Doctor

Esta guía farmacoterapéutica de atención primaria pretende ser un sistema de ayuda a la prescripción, que facilite al médico la elección crítica de los medicamentos, al proporcionarle una información objetiva, contrastada y de fácil consulta.

Background: Industrial actions have become a common means by which medical doctors attempt to communicate their grievances to the  government. Paediatricians are frequently caught between a desire to support the course of their professional association and caring for their patients. The purpose of this study was to assess the opinion of paediatricians and trainee paediatricians regarding strike actions, the likely cause(s) and their reasons for and against industrial actions as a means for communicating grievances to the government.Methods: A cross-sectional descriptive study was conducted using self-administered questionnaires randomly distributed to consenting participants at the 48thAnnual Scientific Conference of the Paediatric Association of Nigeria. Data were analysed using SPSS version 20.Results: A total of 102 respondents from the 6 geopolitical zones in Nigeria returned appropriately filled forms. Fifty-seven (55.9%) were females, 91 (81.2%) were married, 72 (70.6%) were C...

Prevalence studies show high levels of burnout, anxiety, fatigue and other symptoms of distress among medical doctors. However, there are very few randomized controlled trials testing interventions against these problems. This randomized controlled trial (NCT02838290; ClinicalTrials.gov, 2016) tested interventions teaching 227 doctors about the psychology of burnout, stress, coping with patient death, and managing distress, as well as giving them information about prevalence rates among doctors. Primary outcomes included burnout, anxiety, insomnia, grief, alcohol/drug use, binge eating, physical symptoms, and psychiatric morbidity. The outcomes were tested before and after the interventions with a 7-day time-lag. The intervention significantly decreased doctors’ levels of burnout (e.g. emotional exhaustion and depersonalization) and anxiety. Doctors in the control group had no significant changes in these signs of distress. The intervention did not significantly reduce other health and habit-related outcomes potentially because these need a longer time-lag than 7 days. Interventions teaching doctors about the psychology of work-related distress reduce burnout and anxiety by helping doctors realize that distress is a normal, human reaction to external stressors, common in medicine, and solvable by learning about psychological coping strategies.

La inmediata conexión con los errores médicos suele ser un tema de gran sensibilidad como es la denominada “mala praxis médica”, ya que genera discusiones entre profesionales de la salud y abogados, y sobre el cual nos urge delinear algunas alternativas para su gestión –como uno de los tipos de conflictos que aborda la conflictología sanitaria-, mediante la combinación de los principios del Derecho de la Salud y los métodos de resolución alternativa de controversias (RAC).
Nos hemos ocupado de describir el fenómeno que se ha instalado en nuestra sociedad, que se lo conoce como “judicialización de la salud” o, como lo denomina el académico Víctor Abramovich, la “rutinización” de los reclamos vinculados con el derecho a la salud interpuestos por pacientes que procuran obtener la protección judicial de su derecho.
Y en el tipo de conflicto que nos ocupa -que involucra al equipo de salud y a los pacientes- se habla de “mala praxis médica”, “industria del juicio”, “caranchos de la salud”, “enfermedad de la judicialización”, “Síndrome Judicial” y hasta “Justicia terapéutica”. Se encuentra asimismo  en la tabla de materias del fuero civil y comercial del Poder Judicial de la provincia de Buenos Aires como “Daños y perjuicios por responsabilidad profesional”.
Según el estudio de la mediación prejudicial obligatoria realizado por el Programa de Naciones Unidas para el Desarrollo –Argentina y la Fundación Libra, “la cantidad de juicios por mala praxis médica aumentaron anualmente a partir del año 2003. Esta alza podría estar relacionada con el mayor conocimiento por parte de la población de la posibilidad de realizar su reclamo en el marco de la figura de mala praxis. Puede mencionarse que la difusión masiva de este concepto es relativamente reciente al haber aumentado la importancia de los sectores proveedores de servicios profesionales en el marco de la economía nacional.
De acuerdo con los datos de la Superintendencia de Seguros de la Nación se ha observado que la estructura de la cartera de juicios (incluyendo mediaciones abiertas) al año 2009 es de 147.468 siniestros, con preponderancia de los ramos automotores (65,4%), seguido por el transporte público de pasajeros (16,8%) y luego por responsabilidad civil (11,5%), que en conjunto representan el 93,7%.
La opinión de las compañías que se dedican a seguros de responsabilidad civil por praxis médica, sostiene el valor de la mediación y no manifiestan dificultades respecto del cálculo de la reserva, que desde octubre de 2009 se cambió por disposición de la SSN. Consideran que la instancia de mediación prejudicial obligatoria otorga la oportunidad de hacer un análisis de viabilidad jurídica, lo que genera un nivel interesante de reclamos que se desisten. Se pronuncian a favor de “nacionalizar la mediación” haciéndola obligatoria y previa al juicio en las restantes provincias. Correlativamente, de los datos proporcionados por la SSN se aprecia que el porcentaje de mediaciones que se desisten alcanza al 25% de las iniciadas, mayor que el 15% correspondiente a los reclamos relacionados al automotor.”
Ello nos lleva a presentar algunas conceptualizaciones iniciales para llegar a comprender el núcleo central de esta propuesta.

The purpose of this article is to identify the effects of dark tetrad personality traits (such as narcissism, psychopathy, Machiavellianism and sadism) on counterproductive work behavior with the mediating role of psychological contract breach and the moderating effect of political skills. Previous researches have focused on the direct effect of the dark triad to measure the counterproductive work behavior of individuals. Recently, everyday sadism has been added to the dark triad and become dark tetrad personality traits. Therefore, this study examines the dark tetrad personality traits to study counterproductive work behavior. This study applied structural equation modeling using partial least square to test the hypotheses on a sample of 400 doctors from the health sector of Pakistan. The results of this study reveal that dark tetrad has a positive and significant effect on counterproductive work behavior, and psychological contract breach significantly partially mediates in the relationship between dark tetrad and counterproductive work behavior. Furthermore, findings show that the moderating effect of political skills also positively and significantly strengthening the link between dark tetrad and the psychological contract breach. The conclusion of this study is made an innovative contribution to the Pakistan health sector,

Medicine intake, as prescribed by physicians and health care providers, is important not only for minimizing the risk of relapse but also to treating conditions and improving one's overall well-being. However, adherence to a medication routine seems to be a problem for some people which is usually affected by a variety of factors such as hectic day-today activity schedules, poor prescription instruction, concurrent intake of multiple medications, and forgetfulness. Medication adherence has been then considered as one of the major medical problems globally. In such cases, a medical device that could alert and remind patients in taking their medicines on time will come in handy. Consequently, this study aimed to design and develop a pocket-sized electronic pillbox device using TFT LCD display, Arduino microcontroller, Piezo Buzzer (for sound notification), Eccentric Rotating Mass (for vibration notification), Lithium Ion battery as power source, and plastic organizer as the main b...

Angora PACS Sistemi tamamı DataMed tarafından geliştirilmiş yazılımlardan oluşur, tüm Türkiye’de çok sayı-da tıbbi merkezde kuruludur. Sistemde her türlü görüntüleme cihazından tıbbi görüntüler alınabilir, DICOM formatında depolanabilir, Radyolog ve Klinisyenler tarafından görüntüler izlenebilir, hastaya verilmek üzere içinde Türkçe DICOM görüntüleyici bulunan DICOM CD\DVD basılabilir, DICOM PRINT yapılabilir, PACS sunucuda bulunan görüntülere web üzerinden online erişilebilir ve HBYS hastane otomasyon programları ile entegre edilebilir. Ayrıca Radyolog İş İstasyonu DICOM görüntüleyicide MIP, MPR, MINIP, 3D Volume gibi ileri teknik özellikler bulunmaktadır.

The paper shows my investigation of all private hospitals and several officals and doctors around Region VIII in Philippines. Actually, I started making this as a Microsoft Access to clarify the results in the form of table, query, form and report but since Academia doesn't support the file type so I transferred it in Microsoft Word.

Doctor Enrique Galindo Andújar
Cirujano Ortopédico, Cirujano Traumatológico, Traumatólogo.
Madrid España Consulta de Traumatologia (patologia de cadera, rodilla, hombro, tobillo, pie y muñeca) - Artroscopia - Cirujia Ortopédica - Aporte de Factores de Crecimiento autólogos de origen plaquetario en patologías de traumatología. - Rehabilitación de Traumatologia. Fisioterapia. - Radiología convencional - Resonancia Magnetica abierta (RMN abierta) - Cámara Hiperbárica - Consulta de Odontología - Consulta de Psicólogo - Consulta antiedad (anti-aging) - Aporte de Células madre (Stem cells) - Rehabilitación avanzada.

The nature of their work requires the healthcare professionals to work in shifts, work overtime, report to duty at odd hours, take care of people who are sick and are sometimes terminally ill. Apart from draining them of physical energy, being in contact with such people also has a bearing on their psychological health. Striking a balance between life and work is a daunting task for the healthcare professionals. This study aimed at identifying the determinants of work life balance among Health care professionals, because they play a critical role in determining the efficiency, effectiveness and sustainability of health care systems. Data was collected from Healthcare Professionals like Physicians, Nurses, Clinical Support Staff and Administrative staff from both the Public and Private Hospitals in Nagpur District using a structured questionnaire. Factor Analysis revealed five factors namely Demographic Factors, Supportive Work Culture, Working Conditions, Work Provisions and Travell...

Many people suffer from a common condition called a lipoma, which is a tumor composed of fatty tissue that most often appears on the thighs, shoulders, arms, or back. Lipomas are usually small and moveable, with a rubbery texture. They are by definition benign, posing no real threat to health. Many people are concerned about the appearance of their lipoma and wonder if it will go away on its own, or if it will disappear with weight loss. The answer is, unfortunately not. Although lipomas are composed of fatty tissue, losing weight does not make them go away. In fact, it may make them more prominent, as there will be less surrounding fat to mask them. If a person wants to get rid of a lipoma, the best way is through surgery or liposuction. The board-certified lipoma specialists at Lipoma Removal Center of Excellence in Los Angeles are highly skilled at removing unwanted lipomas in a safe and effective manner.

When to Remove a Lipoma

Some lipomas are painful or tender, due to various reasons such as blood vessels, muscle tissue, or other types of cells within the tumor. Sometimes tumors can press on nerves, which also causes pain. In rare cases, pain may be because the tumor is not a lipoma, but in fact a lipoma sarcoma, which is a type of cancerous tumor. If a tumor exhibits rapid growth or other symptoms, it should be examined by a specialist to see if it is cancerous. Lipomas can grow to large sizes, which are unsightly and may cause self-consciousness or self-confidence issues in patients. Any of these cases are a valid reason to have a lipoma removed.

Lipoma removal is often covered under insurance if it is for medical health reasons. If the removal is for cosmetic purposes only, then insurance may not cover it. Lipoma Removal Center of Excellence is dedicated to helping each of their patients get the care they need, and will work with each individual in navigating finances and insurance.

Types of Lipoma Removal

There are three main ways to remove a lipoma: surgery, liposuction, or steroid injections. Depending on the patient’s goals and the size of the lipoma, any one of these can be effective. Steroid injections are the least invasive way to treat a lipoma, but unfortunately these injections can only reduce the size of the lipoma, not eliminate it entirely. Steroid injections may be a good option for patients with very small lipomas who do not want to undergo invasive treatment. Liposuction is more effective and results in practically no scarring or recovery time, but it is difficult to remove the entire mass through liposuction and there is a chance that the lipoma could regrow. Surgery is generally considered the best option for complete lipoma removal, as it is the most effective.

Lipoma removal surgery is a short procedure with minimal recovery time and scarring. It is done on an outpatient basis, and patients can return to work the next day, with full recovery happening over a matter of weeks.

Aim: Primary care will play a more significant role on the diagnosis and management of neurodegenerative diseases in near future. This study aimed to determine the level of awareness on the early diagnosis and management of Alzheimer’s disease among primary care physicians and interns in Denizli, Turkey.

Methods: This cross-sectional study was completed in the Denizli city center. Two different groups, family physicians
in primary care of Denizli [93 (60.4%)] and the interns of Pamukkale University Faculty of Medicine [65 (89.0%)] were included. After completing ethical requirements, we applied the University of Alabama, Alzheimer’s and Alzheimer’s Disease Knowledge Test.

Findings: The mean (SD) Alzheimer’s disease knowledge
score of family physicians and interns were 5.16±1.83 and 7.34±1.85, respectively (p <0.001). Interns who previously took any course on Alzheimer’s disease had a higher average score of 8.41±1.67 than that of those who did not (5.07±1.95, (p=0.04). Previous course among Family physicians did not make any difference (p=0.568).

Conclusion: Alzheimer’s disease knowledge among primary
care physicians currently is insufficient. Authorities should take the necessary actions to improve this situation.

Cheap Fees MBBS without donation Direct MBBS Admission Criteria for MBBS in Bangladesh Indian Student can get admission in Govt & Pvt Colleges Smile Education Authorised admission information Center in Kolkata. https://www.smileeducation.org/ MBBS in Bangladesh Direct MBBS Admission without Donation with Low Package MCI Approved Colleges.
Direct MBBS Admission without Donation with Low Package MCI Approved Colleges. Indian students who are trying to become a Doctor by profession can surely consider Bangladesh as an appropriate country for MBBS in Bangladesh.

Background: Adverse drug reaction (ADR) is a response to a medicinal product which is noxious and unintended. Spontaneous reporting of ADRs has remained the cornerstone of pharmacovigilance and is important in maintaining patient safety. Therefore, we aimed to assess knowledge and attitude of the health professionals towards pharmacovigilance and ADR reporting.
Method: A face to face questionnaire was conducted with 90 community pharmacists, 98 nurses and 71 physicians in Turkish Republic of Northern Cyprus (TRNC), who consented to participate in the study.
Results: Of those that did respond, only 13% of the pharmacists, 2% of the nurses and 20% of the physicians had knowledge about ‘pharmacovigilance’. Respectively 32%, 12% and 54% of participants stated that their patients reported them an ADR within the recent year, but only 10% of the pharmacists and 3% of nurses and physicians stated that they sent an ADR report to the concerned organization. The common reasons for under-reporting was stated as lack of knowledge of where/how to report, lack of time, ADR reporting being not mandatory, belief that it was not their responsibility, hesitation about their clinical knowledge, avoiding the professional liability.
Conclusion: The results show that the healthcare professionals in Northern Cyprus have insufficient knowledge about pharmacovigilance. Therefore, it seems there is an extensive need for a training program about pharmacovigilance and ADR reporting.

Nama asli Abu Bakar adalah Abdullah bin Utsman bin Amir bin Amr Bin ka'ab Bin sa'ad
Bin Tamim. Abu Bakar berasal dari bani Taim. Bani taim adalah termasuk suku Quraisy
suku Quraisy memiliki 12 Bani. Bani taim bukan termasuk kelompok besar. Nabi
Muhammad memberi gelar As Siddiq kepada Abu Bakar karena dialah orang yang selalu
membenarkan ucapan Nabi Muhammad Shalallahu Wassalam tentang Isra Miraj.

The aim of this study is to identify the features of fraudulent journals. Fraudulent journals wasted valuable manuscripts when scholars and authors publish their works in this kind of journal. Fraud journals publish the articles without reviewing the process with a high rate of fee. Purposive sampling technique and document analysis method have been used to conduct this research. One Scopus indexed journal has been selected for reviewing their articles and investigating the publication process.  Based on the discussion of this study, the researcher found some characteristics of predatory/fraud/ journals that will help the scholars to avoid publishing fake journals.

DR Dave Hepburn( https://www.facebook.com/DrdaveHepburn )is a well-known Dermatologist. A Dermatologist is a doctor who helps patients suffering from skin, nails, hair related diseases. As being a dermatologist in New Zealand he is qualified for helping many patients. The diagnosing process of skin condition is properly looked upon to identify the disease patient is suffering from. Dr. Dave Hepburn has been helping people so the disease they suffer from can be identified and proper care is available to them to get cured.
Being a dermatologist he can identify many symptoms to detect diseases at early as possible. He already has helped many suffering from skin, nail, and hair conditions that are harmful to them. Any part of the skin such as mouth, feet, hands and other parts can suffer from many diseases. The symptoms can be found in both children and adults as well doctor is specialized in the branch of dermatology which can help many. Skin infections such as fungal, bacteria and many other kinds are treated with help from the doctor.
The doctor is helping many in New Zealand. As for skin related diseases, many people suffer from skin cancer the number of people facing this disease is high in New Zealand compared to another country. The dermatologist helps in identifying symptoms at an early stage so he can help save lives of many. Years of experience he has in treating many skin infections and other issues with the skin.
Dr Dave Hepburn has helped many and trained many other doctors guiding them to help patients. The best qualities of this doctor he is very helpful in guiding his clients and future doctors. Nowadays people suffering from a tumor and many types of cancer can die if they do not have medical doctors helping them. The cure is available for many diseases today and for many still, there is no cure to help. But the cure that is available is used best by the doctor for not only helping them but also to provide knowledge and create awareness so everyone is safe and get the medical treatment early as possible. He has been visiting many different places to provide the knowledge he has to other doctors as well. The doctor examines his patients and performs the necessary test to find the issues person is struggling with. As per diseases, anyone can get exposed to illness without even knowing about. But with doctors they can get cure faster and not have to deal with medical; problems.

The economy of Pakistan is significantly contributed by the pharmaceutical industry which is growing at a rapid rate. For pharmaceutical industry doctor is one of the most important stakeholders because he is the ultimate decision maker rather than the direct user. Pharmaceutical industry focuses on doctors rather than the direct users; BTL i.e. below the line marketing strategy is the basis of marketing in pharmaceutical industry, the importance of sales promotion officers as a marketing technique in pharmaceutical industry cannot be denied and ignored. In order to reach the doctors i.e. the prescribers, pharmaceutical industry takes the help of sales promotion officers that constitutes a major place in pharmaceutical marketing strategies. The connection of pharmaceutical industry with physicians is controversial due to the involvement of personal benefits and clash between money and ethics. Trust is one of the fundamental factors of patient-physician relationships, despite of its recognized significance and efforts to measure patient trust have been quite insufficient. This study investigates the patients' perspective regarding the sales promotion by pharmaceutical industry, it highlights the viewpoint of one of the most important stakeholders of health care industry i.e. the patients regarding the matter. Questionnaire was used as the research tool to collect the primary data from patients, 100 questionnaires were filled up from a hospital of Karachi.

Ghimbirul, un condiment natural de provenienta asiatica, fiind folosit de chinezi de peste 2500 de ani in bucatarie precum si in medicina, a ajuns in Romania de curand. Ne bucuram de mirosul si de aroma deosebita a ghimbirului in mancare, dar stiati ca radacina de ghimbir poate fi un remediu in nenumarate afectiuni?

Needless to state that medico-legal postmortem examination is very important part of prosecution evidence and it is therefore necessary that it should be conducted by a doctor fully competent. It is the statement of doctor in the Court and not the postmortem report which a substantive evidence. In our view doctor who examines deceased and conducts postmortem is the only competent person to opine about nature of injuries and cause of death. But where competency itself is inherently defective question arises whether the Court would discard such evidence or based on such evidence of witness who is otherwise not competent would fasten the criminal liability on the Accused.
10 In the case on hand PW-6 Dr. Khamkar had stated in his examination-in-chief that he is B.A.M.S. In cross-examination he admitted that he is not qualified as M.B.B.S. He has not completed the course in Orthopedic. He had no exclusive knowledge in respect of bones. He conducted postmortem in the case of throttling for the first time. Though Dr. Khamkar stated in further cross-examination that he conducted postmortem in 40-50 cases of death due to asphyxia, fact remains that he performed postmortem in case of throttling for the first time i.e. in the present case. There is no evidence to show that Dr. Khamkar had an experience or training to conduct postmortem in case of throttling.
On the contrary unequivocal admissions elicited in cross-
examination of Dr. Khamkar indicate that he was not competent to perform postmortem in the case in question.
11 We therefore find the opinion given by Dr. Khamkar who had no experience, training and qualification in the subject as inherently defective. If expert's evidence is defective Court cannot substitute its opinion for that of the doctor.
Bombay High Court
Dattatray Bajirao Lagad vs The State Of Mah on 16 October, 2015
                                       
                                     
              IN THE HIGH COURT OF JUDICATURE AT BOMBAY,
                        BENCH AT AURANGABAD


                          CRIMINAL APPEAL NO. 214 OF 2012

   

            CORAM :      A. B. CHAUDHARI &
                        INDIRA K. JAIN, JJ.

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Objectives
To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital doctors in Ireland.
Design
National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex, marital status), work grade (consultant, higher/basic specialist trainee),  specialty and work hours and completed well-being questionnaires (the Depression Anxiety Stress Scale, WHO Well-being Index, General Health Questionnaire) and single-item scales on self-rated health and self-stigma.
Setting
Irish publicly funded hospitals and residential institutions.
Participants
1749 doctors (response rate of 55%). All hospital specialties were represented except radiology. Results Half of participants were men (50.5%). Mean hours worked per week were 57 hours. Over half (52%)
rated their health as very good/excellent, while 50.5% reported positive subjective well-being (WHO-5). Over a third (35%) experienced psychological distress (General Health Questionnaire 12). Severe/extremely severe symptoms of depression, anxiety and stress were evident in 7.2%, 6.1% and 9.5% of participants (Depression,
Anxiety, Stress Scale 21). Symptoms of distress, depression, anxiety and stress were significantly higher and levels of well-being were significantly lower in trainees compared with consultants, and this was not accounted for by differences in sociodemographic variables. Self-stigma was present in 68.4%.
Conclusions
The work hours of doctors working in Irish hospitals were in excess of European Working Time Directive’s requirements. Just over half of hospital doctors in Ireland had positive well-being. Compared with international evidence, they had higher levels of psychological distress but slightly lower symptoms of depression and anxiety. Two-thirds of respondents reported self-stigma, which is likely to be a barrier to
accessing care. These findings have implications for the design of support services for doctors, for discussions on quality of patient care and for future research.

Objectives To survey on the availability and use of primary care services in slum populations. Design Retrospective, cross-sectional, household, individual and healthcare provider surveys. Setting Seven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh). Participants Residents of slums and informal settlements. Primary and secondary outcome measures Primary care consultation rates by type of provider and facility. Results We completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than singlehanded providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/ nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household's monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%-78%) and service quality (31%-95%) being a reason for choosing a provider than fees (23%-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. Conclusions People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries.

A biography of intellectual emigration and exile from Fascist Italy, with photos, maps and timeline of movements, emigrated family members, reference and support networks http://intellettualinfuga.fupress.com/scheda/calabresi-massimo/347,
in the bilingual website "Intellectuals Displaced from Fascist Italy. Migrants, Exiles and Refugees Fleeing for Political and Racial Reasons" http://intellettualinfuga.fupress.com/en.
Legato a Salvemini e allievo di un indesiderabile al regime, nel 1927 andò a Milano a fare l’assistente universitario volontario, cioè non pagato, pur di cambia r aria e costruirsi una carriera come cardiologo. Dispensato dal servizio nel 1938, a 35 anni con un eccellente curriculum, moglie e due bambini, la decisione di andarsene oltre oceano fu quasi ovvia.
Caduto il fascismo, qual era la scelta giusta da fare? Tornare indietro o restare negli Stati Uniti? Insegnava alla Yale University ma fece istanza per essere reintegrato all’università di Milano: era suo diritto, riconobbe il rettore. Ma non tornò.

In this Paper the main objective is how to reduce the waiting time. As it is commonly known that in the hospital minimum you need to wait for half an hour to one hour, which is a sheer waste and also the doctor is very busy who does not like to wait for his patients, since he will run out of his schedule if one of them fails to show up in time. The objective of this paper is to optimize balance between the patients' waiting time, the doctor's idle time and the overtime. The initial problem is to find an optimal appointment system for the hospital on per day basis. We suppose that there are eight types of patient. They all have a lognormal service time and their actual arrival time is drawn from a triangular distribution. A different type of patients is described. In the second column the average service time for every patient is shown. The next column shows the standard deviation of the service times. Column four and five give the parameters inserted in the lognormal distribution to achieve the values in the first two columns. Since the lognormal distribution has no upper bound it is truncated to a maximum service time of one hour.

When I first went to Tanzania in 1980 my portable medical library comprised the Ross Institute's Preservation of Personal Health in Warm Climates and the Cambridge Expeditions Medical Handbook. The former, aka the Little Red Book, betrayed its origin in a milieu in which the nervous disposition of one's wife and the behaviour of one's servants were common concerns -- more, certainly, than they were to a 22 year-old explorer of the nether regions of Ujamaa (later in life, though, I could have done with an update). The Cambridge Handbook was much more useful, though its diagnostic tables tended to induce hypochondria. Instead of reading possible diagnoses from the combination of symptoms, it was much easier to pick on the worst disease and imagine the symptoms that were listed under it. And so every crick in the neck mirrored meningitis and every instance of colic conjured up appendicitis. Although this is a hazard associated with all self-help health guides, the Handbook's crude diagrams and simple matrices seemed designed to maximise the inflation of illness and a category of anxiety that the Little Red Book didn't cover.