Initially I developed a system using the first handheld PDA (Psion 3), and named this as "PAT" (Paediatric Assessment Tool). This simple tool was created to help train junior doctors and medical students aquire the skill to differentiate "Minor from Serious Illness".
I started seeing children with minor illness labelled as (URTI, LRTI, Flu, Cough, UTI) were referred by family doctors and admitted to hospital. I felt it is not safe to admit children with minor viral infections visiting or admitted to hospital because they are prone to get secondary infections with antibiotic resistant bacteria.
In 1996, some healthcare providers started using "Pre-printed Assessment Sheet" to collect information and offer advice and treatment. We felt this is not in the interest of medical profession and also result in poor quality of training doctors.
In 2000, I was not happy because MRSA started spreading in community (Ca MRSA) and was also developing resistance to Vancomycin (VRSA). I decided to re-trained and qualified as a family physician (Gp) to work in the community. Here my mission was to find out what makes a patient anxious to consult a doctor or go to hospital. After collecting information, I noticed there were only twelve symptoms that are common but I could not label any one as "Common Ailment or Illness".
I noticed increasing demand, staff crisis resulted in the quality of care offered reduced. Antibiotic abuse was rampant and the spread of superbugs was getting out of hand. More people in hospitals were dying and the chances of developing alternate treatment was bleak. I hoped to develop a simple tool that every person on earth can afford, use and get the correct diagnosis and treatment they need.
Working as a locum doctor, it gave me an opportunity to read notes and speak to the patients.
I started collecting data and compiled list of presenting complaint, hypothetical diagnosis and divided the list into "Patients who required clinical examination and the ones who were diagnosed based on history. I listed twelve common complaints (symptoms) that made patients very anxious and demand emergency appointments or visit hospitals.
In 2003, I was invited by a nurse to work as a Gp, train and certify nurses to diagnose infections and prescribe antibiotics in a"Pilot Nurse-led Practice in the NHS". Hoping this will help me test my hypothesis and validate my tool (MAYA), I accepted this opportunity. After training two batches of nurses, I felt very uncomfortable because patients who consulted nurses in the local walk in clinic or nurse led practice were returning with complications.
Unfortunately, the nurses were allowed to work as doctors in local Walk-In-Clinics, Nurse-Led Practice and prescribe antibiotics. The so called "Independent Nurse Practitioners" were making clinical errors in diagnosis, interpreting test results and prescribing antibiotics. This resulted in false reassurence offered to patients and so delay in diagnosis resulted in minor and serious complication. As doctors we raised concern and also informed the General Medical Council, World Medical Association and people in power, but no change was implemented. profession.
Initially I created MAYA (Medical Advice You Access) to help receptionist, nurses and junior doctors to differentiate serious illness based on combination of symptoms and refer patients to consult doctors or hospitals.
We anticipated superbug and emerging infections will be a threat to doctors and nurses working in acute and emergency care. After testing few hypotheses and we successfully integrated our innovations (Maya) to help share information, educate patients to differentiate well from unwell and seek help from doctors only when they must. We published our innovation in a website and named "Medical Advice You Access" in the internet.
Presenting symptoms like runny nose, snuffles, or rhinitis have been diagnosed as common colds, and coughs with fever were diagnosed as chest infections. Asthmatics were labelled as wheezy bronchitis, viral infections, sore throat, red ears, and flu and were often treated with antibiotics that they didn’t need. Western medicine is about diagnosing and eradicating infectious diseases using antibiotics and vaccinations.
Unfortunately, this callous attitude of allowing spread of MRSA has now resulted in an army of eighteen bacteria, numerous viruses, TB, HIV, Malaria and fungus threatening our very existence.
Why You Must Use Dr Maya?
Management of common diseases as seen in primary and secondary medical care vary and depend on the primary care physician’s or nurse’s experience of interpreting symptoms.
Since 2003, the number of children less than five years admitted in hospitals for less than twenty-four hours has doubled in the NHS (UK). These children were diagnosed to have serious URTI (upper respiratory tract infection), LRTI (lower respiratory tract infection), and URTI (urinary tract infections) (Peter Gill, Arch of Dis in Child, 2013).
We published a letter in BMJ Quality & Safety (1996) criticising pre- printed assessment sheet used in hospital to systemise care. We said “When a patients describe the symptoms for which they are seeking professional attention, they are also reporting the story of an illness as they have lived, and remembered it, and so it can vary. To some extent, symptoms are universal human experience. Virtually every person experiences some discomfort for which he or she is seeking some help. (Srivatsa KM, BMJ Quality & Safety, 1996)
The duty of primary care physicians is to listen to story of the illness, use their knowledge and experience to diagnose illness and offer advice to manage – not to prescribe or promote drugs. We are not God with a magic wand nor have “Miracle cure” for illness. All that we can do is help reduce pain, suffering, prevent complications, and postpone death.
Doctors’ first priority is to satisfy themselves that there is no evidence of serious disease, and if so, they must reassure the patient accordingly. This may be all that is necessary; patients do not necessarily want advice on managing their illness, and traditional nursing advice (e.g., rest, copious fluids, and regular Paracetamol) is also not well supported by research.
Doctor Patient Relationship
Discouraging patients’ access to healthcare is unethical because we know common symptoms are common, but let us not forget serious illnesses also present with symptoms that make one assume it is a minor ailment. By discouraging patients with so-called minor ailments from consulting a doctor or visiting a hospital to receive the right treatment, we are inflicting pain and suffering, which could lead to complications.
By knowing the cost of healthcare will increase in order to treat or manage complication because of hospitalization, which can result in long-term problems and even death, we must help bring in changes and defend our medical ethics.
In Western medicine, the placebo effect is regarded as a nuisance that interferes with the evaluation of the real effects of a treatment in clinical trials. Yet the placebo effect is itself very real and represents the influence of the patient’s belief in the intrinsic healing ability of the body. One can harness this effect very easily by being positive and emphasizing that a good recovery is likely.
The placebo effect of any treatment that you suggest will be enhanced by the fact that you have particularly recommended it. We have tested this hypothesis and know it is very essential for doctors to build good rapport and have access to their advice twenty-four seven to help us fight the threat to humanity, the medical profession, and our lives.
Doctors must know it is unethical to offer treatment that is not required or withhold available treatment that helps patients. For example, when it comes to prescribing simple linctus to suppress cough, or using vitamin pills or tonics to help boost immunity, there’s no evidence that this offers any benefits, and the patient must be discouraged. Yes, therapy that makes the patient feel better (placebo effect) is likely to accelerate the healing process, but doctors must know introducing drugs and chemicals into the body alters physiological processes and so may inflict more harm than good.
Unfortunately, changes implemented in medical school training, over- enthusiastic urges to perform tests and investigations, and giving less importance to clinical examinations have resulted in loss of human life and made people distrust family physicians.
"The threat of viral, antibiotic resistant bacterial and emerging infections is real".
Scientists and pharmaceutical companies have not invested time and so there is one antibiotic undergoing trial. This drug may or may not be made available for human consumption in ten years. Hope of developing eighteen to twenty antibiotics and innovations to manage common infection has rapidly declined.
Pharmaceutical companies are not keen to take a drug from discovery to market is estimated to cost £700m and loose their investment in few months because bacteria develop resistance very rapidly. have stopped investing, since bacteria are very quickly developing resistance.
CDC reported that “bacteria that resist the last resort antibiotic “colistin” – a polymixin antibiotic have been discovered in the UK. Drug manufacture almost inevitably depends on the pharmaceutical industry and unfortunately it is very difficult to make economically viable models for antibiotics.”
Spread of infection is by contact with contaminated hands of hospital staff, contaminated surfaces such as door handles, over-bed tables and call bells, contaminated equipment, such as stethoscopes and blood pressure cuffs.
Dr MAYA is a simple tool that was designed based on clinical acumen and criteria doctors use to differentiate minor from serious illness. We feel this simple tool will help us reduce the culture of dependency and encourage you to consult if the combination of symptoms is potentially serious.
Integrating innovations to initially identify infected individual and isolate them to help protect people is now mandatory. Knowing more than fifty present of people who died in Ebola epidemic in West Africa are healthcare workers (doctors, nurses, midwives, cleaners, lab technicians, equipment operators, phlebotomists and staff), it is unethical for doctors to ignore to avert a major threat to our very existence.
Maya monitor identify symptoms chosen by the user. This helps us identify cluster of patients with similar symptoms that may suggest spreading infections. Epidemics often being in hospital or home and rapidly spread to others living with this patient or by contact.
By identifying infected individual early, members living at home can isolate the patient to protect their family and friends. Preventing infected patients travel to hospital, clinics or surgery, we hope to protect doctors, nurses, lab technicians, porters and also in-patients.
As Albert Einstein said,
“THE WORLD WILL NOT BE DESTROYED BY THOSE WHO DO EVIL BUT BY THOSE WHO WATCH THEM WITHOUT DOING ANYTHING”
We have been observing how one bacteria MRSA (Methicillin Resistant Staphylococcus aureus) I encountered in 1989 has successfully created an army that threaten our profession and very existence.
We have created TWO APPS to help doctors and patients create local network and share information, educate and also spread message to avert endemics. Using communication technology and internet we have created a tool to monitor symptoms entered in our App and identify cluster of infections. Using the tool we hope to preventing infected individual travel, visiting health centre, clinic, surgery or hospital is mandatory to protect fellow human, doctors, nurses and staff.
We sincerely hope nurses, doctors, and you will download our apps and help us create a network of doctors and users. We have integrated innovation to initially identify infected individual early by monitoring the symptoms and isolate them.
Please do not be the one who watch our world destroyed by micro- organisms but act by downloading our Apps, reading our book and help us fight this threat to our profession and our very existence.