IMA stresses on the importance of reviving family physicians The need is imminent in the wake of a rising shortage of doctors, establishments, and beds in the country New Delhi, 26th June 2017: According to statistics, India has one doctor for every 1700 people against the WHO recommended norm of 1 doctor for every 1,000 people. With a population of more than a billion, India is facing a shortage of doctors, establishment and beds. There are not enough doctors to take care of the health needs of all. Adding to this, is the issue of unqualified quacks who dupe people in the name of medical practice. Research shows that about 80% of the population in India turns to private caregivers and more than 75% of their health care spending is out of their own pocket. All this makes it imperative to bring back the concept of a 'family physician'. Family doctors can help restore the faith of patients in medical professionals, which currently is seeing a downward trend. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "In earlier days, family physicians looked after all the health needs of a family, even many generations of a family, regardless of their specialization. They treated and provided preventive health care to a family as a whole because they were aware of the family history and served as a link between the patient and the specialist. The situation is different today: lack of communication has fostered distrust among patients which is evident in the form of rising litigations or often violence against doctors. The need of the hour, therefore, is to reintroduce the family physician system. They are the first link in health care delivery for the population and play a pivotal role in preventive health, early diagnosis, and timely referral including maintaining health details of all family members." A physician should be aware of the social determinants of health such as the conditions in which people are born, grow, work, live, and age, for good health outcomes. An organized chain of qualified family doctors will help in substantially easing the burden on large hospitals by detecting primary-stage ailments, and reducing cases that require complicated procedures. The society should be educated on the benefits of getting treatment through a family doctor. Adding further, Dr Aggarwal, said, "Family physicians offer several advantages. Some of them are familiarity, trust, and ease of communication. As a result, the patient is more likely to open up about his/her problems and adhere to the treatment prescribed. Family physicians provide a continuum of care at all levels of care, including emergency care. While specialization is required today keeping in mind the medical advancements, the psychological impact of a family doctor on the patients is invaluable, particularly due to the stressful and busy life people lead today." As part of its efforts to update the older lot of general practitioners (aged 45 years and above) with the latest medical advancements, the IMA is already offering a series of continuing medical education programmes with short courses in diabetes, ECG, oncology, etc. to keep them abreast of the latest developments. It is important to encourage more practitioners to undertake the diploma courses in family medicine so that they no longer deal with mundane and routine health issues.
Tuesday, 27 June 2017
Genesis of medical accidents Patient safety is of prime concern in day-to-day practice. But despite, all precautions, medical accidents do occur. Medical accident is an unforeseen or an unintended occurrence. Most medical accidents are preventable. Hence, it is important for us to analyse why medical accidents occur. Several factors contribute to medical accidents. Fatigue, sleep deprivation, poor communication, inadequate preoperative planning are some common reasons for medical accidents. Distraction is another very important factor in medical accidents. Smart phones are a major source of distraction for the operating team in the OTs including the anesthetists or in critical care areas. Doctors may talk and attend to their mobile phones during a surgery and may communicate through a nurse or a junior who works as a bridge between the surgeon and the caller or may check or send e-mails or text messages. Mobile phone distractions adversely affect the performance of the entire team with greater likelihood of accidents that otherwise would not occur. E.g. an accidental injury to the intestine during an appendicectomy. Hands-free phone can be as distracting as talking on a hand-held mobile phone. The role of the navigator or the person who sits in the front passenger seat of a car can be an apt analogy here. It is a rule that he or she should not sleep or talk on the phone but stay alert. Besides navigation, he has to stay awake with the driver, especially on long drives, and also help the driver stay awake. Majority of car accidents are caused by human errors and are a result of distracted driving. It is important to concentrate on the task at hand and not let distractions take away the focus and cloud one’s judgement. Dr KK Aggarwal National President IMA & HCFI Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO) Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)
Monday, 26 June 2017
Lack of awareness impediments treatment of Parkinson's disease Disease causes 60% to 80% of dopamine-producing cells to become damaged New Delhi, 25 June 2017: According to a report published in the International Journal Of Nutrition, Pharmacology, Neurological Diseases out of every 1, 00,000 people in India, 70 have Parkinson’s disease. What is alarming is that the brain has already lost more than half of its dopamine-producing cells, by the time the characteristic symptoms develop in patients. The symptoms of this disease are so subtle that it can remain undiagnosed for years. Parkinson's disease is a neurodegenerative disorder that is chronic and progressive. It occurs when the nerve cells in the brain stop producing dopamine, a chemical which helps in controlling movement. Dopamine helps in the smooth transmission of messages to different parts of the brain and regulates body movements in healthy adults. When a person develops this disease, about 60% to 80% of the dopamine-producing cells get damaged. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "The main impediment to managing Parkinson's is the lack of awareness about this condition. This disease generally affects those who are above the age of 60 and the risk increases with age. The symptoms can vary from person to person. Some early stage symptoms include very slight shaking of hands, difficulty in walking and/or postural imbalance. The four key motor symptoms of Parkinson’s disease include tremors (hands, arms, legs, jaw); stiffness or rigidity (arms, legs, trunk); slowness of movement; and postural imbalance (poor balance and coordination). This is a progressive disorder but not life threatening. However, people with Parkinson’s disease may be unable to perform daily movement related functions and eventually stop working due to progressively disabling symptoms." Diagnosis of Parkinson's can be done through a 99mTc-TRODAT-1 SPECT scan of the brain. Early detection is very important in minimizing dopamine loss in the brain and maintaining muscle function. Adding further, Dr Aggarwal, said, "While there is no cure for Parkinson's disease as yet, treatment can definitely help people live a good quality life, provided the diagnosis is done at the right time. The decision to start taking medicine, and which medicine to take, varies from person to person." Tips for people with Parkinson's disease • Simplify daily tasks and set realistic goals. • Plan activities such as household chores, exercise, and recreation well in time. Distribute them throughout the day. • Take some rest before and after any activity. • Do not plan activities right after a meal. Rest for 20 to 30 minutes after each meal. • Divide your work among friends and family. Do not hesitate to ask for help. • Get proper sleep and elevate your head when sleeping. Avoid extreme physical activity or lift heavy objects.
Inform your patients before traveling The doctor-patient relationship is a sacred relationship. This relationship is initiated when the patient comes to the doctor, who in turn agrees to treat him. This ‘implied contract’ imposes on the doctor a legal duty to exercise due skill and care in providing medical treatment. Once a doctor takes on the care of the patient, he also has a duty to provide continuity of care when he is traveling or is unable to attend to the patient. The ‘fiduciary’ nature of the relationship, one that is based on trust, which the patient reposes in his doctor also places an ethical obligation on the doctor to always put the interests of the patient first. Patients rely on doctors for help in their time of need. Regulation 1.2.1 of MCI Code of Ethics requires that “…Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion.” So, before you undertake a case, if you are planning a visit out of town or a vacation, you still need to take care of your patients. Communication is the key to developing and nurturing the trust in a doctor-patient relationship. So, if you are going to be away on a vacation or for a conference etc. also convey the same to your patient. Inform them about the duration of time you would be away and the dates of your departure and return. If you have arranged for another physician to take care of your patients in your absence, then share the names, along with his or her credentials and training, with your patients also. This enables the patient to make an informed decision, whether to continue with you as his doctor. Before doing a surgery, the patient must know that you would not be there for his postop care. Take an informed consent of the patient, otherwise avoid doing the surgery. A physician is required to be “diligent in caring for the sick” (MCI Regulation 1.1.2). Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family (MCI Regulation 2.4). Failing to do so might put you at risk for a medical malpractice claim. Dr KK Aggarwal National President IMA & HCFI Dr K K Aggarwal Recipient of Padma Shri, Vishwa Hindi Samman, National Science Communication Award, Dr B C Roy National Award & FICCI Health Care Personality of the Year Award National President IMA Vice President Confederation of Medical Associations of Asia and Oceania Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)
Sunday, 25 June 2017
Family physicians are the need of the hour With a population of more than a billion (~1.32 billion), India is facing a shortage of doctors, establishment and beds. Presently, India has one doctor for every 1700 people against the WHO recommended norm of 1 doctor for every 1,000 people. There are not enough doctors to take care of the health needs of all. This is the time to bring back the age-old concept of ‘Family physician’. Unlike a General Practitioner, a family physician looked after all the health needs of a family, even many generations of a family, regardless of his/her specialization. They not only treat, but also provide preventive health care to the family being aware of the family history and was the link between the patient and the specialist. Considered a part of the family, he was an integral part of all important family functions and events. All in all, he was a ‘friend, philosopher and guide’ of the family. For good health outcomes, a physician has to be aware of the social determinants of health i.e. the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. It is important to know the socio-economic circumstances of a patient, because these influence outcomes. Family physicians address the social determinants of health. Family physicians also offer several advantages; most important are familiarity, trust, and ease of communication due to a long-lasting relationship. As a result, patient is more likely to open up about his problems and adhere to the treatment prescribed. Family physicians provide a continuum of care at all levels of care, including emergency care. Medicine has become highly specialized today leading to isolation among different specialties as well as from patients. Lack of communication has fostered distrust among patients becoming evident as rising litigations or often as violence against doctors. Hence, instead of destroying the family physician system, re-introducing the ‘traditional concept’ of family physician is the need of the hour. They are the first link in health care delivery for the population and play a pivotal role in preventive health, early diagnosis and timely referral including maintaining health details of all family members. Their services can be used on a retainership basis. One of our demands in the Dilli Chalo Movement on 6th of this month was that we need more than 25,000 additional PG seats in Family Medicine. Dr KK Aggarwal National President IMA & HCFI
Timely diagnosis of congenital heart disease imperative for right treatment About 1.8 lakh babies in India are born with congenital heart disease, which may occur due to genetic factors New Delhi, 24 June 2017: About 8 out of every 1000 children in India are born with a congenital heart disease (CHD) resulting in about 1.8 lakh babies born every year with a CHD. Of these, about 60,000 to 90,000 have critical CHD, which requires an immediate intervention. Children with high-risk CHD can die if not diagnosed in time and this makes early diagnosis extremely important. Some chhildren with uncorrected heart defect may survive into adulthood and require intervention later. Congenital heart disease is a result of a defect in the formation of the heart. Care should be taken to avoid medications or alcohol etc. that are likely to interfere with organ formation in the fetus to lower the risk of CHD. Newborns with critical CHD exhibit symptoms that can be identified soon after birth. However, in some cases diagnosis is not possible till a later time. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "Certain medications such as retinoic acid for acne, alcohol or drug abuse during pregnancy, and poorly controlled blood sugar in women who have diabetes during pregnancy increase the risk of CHD in the baby. Although the exact cause is not known, CHD may be genetic and get passed down through families. Although not entirely preventable, it is possible for children with CHD to lead active and productive lives with timely diagnosis and the right treatment. Though there is a good success rate for treatments, it is important to diagnose this condition early enough and reach the hospital on time. However, most of the times babies are diagnosed much later and reach the hospital in a critical stage. This reduces the efficacy of treatments." It is possible to detect any structural abnormalities in the fetus, including in the heart, with the help of a level-II ultrasound in the second trimester. Adding further, Dr Aggarwal, said, "It is imperative to make testing for CHD a standard practice in hospitals before babies are discharged. As a part of the efforts to save lives of children with CHD, the HCFI under its flagship project, the Sameer Malik Heart Care Foundation Fund, has saved over 500 lives in the past two years. This fund was initiated towards ensuring that no one dies of a heart disease just because they cannot afford treatment." Though it is not possible to prevent the likelihood of CHD in babies, there are some precautions that mothers can take during pregnancy. • Get vaccinated against rubella and flu • Avoid drinking alcohol or taking drugs • Taking folic acid supplement during the first trimester relatively lowers the risk of giving birth to a baby with CHD or any other birth defects. • Do not take any over the counter (OTC) medication including herbal remedies without consulting your doctor. • Avoid contact with people who have any infection. • Women with diabetes should try and keep the condition under check. • Avoid exposure to organic solvents, such as those used in dry cleaning, paint thinners, and nail polish remover.
Saturday, 24 June 2017
Cellulose-based capsules to replace gelatin capsules Capsules are a very widely used dosage form. They are easy to administer, mask the odor and taste of drugs, which may be unpleasant to some patients. Due to rapid disintegration, the drug is rapidly released in the stomach. Hence, they are a necessary form of drug. However, one aspect that is of concern is their storage. Capsules should be stored in airtight containers and in a cool and dry place to avoid degradation. They need to be protected from light and moisture. Gelatin has been commonly used to manufacture capsules, which is derived from animal sources, including bones. But now, the Govt has recommended a proposal to replace gelatin capsules with vegetable capsules. The sources of these vegetable capsules are plant in origin. In March this year, an Expert Committee was constituted to address all technical issues pertaining to the replacement of gelatin (non-vegetable) capsules with cellulose-based capsules. According to notice from the Directorate General of Health Services (DGHS) office dated June 2, 2017, the proposal is open to suggestions/comments within 21 days. The Bureau of Indian Standards (BIS) has formulated Draft Indian Standards for cellulose based vegetable capsule shells. Hydroxypropyl methyl cellulose (HPMC), most commonly known as hypromellose, is used in the manufacturing of the cellulose-based capsule shell. India is a land of diverse religious and cultural beliefs and traditions. A vegetable alternative should be available. On account of religious and cultural sentiments, patients may prefer the cellulose-based capsules over gelatin capsules. Additionally, personal preferences may influence the choice of the vegetable capsules. We have to respect these choices. Patients should be conveyed that the capsule is non-vegetable. In addition their safety and stability, the most important concern to be addressed is affordability to the patient. If the cost comes out to be the same as gelatin capsules, then the gelatin capsules can be replaced with cellulose-based capsules. But, if these capsules would cost more than the gelatin capsules, then both the options should be made available, leaving it to the patient to choose his preference. Another issue that comes up is the manufacturing capacity. More than a billion capsules are manufactured in India every year. Do we have the production capacity to match and then meet the growing demands? How do we differentiate the vegetable capsules from gelatin capsules? Will they be identified by the green and maroon circles in a square as used on food items? A maroon dot indicates the presence of non-vegetarian ingredients, while a green dot identifies vegetarian food. In May last year, the Drugs Technical Advisory Board (DTAB) had rejected the proposal to label the cellulose-based capsule with green dot to indicate its vegetarian origin to differentiate them from the normally available gelatin-based capsules stating that “unlike food, drugs are not taken by choice but are prescribed by the doctors to save lives and marking them vegetarian or non-vegetarian origin is not desirable”. DCGI is the regulatory authority, which provides the standards and quality of manufacturing, selling, import and distribution of drugs in India. Any drug approved by the Drugs Controller General of India (DCGI) is safe and a quality drug. But, there are issues that need to be addressed. Dr KK Aggarwal National President IMA & HCFI