Medical Malpractice

We know, clinically, that many PDE-5 nonresponders will be restored to sexual health through a CT integrating sex therapy and sexual pharmaceuticals. Yet how do we conceptualize such a model so that standard treatment algorithms could be stretched to incorporate this concept? The answer is twofold. We need a schema for understanding psychosocial obstacles (PSOs) to successful treatment, integrated into a model that executes that understanding.

Combination therapy is the therapeutic modality of choice for any SDs. Combination therapy refers to a concurrent or step-wise integration of psychological and medical interventions. We have previously described developing adherence for this approach to erectile dysfunction, with enthusiasm growing within the FSD treatment community. Combination therapy is already being recommended for PE, and is likely to be recommended for the full range of ejaculatory disorders. Although desire disorders for men and women have a strong psychosocial cultural component, there is little doubt that sexual "desire" has biological underpinnings and is likely to be distributed on the same bell-shaped distribution curve as other human characteristics.

This simply means that all SDs have a biopsychosocial basis and that treatment must incorporate medical and psychological dimensions. Without adequate desire, motivation, and realistic expectations, treatment outcome is likely to be disappointing and with high discontinuation rates. Medical interventions do not motivate the sexually reluctant patients or partners to try treatment, nor do they help overcome psychological obstacles to success. Reciprocally, it would constitute malpractice to only focus on psychological factors to the exclusion of all possible organic etiology for an individual seeking assistance. Then, how can an ethical and motivated clinician proceed?

Combination Therapy Guidelines: Who, How, and When?

There are two alternative models for CT: both will likely be adopted within the framework of sexual medicine, by different clinicians. First, working alone, PCPs, urologists, psychiatrists, and eventually gynecologists will integrate sex counseling with their sexual pharmaceutical armamentarium to treat SD. "Sex counseling" in this situation, is utilizing sex therapy strategies and techniques to overcome psychosocial resistance to sexual function and satisfaction. In a second model, the above clinicians will collaborate with nonphysician MHPs (sex therapists), resolving SD(s) through a coordinated multidisciplinary team approach to treatment.

The clinical combinations will vary according to the presenting symptoms, as well as the varying expertise of these health care providers. The utilization of these two different models will require three steps. (i) The clinician first consulted by the patient will consider their interest, training, and competence. (ii) The bio-psychosocial severity and complexity of the SD as a manifestation of both psychosocial and organic factors will be evaluated. (iii) The clinician in consideration of the two previous criteria, together with patient preference, will determine who initiates treatment, as well as, how and when to refer. The guidelines for managing the relative severity of the dysfunction will essentially be expanded, but continue to match the type of treatment algorithm described in "The Process of Care" and other step-change approaches.

Have you finally decided to correct that flaw that's been driving you crazy? Have you finally decided to take the plunge and undergo plastic surgery? You've read up on all the literature, researched the web, you've imagined yourself with your new nose, breasts, or lips, and all that remains is to find the absolute best doctor to perform the surgery. It might seem easy and breezy, considering how many doctors are out there. But in truth, this is when most women go wrong.

Finding the best surgeon is perhaps the most important step in the entire process of cosmetic surgery. A good surgeon will pick up any other problems that may be involved in the surgical process, will ask some very uncomfortable questions, and will find a way to perform a surgery in a realistic manner. For example, a good surgeon will not perform surgery that would make your breasts seem disproportionate to your body, or perform a fifth surgery on your nose for no reason. There are several important things to keep in mind when shopping for the right plastic surgeon.

Here are a few things to pay close attention to when selecting a surgeon.

Board Certification: Make absolutely sure that the surgeon that you select is board certified in the state he practices in. For example, if the doctor you are interviewing practices in New York, he should be New York State board certified for plastic surgery. It is easy to find out if a surgeon is board certified as he claims online with a simple search. Under no circumstances hire a surgeon that claims to be board certified without checking credentials, nor should you hire a surgeon who isn't board certified at all.

References: Make an effort to meet real people that have had the procedure done and hear their testimonials about the doctor you are considering. Speak to other women who've had the same procedure done. I.e. if you are interested in breast enlargement, speak to other women who've had breast enlargements and ask them how satisfied they are with the doctor and the procedure. Request references from the doctor you are interviewing before you sign on for the procedure.

The Right Questions: While meeting a doctor for the first time to discuss a cosmetic procedure, he should ask you some extremely uncomfortable questions, or he isn't doing his job. In fact, only very irresponsible plastic surgeons will not ask you questions about your self-image, how you think the surgery will affect your life, if you've had surgery before, and if you think that maybe a 32DD may be a bit too large for your boyish frame. The surgeon should also ask you questions about your eating habits, if you've ever suffered from depression, and should insist on receiving your complete medical record. At all costs avoid a surgeon who agrees to do anything you desire without asking you a series of questions. No matter what you might think you know about plastic surgery, it certainly isn't enough to decide what is possible without medical help.

Shop Around: Even if the first surgeon you go to is wonderful and has board certification, great references, and asked you all the right questions, go and see a couple more, just to make sure. It is also very important to feel extremely comfortable with the surgeon you've selected, and the more options you have, the more informed your decision will be in the end. Surgery, or any cosmetic procedure for that matter, is not something to take lightly. You must trust your surgeon without reserve, especially if you are fully sedated. For that reason alone, make sure that you shop around until you find the absolute best match for you.

Research: Once you've selected a likely surgeon, do some research on the cosmetic surgery center they work from. Look for any malpractice suits in the past, any horror stories on the internet, and just read around to see if you can find anything that makes you uncomfortable. The wonderful thing about the internet is how easy it is to obtain information that you should know before selecting a doctor. Never select a cosmetic surgery center or doctor without researching it first.

It is possible to find the right plastic surgeon for you by simply following these simple guidelines. Whether you are interested in breast implants, Botox, a face lift, or a breast reduction, finding the absolute best surgeon is imperative. Doing just a little bit of homework can make all the difference between the most natural looking cosmetic procedure in the world, and a world-class nightmare.

Most people are familiar with the four kinds of insurance that is important to have: automobile, home, life and medical. As a business owner, you need additional insurance to cover two important assets: your business and your employees.

Business Insurance

Provides three types of coverage that an entrepreneur must consider:

• Property Insurance protects the business against unforeseen losses due to fire, lightning, vandalism and other mishaps. Earthquake and flood insurance is available for areas that are prone to this kind of damage.
• Contents Insurance protects business equipment such as office machines, computers, copiers, office furniture, etc. from fire, flood, and theft. Take inventory of office equipment and figure out the replacement cost in order to arrive at a value that should be placed on office contents.
• Business Liability Insurance protects your business from liability due to negligence that can cause bodily injury to a customer or an employee. There are various categories under business liability insurance that covers manufactured products and professional services for doctors, lawyers, or anyone who may need malpractice insurance.

Employee Insurance Benefits

An equally important asset to a business owner is the labor pool of employees.

• Workers Compensation Insurance is required by every state except Texas and covers job-related injuries and illnesses. This insurance covers an employee's medical, disability income, rehabilitation and death benefits.

It is important to choose an insurance agent or a broker with the experience and expertise to guide a business owner through the various policies that will provide the best coverage. Choosing the right insurance expert is just as important as identifying the right insurance coverage.

Provinces are very proactive in demanding provincial autonomy but their performance in Provincial subjects of Education, Health and Police (Law and Order) is zero and infact X, Inspite of Donations of Billions of Rupees from Federal Government and International Organizations provinces has chronically failed in delivering any thing to common people, It is very important to analyse the performances of provinces in view of continuous deteriorating situation in Pakistan, specially killing of ethnic minorities in Balouchistan province by majority Balouch ethnic group, denial of rights of Identity and land ownership of ethnic minorities in city of Karachi and province of Sind by majority of Sindhi and Urdu speaking people, the disease of Provincialsim and ethnocentrism is spreading and spreading without any stop, the details of disease of Provincialism and ethnocentrism and failure of provinces in serving common citizens with fairness due to Provincialsim and ethnocentrism are as follows:

Performance of Provinces in the subject of Education:

o In Examinations cheating is common.
o Even bribe is demanded from position holder's students from the official of Boards.
o Standard of education has been totally destroyed in government's schools.
o Even poor people do not like to admit their children in government schools
o Schools have been converted into Otaaqs and leisure rooms of addicted people.
o Literacy rate is stagnant from last 25 years.
o Teachers are recruited on political and ethnic basis without any merit.
o Ghost schools are common without any teaching, fake teachers are gaining salaries.
o Practice of molesting innocent children by teachers in government school is
Common.
o Citizens and children are denied their right of education on the basis of ethnicity.
o On the basis of ethnicity admissions are given in colleges without any merit.

Performance of Provinces in the subject of Law and Order (Police):

o Provinces are using subject of Police as Jobs Banks for their ethnic and provincial supporters instead of recruiting people on merit for maintaining law and order.
o When any person is recruited in police a huge amount of money is taken from that man as bribe.
o When any one retires from police department he is required to pay money as bribe for the processing of his pension documents.
o Even no proper training is given to policemen for maintaining law and order by provincial governments.
o Even no proper training is given to policemen for their own safety by provincial governments.
o Policemen are performing their duties without wearing any protective helmets and bullet proof jackets.
o Due to provincialism, ethnocentrism and racialism prevailing in structures of provinces, policemen are not committed with their duties and do not have any motivation for prevention of crimes and evils.
o Due to provincialism, ethnocentrism and racialism, Policemen are involved just in making money by taking bribes from common and noble people.
o Policemen are frightening noble citizens for taking bribes from them, but are friends of criminals involved in narcotics trade, social and immorals crimes.
o Due to no commitment with any moral and ethical Ideology and due to disease of provincialism and ethnocentrism, criminals are committing their crimes freely and police Department is totally inefficient in protecting the life and property of people which is obvious from following examples.

1) Merciless killing and massacre in Karachi on 12 May 2008, in which police and provincial government were found helping the criminals, and officially no investigation was made by provincial government against such delirious crimes.
2) Loot and arson on 27 December 2008, on the day of death of Benazir Bhutto, free hand was given to criminals for each and every type of crime by provincial governments and police and Railway and transport of people of other provinces was main target of these criminals, and later on all cases against these criminals were removed by Chief Minister of Sind.

3) 0n 27 December once again police of province failed event to protect the property of people and free hand was given to criminals in committing their crimes.

Moreover whenever people ask provincial police to help them as their duty and responsibility police never help to people.

In case of snatching a car or Motor cycle when people go for registration of FIR to police, even then police ask for payment of bribe when the person is himself suffering from great trauma.

Provincialism is blocking the progress of Pakistani nation and creating problems in the development due to making of decisions on ethnic and racial basis by Provincial governments, These Provincial governments are blocking people's movement from one place to another place and violating basic right of movement of common people and thus hindering urabanization which is the basis of all developments.

Performance of Provinces in the subject of Health:

o Hospitals maintained by Provincials Government (such as civil Hospital Karachi) have been converted
into ruins.
o Admissions in Medical Colleges are given on the basis of Ethnic basis.

o Provincial government had established Medical colleges in different cities on ethnic basis.
o Medical colleges have become places of promotion of provincialism and ethnocentrism.
o Medical Treatment is given to patients in hospitals on the basis of their link with any ethnic or political
party and not on the basis of humanity.
o Citizens are unable to gain any drugs from hospitals even vaccines are not
provided to infants and children for eradication of Diseases.
o Due to lack of motivation and any ethical commitment all program of polio and Tuberculosis
eradications have failed.
o There is no visible program for eradication of HIV, AIDS and Hepatitis.

o There is continuous flow of population from India into Pakistan having Diseases like AIDS, HIV,
Hepatitis, Swine Flue and Tuberculosis but provincial governments are doing nothing to block or to
monitor to people coming from India into Pakistan.

o Pakistan is leading country in the world whose population is suffering from Diabetes, Heart Diseases
and Tuberculosis but provincial governments visibly are doing nothing for controlling such diseases.
o Provincial Drugs Inspectors are involved in corruption and malpractices.
o Even children are selling drugs in medical stores without any license.
o There is no monitoring of food items sold in hotels, restaurants and on road side.
o Even in city of Karachi there is not only shortage of water but also water is usually without any
treatment and having sewerage contamination.
o There is no program by Provincial government for prevention of diseases.
Moreover Provincial governments are Blocking the mix up of different races and ethnic groups which is also hindering evolution of good genetic health characteristics in present races and due to provincial government, such policies, racial and ethnic group are becoming confined just to their community and causing increase in genetic and hereditary diseases in present population.

From above examples it is quite clear that disease of ethnocentrism and provincialism has become a cancer for common people and has become a main source of victimization of noble citizens and this disease is destroying all moral values and all state institutions.

Therefore, there should be strict monitoring by Federal Government and international community of Provincial Education, Health, Police (Law and Order) Departments and other departments and in case of no improvements then these Subjects should be taken back from provinces to federal Government.

Written By:
M.AKRAM KHAN NIAZI
Email:akrumniazi@hotmail.com

Plastic surgery is getting to be a pretty popular thing to do these days. From breast augmentations, nose jobs, face lifts, to many many others. There are many reasons women decide to get breast augmentations. They either want bigger breasts, sometimes smaller breasts even, or they want them to be perky and not saggy, or they want them the same size, equal. Plastic surgery in all reality is a pretty big deal, and what doctor you pick is most important.

A lot of women decide to get breast augmentations after they have children, because in some cases causes the breasts to sag or "deflate". Nowadays, doctors can even cut the nipple smaller, lift the breast, etc all in the same surgery. It does add on the dollar signs though. I think they are pretty safe for the most part, but I do suggest going to at least three consultations with three different doctors before you decide on a doctor. You want to make sure you feel comfortable with this doctor, that he has a lot of experience, that he is kind and patient, if they are a verified doctor etc.

There are many different things women would like to know about their doctor, so I have made a list. It's a good idea to take this list of questions to every doctor you see and have them answer all of the questions. After seeing all of the doctors, you can sit down and pick your favorite or do the pros and cons, whatever makes YOU feel most comfortable. After all, this is about you.

Ask the doctor if they are a a board-certified plastic surgeon with the American Board of Plastic Surgeries? What is their safety record? What areas do they specialize in? An important one, have they ever had their malpractice insurance coverage denied, revoked or suspended? Does this doctor believe that what you want to achieve is reasonable? Are your expectations realistic? Ask him if there is anything in your medical history that he thinks may cause complications. Also, be sure to look at all of his before and after photos.

Plastic surgery is an important procedure. It will change your life in some cases, and this will be with you for the rest of your life. Be careful, choose the right doctor, make sure you are informed. Be smart about the decisions you make. There are some sites that have great doctors with commentary as well. These sites may help you out..

Most of your health insurance premiums pay for actual health care services - not profits, admin costs, etc. Seriously, it's about 80% of your premium. The 20% of us who have the most health care costs use up about 80% of the amount spent on health services. Six percent of the people are in the 80% every year, and 14% of those could be any one of us - a birth, a broken leg, an appendectomy all put you in the 20% group. You pay a premium to protect you for the times you are in the 20%.

Lack of real competition in the health insurance market is an issue. A few large insurance companies that control the market have been created by how doctors and hospitals charge for their services. Try finding out what it costs to have a baby at the local hospital. Princeton healthcare economist Uwe Reinhardt tried to call local hospitals and got nowhere. You can't compare cost and quality when you're buying health services if you can't figure out how much care costs.

It's not that complex. Doctors set up fixed price arrangements all the time - fee schedules, case rates, per diems etc. with the big insurance companies. It's time doctors stopped bleeding consumers to make up for the low fees given to big insurance carriers.

Doctor and hospital charges are fictitious numbers unless you don't have health insurance, or are not the major carrier with the good discounts. In some markets they are 5 times more than what they accept from the major insurance company in your area.

This prevents all health insurance companies from competing and makes your premiums much higher than they have to be. If everyone paid the same amount for health care services, health insurance premiums would drop dramatically.

Lawsuits are another issue, particularly malpractice costs, defensive medicine and the impact on the morale of the medical community. And let's not forget the quality of care issue. Statistics indicate that the effect of poor quality health services costs over $1,300 a year for every employee covered by health insurance.

Consider this as well--every time a new drug or new technology is introduced, the cost of health care shoots up. You might want to call that inflation, just like doctors who promote medical inflation - meaning they (and the hospitals) keep charging more for the same services. And this will make you blanch. The rate they're charging has been about 150% of the overall inflation rate.

The conundrum is what to do to solve these problems.

Quite simply, a doctor answering service can provide assistance where human capacity fails. A doctor answering service is neither completely robotic (like an answering machine) nor completely human (which would imply human hindrances).  It is a combination of the best of both words. On one hand, when you use an answering service you are definitely providing a human touch. Your patients and your acquaintances can all speak to a live operator or triage nurse directly. This is far more satisfying than talking to a machine. Even patients suffering from high anxiety will be far more comforted by a live person than by spilling their guts to a recording.

On the opposite end, you have to consider that answering services offer new technology that far surpasses the capacity of a single office. Let's say that you hire an experienced receptionist. She may be experienced and a hard worker, but chances are you will only be able to use her on weekdays, the same time you're in the office. Now what if you were able to hire such a qualified worker to work every moment of every day, including nights, weekends and holidays? Better yet, you could hire this comparable employee for a fraction of the cost of a year's salary? 
 
That is the advantage of outsourcing calls to a medical call center. An answering message service provides patient assistance 24-7, and everyday of the year if required. However, unlike a salaried employee, you have the right to expand or limit your telephone answering service based on your needs. That means that you can plan for slow months or an overflow of traffic without having to go through a lengthy period of hiring or laying off employees. 
 
Furthermore, a call answering service can be very valuable during disaster recovery planning or disaster recovery solutions. Let's say that an emergency scenario happens that cuts off your phone. This could be caused by a power outage, severe weather or problems with the phone company. What would your patients do in this crucial time? Since you are a medical professional you cannot afford to let patients fend for themselves-not in this age of multiple malpractice lawsuits! You have to be available for your patients in some way, even if you cannot speak to them one-on-one.