Thursday, 21 September 2017

Draft Recommendations to decide professional incompetence: Report of the Study Group

Draft Recommendations to decide professional incompetence: Report of the Study Group For Comments The present Study Group came to be constituted by the President Medical Council of India in response to a communication from National President Indian Medical Association Dr. K. K. Aggarwal addressed to her bringing to notice that Rule 8.6 in the Code of Medical Ethics Regulation 2002, which brings out that Medical Council of India has to prescribe guidelines with respect to judgment by a peer group pertaining to ‘professional incompetence’ of a professional. Accordingly the Study Group critically debated and discussed the said issue and is pleased to observe as under: Rule 8.6 of the Code of Medical Ethics Regulations 2002 reads as under: “Professional incompetence shall be judged by peer group as per guidelines prescribed by Medical Council of India” As such, it is evident that professional incompetence of a professional duly registered with the State Medical Council upon fulfilling the precondition of the eligibility of having acquired recognized medical qualifications from a University and duly incorporated in the concerned schedule appended to the Indian Medical Council Act, 1956, is required to be judged by a peer group in accordance with the guidelines prescribed by the Medical Council of India. It is noted that as of now no such guidelines have been prescribed by the Medical Council of India as contemplated under Section 8.6 of the Code of Medical Ethics Regulation 2002 whereby the modality of the assessment of professional incompetence of a professional required to be dealt by the registering council through a peer group constituted for the said purpose is not in vogue for want of prescribed guidelines by the Medical Council of India. In this context the Study Group noted that ‘professional incompetence, professional misconduct and professional incapacitation’ by and large are used interchangeably in a colloquial as well as operational sense on practically more occasions than not primarily because all the three within their fold include failure on part of the professional to take reasonable steps to safeguard the life and health of the person under his care. It is for this reason it is imperative that the distinction between the three needs to be taken note of. Preamble: These guidelines shall be titled as ‘Guidelines governing assessment of professional incompetence by a peer group under Rule 8.6 of Code of Medical Ethics Regulation 2000 as amended from time to time. 1. These shall come into the force from date of its Notification by the Medical Council of India. 2. Extent and coverage: These shall be applicable for any medical trial jurisdiction at the institutional or at any council level. They shall not cover criminal aspect of professional negligence. 3. Definitions: Unless the context requires otherwise a) ‘Adverse event’ means an unintended injury to patient that results from healthcare management (rather than the underlying condition of the patient), which results in measurable disability, prolonged hospitalization or both b) ‘Bolam Test’ means the test evolved out of the judgment in the case of Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 used to assess standard of care when deciding medical negligence. c) ‘Clinical Establishment’ means an establishment as defined in the Clinical Establishment Act, notified by the Government of India. d) ‘Guidelines’ means recommendations or standards notified by the Medical Council of India in terms of Section 8.6 of Code of Medical Ethics Regulation 2002. e) ‘Institution’ means a medical college permitted / approved / recognized by the Medical Council of India/Non teaching Hospitals f) ‘Medical accident’ means an unforeseen or unexpected medical event causing loss or physical damage or injury, brought about unintentionally, as a result of treatment or failure to treat appropriately due to ignorance or lack of knowledge. g) ‘Medical Council of India’ means the council constituted in terms of section 3 of the Indian Medical Council Act, 1956. h) ‘Medical error’ means the failure of a planned action to be completed as intended or use of a wrong, inappropriate, or incorrect plan to achieve an aim. i) ‘Medical malpractice’ means negligent or improper or unreasonable lack of skill in the treatment of a patient, on the part of a health care professional or health care facility that causes harm, injury, or death to a patient or any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient. Or improper, unskilled, or negligent treatment of a patient by a Health Care professional. Or medical malpractice is the failure of a medical professional to follow the accepted standards of practice of his or her profession, resulting in harm to the patient. j) ‘Medical mishap’ means an unfortunate accident k) ‘Peer’ means a person who is equal in ability, standing, or rank with another l) ‘Professional incapacity’ means inability to carry out professional activities and responsibilities/obligations due to a physical or mental condition/illness that may limit the capacity of a professional person to fulfill his/her professional responsibilities/obligations temporarily or permanently m) ‘Professional incompetence’ means failure to exercise due care and diligence in professional responsibilities due to lack of knowledge, skill. n) ‘Professional misconduct’ means unacceptable/dishonorable and unethical behavior by a professional person or noncompliance with the applicable laws and regulations o) ‘Professional negligence’ means an act or omission (failure to act when there is a duty to act) which a reasonable man in the circumstances would do or an act of commission (wrong doing) by a medical professional, which a reasonable man in the circumstances would not do. p) ‘State Medical Council’ means a council constituted and notified under the governing legislative enactment adopted by the concerned State legislature. q) ‘Untoward event’ means an unfavorable or adverse event 4. Mandate: To judge professional / medical incompetence of a registered medical practitioner by a duly constituted peer group 5. Composition of the peer group: a) Peer Group shall be constituted at Institutional / Clinical Establishment / State Medical Council / Medical Council of India level to judge the professional incompetency of a registered medical practitioner in a time-bound manner. b) The peer group shall be a three-member committee with a chairman, one IMA nominee and one professional subject expert. c) The peer group on receipt of any complaint shall examine the allegation in a time-bound manner, preferably within two weeks and forward its reasoned-out speaking order following the principle of natural justice and based on “Bolam’s Test” to the Institutional Head, Clinical Establishment Head / Chairman of the Ethics Committee of the State Medical Council / Chairman of the Ethics Committee of the Medical Council of India as the case may be. Report submitted to the President, Medical Council of India, New Delhi, for needful. Dr Vedprakash Mishra Chairman, Academic Committee, MCI & Convener Study Group Dr KK Aggarwal Dr RN Tandon National President, IMA Secretary General, IMA Member Member Dr Vinay Aggarwal Past National President, IMA Member Place: New Delhi Date: 23rd Sept. 2017

Adopting a healthy lifestyle is key to reducing the burden of NCDs

Adopting a healthy lifestyle is key to reducing the burden of NCDs
• About 23% of those with NCDs are prone to premature death • One should aim at increasing daily physical activity
New Delhi, 20 September 2017: As per recent statistics, about 61% of deaths in India are now attributed to non-communicable diseases. This includes heart disorders, cancer, and diabetes. Additionally, about 23% of those with these diseases are prone to premature mortality. As per the IMA, the situation is exacerbated by the fact that there is not much progress on the fight against these chronic conditions in the country. Due to rapid urbanization, India is experiencing an epidemiological transition moving away from a predominantly communicable or infectious to a predominantly non-communicable disease pattern. Four risk factors responsible for the burden of NCDs are tobacco, unhealthy diet, physical inactivity, and excessive consumption of alcohol. Some major metabolic risk factors include obesity, and raised blood pressure, blood glucose, and blood cholesterol levels. All these are behavioral risk factors and are modifiable through lifestyle changes. 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, “Modern and advanced technology has certainly made life easy and convenient for us – online shopping, online payments, accessing information, etc., all of which can be done from the comfort of our homes. What technology has done all of this at the cost of our health; we are less physically active now – sitting at a desk for a long time working on the computer, using social media on smart phones, watching TV or sitting in a meeting, all these activities promote sedentary behavior. The benefits of exercise on physical health as well as mental health are well-established and know to us all. But, the level of physical activity among all age groups has decreased, either due to lack of initiative or lack of safe open spaces. A heavy work schedule is often a deterrent to physical activity for many of us.” NCDs are not only a health problem but a development challenge as well. They force many people intopoverty as treatment for most of them is very expensive. They also have a large impact on undercutting productivity. Adding further, Dr Aggarwal, said, “To control NCDs and promote physical activity, the IMA has proposed a campaign called ‘Move Move, and Move’. People should move around more often all through the day in addition to getting regular exercise. It is good to indulge in a brisk walk for 80 minutes a week with a speed of 80 steps per minute.” Many of these issues and the way forward will also be the key topics of discussion at the upcoming Perfect Health Mela being organized by HCFI, to be held from 4th to 8th October 2017 at the Talkatora Stadium in New Delhi. IMA is the knowledge partner for the event. It is a must visit for those interested in learning more about preventive health and well-being. Here are a few simple ways to increase physical activity both at home and your workplace. • Take the stairs as often as possible. • Get off the bus one stop early and walk the rest of the way. • Have “walk-meetings” instead of “sit-in” meetings. • Walk to the nearby shops instead of driving. • Stand up and walk while talking on the phone. • Walk down to speak to your colleague instead of using the intercom/phone. • Walk around your building for a break during the work day or during lunch. • Buy a pedometer.

Wednesday, 20 September 2017

Sleep deprivation may lead to chronic kidney disease

Sleep deprivation may lead to chronic kidney disease • The disease does not have any apparent symptoms until the later stages • Those with underlying conditions should be careful
New Delhi, 19 September 2017: As per a recent study, those who sleep for less than 6 hours at night may be more vulnerable to chronic kidney disease (CKD). Interrupted sleep or sleep fragmentation was associated with a slightly elevated risk of developing kidney failure, the study indicated. Those with CKD also have co-occurring hypertension, obesity and diabetes, most of the times. As per the IMA, it is important to get the kidney function checked in a person who has one or more of the ‘high risk’ factors. CKD is characterized by a gradual loss of kidney function over time and may eventually lead to kidney failure, leading patients to undergo dialysis or a kidney transplant. The signs and symptoms are not noticeable until the disease is fairly well advanced and the condition has become severe. By this time, most of the damage is irreversible.
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, "Kidneys help in filtering out the excess waste and fluid material from the blood. They can eliminate most of the waste materials that our body produces.

However, when the blood flow to the kidneys is affected, they cannot work properly. This can happen due to some damage or disease. Problems can occur even when the urine outflow is obstructed. At an advanced stage of CKD, dangerous levels of fluid, electrolytes, and wastes can build up in the body. Those with underlying conditions such as diabetes, high blood pressure, cardiovascular disease, abnormal kidney structure, and a family history of the disease are at more risk. Additionally, those who smoke and are obese can also be potential candidates for CKD over the longer term.”
Some symptoms of CKD include nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, decreased mental sharpness, muscle twitches and cramps, edema, persistent itching, chest pain, shortness of breath, and hypertension that is difficult to control. However, these can be confused with other ailments.
Adding further, Dr Aggarwal, said, “Often, there is no cure for CKD. Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. In case of a severe damage to the kidneys, a person may need treatment for end-stage kidney disease. At this point, the doctor will recommend a dialysis or kidney transplant.”
Following are the 8 golden rules that can prevent someone from kidney failure.
• Keep fit and active, it helps reduce your blood pressure and on the move for kidney health. • Keep regular control of your blood sugar level as about half of people who have diabetes develop kidney damage. • Monitor your blood pressure. It is also the most common cause of kidney damage. The normal blood pressure level is 120/80. Between this level and 129/89, you are considered prehypertensive and should adopt lifestyle and dietary changes. • Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with CKD. Reduce your salt intake. The recommended sodium intake is 5 to 6 grams of salt per day. In order to reduce your salt intake, try and limit the amount of processed and restaurant food. • Maintain a healthy fluid intake. Traditional wisdom has long suggested drinking 1.5 to 2 liters (3 to 4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing CKD. • Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50%. • Do not take over-the-counter pills on a regular basis: drugs like ibuprofen are known to cause kidney damage and disease if taken regularly

Is quantum communication the future?

Is quantum communication the future? Dr KK Aggarwal For the first time, entangled particles of light have been successfully transmitted through sea water, which is known to absorb light, in a feat that can be called as ‘quantum communication’ or ‘quantum teleportation’. Researchers from the Shanghai Jiao Tong University in China tested entanglement of photons in water in a proof-of-concept experiment. Saltwater from the Yellow Sea was put in a container. And, they were able to transmit entangled photons through the seawater in the 3.3 meter long container without disturbing their quantum link. In the study published in the journal The Optical Society, the researchers said, “Our results confirm the feasibility of a seawater quantum channel, representing the first step towards underwater quantum communication.” This experiment was based on the concept of “quantum entanglement”, a concept that was once considered impossible by Einstein, who termed this phenomenon as "spooky action at a distance". Matter, we know, can be sequentially converted into atoms and then to subatomic particles (protons, electrons and neutrons), photons, quantum and wave. A photon (or quantum) has properties not only of a wave but also of a particle simultaneously (wave particle duality). When two photons interact or become “entangled” and then separate, they are connected at a speed much faster than the speed of light and affect each other, even when separated by huge distances. In this entangled state, the two photons (or quantum bits – qubits) share an existence or characteristics (quantum information measured as quantum bits ‘qubits’) and are interdependent. When one is altered in any way, the other too is altered even at a distance. Transmission of quantum information from one location to another is called quantum communication or quantum teleportation. All communication today is local i.e. antenna, wires, cables, optical fibers are required for transmission of information. Wireless communication includes applications such as two-way radios, cellular telephones, personal digital assistants and wireless networking (Wikipedia). Quantum communication or teleportation, on the other hand, is indicative of non local connectivity. This proof of quantum communication has raised possibility of ‘quantum’ internet in the future and also that transmitting ‘quantum’ information or messages underwater without fear of their being intercepted may soon be a reality. Disclaimer: The views expressed in this write up are entirely my own.

Tuesday, 19 September 2017

Ovarian cancer symptoms not apparent until later stages

Ovarian cancer symptoms not apparent until later stages • It is the eighth most common cancer in women • Lifestyle changes can help reduce risk New Delhi, 18 September, 2017: Of all cancers in women, ovarian cancer is the eighth most common cancer and ranks fifth in terms of mortality, according to statistics. About two-thirds of those with this condition stand at an advanced stage of the disease during diagnosis and less than 50% survive longer than five years after being diagnosed. As per the IMA, the primary reason for reaching the advanced stage and eventual death is that in many women with this disease, there are no symptoms. Ovarian cancer refers to any cancerous growth in the ovary. A majority of ovarian cancers arise from the epithelium (outer lining) of the ovary. The most common ovarian cancers are called epithelial ovarian cancers (EOC) and other types include ovarian low malignant potential tumor (OLMPT), germ cell tumors, and sex cord-stromal tumors. 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, "Ovarian cancer often goes undetected until it spreads within the pelvis and stomach. In such an advanced stage, it may not be possible to treat the condition making it life threatening. Often, this condition has no symptoms in the early stages and even at a later stage; there are non-specific symptoms such as loss of appetite and weight loss. Mutations in BRCA1 and BRCA2 are responsible for most inherited ovarian cancers. When these genes are normal, they help prevent cancer by making proteins that keep cells from growing abnormally. However, inheriting a mutation in one of these genes from either parent, makes this cancer preventing protein less effective. This increases the chances of developing ovarian cancer.” Some possible early symptoms of ovarian cancer include pain in the pelvis, lower side of the body, lower stomach, and back; indigestion or heartburn; feeling full rapidly when eating; more frequent urination; pain during intercourse; and changes in bowel habits. As it progresses, symptoms such as nausea, weight loss, breathlessness, tiredness, and loss of appetite can also appear. Adding further, Dr Aggarwal, said, “The treatment for this condition consists of surgery, chemotherapy, a combination of surgery with chemotherapy, and at times, radiotherapy as well. The mode is decided depending on factors such as type of ovarian cancer, its stage and grade, and the patient’s general health. Contraceptive pills can help reduce the risk of ovarian cancer in women and also protect them from the disease even 30 years after they stop taking the drugs.” Some other tips that can help prevent the risk of ovarian cancer in women include the following. Breastfeeding The longer a woman breastfeeds, the lower her risk of ovarian and fallopian tube cancer. Pregnancy The more full-term pregnancies a woman has had, the lower her risk of ovarian and fallopian tube cancer. Surgical procedures Women who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian cancer. Adopting a healthier lifestyle This entails consuming more fruits and vegetables, exercising regularly, and avoiding smoking and drinking.

Changing lifestyles also contribute to breast cancer

Criteria to evaluate decision-making capacity for consent Dr KK Aggarwal Consent taking is an integral part of clinical practice. Doctors are required to obtain informed consent from their patients before initiating treatment or carrying out any procedure, therapeutic or diagnostic. The concept of consent is derived from the ethical principle of patient autonomy. Consent is therefore an ethical obligation and legal requirement. There are three components of a valid consent: • The patient gives it voluntarily without any coercion • The patient has the minimum of adequate level of information about the nature of the procedure to which he is consenting to. • The patient has the capacity and competence to give consent Criteria that have been deemed to be necessary to reach to a decision by the patient regarding his/her treatment have been defined: Understanding, expressing a choice, appreciation and reasoning. Assessment of these criteria for decision making capacity is an essential part of the process of informed consent. Understanding: Is the patient able to grasp or comprehend the meaning of the information provided to him/her by the doctor and retain that knowledge? This includes information about the disease condition, the proposed treatment or alternative treatments, the associated benefits and risk of proposed treatments, alternative treatments as well as no treatment. The ability to understand the relevant facts has a great role in the decision making ability of the patient. Because if the patient does not understand the information given, he/she cannot pick information that is relevant to their situation. The information must be simple and clear and imparted in language, which the patient can understand, avoiding too many medical terms. Memory problems, intelligence can affect understanding of the information. Expressing a choice: Is the patient able to clearly communicate to the doctor his/her choice of preferred treatment option from the multiple proposed treatment options and is the patient able to maintain a relatively stable decision regarding treatment choice for it to be implemented? Patients may often change their mind about their treatment choice and withdraw consent at any time. This does not mean that the patient lacks the capacity to make a decision if the patient is able to give a justifiable rationale for the change in decision. However, frequent changes in decision making may put a question mark on the capacity of the patient to come to a decision. Appreciation: This component goes beyond the mere understanding of the facts given to a patient. Is the patient able to relate the information about the proposed diagnostic and treatment intervention and the likely consequences to himself/herself directly? Whether the patient understands the consequence of refusal of treatment? Reasoning: Is the patient able to rationally use the relevant information and give reasons for selecting a particular treatment option keeping his best interests in mind? This component deals with the process by which the patient arrives at a decision and not the final decision as chosen by the patient. If a patient lacks reasoning, he/she will not be able to compare the benefits and risk of various treatment options in a rational or logical manner. Reasoning is affected in conditions like psychosis, depression, any phobia, dementia.

Monday, 18 September 2017

Changing lifestyles also contribute to breast cancer

Changing lifestyles also contribute to breast cancer • Regular checkups are a must to identify any possible risk factors • Those with a genetic predisposition must get screened on time New Delhi, 17 September 2017: Of all cancers in women in India, breast cancer accounts for 27% of such cases. Its incidence rises in the early 30s and peaks between 50 and 64 years of age. Statistics also indicate that 1 in 28 women is likely to develop breast cancer during her lifetime.[1] According to the IMA, breast cancer is developing at a younger age in Indian women. The difficulty in treatment is due to lack of awareness and the resultant delay in diagnosis. Breast cancer is a type of cancer that develops from the breast tissue. Among the many risk factors are interplay of genes, the environment and lifestyle. It is imperative for women over the age of 30 to go for mandatory screenings and tests, and make certain lifestyle changes to lower their risk of developing breast cancer. 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, “It is known that normal breast cells become cancerous due to mutations in the DNA. Although some of these are inherited, most DNA changes related to breast cells are acquired during one's life. Cells grow with the help of proto-oncogenes. When these cells mutate, they can increase growth of cells without any control. Such mutations are referred to as oncogenes. An uncontrolled cell growth can lead to cancer. The mutations occur in the BRCA1 and BRCA2 genes. Those who inherit a mutated gene from a parent have a significantly higher risk of developing breast cancer. Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.” Some symptoms of breast cancer include a lump in the breast or armpit, bloody nipple discharge, inverted nipple, orange-peel texture or dimpling of the skin over the breast, breast pain or sore nipple, swollen lymph nodes in the neck or armpit, and a change in the size or shape of the breast or nipple. Adding further, Dr Aggarwal, said, “Estrogen stimulates cells of the breast’s glandular tissue to divide. The longer a woman is exposed to estrogen, the greater her risk for breast cancer. Estrogen exposure is increased if a woman began menstruating at or before 11 years of age, or if she experiences menopause at age 55 years or older. Women age 45 and older should have a screening mammogram every year until age 54. Women 55 years of age and older should have biennial screening or continue screening annually.” Here are some tips to prevent breast cancer. Limit alcohol consumption Alcohol increases the risk of developing breast cancer. Limit the intake to 1 drink per day as even small amounts can increase risk. Avoid smoking Research indicates that there is a link between smoking and breast cancer and therefore, it is best to quit the habit. Control your weight and be active Being overweight or obese increases the risk of breast cancer. Have an active lifestyle and exercise regularly for about 30 minutes a day. Breast-feed Breast-feeding might play a role in breast cancer prevention. The longer you breast-feed, the greater the protective effect. Limit dose and duration of hormone therapy Combination hormone therapy for more than three to five years increases the risk of breast cancer. Use the lowest dose that works for you and continue to have the doctor monitor the length of time for which you take the hormones. Eat a healthy diet, rich in fruits and vegetables, whole grains and low in fat. Avoid stress, as it reduces immunity and impairs defense mechanisms of the body. Practice yoga, deep breathing exercises.