty school library. Hobson took the lead. “What worked?” he asked.

Critzer said she had been trying to increase the time that students spend on independent practice during classes, and she thought she was doing a good job. She was also trying to “break the plane” more—get out from in front of the whiteboard and walk among the students—and that was working nicely. But she knew the next question, and posed it herself: “So what didn’t go well?” She noticed one girl who “clearly wasn’t getting it.” But at the time she hadn’t been sure what to do.

“How could you help her?” Hobson asked.

She thought for a moment. “I would need to break the concept down for her more,” she said. “I’ll bring her in during the fifth block.”

“What else did you notice?”

“My second class has thirty kids but was more forthcoming. It was actually easier to teach than the first class. This group is less verbal.” Her answer gave the coaches the opening they wanted. They mentioned the trouble students had with their math conversations, and the girl-boy pair who didn’t talk at all. “How could you help them be more verbal?”

Critzer was stumped. Everyone was. The table fell silent. Then Harding had an idea. “How about putting key math words on the board for them to use—like ‘factoring,’ ‘perfect square,’ ‘radical’?” she said. “They could even record the math words they used in their discussion.” Critzer liked the suggestion. It was something to try.

For half an hour, they worked through the fine points of the observation and formulated plans for what she could practice next. Critzer sat at a short end of the table chatting, the coaches at the long end beside her, Harding leaning toward her on an elbow, Hobson fingering his beard. They looked like three colleagues on a lunch break—which, Knight later explained, was part of what made the two coaches effective.

He had seen enough coaching to break even their performance down into its components. Good coaches, he said, speak with credibility, make a personal connection, and focus little on themselves. Hobson and Harding “listened more than they talked,” Knight said. “They were one hundred per cent present in the conversation.” They also parcelled out their observations carefully. “It’s not a normal way of communicating—watching what your words are doing,” he said. They had discomfiting information to convey, and they did it directly but respectfully.

I asked Critzer if she liked the coaching. “I do,” she said. “It works with my personality. I’m very self-critical. So I grabbed a coach from the beginning.” She had been concerned for a while about how to do a better job engaging her kids. “So many things have to come together. I’d exhausted everything I knew to improve.”

She told me that she had begun to burn out. “I felt really isolated, too,” she said. Coaching had changed that. “My stress level is a lot less now.” That might have been the best news for the students. They kept a great teacher, and saw her get better. “The coaching has definitely changed how satisfying teaching is,” she said.

I decided to try a coach. I called Robert Osteen, a retired general surgeon, whom I trained under during my residency, to see if he might consider the idea. He’s one of the surgeons I most hoped to emulate in my career. His operations were swift without seeming hurried and elegant without seeming showy. He was calm. I never once saw him lose his temper. He had a plan for every circumstance. He had impeccable judgment. And his patients had unusually few complications.

He specialized in surgery for tumors of the pancreas, liver, stomach, esophagus, colon, breast, and other organs. One test of a cancer surgeon is knowing when surgery is pointless and when to forge ahead. Osteen never hemmed or hawed, or pushed too far. “Can’t be done,” he’d say upon getting a patient’s abdomen open and discovering a tumor to be more invasive than expected. And, without a pause for lament, he’d begin closing up again.

Year after year, the senior residents chose him for their annual teaching award. He was an unusual teacher. He never quite told you what to do. As an intern, I did my first splenectomy with him. He did not draw the skin incision to be made with the sterile marking pen the way the other professors did. He just stood there, waiting. Finally, I took the pen, put the felt tip on the skin somewhere, and looked up at him to see if I could make out a glimmer of approval or disapproval. He gave me nothing. I drew a line down the patient’s middle, from just below the sternum to just above the navel.

“Is that really where you want it?” he said. Osteen’s voice was a low, car-engine growl, tinged with the accent of his boyhood in Savannah, Georgia, and it took me a couple of years to realize that it was not his voice that scared me but his questions. He was invariably trying to get residents to think—to think like surgeons—and his questions exposed how much we had to learn.

“Yes,” I answered. We proceeded with the operation. Ten minutes into the case, it became obvious that I’d made the incision too small to expose the spleen. “I should have taken the incision down below the navel, huh?” He grunted in the affirmative, and we stopped to extend the incision.

I reached Osteen at his summer home, on Buzzards Bay. He was enjoying retirement. He spent time with his grandchildren and travelled, and, having been an avid sailor all his life, he had just finished writing a book on nineteenth-century naval mapmaking. He didn’t miss operating, but one day a week he held a teaching conference for residents and medical students. When I explained the experiment I wanted to try, he was game.

He came to my operating room one morning and stood silently observing from a step stool set back a few feet from the table. He scribbled in a notepad and changed position once in a while, looking over the anesthesia drape or watching from behind me. I was initially self-conscious about being observed by my former teacher. But I was doing an operation—a thyroidectomy for a patient with a cancerous nodule—that I had done around a thousand times, more times than I’ve been to the movies. I was quickly absorbed in the flow of it—the symphony of coördinated movement between me and my surgical assistant, a senior resident, across the table from me, and the surgical technician to my side.

The case went beautifully. The cancer had not spread beyond the thyroid, and, in eighty-six minutes, we removed the fleshy, butterfly-shaped organ, carefully detaching it from the trachea and from the nerves to the vocal cords. Osteen had rarely done this operation when he was practicing, and I wondered whether he would find anything useful to tell me.

We sat in the surgeons’ lounge afterward. He saw only small things, he said, but, if I were trying to keep a problem from happening even once in my next hundred operations, it’s the small things I had to worry about. He noticed that I’d positioned and draped the patient perfectly for me, standing on his left side, but not for anyone else. The draping hemmed in the surgical assistant across the table on the patient’s right side, restricting his left arm, and hampering his ability to pull the wound upward. At one point in the operation, we found ourselves struggling to see up high enough in the neck on that side. The draping also pushed the medical student off to the surgical assistant’s right, where he couldn’t help at all. I should have made more room to the left, which would have allowed the student to hold the retractor and freed the surgical assistant’s left hand.

Osteen also asked me to pay more attention to my elbows. At various points during the operation, he observed, my right elbow rose to the level of my shoulder, on occasion higher. “You cannot achieve precision with your elbow in the air,” he said. A surgeon’s elbows should be loose and down by his sides. “When you are tempted to raise your elbow, that means you need to either move your feet”—because you’re standing in the wrong position—“or choose a different instrument.”

He had a whole list of observations like this. His notepad was dense with small print. I operate with magnifying loupes and wasn’t aware how much this restricted my peripheral vision. I never noticed, for example, that at one point the patient had blood-pressure problems, which the anesthesiologist was monitoring. Nor did I realize that, for about half an hour, the operating light drifted out of the wound; I was operating with light from reflected surfaces. Osteen pointed out that the instruments I’d chosen for holding the incision open had got tangled up, wasting time.

That one twenty-minute discussion gave me more to consider and work on than I’d had in the past five years. It had been strange and more than a little awkward having to explain to the surgical team why Osteen was spending the morning with us. “He’s here to coach me,” I’d said. Yet the stranger thing, it occurred to me, was that no senior colleague had come to observe me in the eight years since I’d established my surgical practice. Like most work, medical practice is largely unseen by anyone who might raise one’s sights. I’d had no outside ears and eyes.

Osteen has continued to coach me in the months since that experiment. I take his observations, work on them for a few weeks, and then get together with him again. The mechanics of the interaction are still evolving. Surgical performance begins well before the operating room, with the choice made in the clinic of whether to operate in the first place. Osteen and I have spent time examining the way I plan before surgery. I’ve also begun taking time to do something I’d rarely done before—watch other colleagues operate in order to gather ideas about what I could do.

A former colleague at my hospital, the cancer surgeon Caprice Greenberg, has become a pioneer in using video in the operating room. She had the idea that routine, high-quality video recordings of operations could enable us to figure out why some patients fare better than others. If we learned what techniques made the difference, we could even try to coach for them. The work is still in its early stages. So far, a handful of surgeons have had their operations taped, and begun reviewing them with a colleague.

I was one of the surgeons who got to try it. It was like going over a game tape. One rainy afternoon, I brought my laptop to Osteen’s kitchen, and we watched a recording of another thyroidectomy I’d performed. Three video pictures of the operation streamed on the screen—one from a camera in the operating light, one from a wide-angle room camera, and one with the feed from the anesthesia monitor. A boom microphone picked up the sound.

Osteen liked how I’d changed the patient’s positioning and draping. “See? Right there!” He pointed at the screen. “The assistant is able to help you now.” At one point, the light drifted out of the wound and we watched to see how long it took me to realize I’d lost direct illumination: four minutes, instead of half an hour.

“Good,” he said. “You’re paying more attention.”

He had new pointers for me. He wanted me to let the residents struggle thirty seconds more when I asked them to help with a task. I tended to give them precise instructions as soon as progress slowed. “No, use the DeBakey forceps,” I’d say, or “Move the retractor first.” Osteen’s advice: “Get them to think.” It’s the only way people learn.

And together we identified a critical step in a thyroidectomy to work on: finding and preserving the parathyroid glands—four fatty glands the size of a yellow split pea that sit on the surface of the thyroid gland and are crucial for regulating a person’s calcium levels. The rate at which my patients suffered permanent injury to those little organs had been hovering at two per cent. He wanted me to try lowering the risk further by finding the glands earlier in the operation.

Since I have taken on a coach, my complication rate has gone down. It’s too soon to know for sure whether that’s not random, but it seems real. I know that I’m learning again. I can’t say that every surgeon needs a coach to do his or her best work, but I’ve discovered that I do.

Coaching has become a fad in recent years. There are leadership coaches, executive coaches, life coaches, and college-application coaches. Search the Internet, and you’ll find that there’s even Twitter coaching. (“Would you like to learn how to get new customers/clients, make valuable business contacts, and increase your revenue using Twitter? Then this Twitter coaching package is perfect for you”—at about eight hundred dollars for a few hour-long Skype sessions and some e-mail consultation.) Self-improvement has always found a ready market, and most of what’s on offer is simply one-on-one instruction to get amateurs through the essentials. It’s teaching with a trendier name. Coaching aimed at improving the performance of people who are already professionals is less usual. It’s also riskier: bad coaching can make people worse.

The world-famous high jumper Dick Fosbury, for instance, developed his revolutionary technique—known as the Fosbury Flop—in defiance of his coaches. They wanted him to stick to the time-honored straddle method of going over the high bar leg first, face down. He instinctively wanted to go over head first, back down. It was only by perfecting his odd technique on his own that Fosbury won the gold medal at the 1968 Mexico City Olympics, setting a new record on worldwide television, and reinventing high-jumping overnight.

Renée Fleming told me that when her original voice coach died, ten years ago, she was nervous about replacing her. She wanted outside ears, but they couldn’t be just anybody’s. “At my stage, when you’re at my level, you don’t really want to go to a new person who might mess things up,” she said. “Somebody might say, ‘You know, you’ve been singing that way for a long time, but why don’t you try this?’ If you lose your path, sometimes you can’t find your way back, and then you lose your confidence onstage and it really is just downhill.”

The sort of coaching that fosters effective innovation and judgment, not merely the replication of technique, may not be so easy to cultivate. Yet modern society increasingly depends on ordinary people taking responsibility for doing extraordinary things: operating inside people’s bodies, teaching eighth graders algebraic concepts that Euclid would have struggled with, building a highway through a mountain, constructing a wireless computer network across a state, running a factory, reducing a city’s crime rate. In the absence of guidance, how many people can do such complex tasks at the level we require? With a diploma, a few will achieve sustained mastery; with a good coach, many could. We treat guidance for professionals as a luxury—you can guess what gets cut first when school-district budgets are slashed. But coaching may prove essential to the success of modern society.

There was a moment in sports when employing a coach was unimaginable—and then came a time when not doing so was unimaginable. We care about results in sports, and if we care half as much about results in schools and in hospitals we may reach the same conclusion. Local health systems may need to go the way of the Albemarle school district. We could create coaching programs not only for surgeons but for other doctors, too—internists aiming to sharpen their diagnostic skills, cardiologists aiming to improve their heart-attack outcomes, and all of us who have to figure out ways to use our resources more efficiently. In the past year, I’ve thought nothing of asking my hospital to spend some hundred thousand dollars to upgrade the surgical equipment I use, in the vague hope of giving me finer precision and reducing complications. Avoiding just one major complication saves, on average, fourteen thousand dollars in medical costs—not to mention harm to a human being. So it seems worth it. But the three or four hours I’ve spent with Osteen each month have almost certainly added more to my capabilities than any of this.

Talk about medical progress, and people think about technology. We await every new cancer drug as if it will be our salvation. We dream of personalized genomics, vaccines against heart disease, and the unfathomed efficiencies from information technology. I would never deny the potential value of such breakthroughs. My teen-age son was spared high-risk aortic surgery a couple of years ago by a brief stent procedure that didn’t exist when he was born. But the capabilities of doctors matter every bit as much as the technology. This is true of all professions. What ultimately makes the difference is how well people use technology. We have devoted disastrously little attention to fostering those abilities.

A determined effort to introduce coaching could change this. Making sure that the benefits exceed the cost will take work, to be sure. So will finding coaches—though, with the growing pool of retirees, we may already have a ready reserve of accumulated experience and know-how. The greatest difficulty, though, may simply be a profession’s willingness to accept the idea. The prospect of coaching forces awkward questions about how we regard failure. I thought about this after another case of mine that Bob Osteen came to observe. It didn’t go so well.

The patient was a woman with a large tumor in the adrenal gland atop her right kidney, and I had decided to remove it using a laparoscope. Some surgeons might have questioned this decision. When adrenal tumors get to be a certain size, they can’t be removed laparoscopically—you have to do a traditional, open operation and get your hands inside. I persisted, though, and soon had cause for regret. Working my way around this tumor with a ten-millimetre camera on the end of a foot-and-a-half-long wand was like trying to find my way around a mountain with a penlight. I continued with my folly too long, and caused bleeding in a blind spot. The team had to give her a blood transfusion while I opened her belly wide and did the traditional operation.

Osteen watched, silent and blank-faced the entire time, taking notes. My cheeks burned; I was mortified. I wished I’d never asked him along. I tried to be rational about the situation—the patient did fine. But I had let Osteen see my judgment fail; I’d let him see that I may not be who I want to be.

This is why it will never be easy to submit to coaching, especially for those who are well along in their career. I’m ostensibly an expert. I’d finished long ago with the days of being tested and observed. I am supposed to be past needing such things. Why should I expose myself to scrutiny and fault-finding?

I have spoken to other surgeons about the idea. “Oh, I can think of a few people who could use some coaching” has been a common reaction. Not many say, “Man, could I use a coach!” Once, I wouldn’t have, either.

Osteen and I sat together after the operation and broke the case down, weighing the decisions I’d made at various points. He focussed on what I thought went well and what I thought didn’t. He wasn’t sure what I ought to have done differently, he said. But he asked me to think harder about the anatomy of the attachments holding the tumor in.

“You seemed to have trouble keeping the tissue on tension,” he said. He was right. You can’t free a tumor unless you can lift and hold taut the tissue planes you need to dissect through. Early on, when it had become apparent that I couldn’t see the planes clearly, I could have switched to the open procedure before my poking around caused bleeding. Thinking back, however, I also realized that there was another maneuver I could have tried that might have let me hold the key attachments on tension, and maybe even freed the tumor.

“Most surgery is done in your head,” Osteen likes to say. Your performance is not determined by where you stand or where your elbow goes. It’s determined by where you decide to stand, where you decide to put your elbow. I knew that he could drive me to make smarter decisions, but that afternoon I recognized the price: exposure.

For society, too, there are uncomfortable difficulties: we may not be ready to accept—or pay for—a cadre of people who identify the flaws in the professionals upon whom we rely, and yet hold in confidence what they see. Coaching done well may be the most effective intervention designed for human performance. Yet the allegiance of coaches is to the people they work with; their success depends on it. And the existence of a coach requires an acknowledgment that even expert practitioners have significant room for improvement. Are we ready to confront this fact when we’re in their care?

“Who’s that?” a patient asked me as she awaited anesthesia and noticed Osteen standing off to the side of the operating room, notebook in hand.

I was flummoxed for a moment. He wasn’t a student or a visiting professor. Calling him “an observer” didn’t sound quite right, either.

“He’s a colleague,” I said. “I asked him along to observe and see if he saw things I could improve.”

The patient gave me a look that was somewhere between puzzlement and alarm.

“He’s like a coach,” I finally said.

She did not seem reassured. ♦

ILLUSTRATION: BARRY BLITT

Most path labs unauthorized

noreply@blogger.com (Unknown) — Sun, 25 Sep 2011 19:05:00 +0000

Source

BERHAMPUR: Before undergoing any pathological tests,. Most of the you should check the genuineness of the pathological laboratory pathological laboratories mushrooming in every nook and corner of the state are not operated by trained pathologists, nor do they get valid license from the government to run the laboratory.
"Most of the pathological laboratories are run by non-pathologists, non-technicians and without proper license," said Nimai Charan Parija, president of Indian Association of Pathologists and Microbiologists (IAPM) here, on the sidelines of the Orissa chapter of annual conference of IAMP on Saturday.
He said the IAPM was constantly fighting against the illegal practice in various states of the country and urged upon authorities to crack down on unauthorized laboratories.

Doctors’ poison pill burns our pockets

noreply@blogger.com (Unknown) — Mon, 12 Sep 2011 17:43:00 +0000

It’s all well to talk about Bofors and 2G corruption. But what about the cuts taken by doctors who refer patients for tests and scans?

In these heady days of Anna's triumphs, it is difficult to write about anything but corruption in India, and the subject is so vast, encompassing as it does every aspect of human activity, that the mind cannot think of other subjects on which to write.

Anna Hazare's campaign and the Jan Lokpal Bill have concentrated on corruption among government servants-the term extending from the prime minister to the lowest clerk in a tehsildar's office. This covers a wide swathe of economic and social activity of the people.

Corruption erodes the moral and ethical fibre of the bribe-taker and the bribe-giver. But this is not the worst effect of bribes, graft, kickbacks. The worst effect is that corruption is a cost of production. This is well-known, but few realise that it is the first axiom in the geometry of graft.

Bofors paid a bribe of Rs64 crore to some of the highest people in the land. We know who they were, but officially they were unknown and unnamed. Do you think Bofors wrote off the payment as charity? No way. The equivalent of Rs64 crore was added to the cost of the Bofors guns delivered to India. And who footed the bill? The people of India through the defence budget of the Government of India.

And let us take the tonnes of crores of graft paid in the 2G scam? Who will really reimburse the cost to the mobile phone companies? Who else but the users of the ultra-smart mobile phone services that the licensee companies will put on the market. It will be you and me; the man in the street may escape.

Let me take an example which affects all of us, including the man in the street, and the dog at the lamp-post: the kickbacks taken by doctors who refer patients to scan centres and diagnostic labs. Yes, we put the haloes on the doctors' heads, but they are not shining white, they are black and baleful.

It all seems so simple and innocent, doesn't it? The general physician, or the specialist, examines your wife. He prescribes a scan and recommends a particular scan centre. He even has the centre's requisition pad with him and writes down your name and the investigations required.

You go to the scan centre and wince inwardly at the huge cost. But you think it is good for the beloved wife and you pay up; you notice it's all in cash. You take the scan to the doctor and the process continues.

You do not know that you have been cheated by as much 15% or 20% of the price of the scan. The doctor has an arrangement with the scan centre: up to 20% (depending on the number of referrals) of the value of the scan goes to the doctor as kickback. The amount of kickback is added to the cost of the scan, so your bill is bloated by that much more. Everyone's happy, including the patient who does not know. Ignorance is bliss, as the proverb goes?

I have written this on the basis of first-hand experience and a story that I wrote for my newspaper, about 15 years ago, detailing the entire process.

At the end of each month, the doctor sends to the scan centre, a list of patients that he has referred, the real cost of the scans and the total cut due to him. The amount is delivered in cash the next day. If it is not, the tap is turned off and the doctor starts referring patients to another scan centre. This keeps the scan centre owner in line.

I had written the story on the basis of written records, including the doctors' letters, the scan owners' record of payments, the cost of the scan before the kickback, the price charged to the patient and a few other bits and pieces of evidence.

Not surprisingly, nothing happened. One of the aphorisms I worked out is: today's newspaper wraps tomorrow's peanuts.

But I didn't give up. I sent the whole lot of evidence to the income-tax officer in whose ward the doctor fell. Again, nothing. And I thought of the saying: there are two types of people whom one does not antagonise, doctors and income-tax officers. Here the income-tax officer did not want to antagonise the doctor, who happened to be a neurosurgeon.

And nothing has changed.

(R Vijayaraghavan has been a professional journalist for more than four decades, specialising in finance, business and politics. He conceived and helped to launch Business Line, the financial daily of The Hindu group. He can be contacted at rvij10@yahoo.com.)

-Source

Dangerous Chemical: Dihydrogen Monoxide

noreply@blogger.com (Unknown) — Fri, 26 Aug 2011 18:09:00 +0000

A student at Eagle Rock Junior High won first prize at the Greater Idaho Falls Science Fair, April 26. He was attempting to show how conditioned we have become to alarmists practicing junk science and spreading fear of everything in our environment. In his project he urged people to sign a petition demanding strict control or total elimination of the chemical "dihydrogen monoxide."
And for plenty of good reasons, since:

it can cause excessive sweating and vomiting
it is a major component in acid rain
it can cause severe burns in its gaseous state
accidental inhalation can kill you
it contributes to erosion
it decreases effectiveness of automobile brakes
it has been found in tumors of terminal cancer patients

He asked 50 people if they supported a ban of the chemical.

Forty-three (43) said yes,
six (6) were undecided,
and only one (1) knew that the chemical was water.

The title of his prize winning project was, "How Gullible Are We?" He feels the conclusion is obvious.

Source

Desire to serve still drives some doctors in India

noreply@blogger.com (Unknown) — Sun, 03 Jul 2011 18:59:00 +0000

In these days of crass commercialisation of healthcare, it may be hard to believe that a band of dedicated young doctors is giving up lucrative assignments and even risking their lives to serve in rural areas on a voluntary basis.

You may have never heard of a group called 'Doctors for You' (DFY), but this group created ripples in international medical circles this past week by winning the best 'Medical team in a crisis zone' award leaving behind strong contenders such as Medecins Sans Frontieres and Save the Children. The group got the award for medical relief it offered during the 2008 Kosi floods in Bihar. The award, instituted by publishers of the British Medical Journal celebrates an individual or team that has had an exceptional impact on a crisis situation.
The group deployed 110 of its members who treated 130,000 patients over six months through 300 mobile clinics, district hospitals and camps.

Interestingly, this group of mostly young doctors and medical students from government hospitals and medical colleges was born out of a necessity in August 2007.
It is not a typical NGO looking for opportunities for social work. During the monsoon season, government hospitals face shortage of blood and platelets when they are flooded with cases of malaria and dengue. In order to deal with such shortages, some medicos in Mumbai formed a group to promote voluntary donation of blood and platelets.
When Bihar faced the flood situation, Dr Ravikant Singh - who hails from the state and had founded the voluntary blood donation group - decided to take a small medical team there in August 2008. This slowly grew into a larger engagement over the next six months with several teams providing medical relief in flood- affected villages in rotation.
One young member of the team, Chandrakant Patil, lost his life when he was struck by lightning while sleeping in the open in a medical camp. Because of his pre-occupation in Bihar, Singh had to lose one full term of his post graduate training and an attractive offer to work for the WHO. DFY continues to prepare itself for future emergencies through constant training and by forging alliances with organisations all over the globe.
'A snakebite and a heart attack are both medical emergencies but you need different skill sets to handle them', pointed out Dr Vivek Chhabra, an active member. The group has set up maternal and child health centres - one in Biratpur in Saharsa district and another one in a Mumbai slum. Since March 2009, the Biratpur centre has treated over 50,000 patients and conducted over 100 hospital deliveries without charging any fee. The centre, manned by two doctors and nurses each, has six beds and provides round- theclock emergency services to pregnant women. The plan is to replicate this model in other districts of Bihar and other states like Uttar Pradesh and Jharkhand.
It is the dream and determination of groups like DFY which offers some hope for the health system in India.

Divya Bhasker News -Illegal Labs

noreply@blogger.com (Unknown) — Tue, 03 May 2011 07:10:00 +0000

Internist Vs Pathologist

noreply@blogger.com (Unknown) — Tue, 05 Apr 2011 14:32:00 +0000

An interesting material ( copied from some where)

noreply@blogger.com (Unknown) — Wed, 16 Mar 2011 17:39:00 +0000

280 लाख करोड़ का सवाल
है ...भारतीय गरीब है लेकिन भारत
देश कभी गरीब नहीं रहा"* ये
कहना है स्विस बैंक केडाइरेक्टर
का . स्विस बैंक के डाइरेक्टर ने

यह भी कहा है कि भारत का लगभग
280 लाख करोड़ रुपये
(280 ,00 ,000 ,000 ,000)
उनके स्विस बैंक में जमा है . ये
रकमइतनी है कि भारत का आने वाले
30 सालों का बजट बिना टैक्स के
बनाया जा सकता है.या यूँ कहें
कि 60 करोड़ रोजगार के अवसर दिए

जा सकते है. या यूँ भी कह सकते
हैकि भारत के किसी भी गाँव से
दिल्ली तक 4 लेन रोड
बनाया जा सकता है. ऐसा भी कहसकते
है कि 500 से ज्यादा सामाजिक
प्रोजेक्ट पूर्ण किये जा सकते
है . ये रकमइतनी ज्यादा है कि अगर

हर भारतीय को 2000 रुपये हर
महीने भी दिए जाये तो 60साल तक
ख़त्म ना हो. यानी भारत
को किसी वर्ल्ड बैंक से लोन लेने
कि कोई जरुरतनहीं है .
जरा सोचिये ... हमारे भ्रष्ट
राजनेताओं और नोकरशाहों ने कैसे
देश कोलूटा है और ये लूट

का सिलसिला अभी तक 2011 तक
जारी है. इस सिलसिले को अब
रोकनाबहुत
ज्यादा जरूरी हो गया है.
अंग्रेजो ने हमारे भारत पर करीब
200 सालो तक राजकरके करीब 1
लाखकरोड़ रुपये लूटा. मगर
आजादी के केवल 64 सालों में
हमारे भ्रस्टाचार ने 280लाख

करोड़ लूटा है. एक तरफ 200 साल
में 1 लाख करोड़ है और दूसरी तरफ
केवल 64सालों में 280 लाख
करोड़ है. यानि हर साल लगभग
4.37 लाख करोड़, या हर
महीनेकरीब 36 हजार करोड़
भारतीय मुद्रा स्विस बैंक में
इन भ्रष्ट

लोगों द्वारा जमाकरवाई गई है .
भारत को किसी वर्ल्ड बैंक के लोन
की कोई दरकार नहीं है .
सोचो कीकितना पैसा हमारे भ्रष्ट
राजनेताओं और उच्च
अधिकारीयों ने ब्लाक करके
रखा हुआहै . हमे भ्रस्ट
राजनेताओं और भ्रष्ट

अधिकारीयों के खिलाफ जाने
का पूर्ण अधिकारहै .हाल ही में
हुवे घोटालों का आप
सभी को पता ही है - CWG घोटाला,
२ जीस्पेक्ट्रुम घोटाला , आदर्श
होउसिंग घोटाला ... और ना जाने
कौन कौन से घोटालेअभी उजागर
होने वाले है ........आप लोग जोक्स

फॉरवर्ड करते ही हो. इसे
भी इतनाफॉरवर्ड
करो की पूरा भारत इसे पढ़े ... और
एक आन्दोलन बन जाये भ्रष्टाचार
पर एन विट्ठल , किरण बेदी, एपीजे
अब्दुल कलाम की रायएनविट्ठल
( पूर्व केंद्रीय
सतर्कता आयुक्त) : भ्रष्टाचार

समाज में कैंसर कीतरह है और इससे
देश को व्यापक नुकसान हो रहा है।
भ्रष्टाचार के खिलाफ
आमनागरिकों में रोष भी है।
सभी इसके बारे में चर्चा करते
हैं , लेकिन कोई कुछकरने
की स्थिति में नहीं है।किरण
बेदी (पूर्व आईपीएस अधिकारी):

भारतमें सफेदपोश
अपराधी ही भ्रष्टाचार में लिप्त
हैं। जितना बड़ा अपराध
औरअपराधी होता है उसके बचने
की संभावना भी उतनी ही ज्यादा होती है।
एपीजेअब्दुल कलाम (पूर्व
राष्ट्रपति): भ्रष्टाचार कैंसर
की तरह देश को निगल रहाहै और अब

इसकी तत्काल कीमोथेरेपी किए
जाने की आवश्यकता है।
भ्रष्टाचारमुक्त भारत बनाना आज
सबसे बड़ी चुनौती है और इसके लिए
युवाओं को आगे आनाहोगा।

Action started against ILLEGAL LABS in BHUJ

noreply@blogger.com (Unknown) — Mon, 07 Mar 2011 16:11:00 +0000

Hematologist v/s Pathologist

noreply@blogger.com (Unknown) — Fri, 29 Oct 2010 06:07:00 +0000

CBI arrests two Chandigarh doctors for admissions racket

noreply@blogger.com (Unknown) — Fri, 08 Oct 2010 04:57:00 +0000

The Central Bureau of Investigation (CBI) Tuesday arrested two doctors of the prestigious Post-Graduate Institute of Medical Education and Research (PGIMER) here after the lid was blown off an organised admissions racket at the premier health institute.

CBI officials here said that the doctors, Amit Musale and Sujay Sonawane, were pursuing a post-graduation course at the PGIMER. The doctors had obtained admission to the course, one of the most sought after in the country, on the basis of impersonation and manipulation during the admission process.

CBI sources said that another person, who was running the admissions racket, was arrested by their counterparts in Mumbai.

'Anti-Corruption Branch of CBI, Chandigarh, has registered a case against two doctors pursuing their post-graduation at PGIMER and few other people on the allegation that these two doctors have procured admission in the post-graduation course on the basis of impersonation and manipulation,' CBI Deputy Inspector General Mahesh Aggarwal said.

The sources said that seats in the prestigious course were going for as high as Rs.80 lakh per student.

PGIMER authorities here, embarrassed by the startling disclosures, have offered to help the CBI investigations.

CBI sources said that several past admissions to the PGIMER could be investigated.

'These doctors obtained admission through organised racket assuring admissions in various private and government medical colleges by charging hefty amounts running into lakhs of rupees. The admissions to government colleges are procured by impersonation,' the CBI official said in a statement here.

'In such cases some brilliant student, part of the organized racket, appears in the entrance exam by impersonating the aspiring candidate. The two doctors pursuing post-graduation at PGIMER, Chandigarh were questioned by the CBI team. After questioning, these two doctors have been placed under arrest,' he added.

The CBI conducted raids Tuesday at several places, including Chandigarh and Mumbai, to find the roots and beneficiaries of the admission racket.

'A number of incriminating documents and other material have been seized pointing to the wide reach of this network. The aspiring candidates took admission on the basis of result of their impersonators,' the CBI official said.

Earlier September, the CBI had unearthed a racket of admissions in Punjab Engineering College here. These admissions were procured on the basis of fake and forged documents

PG seat for sale in Prestigious medical colleges

noreply@blogger.com (Unknown) — Thu, 30 Sep 2010 12:28:00 +0000

PG seats for sale in prestigious medical colleges like PGI chandigarh and ??AIIMS,

read here

UPDATE- Pathology labs run by DMLT technicians banned by Gujarat Highcourt

noreply@blogger.com (Unknown) — Tue, 21 Sep 2010 14:57:00 +0000

Complete high court judgment now available at following link

High Court Judgement

Pathology labs run by DMLT technicians banned by Gujarat Highcourt

noreply@blogger.com (Unknown) — Sun, 19 Sep 2010 04:14:00 +0000

Gujarat high court has banned all pathology laboratories run by DMLT technicians.

For details in Gujarat Samachar pl. click below

Gujarat Samachar

Diagnostic Lymph Node Pathology

noreply@blogger.com (Unknown) — Thu, 26 Aug 2010 07:40:00 +0000

Diagnostic Lymph Node Pathology is a comprehensive and generously illustrated guide, making it the ideal practical reference book. The international team of highly regarded haematopathologists write in an authoritative and accessible style with an emphasis on morphological evaluation as well as immunohistochemistry. The book clearly and logically presents the criteria for differential diagnosis with illustrations of both classical and less well-known features of each disease process. This will prove to be an essential guide for all surgical pathologists and haematopathologists involved in interpreting lymph node biopsies and will be an invaluable learning text for histopathologists in training.

Drinking water before meals helps dieting, says study

noreply@blogger.com (Unknown) — Wed, 25 Aug 2010 04:26:00 +0000

Drinking water before meals can help people to lose weight, says a US study.

Scientists from Virginia found that slimmers can lose an average of 5lb extra if they drink two glasses of water three times a day before meals.

They tested the theory on 48 older adults, split into two groups, over 12 weeks.

While drinking water can make you feel full on zero calories, say researchers, too much water can also lead to serious health problems.

The researchers presented their findings at the National Meeting of the American Chemical Society in Boston.

All adults who took part in the study were aged 55 to 75.

The first group followed a low-calorie diet but did not drink any extra water before meals.

The second group followed the low-calorie diet but also drank two glasses of water before each meal.

'No calories'

Over the course of 12 weeks, those drinking water lost about 15.5lbs while the others lost about 11lbs.

A previous study found that middle-aged and older people who drank two glasses of water before eating a meal ate between 75 and 90 fewer calories during that meal.

Professor Brenda Davy, senior author of the study, from Virginia Tech, said it was the first randomised controlled trial looking at water consumption and dieting.

She said the reason water may be so effective is because it fills up the stomach with a liquid that has no calories.

"People should drink more water and less sugary, high-calorie drinks. It's a simple way to facilitate weight management," Professor Davy said.

Diet drinks and other drinks with artificial sweeteners may also help people reduce their calorie intake and lose weight, researchers said.

However, Professor Davy advised against drinks sweetened with sugar, because they are high in calories.

A regular can of fizzy drink contains about 10 teaspoons of sugar, she explained.

The study was funded by the charity, The Institute for Public Health and Water Research.

VIolance against Doctors of Surat

noreply@blogger.com (Unknown) — Sun, 22 Aug 2010 14:57:00 +0000

On the 9th of August, The medical fraternity of Surat was witness to this in human Act of Violence at a local Hospital. A pregnant patient was admitted with high grade fever. She was seriously ill when brought to the hospital. The gravity of the situation was explained to the relatives and needed signatures were taken from the husband. She succumbed to her illness by evening with a Probable diagnosis of Swine flu. She was ill for the past 4 days, but brought to the hospital on this very day. The relatives took away the body and later after a few hours at 11PM, a mob of 70-80 people came and ransacked the Hospital ICCU, beating the Doctors, nurses and watchman. The pregnant nurse had a premature delivery(7th month) after that and the doctor has a fractured rib. The Entire staff of that Hospital is scared to treat serious patients now.

Biodisc - fraud of the century

noreply@blogger.com (Unknown) — Mon, 09 Aug 2010 11:43:00 +0000

Introduction:
One of the leading magazine from Gujarat, India (Chitralekha), has published cover story about Biodisc. According to them Water that come into contact with biodisc become structured and organised, which appear crystalised!!!! Wow now you can change the physical properties of water!!! This water can do miracle, and treat almost anything!!!

At last they say the cost of biodisc (Rs. 17,750 for 1, Rs. 31400 for 2), which can be purchased by phone number given by them or someone linked with qnet.

Analysis:
Being a doctor, thing like this is difficult to digest, so I did some googling. One of the pioneer of this energized water theory is Dr. Masaru Emoto. In 2003, James Randi publicly offered Emoto one million dollars if his results can be reproduced in a double-blind study. No need to say that no one has won one million dollar from James Randi till date.
Gary Greenberg commented on Emoto's work:

"As a scientist, I was astonished. It didn’t surprise me that I couldn’t find any scientific experiments [Emoto] has performed or any peer-reviewed journal articles that have been published describing controlled studies of Emoto’s work. A further search revealed that Emoto’s degree was from the Open International University in India, where an M.D. degree costs $500 and a Ph.D. costs $350, no classes or tests required."

Kristopher Setchfield has researched on Emoto's work and concluded, "After the lengthy review of Emoto’s research methods and results, I have come to believe that Dr. Emoto is offering pseudoscience to the masses in the guise of defensible research."

Here is the disclairmer by amezcua, the company selling biodisc,

"Disclaimer

Your use of this website constitutes your acceptance to the terms of this Disclaimer.

No Warranty to Accuracy

The information provided by us on this website is on an "as is" basis and is for general, indicative purposes only. We do not give any express or implied warranty as to the accuracy of the information contained in this website. As such, we will not be liable for any errors in, omissions from, or mis-statements or misrepresentations concerning any such information and will not have or accept any liability, obligation or responsibility whatsoever for any loss or damage, including without limitation, consequential loss or damage arising from or in respect of any use or misuse of or reliance on the information delivered in this website.
We expressly disclaim any guarantee or warranty of promised future income or earning. Any claim of earning or earning potential should be treated as an opinion only and you shall not rely on it unless you have verified its accuracy. We shall not be held liable to and shall not accept any liability, obligation or responsibility whatsoever for any loss or damage arising from your reliance on such claims. You do so at your own risk."

In the end, it's really an outright fraud! It's like selling hamburgers that can heal your stomach problem!