Authors' response to commentaries on "Emergency care in rural settings"

We are grateful to Kattula and Jain, Patil and Phutke for their comments on our article on rural emergency medical care and our real problems in rural practice, their management and the threat to our survival. We agree with most of their points and the solutions they have advocated.

Emergency care in rural settings: Can doctors be ethical and survive?

We describe below the pressures of running a small private hospital in an underserved rural area, while providing emergency healthcare for victims of poisonous stings, accidents, and other acute health conditions. Both ethics and law demand that payment is not asked for upfront in emergency cases. Yet patients and their families often fail to pay normal dues for months or even years. It is disturbing to encounter such behaviour even in villages; and doctors in small communities are easy prey. In these conditions can one be true to ethical principles and ensure one’s own survival?

C-peptide and cardiovascular system.

Background: C-peptide and insulin are secreted by pancreatic beta cells in equimolar concentrations. C- Peptide is associated with increased risk of cardiovascular disease. Methods: Routine outpatient department patients were investigated for serum C-peptide, Diabetes, Ischemic heart disease, hypertension and skin lesion acanthosis negrican. Results: Total ninety five patients enrolled in study of these peptide level 2, 2 to5 and >5 found in 22,46,27 patients respectively, with diabetes mellitus in 21 (95%), 39(55%) and 24 (89%), ischemic heart diseases 1(5%), 15(33%), 13(48%) , hypertension 9(41%), 20(44%), 12(45%), acanthosis negrican 9 (41%), 27 (59%), 21 (78%), family history 1 (5%), 18 (39%), 11 (41%) respectively. Conclusion: Significant incidence of hypertension and ischemic heart disease is related to raised level of circulating C-peptide

Problems of isolated private hospitals in a rural setting.

In the era of the Consumer Protection Act, doctors running small private hospitals in rural settings face unique ethical challenges, especially in acute medical emergencies. I would like to share a few such cases