Monday, 24 July 2017

Principles of communication

Principles of communication Communication is the foundation of an effective doctor-patient relationship. It works both ways i.e. it has advantages for both the patient as well as the doctor. Good communication is the key to building trust, patient compliance to the prescribed treatment, patient satisfaction including better clinical outcomes. A good communicator is also a great motivator. Poor communication has been attributed as a major contributor to litigations against doctors. Hence, good communication skills are therefore very important for the doctor. There are certain principles of communication that should be followed for effective outcomes. • Know your target audience. Your audience is made up of diverse group of people, with different cultural backgrounds and health literacy levels. Assess their level of awareness of your audience and tailor your message accordingly. If the level of awareness is low, talk to them at their level and gradually build up the level of your message. Do this even if this is the case with even one member of the audience so that all get the benefit of your message and nobody feels left out. Remember, “One size fits all” messages don’t work always. • Decide your agenda. You must know what message you want to give. The health information should be field tested and should not create any panic or fear in the society. Communication should be concise and focused. • Use multiple channels of communication. Decide how you want to deliver the message. There are several channels of communication. Print – newspapers, posters, press releases etc. Audiovideo – radio/TV interviews, press conferences etc. or internet – email, social media, SMS. • Message should be evidence-based. Your message should be fact-based or evidence-based and not based on opinions or myths. Higher the level of evidence, lesser the chances of your message being contradicted or refuted. While giving a health statement, quote a credible source of information such as meta-analysis, randomized-controlled studies and reviews published in credible journals. • Strike while the iron is still hot. Timing is of great importance in effective communication for desired outcomes. • Follow the cycle of Teach, Reason, Summarize and Revise. Pre and post evaluation of the audience is important. Always revise at the end to find out what is understood. • Word of mouth communication. Involve “community leaders” or “celebrities” people who count in the community, who are considered reliable by the people, who people look up to as role models.

IMA adopts Aao School Chalen Project

IMA adopts Aao School Chalen Project • Emphasizes on the importance of imparting public health education in schools • Fifth day of every month to be designated to activities under this project New Delhi, 23 July 2017: According to statistics, about 60% of the country’s population is below the age of 45 including the sub-group of schoolchildren. The health and well-being of the country’s young people is not a matter of luck and neither is it a chance or random event. It must be a planned outcome. Considering this, the IMA has adopted the "Aao School Chalen Project" initiated by Delhi Medical Association in the recent past as a National Project. Under the project, the 5th day of every month has been designated for any activity related to this project. The IMA has always stressed on the importance of imparting public health education in schools and this is a step in that direction. As a part of the 'Aao School Chalen' project, lectures and awareness campaigns will be held in schools to sensitize school children on various public health issues. 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, "School health is very important as schools are not just centers that impart formal education, but also influence overall development of a child. To enjoy good health during adulthood, healthy lifestyle including hygiene habits must be inculcated in childhood itself. These habits learned during childhood last through to adulthood and then through life. Moreover, children are naturally inquisitive and keen learners. Thus, they are not only beneficiaries of any health-related activity but also agents of change in their family.” School health education programmes can help reduce health risk behaviors such as tobacco use, poor nutrition, lack of physical activity, drug and alcohol use. It is imperative to impart quality public health education in schools and promote positive health behavior among children and adolescents alike. Adding further, Dr Aggarwal, said, “Visit your old school if you can or any nearby school during the school assembly and interact with students and teachers to sensitize them on issues of public health importance. Speak to the principal of the school beforehand about this. It need not be a long-drawn talk, but a short talk of 10 to 15 minutes. Get a certificate (proforma) signed by the Principal. Send the proforma to IMA HQs along with the photographs taken with students during assembly for records.” The schedule of the lectures to be organized is as under. • 5 August - Vector-borne diseases • 5 September – Lifestyle • 5 October - Menstruation myths • 5 November - Health and hygiene • 5 December – Substance abuse IMA adopts Aao School Chalen Project • Emphasizes on the importance of imparting public health education in schools • Fifth day of every month to be designated to activities under this project New Delhi, 23 July 2017: According to statistics, about 60% of the country’s population is below the age of 45 including the sub-group of schoolchildren. The health and well-being of the country’s young people is not a matter of luck and neither is it a chance or random event. It must be a planned outcome. Considering this, the IMA has adopted the "Aao School Chalen Project" initiated by Delhi Medical Association in the recent past as a National Project. Under the project, the 5th day of every month has been designated for any activity related to this project. The IMA has always stressed on the importance of imparting public health education in schools and this is a step in that direction. As a part of the 'Aao School Chalen' project, lectures and awareness campaigns will be held in schools to sensitize school children on various public health issues. 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, "School health is very important as schools are not just centers that impart formal education, but also influence overall development of a child. To enjoy good health during adulthood, healthy lifestyle including hygiene habits must be inculcated in childhood itself. These habits learned during childhood last through to adulthood and then through life. Moreover, children are naturally inquisitive and keen learners. Thus, they are not only beneficiaries of any health-related activity but also agents of change in their family.” School health education programmes can help reduce health risk behaviors such as tobacco use, poor nutrition, lack of physical activity, drug and alcohol use. It is imperative to impart quality public health education in schools and promote positive health behavior among children and adolescents alike. Adding further, Dr Aggarwal, said, “Visit your old school if you can or any nearby school during the school assembly and interact with students and teachers to sensitize them on issues of public health importance. Speak to the principal of the school beforehand about this. It need not be a long-drawn talk, but a short talk of 10 to 15 minutes. Get a certificate (proforma) signed by the Principal. Send the proforma to IMA HQs along with the photographs taken with students during assembly for records.” The schedule of the lectures to be organized is as under. • 5 August - Vector-borne diseases • 5 September – Lifestyle • 5 October - Menstruation myths • 5 November - Health and hygiene • 5 December – Substance abuse

Sunday, 23 July 2017

“Time Churao” campaign: “Steal” time out of your busy schedule

“Time Churao” campaign: “Steal” time out of your busy schedule Almost everybody today complains of lack of time… “There is so much to do and too little time to do”. Everybody seems to be busier than ever. Well, being a doctor is not an easy job, it’s also a busy job. Being a doctor also means multifaceted responsibilities. A doctor not only has to treat his patients, he is also a teacher, researcher, manager, communicator, community leader. Health education is an important component of the duties and responsibilities of a doctor. It has a direct link to patient satisfaction. However, in a busy practice, doctors often lack the time to educate their patients and families about different health-related issues. Juggling both practice and home often leaves doctors with no time left for community health activities. Here is what I do. Whenever I am invited to a function and the chief guest is running late, I ask the organizers for the mike and start ‘zero hour’. Instead of sitting on the dais, I like to walk around the room, among the audience and interact with them. Being on the same level as the audience breaks a barrier and people may find it less intimidating to raise questions. During Zero hour in the Parliament, members can raise any important matter that is relevant to the public. These questions do not require any prior notice. Similarly, I ask them questions on any health-related topic – of current interest or any other - and try to engage them in discussion. I find that a lively Q &A session is a good way to disseminate information and educating the people as I also come to know their level of awareness about a topic. I avoid speaking too much of medical jargon or scientific terms because the audience soon loses interest. This is how I “steal” time out of my busy schedule to converse with the public. I encourage all of you to do such activity to educate your patients, their families and friends and the public. 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 Medalist 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)

IMA delegation visits and congratulates the newly elected President of India

IMA delegation visits and congratulates the newly elected President of India The Association is hopeful of some positive changes in the healthcare scenario in the country under the President’s leadership New Delhi, 22 July 2017: An IMA delegation led by its National President, DR K K Aggarwal, visited the newly elected 14th President of India, Shri Ram Nath Kovind. The visit was aimed towards not only congratulating the President but also to take a step ahead in working together for the betterment of the medical profession. IMA has since long been actively fighting to restore the nobility and dignity of the medical profession and recently concluded the Dilli Chalo movement to voice the concerns of the fraternity at large. Both India’s healthcare sector and the medical fraternity have many challenges to address. Not only is there a dearth of adequate doctors but the existing ones also face issues such as violence at the hands of the public. All this requires urgent consideration and by meeting the President, the IMA hoped to make a head start to address them. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI), Dr RN Tandon – Honorary Secretary General IMA and Dr Narender Saini, Former Secretary General IMA in a joint statement, said, “At the outset, we would like to congratulate Shri Ram Nath Kovind for assuming office as the 14th President of India. It is indeed an honor to have a leader like him working for the welfare of the nation. Healthcare delivery in India is undergoing many changes be it in terms of prevention, diagnosis, or treatment. All entities in the healthcare sector need to work in tandem with each other to resolve the issues that our profession is facing today. The medical profession is facing one of the toughest times today. Repeated pleas and appeals by the medical fraternity have not materialized into anything except reassurances. It is in these areas that we seek the Hon’ble President’s cooperation and support.” The last few months have seen several other initiatives by the IMA on this front such as STOP NMC Sathyagraha, two National Protest Days against violence on doctors, NO to NEXT strike in medical colleges, and the National Black Day against West Bengal Clinical Establishments Act. Other than this, 3 action committee meetings and 2 meetings of FOMA were also conducted. Adding further, Dr Aggarwal, said, “For any movement to be successful, the leadership should fall in the right hands. And we believe that with Shri Kovind as the President, IMA’s efforts will be adequately supported. The need of the hour is collective action and decision which would do justice to this profession.” The IMA is working towards resolving the following issues. • Criminal prosecution of medical negligence and clerical errors • Stringent central act against violence on doctors • Capping the compensation in CPA on doctors • Professional autonomy in treatment and prescriptions • Amendments in PC PNDT, Central CEA, West Bengal CEA Acts • No unscientific mixing of systems of medicine • Empower MBBS graduates • One drug - One company - One price • Implement inter-ministerial committee recommendations in six weeks • Single window accountability • Single window registration of doctors and medical establishments • No to NMC: Amend IMC act to maintain professional autonomy • Uniform final MBBS exam instead of ‘NEXT’ • Uniform service conditions for service doctors & faculty • Same work - Same pay - Pay parity - No to adhocism • Fair conduction of NEET exam • IMA member in every government health committee • Central anti-quackery law • Reimbursement of emergency services provided by private sector • 25000 family medicine PG seats • Aided hospitals and retainer ship in general practice • Health budget of 5 % of GDP for universal health coverage

Saturday, 22 July 2017

Aao School Chalen: A national project undertaken by IMA

Aao School Chalen: A national project undertaken by IMA School health is very important as schools are not just centers that impart formal education, they also influence overall development of a child. To enjoy good health during adulthood, healthy lifestyle including hygiene habits must be inculcated during childhood. These habits learned during childhood last through to adulthood and all their lives. Moreover, children are naturally inquisitive and keen learners. So, they are both beneficiaries of any health-related activity and agents of change in their family. To this end, the Indian Medical Association (IMA) has adopted “Aao School Chalen Project” initiated by Delhi Medical Association in the recent past as a National Project. The 5th of every month has been designated for any activity related to this project. Visit your old school if you can or any nearby school during the school assembly and interact with students and teachers to sensitize them on issues of public health importance. Speak to the principal of the school beforehand about this. It need not be long-drawn talk, but should be a short talk of 10-15 min duration. Get a certificate (proforma) signed by the Principal. Send the proforma to IMA HQs along with the photographs taken with students during assembly for records. We have identified few topics for the coming months and there will be common points for discussion for uniformity. The first topic for 5th August is “vector-borne diseases”. The 10 uniform messages for first lecture are as follows: 1. Mosquito-borne diseases are preventable and manageable if detected early. 2. Do not allow water to stagnate in or around the houses, particularly in plastic containers. 3. Wear full sleeves clothes during monsoon season. 4. All patients suffering from dengue, malaria, chikungunya, Japanese encephalitis should use bed nets while sleeping. 5. Treatment of malaria should be started early; it can be for 3 days or 14 days depending on the type of malaria. 6. All patients with dengue do not require platelet transfusion. 7. IMA Slogans: “Katwaieyga to nahi” (I hope you will not get me bitten by a mosquito) or “My premises are mosquito-free, you are invited at my premises”. 8. Look for mosquitoes: inside or outside the house; both small and big containers, during day or night; in the room or on the roof; floor or up on the walls; larvae or the mosquito. 9. Let all schools be declared by the principal as being mosquito-free. 10. Let every child speak a slogan: “From now onwards my house will be mosquito free”. The schedule of the talks is as under: • 5th September: Lifestyle • 5th October: Menstruation myths • 5th November: Health and Hygiene • 5th December: Substance Abuse States and Local Branches of IMA are requested to circulate this information to all the members. Since, this is a national health project, IMA requests all its members to participate to make it a success. Dr KK Aggarwal National President IMA & HCFI

Proper diabetes care essential to keep diabetic foot at bay

Proper diabetes care essential to keep diabetic foot at bay Even a small injury can lead to complications and it is imperative to get feet checked annually in those with diabetes New Delhi, 21st July 2017: According to statistics, during the diagnosis of Type 2 diabetes, at least 1 in 10 people, possess risk factors for foot damage. Studies also estimate the prevalence of diabetic foot in India between 7.4% and 15.3%. It is important to identify this condition at the earliest and provide treatment failing which the condition can lead to serious health issues. A small injury can later develop infections and even end up in amputations. The WHO defines diabetic foot as, "The foot of a diabetes patient that has potential risk of pathologic consequences including infection, ulceration and /or destruction of deep tissues associated with neurologic abnormalities, various degrees of peripheral vascular disease and/or metabolic complications of diabetes in the lower limb." Speaking about this condition, 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 imperative to check the feet every day once diabetes has been diagnosed. Factors such as callus, corn, infections of skin or nailbed, onychocryptosis or ingrown toe-nail can lead to ulcers and must be prevented. Diabetes leads to damage of nerves in the feet. In the absence of pain, such small injuries can go unnoticed. Additionally, other associated conditions such as high blood pressure, smoking, cholesterol, and obesity tend to reduce the blood flow to the feet, in a person with diabetes. All these predispose a person to secondary infections thereby aggravating the problem further. Some other complications associated with diabetic foot include ulceration, infection, septicaemia, gangrene, deformity, and limb loss." Some probable causes of a diabetic foot include peripheral neuropathy (nerve damage), vasculopathy, (obstruction of blood vessels), foot deformity, infection, and oedema (swollen feet). Treating a diabetic foot includes addressing three basic issues: debridement, offloading, and infection control. Adding further, Dr Aggarwal, said, "Those with diabetes should get their feet examined on an annual basis. It is important to notify the doctor if there are any cuts or breaks in the skin, or an ingrown nail, or if the feet become less sensitive or start hurting. It is possible to prevent development of diabetic foot by optimizing glycaemic control, offering patient education including daily feet examination, nail care, proper foot wear, and utilizing emollients to moisturize the feet." Follow these tips to take care of your feet if you have been diagnosed with diabetes: • Keep sugar levels under check: Follow lifestyle tips suggested by your doctor to keep your blood glucose levels in the correct range. • Check your feet every day: Watch out for any red spots, cuts, swelling, or blisters. • Be physically active: Engage in at least 30 minutes of physical activity every day. • Keep your feet clean: Wash your feet every day and dry them carefully, especially the area between toes. • Moisturize feet well: Apply a thin coat of moisturizer over the top and bottom of your feet every day after you wash them. • Trim your nails regularly. • Wear comfortable shoes and socks: It is a good idea to not walk barefoot. Buy footwear that is comfortable and fit well. Ensure that the lining is smooth and there are no objects inside your footwear. • Keep the blood flowing to your feet: Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time.

Friday, 21 July 2017

What is team work?

What is team work? What is team work? When asked this question, the usual answer would be “a group of people with the ability to work effectively in a group with the objective of achieving a common goal”. Each member has a role to play within the team. How well a team works together can spell success and failure of a project. Several success stories have been credited to “team effort” and rightly so. Trust, mutual respect, commitment, communication, taking responsibility, cooperation are some of the skills that are usually listed as required as team work skills to achieve desired results. These are qualities that employers often seek in prospective employees. A team comprises a group of people, each with their own personality. And it is the personality of each team member more than the individual expertise or ability that each has to offer, which determines how well a team works together and delivers desired results in time. Each one of us has a physical profile (defined by our height, complexion, collar number, waist size, etc.), intellectual profile and ego profile (my bank balance, car, job designation, locality of residence, size of house, contacts, power, clothes, etc.). Then there is the “soul profile”. This is most important. Soul profile defines your uniqueness, your strengths. Your occupation or your position in the society or physical profile do not define you. It is your soul profile, which defines you, who you are as a person. According to Dr Deepak Chopra, to know your soul profile, ask yourself the following seven questions while sitting in a meditative poise or in state of relaxation. The answer to each question should be either in three words or three phrases. 1. What is my purpose of life? 2. What is my contribution going to be for my friends and family? 3. Three instances in my life when I had my peak experiences. 4. Names of three people who inspire me the most. 5. Three qualities which I admire in others the most. 6. Three of my unique talents. 7. Three qualities I best express in my relationship The 21 answers to these seven questions characterize your soul profile and define every action you perform in your life. A team therefore should be a right mix of personalities (profiles) with jobs assigned that match their profile. These profiles influence team performance and the dynamics within a team. But, when these profiles match, success becomes a natural and automatic outcome. Conflict results when these profiles are mismatched. A person with a stronger ego profile may be assigned a leadership role. Never put two egoistic people together. To build a great team, a team leader must harness the strength of each member of his/her team. Match these profiles for a more cohesive working. This is also how each member of a team can maximize his/her strengths. Dr KK Aggarwal National President IMA & HCFI

Indians do not take dental health seriously, says IMA

Indians do not take dental health seriously, says IMA
Sensitivity, teeth staining, cavities, and nursing bottle caries common among Indians due to lack of awareness
New Delhi, 20 July 2017: A study conducted recently has indicated that about 95%of Indians have gum diseases, 50% do not use a toothbrush, and 70% of children under the age of 15 have dental caries. It is alarming to note the high incidence of oral health ailments in Indians. Sensitivity is another major problem, with only 4% of those with the issue visiting the dentist for consultation. According to the IMA, Indians tend to indulge in self-treatment by avoiding certain food and drinks, rather than paying a visit to the dentist regularly. Some of the most common dental problems among Indians are tooth sensitivity, staining of teeth, and cavities. This can be attributed to eating habits and other habits such as smoking. Consumption of alcohol and aerated drinks, and smoking can make the teeth lose their natural whiteness. Loss of enamel can also lead to sensitivity. 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, “Dental health is often ignored by many people. Stress can have lasting effects on the teeth as on the overall system. Under stress, many people pick up the habit of smoking and consuming alcohol, which can have serious implications on dental health at a later stage. There is also a high prevalence of dental problems in rural areas due to lack of adequate knowledge. In cities, junk food and other lifestyle habits cause dental cavities and other issues. The increase in the consumption of refined sugars by way of processed food is also affecting the teeth negatively particularly in the younger generation.” One should not ignore warning signs and visit a dentist as soon as possible. A dull tooth ache, which does not subside, bleeding gums, and sensitivity to certain eatables are signs that should not be ignored. Apart from adults, dental problems are also common in babies who drink out of a feeding bottle. This is known as Nursing Bottle Caries and can spoil the upper front four milk teeth. Adding further, Dr Aggarwal, said, “Prolonged exposure to nursing bottles containing juices can cause caries in babies. Mothers should wipe the gums and teeth with a clean cloth after every feed. If left unchecked, dental infections can also lead to systemic diseases including cardiac problems.” Here are some tips to take care of your teeth and prevent decay. • Brush twice a day Brushing helps in preventing the build-up of plaque and bacteria which can cause tooth decay and periodontal diseases. • Floss Flossing helps clean the crevices where the brush can’t reach. • Avoid too much sugar Sugary and starchy foods can cause tooth decay as sugar reacts with the bacteria in saliva to form an acid that erodes the tooth enamel. • Brush your tongue The tongue harbors bacteria too. Therefore, it is a good idea to invest in a tongue scraper and clean it. • Don’t ignore any unusual signs Consult a dentist if your gums are inflamed or if they bleed. It is also important to not ignore any pain in the teeth and gums. • Get your teeth checked every six months Dental cleaning and check-up twice a year is imperative.

Thursday, 20 July 2017

Application of evidence-based medicine in negligence claims

Application of evidence-based medicine in negligence claims Medical negligence is established when a doctor had a duty of care to the patient, there was a breach in the duty of care and the patient suffered damage as a direct result of the breach in duty of care. The Bolam test has been traditionally used to assess two main issues of medical negligence - the standard of care as required by the law and whether the doctor accused of medical negligence has complied with that standard of care. This is decided by the medical opinion of expert ‘experienced’ doctors. The Bolam test is satisfied if it is the opinion of the experts that the medical practice followed by the doctor is proper, even in the event of a mishap. Then he/she is not guilty of medical negligence. “A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art… a doctor is not negligent if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view.” (Bolam v Friern Hospital) In 2015, the UK Supreme Court passed a judgement in the case of Montgomery v Lanarkshire Health Board as a result of which doctors in UK are now required to ensure that the patient is aware of all possible risks associated with a treatment, howsoever, rare. The Montgomery judgement, unlike the Bolam test, is based on evidence The Montgomery judgement has now made the Bolam test redundant ‘as a test to assess standard of care’. It is the court now which will review the available evidence and reach its own conclusion whether the line of treatment adopted was the required standard of care or not. In this age of information, the practice of medicine has become evidence-based. Even the Courts require evidence to defend/prove an allegation of professional negligence. Evidence-based medicine avoids professional bias and conflict, which is a risk in experience-based medicine as it is the expert testimony of individuals. But, it is just not enough to present evidence in your defence. What is important is the level of evidence. The level of evidence that you present before the law strengthens or weakens your defence. A hierarchy of seven levels of evidence have been defined in declining order of significance from Level I to Level VII. Level I is evidence from a systematic review or meta-analysis of all relevant randomized-controlled trials or clinical practice guidelines that have been developed on the basis of evidence. It ranks highest and cannot be challenged by an expert. Opinions of experts or expert committee reports are ranked lowest at level VII. With evidence-based medicine fast becoming the norm, this shift from the Bolam test holds relevance for all doctors. Calling in a large number of experts to give their opinion on what is “accepted clinical practice” may no longer be a good defence when defending a complaint of medical negligence. Dr KK Aggarwal National President IMA & HCFI

Self-medication can make allergic symptoms worse, says IMA

Self-medication can make allergic symptoms worse, says IMA Incidence of allergic disorders is on the rise in the country due to various factors New Delhi, 19 July 2017: Statistics indicate that about 20% to 30% of the Indian population is afflicted with allergic rhinitis. Allergic disorders have increased markedly in the country in the past two decades. As per the IMA, almost one in two people exhibit an allergic response to some common environmental factor. Allergic rhinitis is a chronic inflammatory respiratory disease affecting one-third of the worldwide population. Low acceptance level for the disease exacerbates the condition. What is more alarming is that many people indulge in self-medication by using over-the-counter drugs, which do not provide any relief most of the 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, “Allergic rhinitis is associated with a group of symptoms that affect the nose. These symptoms show up when a person breathes in some allergen such as dust, animal dander, or pollen. Symptoms can also arise when a person consumes certain food items that he/she is allergic to. The body releases histamines upon contact with an allergen. This is a natural chemical that defends the body from the allergen. When histamines are released, it manifests as symptoms of allergic rhinitis including a runny nose, sneezing, and itchy eyes.Although anyone can be affected by allergies, those with a history of allergies in the family are at greater risk. People with asthma or atopic eczema also stand a greater chance of getting allergies.” Some of the most common symptoms of allergic rhinitis include sneezing, runny nose, coughing, a sore throat, itchy and watery eyes, frequent headaches, extremely dry and itchy skin, hives, and excessive fatigue. Certain external factors can make these symptoms worse and include smoke, chemicals, pollution, and fumes. Adding further, Dr Aggarwal, said, “Allergic rhinitis can be seasonal (during certain seasons such as spring) or perennial (round the year). Seasonal allergic rhinitis is more common in children and adolescents. The symptoms begin to show before the age of 20, stay constant through early adulthood, but begin improving during middle age and beyond. The best way to avoid an allergic reaction is to not expose the body to any possible triggers.” Certain drugs such as antihistamines, decongestants, and nasal corticosteroid sprays can help in controlling the symptoms of allergic rhinitis. However, these should only be taken in consultation with a doctor. There are also certain alternative therapies which can be used to manage symptoms. Additionally, following these tips can help in the prevention of allergic rhinitis, more so in those who are susceptible to allergies. • Stay indoors when pollen countis high • Avoid exercising outdoors particularly early in the morning. • Take a shower immediately after being outside. • Keep windows and doors shut as much as possible during the allergy season. • Keep your mouth and nose covered when you go out. • Bathe your dog at least twice a week. • Avoid carpeting the house to reduce dust mites.

Wednesday, 19 July 2017

Unconditional beneficence and absolute non maleficence: The hallmarks of a doctor

Unconditional beneficence and absolute non maleficence: The hallmarks of a doctor “Doctors are next to God”, “Doctors heal, God treats”. These are some oft-repeated well-known phrases. And, much has been written about how doctors have been accorded a ‘God-like’ status in society, which places them “on a pedestal” at a level higher than other profession, though this image of a doctor seems to have slowly eroded over the years. God is omniscient, omnipotent and omnipresent. We seek His refuge in our hard times all the time and have absolute trust in him because he is all-knowing, all-powerful and present everywhere. God is the person in whom one has blind belief and faith. He is there for all of us. Doctors are professionally trained to take care of the sick, look after the health of their patients and also of the community. During illness or in a life-threatening situation, doctors remain the last hope for families and patients put the same belief and faith in doctors to help them as they do in God. Non-maleficence (do no harm) and beneficence (do good) are the two of the four major principles of medical ethics, the other two being respect for autonomy and justice. These are the guiding values of medical practice. Doctors act in the best interests of the patients for their well-being and prevent harm to the patients i.e. treat the patient in a way that does not harm the patient. But, patients are more than just their disease. Doctors should have unconditional compassion and empathy towards their patients to give the best possible care to them, without being judgemental or biased or prejudiced. These are factors that influence patients’ perception of their doctor, sometimes even more than the actual science of medicine. Therefore, I add two adjectives “unconditional” and “absolute” to the two guiding bioethics principles i.e. “unconditional beneficence” and “absolute non maleficence”… just as God loves us all unconditionally and anybody can seek Him. A doctor who has these two qualities perhaps can be said to be God-like. Almost a century ago, in 1927, Dr FW Peabody wrote in an article in JAMA “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient”. This is as relevant today as it was then. Dr KK Aggarwal National President IMA & HCFI

Some simple sodium salt reduction strategies can avert many disorders, says IMA

Some simple sodium salt reduction strategies can avert many disorders, says IMA Indian diet has changed over the years and it is imperative to reduce the consumption of processed food, which is high in sodium content New Delhi, 18th July 2017: As per a recent study, an average Indian consumes 10.98 grams of salt per day, which is 119% more than the recommended limit of 5 grams per day by the World Health Organization (WHO). An excess of salt can result in high blood pressure, which is a leading cause of cardiovascular diseases (CVDs) and the resultant deaths. According to the IMA, making certain lifestyle changes and limiting the intake of dietary sodiumcan help avoid risk factors for these diseases. The Indian cuisine is high on salt. The "salt to taste" phrase becomes a misnomer in the Indian context what with its usage in curries, salads, and other dishes, and reaching extremely high levels in foods like pickles. Add to this the consumption of fast food and processed food, which further increases the chances of acquiring certain disorders. 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 Indian diet has undergone a drastic change over the last many years. We eat less of pulses, fruits and vegetables, and the quantity of processed and fast foods is on the rise. This kind of diet is rich in salt, sugar, and harmful fats and therefore, the likelihood of high blood pressure, obesity, and CVDs is also on the rise in Indians today. With the fast-paced lives that we lead, there is no time to cook food at home and therefore, people prefer eating out. Instant food options are available everywhere but people do not make it a point to read the food labels and understand what the food items constitute. Many of these contain excess sodium salt which can be detrimental to our health.” About 40% sodium is found in common table salt. Sodium is used by the body in small amounts to maintain fluid balance. It is extremely imperative for diabetics to consume a diet low in salt because diabetic hypertensive patients can develop coronary artery disease or an enlarged heart. Adding further, Dr Aggarwal, said, “Packaged and prepared food is high on salt content. Salt is used as a preservative to make food taste good. Restaurant food is also high in salt as are certain food items masked as healthy. It is a good idea to read the nutrition facts mentioned on the label to gauge the amount of salt in it. With some effort, it is possible to adjust to eating less salt in 6 to 8 weeks”. Few strategies for sodium salt reduction are as follows. • Make reading food labels a habit • Stick to fresh foods rather than their packaged counterparts • Avoid spices and seasonings that contain added sodium • Check restaurant websites before dining out; request that your food be prepared without any added salt • Cook rice, pasta, and hot cereals without salt • Choose ready-to-eat breakfast cereals that are lower in sodium • Rinse canned foods to remove some sodium • Buy low-sodium, reduced-sodium, or no-sodium versions of foods • Do not put salt, even on the dining table • Avoid APC, Achar Papar Chatni, as all these are high in salt

Tuesday, 18 July 2017

Levels of awareness

Levels of awareness Doctors meet people from all walks of life and social strata in their day to day practice. And, these patients have different levels of awareness about their illnesses. Broadly speaking, patients can be classified as either “aware” or “unaware” about their illness. But, this is a very simplistic classification. There are four levels of awareness – ignorant, informed, empowered and enlightened. These levels have been defined based on the ability of the person to retain the knowledge or information that has been taught or given to them. • Ignorant patients depend on the doctor to make their decisions about the necessary interventions and treatments, with no questions asked. They are ignorant of their disease and do not participate in decision making. • Then there are informed patients. These patients have some information about their disease and will have few questions for the doctor following which they usually accept the line of management as suggested by the doctor. • The next level is empowered patients. These patients have several more questions for the doctor, they cross check facts and are an equal partner in decision making regarding their treatment. • Enlightened patients seek the opinions of many. They experiment and are only then convinced about the proposed line of treatment. Realization takes time for patients with this level of awareness. There will be multiple sessions of counselling, before these patients are convinced. Patients can also be classified on the principle of “suno – samjho – jano - karo” given by the sages. This means hearing, listening, knowing and wisdom. We should hear, listen, understand and convert it into wisdom. Hearing means that you hear anything but listening means that you should learn its meaning. Understanding means you should understand its value in your context and wisdom means you should practice it, re-practice it and learn intricacies of its implications The Bhagavad Gita has described four types of devotees comes from Bhagvat Gita where Krishna says to Arjuna (7.16) “Chaturvidha bhajante mam janah sukrtino rjuna, Arto jiijnasurarthasthi jnani cha bharatasabha”. This means that there are four types of beings who worship me: those who are unhappy, those who are desirous to have knowledge, those who desire worldly objects, and those who have acquired knowledge. In the next shloka, Krishna says that among them only those who have acquired knowledge (wisdom) are the best because they are always engrossed in worshipping me. He said those who have a knowledge love me, and I love them. A true Bhakt is a person who asks his guru the same question again and again till he understands and implements it. Rabbi Dovid Rosenfeld, a known scholar has classified four types of students in a different way. He describes them as a sponge, a funnel, a strainer, and a sifter according to their ability to retain the knowledge taught to them. • The sponge retains everything, but is unable to distinguish between correct and incorrect points or between significant and insignificant ones. He is devoid of Viveka, the power of discrimination. • The funnel brings in on one side and brings out on the other side. So, a funnel is the one for whom information goes in one ear and out the other. He has no focus on the lecture. His hearing and the mind are in different directions. • The strainer discards the wine – the significant material, and retains the lees – the incorrect or insignificant points. He’s the sort who remembers all sorts of trivial or useless details of the material he studied. Most students try to remember the foot notes of a book and forget the common things. • Finally, the sieve retains the fine flour – the significant material, and discards the dust – the inconsequential details. He is the one who understands the lecture by its main five points and remembers them in the form of sutras. There can also be three types of doctors. One, those who expect patients to accept what they say, second, who give choices to patients and ask them to choose and thirdly, there are doctors who give choices, but help the patient to choose the best option. Miscommunication is at the root of many doctor-patient disputes. When counseling a patient, the doctor has to understand the level of awareness of his patient and his level of awareness has to match with that of his patient to avoid any discordance in communication. (Inputs from Dr Ved P Mishra) Dr KK Aggarwal National President IMA & HCFI

Dietary calcium should be preferred over supplements, IMA

Dietary calcium should be preferred over supplements, IMA Young girls increasingly deficient in calcium, which can cause many health issues at a young age New Delhi, 17 July 2017: According to a recent study, calcium deficiency in women is becoming a prevalent problem in both rural and urban India. This can be blamed on the changing dietary habits, particularly in urban Indians, which has undergone a major change in the last few decades. As per the IMA, people are increasingly relying on processed and packaged foods and consequently, their intake of whole foods has gone down by a major proportion. About 20% of adolescent girls in the age group of 14 to 17 suffer from calcium deficiency, according to statistics. About 70% of our bone weight is due to calcium phosphate crystals, the reason why calcium is the most important nutrient for good bone health. Women need more calcium than men as they are more prone to bone health problems with age. 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, “Our body requires vitamin D to absorb calcium efficiently. In people with vitamin D deficiency, the chances of a calcium deficiency are more even if they their calcium intake is not low. This is because the body is unable to absorb the calcium from your food. Vitamin D is responsible for regulating the amount of calcium in the blood. Sufficient intake of Vitamin D not only helps improve calcium absorption but also helps in decreasing bone loss, lowers the risk of fractures, and helps prevent osteoporosis. Deficiency of calcium can cause many problems such as: issues with blood clotting, blood pressure, and heart rhythm, delayed development in children, and overall weakness and fatigue.” Young girls have a higher requirement of calcium when compared to older women. Girls in the age group of 9 to 18 require 1300 mg of calcium, while those in the age group of 19 to 50 require 1000 mg of calcium. Those above the age of 50 need 1200 mg. Adding further, Dr Aggarwal, said, “Many people resort to calcium supplements sometimes even without consulting a doctor. Supplemental calcium is safe for cardiovascular health if consumed in recommended amounts. However, dietary calcium should be recommended over supplements. Calcium intake over the recommended dietary allowance is not better than intakes that just meet the allowance.” Here are some ways you can boost your calcium intake naturally. Eat foods high in calcium every day. Drink low-fat or fat-free milk to boost your calcium consumption without adding too much fat to your diet. Other dairy products that contain calcium are yogurt and cheese; again, choose varieties that are low in fat. Eat more leafy greens, especially kale, collard greens and dark green lettuce, and green herbs such as basil, parsley and dill. Sardines and salmon are good sources of calcium, as are oats and black, pinto and kidney beans.

Monday, 17 July 2017

Dietary calcium should be preferred over supplements, IMA

Dietary calcium should be preferred over supplements, IMA Young girls increasingly deficient in calcium, which can cause many health issues at a young age New Delhi, 16 July 2017: According to a recent study, calcium deficiency in women is becoming a prevalent problem in both rural and urban India. This can be blamed on the changing dietary habits, particularly in urban Indians, which has undergone a major change in the last few decades. As per the IMA, people are increasingly relying on processed and packaged foods and consequently, their intake of whole foods has gone down by a major proportion. About 20% of adolescent girls in the age group of 14 to 17 suffer from calcium deficiency, according to statistics. About 70% of our bone weight is due to calcium phosphate crystals, the reason why calcium is the most important nutrient for good bone health. Women need more calcium than men as they are more prone to bone health problems with age. 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, “Our body requires vitamin D to absorb calcium efficiently. In people with vitamin D deficiency, the chances of a calcium deficiency are more even if they their calcium intake is not low. This is because the body is unable to absorb the calcium from your food. Vitamin D is responsible for regulating the amount of calcium in the blood. Sufficient intake of Vitamin D not only helps improve calcium absorption but also helps in decreasing bone loss, lowers the risk of fractures, and helps prevent osteoporosis. Deficiency of calcium can cause many problems such as: issues with blood clotting, blood pressure, and heart rhythm, delayed development in children, and overall weakness and fatigue.” Young girls have a higher requirement of calcium when compared to older women. Girls in the age group of 9 to 18 require 1300 mg of calcium, while those in the age group of 19 to 50 require 1000 mg of calcium. Those above the age of 50 need 1200 mg. Adding further, Dr Aggarwal, said, “Many people resort to calcium supplements sometimes even without consulting a doctor. Supplemental calcium is safe for cardiovascular health if consumed in recommended amounts. However, dietary calcium should be recommended over supplements. Calcium intake over the recommended dietary allowance is not better than intakes that just meet the allowance.” Here are some ways you can boost your calcium intake naturally. Eat foods high in calcium every day. Drink low-fat or fat-free milk to boost your calcium consumption without adding too much fat to your diet. Other dairy products that contain calcium are yogurt and cheese; again, choose varieties that are low in fat. Eat more leafy greens, especially kale, collard greens and dark green lettuce, and green herbs such as basil, parsley and dill. Sardines and salmon are good sources of calcium, as are oats and black, pinto and kidney beans.

Do not ignore “trends” in lab reports

Do not ignore “trends” in lab reports Laboratory tests have become routine. Not only do doctors order lab tests, often patients or even otherwise healthy people get them done of their own accord. What is important is how we interpret these reports. Often the results of the tests are interpreted in relation to the normal reference range mentioned alongside, whether the values are within the reference range “normal” or fall outside it “abnormal”. Labs usually have their own reference range. Generally, we tend to give too much weight to a normal result and are reassured by it. But, here it is important to keep in mind the fact that a normal result is just a picture at that point of time. It can change. And, what is equally important is that instead of looking at a single test result, one should look for trends in the results. Always compare the results of a particular test with previous reports even when a result is normal. Results that show change over time i.e. show a rising or declining trend are important and should not be ignored. Any result which has been in the low normal range for the last many years, but is now in the high normal range even though still normal, should be taken cognizance of and investigated accordingly. This can be most commonly illustrated by blood sugar. A fasting blood sugar level higher than 126 mg/dL can be diagnosed as diabetes, according to the recommendations of the American Diabetes Association (ADA). Prediabetes is fasting blood sugar ranging between 100 and 125 mg/dL. If your patient usually has had his blood sugar around 80, but in the latest report, the blood sugar is now, say 98 or 106. This is still not higher than the diagnostic cut-off. But, this is the time, when you can advise lifestyle modifications to your patient – a healthy diet, increasing physical activity, quitting smoking etc. This will keep the blood sugar in check and prevent progression to prediabetes or even full blown type 2 diabetes. Another example is thyroid stimulating hormone (TSH). The normal range is between 1.0 and 4.0. A TSH value greater than 2.5 indicates a risk of hypothyroidism and a value of 4.0 is an indicator of mild hypothyroidism. PSA velocity is another important test in prostate cancer screening. It is the change in the level of prostate specific antigen (PSA) over time. It has been shown that PSA elevations can precede clinical disease by 5 to 10 years. PSA velocity greater than 0.75 ng/mL per year indicates a higher risk of a diagnosis of prostate cancer than the actual PSA level itself. Liver chemistry, kidney function tests, electrolytes, lipid profiles, reticulocyte count, SGOT/SGPT ratio are some tests, which should be interpreted carefully, taking into consideration the previous reports, before labeling them as normal. An example of declining trend is hemoglobin. If the hemoglobin has been slowly decreasing, but within the normal range, then evaluate the patient for the cause of anemia. In dengue patients, more than the falling platelet count, it is the "rapidity" of fall in platelet count, which is significant. A rapid fall of platelets is a warning sign of impending severe dengue. Be alert to changing trends in lab results even if within normal limits. Take note of the family history. Repeat the test and/or investigate your patient further. This is how diseases can be diagnosed early and treated timely. Dr KK Aggarwal National President IMA & HCFI

Sunday, 16 July 2017

Symptoms of lactose intolerance may not be very apparent, says IMA

Symptoms of lactose intolerance may not be very apparent, says IMA
• Milk is not the only source of calcium • This condition does not have a cure but can be managed with dietary changes
New Delhi, 15 July 2017: As per statistics, about 70% of Indians are lactose intolerant with the incidence higher in southern Indian than in the North. Lactose intolerance is one of the most common forms of food intolerance. Those who consciously or unconsciously avoid milk due to this disorder do not realize that they need a supplement to replenish calcium levels in their body. According to IMA, a deficiency of calcium can lead to problems at a later age and therefore, one should include other sources of calcium in one's diet. Lactose intolerance is caused when one cannot digest the high amount of sugar present in milk, called lactose. This is because they don’t have enough secretions of lactase, an enzyme that helps break down this sugar. Such people can, therefore, not digest milk or milk products. 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 cells lining the small intestine produce an enzyme called lactase which attaches to lactose molecules in the food that we eat and breaks them into two simple sugars: glucose and galactose. These can be absorbed into the bloodstream. A reduction in this enzyme makes most of the lactose go unprocessed into the colon, where normal intestinal bacteria interact with it causing gas, bloating, and diarrhea. Constantly deluging the colon by fermenting lactose can leave the digestive system permanently weakened. It can also lead to an overgrowth of harmful bacteria and weaken immunity. Babies can produce enough lactase in the digestive systems to digest milk. With age, the enzyme in the body starts to decrease and so does the ability to break down lactose." The very first symptom of lactose intolerance is the Irritable Bowel Syndrome (IBS) which causes belly discomfort and change in the bowel habits overtime. Other symptoms include diarrhea, constipation, and cramps usually in the lower half of the belly. Adding further, Dr Aggarwal, said, "The first and foremost side effect in a lactose intolerant person is calcium and Vitamin D deficiency. However, due to the fact that the body is unable to break lactose to provide nutrients even in the normal state ensures that this side effect does not make much difference. Look for alternative sources of calcium and Vitamin D to replenish the requirements. Some examples include almond and soy milk, and vegetables like spinach and broccoli." While there is no cure for lactose intolerance, following these tips can make it easier for you. • Choosing smaller dairy servings. This will make it less likely for you to get gastrointestinal problems. • Drinking milk with other foods can help slow down the digestive process and therefore lessen the symptoms too. • Not all dairy products have the same amount of lactose. Try cultured milk products such as yogurt which carry enzymes that can help break down lactose. • Try opting for lactose-free products. These are available widely today. Also, watch out for hidden lactose in cereals, instant soups, salad dressings, nondairy creamers, processed meats and baking mixes. • Take lactase enzyme tablets or drops in consultation with your doctor.

Saturday, 15 July 2017

IMA White Paper on Indian Medical Service

IMA White Paper on Indian Medical Service

Dr Ved Prakash Mishra
Chairman, Academic Committee, MCI

Historical perspective

The Indian Medical Service owes its origin to the East India Company formed by the British. It was on December 31, 1600 that Queen Elizabeth granted a charter to the Association of Merchant Adventures of London to trade with the East, which gave birth to the East India Company. As a matter of fact the establishment of the company was a result of a huge struggle amongst the nation for the control of lucrative spice trade, in which to begin with the Venetians, then the Portuguese, the Spaniards, the Dutch, the French and finally the British came to be drawn into the treasure hunt.

For the said trade, the First Fleet of the East India Company under the command of Captain James Lancaster, in December, 1600 sailed out. Each of the four ships in the fleet carried ‘Surgeons’ and a ‘barber’. They came to be designated as ‘Ship Surgeons’. This was also the voyage, which resulted in experiment on lemon juice as a cure for scurvy.

With the establishment of trading posts around India, more surgeons and physicians found employment not only with Europeans but also in the service of wealthy natives. These men of medicine included Nicholas Manucci, a Venetian, born in 1639, who served Dara Shikoh before studying medicine in Lahore where he served Shah Alam from 1678 to 1682. An Armenian named Sikandar Baigh served as Surgeon to Suleman Shikoh, son of Dara Shikoh and there are records of several Dutch and French physicians in courts across India.

Surgeons were also availed for diplomatic missions to various courts and they were found to be very effective. Operationally speaking, the Indian Medical Service (IMS) was a military medical service in British India, which also was attributed some civilian functions. It has served during the two world wars and remained in existence until the independence of India in 1947. Many of its officers who were both British and Indian served in civilian hospitals as well.

The East India Company in 1614 introduced a hierarchy in their establishment with the appointment of a Surgeon General. The first to be appointed to the said post was John Woodall. However, he was accused of financial embezzlement in respect of pay from apprentices as a result of which he was retrenched in 1642.

There are many anecdotes of which one of the important depiction is of Gabriel Boughton who is reported to have saved Shahjahan’s daughter Princes Jahanara from injuries due to burns. In reward he was given Duty Free Trading Rights and it is said that it was the very document, which was availed by the East India Company to procure Rights for itself from the ruler in Surat. 

Historically speaking the First sign of organization came into being with the establishment of the Bengal Medical Service on 20th October, 1763, with fixed grades, rules for promotion and services. On the similar lines Madras Medical Services and Bombay Medical Services came to be established in 1764. It was due to increased military actions that compelled the separation of ‘Military Surgeons’ from the ‘Civil Surgeons’.

As a matter of rule each nonnative military regiment had a surgeon and as a result of which the strength of the medical service grew. A census record of 1854 reveals that the Bengal Medical Service had a strength of 382, while Madras Medical Service had 217 people and Bombay Medical Service had a strength of 181. The medical services of these three Presidencies were united into a single Indian Medical Service after 1857, which was in vogue till 1947.

The personnel under the medical services contributed to the foundation of other departments as well under the organization of the Govt. Dr William O’Shaughnessy, while serving as Professor of Chemistry at Calcutta conducted the first experiment for the introduction of electric telegraph in India and was designated as Director General of Telegraphs in 1852. In 1861, Dr James Rankin was appointed as Director General of Post Offices in India. Dr John Royale represented the East India Company as a Reporter on their economic products as the great exhibition of 1851 and the first four appointments of Conservator of Forest were also filled by the Medical Officers under the medical services of the presidencies.

In 1858, when the Crown took over the Government of India, and in the context of several epoch making developments that were occurring in the art of medicine the Indian medical service entered upon a new phase of the history. The General Hospitals were built in the presidency towns and several smaller hospitals and the dispensaries came to be established in the Districts. In 1835, a medical college was founded at Calcutta and another one at Madras. A decade later another medical college was instituted at Bombay. From 1853 onwards, several medical schools were laid out, which mandated the services of the medical officers working under the presidential medical services to be availed for teaching at the initiated medical schools till they had trained graduates to succeed them.

The Indian Medical Service always primarily remained a military service so as to provide medical officers for duty with the Indian Army in the time of War. During the 1914-1918 First World War, the service was represented in France, Palestine, Asia Minor, Persia, China, East and West Africa. Ninety-two Retired officers rejoined for duty and well over 1000 temporary commissions came to be granted. Likewise during the Second World War, more than 1000 filled medical units were mobilized over and above, the hospital accommodation for 11000 officers and 1.50 lakh other ranks arranged for in India. In the course of all these, members of the Indian Medical Service earned ‘Victoria Cross’ for five times. And one of the recipient of the same Dr John Alexander Sinton was later conferred the fellowship of Royal Society in his researches for the problems of Malaria.

It is a matter of record that in the legislative council in Delhi in 1918 a motion was brought forward by an Indian Member of the council to disband the Indian Medical Services primarily on the ground that India was a poor country and could not afford to maintain such a service. 

The defense that was put forth by the then Surgeon General Dr Edwards gives a significant insight into the utility of the Indian Medical Service at that point of time. The text of the defense put across by him is as under:

“I need not dwell, on the fact that this resolution is tantamount to the abolition of the distinguished service to which I have the honour to belong, but before proceedings with my reply I wish to say few words concerning the work which has been done by this service in recent year and which is still being done, for I do not think that this council is fully aware of the extraordinary value of the Indian Medical Service not only to India but to the world at large. This service has worked out the life history of the malarial parasite, a discovery which has revolutionized our ideas concerning malaria and which, among other things, has enabled the Panama Canal to be successfully built. It has reduced the mortality of cholera by 2/3rd and Shorn amoebic dysentery of most of its terrors. It has worked out the method of transmission of bubonic plague, work which points the way to the ultimate eradication of that disease. Enlarge prostate, that terrible and fatal concomitant of old age, can now be overcome, thanks to the member of Indian Medical Service, while in the domain of eye surgery more specifically with regard to cataract and glaucoma the work of the service is recognized throughout the scientific world.”

The resolution so moved did not succeed and the Indian Medical Service continued for nearly three decades thereafter with significant work and contribution in research and the unending problems of public health resulting in several achievements as a result of which it stands the scrutiny at the bar of history. Great names attached with it are Ronald Ross, Leonard Rogers, Rickard Christophers, Robert McCarrison, Henry Shortt and many others.

In the year 1943, the Government of India, decided for a review of the whole medical position and also to seek suggestions for future improvements. In fact it was aimed that evolving a model like that of National Health Service, however, the disease burden that was observed was too huge. It was stated in the report that in India that nearly 10 crore suffer every year from malaria. Five lakh deaths from tuberculosis every year and a further 25 lakh active cases required treatment, cholera, small pox and plague add to the said disease burden. The other diseases of topic namely leprosy, filaria, hookworm, guinea-worm saddle the country with innumerable chronic sufferers. To combat adequately, this magnitude of disease burden and many other problems involved and to provide a comprehensive health service for whole of the population would require a staff of 2.5 lakh doctors, 7.50 lakh nurses along with a great army of associate medical workers. The Indian Medical Service which served India, so well almost for last 300 years definitely had prepared a way for the same, but when power was transferred in 1947, the Indian Medical Services stood abolished.

The foundation of the service

The Bengal Medical Service was founded by orders passed dated 20th October, 1763, whereby the individual medical officers then serving in the Bengal Presidency were, with effect from 1st January, 1764 combined into a regular medical establishment with fixed grades and definite rules for promotion from grade to grade. The Madras and Bombay medical services appeared to have come into existence at about the same time as the Bengal Service.

A list of Bengal Medical Service in 1774, preserved in the Calcutta record office gives a strength of total 69 viz. 18 surgeons, including the Surgeon General and Surgeons Majors, 7 Subordinate Surgeons and 44 Assistant Surgeons.

A list compiled by Surgeon General Denial Campbell in 1777 comprises 64 names that include 22 Surgeons and 42 Assistant Surgeons. Another list compiled for the Governor General Warren Hastings in 1777 gives 27 Surgeons and 45 Assistant Surgeons totaling to 72. Of these, 11 surgeons and 13 Civil Assistant Surgeons are shown in the civil employment as against 15 surgeons and 32 Assistant Surgeons on Military Duty, while one man noted as dead is not shown under either head.  

The First Maratha War occurred in 1780-81, the Second Mysore War in 1781, with Campaign against the Raja of Banaras was undertaken in the same year. Five battalions under Col PD Pearse marched from Bengal to Madras towards the end of 1780. Six battalions with artillery and cavalierly were detached to Bombay from 1778 to 1784. All these troops required extra medical officers, and vacancies caused in this campaigns required to be filled up. To indent on the court of Directors at home for more medical officers was of little use, as new men from home even if recruited in sufficient numbers could not arrive for more than a year after the requisition for their services was sent home. The Indian govt. accordingly appointed a large number of men, recruited locally to the Bengal medical service. They were obtained chiefly from two sources. Firstly, the surgeons of the India men trading between England and India and secondly, subalterns or free adventurers who had some medical training in some cases had practiced medicine at Home, before coming to India.

Rules regarding medical personnel in military employment holding collateral civil charges and vice versa were laid down in Bengal Gazette of 12th March, 1836. Practically the same rules continued to be in force till 1947, when the services were disbanded. No officer civil or military was at liberty to decline such collateral charges.

In the early settlement of the East India Company in India, the question of rank was not of much importance. The President or Agent stood first next to the President, then came the members of his council. The governing body consisted of four members. The Agent, the Accountant, the Store Keeper, the Purser Marine; fifth rank was the Secretary. The surgeon was sixth after the Secretary, they came the Steward and after him the General Body of Merchants, Writers, and Apprentices. The writers as the name employees were the clerks. But from this small body of commercial servants has developed the finest Governing Body in the World, the Indian Civil Service.

As such, the chronology of events in a sequential manner brings out as to how the Indian Medical Service came to be created by the East India Company to begin with and then how it came to be structured in a definitive manner with stipulated rules and regulations in respect of ‘Rank, Pay, Leave, Duties and Responsibilities’ and other cogent official matters.

Taking into consideration the successes and the effectiveness that got accrued to the said service during a period spanning nearly three centuries, it can be safely deduced that it needs to be revived afresh by suitable incorporations therein in terms of the contemporary and long term perceived requirements.

Bibliography


1.        A History of the Indian Medical Service by Lieu. Col. G. D. Crawford

A shift towards person-centric medicine

A shift towards person-centric medicine Every person has a distinct unique set of characteristics that distinguishes them from the other. “Individualization” is inherent in the science of homeopathy, which recognizes every patient to be different from the other, even if they have the same disease and individualizes treatment for every person. The modern system of medicine is also now shifting towards person-centric medicine. Every patient has to be managed differently for the best possible outcome. What is acceptable to one patient, may not be acceptable to the other. Treatment must be tailored to each individual patient taking into consideration their individual characteristics, culture, personal preferences, expectations etc. The Institute of Medicine (IOM) has defined patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” A few days back, I spoke about the social determinants of health; the social situation of the patient, environmental factors, which influence health of a person. These may differ from patient to patient. Their personal and family history including medical history are different. Individual response to drugs may vary, the side effects may vary. All these variables need to be taken into account when formulating a treatment plan. For this reason, the standard treatment guidelines need to be challenged. Guidelines are evidence-based recommendations for groups of patients, but not the individual patient. While they give a direction, they cannot be applied to all patients alike. Doctors must exercise clinical judgement in selecting the best treatment option for a particular patient. Individualized treatment plans are based on the unique demands of that particular patient and address the needs of that patient and what the patient wants. They also involve the patient and encourage shared decision making with the patient and the family. Dr KK Aggarwal National President IMA & HCFI

CPQIH training to be held at IMA headquarters

CPQIH training to be held at IMA headquarters IMA recognizes the importance of skill building in a hospital setting as a way of quality management New Delhi, 14 July 2017: Recognizing the importance of skill building as an important aspect of quality promotion, the IMA will be hosting the next training programme of CPQIH at IMA Head Quarters in New Delhi. Accreditation of hospitals is a step towards helping them improve patient care and has been a regular feature in the developed countries for more than 50 years. This procedure is recognized globally as an effective quality evaluation and management tool. The Quality Council of India created NABH in 2005. To build capacity and mentor hospitals, especially to fulfil NABH pre-accreditation entry-level certification standards, the CAHO (Consortium of Accredited Healthcare Organizations) initiated the programme for training Certified Professionals for Quality Implementation in Hospitals (CPQIH). Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) , Dr RN Tandon – Honorary Secretary General IMA and Dr Vijay Agarwal, President CAHO in a joint statement, said, "The perceived benefits of accreditation and also the mandatory requirements by state and other scheme empanelment have created tremendous demand for accreditation and in turn for well-trained professionals to handhold hospitals at an affordable cost. The process of accreditation provides a visible commitment by an organization to improve the quality of patient care, ensure a safe environment, and to continually work to reduce risks to patients and staff. Accreditation is also about improving the organizational and clinical performance of health services, and not just obtaining a certificate or award or merely assuring compliance with minimum acceptable standards." The CPQIH programme provides training to Doctors, Nurses, Allied Health Professionals and Administrators of Hospitals who have experience in quality management or interest in quality implementation. Adding further, Dr Aggarwal, said, "The ability to continuously track and improve performance is a foundational goal of health care reform and one that must be embraced. Quality assurance helps improve effectiveness and efficiency. It also helps in containing costs, maintaining accountability, and in the effort towards reducing errors and increasing safety in the system." The army of 246 CPQIH today forms the backbone of CAHO. They are motivated and available to propagate accreditation and quality beyond the borders of their own hospitals. CAHO has become a platform for all these professionals to come together, share best practices, clear their doubts and induct their peer professionals into this journey. The benefits of accreditation can be summed up as follows. • It is a transparent system of control over the accredited hospital assuring that the hospital will constantly fulfill all the accreditation criteria. • On-site survey of the hospital and staff by the experienced accreditation assessment team encourages them to establish educational and performance improvement goals. • It provides patients with the opportunity to give feedback on the services availed during their stay in the hospital and also express dissatisfaction, if any. • Ensures that both public and private hospitals play their expected roles in the national health system.

Friday, 14 July 2017

The human body too requires regular maintenance as does your car

The human body too requires regular maintenance as does your car Yesterday, I sent my car for servicing. It will be due for another service again in the next quarter. Car maintenance can be expensive, depending on the car model. Yet we accept these bills and make regular payments with no questions asked. Why is it important to get your car serviced? The obvious answer is to make sure that the car engine runs smoothly, utilizes fuel efficiently and does not break down on the road. In other words, so that it stays “healthy”, and any faults, if detected, can be repaired timely before one is stranded on the road. So, when we comply with the service schedule as provided by the service center, why do we not do the same for our body even though we routinely subject it to wear and tear every day? Our body is exposed to stress daily, both physical and mental, but we ignore its health. Adopting a healthy lifestyle is one way of taking care of the body. A good diet and regular physical activity keep us healthy and there is ample scientific evidence to support this. In addition to a healthy lifestyle, preventive health check-up is also an important way to take care of our body. Usually, people go to doctors only when they fall ill or for follow-up for their illness for which they are on treatment. Preventive health check-up ensures primary prevention “preventing the onset of disease” by identifying and controlling the risk factors for a disease. This way measures, including lifestyle changes can be instituted timely. It also helps early detection and treatment of any health problem. Early diagnosis prevents or delays onset of complications. Earlier the diagnosis, better are the chances for a cure or improved survival. Preventive health check-ups can be expensive. For this reason, patients often ask for discounts on bills, be it for consultation, diagnostic tests etc. And, they are often reluctant to pay. And in a country like India where out-of-pocket expenditure is the major health expenditure, there is no denying that cost is a concern. I was billed Rs. 18,000/- for my car, a Toyota. I paid the due amount for my car service and will again shell out perhaps an equivalent amount for the next due services regularly every year as most of us will do. Because it is necessary for the maintenance of the car or the vehicle. So, why can’t we do the same for our body? Do we rate a car/vehicle higher than our body? Just as you send your car for regular check-ups, the human body too requires regular preventive check-ups and care. A well-serviced car runs better, the same holds true for the human body. Doctors are “notorious” for ignoring their health. Doctors die, on an average, 10 years earlier than non-doctors. Charity begins at home. We need to take care of our own health needs. All state and local IMA branches must organize or arrange for annual check-ups for members and their families with provisions for all vaccinations including flu and pneumonia. Be proactive about health for a good quality of life…After all, “Health is wealth”. Nothing is more valuable than good health. Dr KK Aggarwal National President IMA & HCFI

Do not use pools as a place to urinate, says IMA

Do not use pools as a place to urinate, says IMA
• Watch out for telltale signs such as a string odor before stepping into a pool • Important to follow hygienic practices to avoid infections
New Delhi, 13 July 2017: According to recent research, the smell of what many people think is chlorine in swimming pools may not be actually so. It is, instead, the smell of chemicals as the chlorine mixes with urine, feces, sweat, and dirt. Those who get a red eye and irritation after taking a dip in the pool should perhaps blame urine and not chlorine. In light of this, the IMA has advised people to not use pools as a place to urinate. Urine combined with a lot of other waste can cause extreme dryness to the eyes as also chemical allergy. Healthy pools and water parks don’t have a strong chemical smell. Research also indicates that if the pH and disinfectant levels are appropriate, this chemical mix should not spell trouble. 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, "A mixture of urine and chlorine turns chlorine into an ammonia derivative called chloramine. This has a distinctive smell and can cause respiratory problems and eye infections. There is also an additional problem. Those with diarrhea can spread Cryptosporidium, which is a filter and chorine-resistant parasite and a leading cause of waterborne diseases in people who use a pool regularly. Some of the germs that cause diarrhea can live in the pool from minutes to days, even if the pool is well-maintained. Once contaminated, all it takes is for someone to swallow a small amount of pool water to get the infection. To eliminate the irritants caused by nitrogen-containing compounds found in urine, more chlorine may need to be added to a pool." It is imperative to take along and use a pair of swimming goggles as part of your swimming attire. There are test strips available today that can help check chemical levels. It is possible to ease the allergic reaction using artificial tears with lubrication. Adding further, Dr Aggarwal, said, "Indoor pools are riskier as the irritants can move into the air surrounding a pool and trigger coughing, wheezing, or even asthma attacks particularly in those with lower immunity. It is the responsibility of everyone who uses the pool to ensure that they contribute to taking care of hygiene and sanitation. This can only happen if they maintain personal hygiene and even teach their children the same." Here are some things you can do to ensure that the pool you are using is clean and safe. • Watch out for a strong smell. Healthy and clean pools and water parks do not have a strong characteristic smell. • Look at the pool to see whether it's clean and clear, and the drain is visible. • Do not urinate in the water and ensure that your children are taught the same. • Avoid swallowing the water. • Stay out of the water if you have diarrhea. • Shower immediately after using the pool.

Thursday, 13 July 2017

Personal care medicine: Social health

Personal care medicine: Social health “Health is not just the absence of disease, but a state of complete physical, mental and social well-being”. This is a well-recognized definition of health as given by the World Health Organization (WHO). As this definition clearly states, the social contexts of health and disease or “social health” also form important aspects of health. These are the conditions in which we live, learn, work and age i.e. the conditions of day-to-day life, which in turn are influenced by the political, social and economic systems of the country. How a person gets along with other people and how do people talk about a person behind his back is also social health. These social determinants of health are equally important or perhaps even more important in influencing the health and well-being of an individual. For this reason, they have also been called “the causes of the causes”. The WHO has identified 10 social determinants of health: 1. Social gradient 2. Stress 3. Early life 4. Social exclusion 5. Work 6. Unemployment 7. Social support 8. Addiction 9. Food 10. Transport Social gradient is measured by variables such as income, education, housing or occupation. Education inculcates healthy behaviors. Housing determines better access to healthy foods and health services. Conflicts, gender inequality are also important social determinant of health as they may also influence availability and access to health services. Food- and water-borne diseases are due to lack of access to safe food and clean drinking water and poor sanitation. These are more often than not the consequence of poverty or low income, which is associated with poor housing, overcrowding and poor sanitation. So, you may treat that one episode of diarrhea but, the patient who lives in areas of poor housing and sanitation may come back to you with recurrent episodes of diarrheal diseases. Air pollution is a major environmental risk to health. NCDs, such as cardiovascular diseases including stroke, chronic respiratory diseases and cancers have been linked to outdoor air pollution. Exposure to biomass smoke, or indoor air pollution, is a major risk factor for COPD. A patient who is struggling to meet his daily needs may not be amenable to advice about lifestyle modifications – quitting smoking, physical activity/exercise, healthy food. These will not be a priority for him. Social isolation and loneliness will only further aggravate the condition in a patient of depression. Persons whom we come in contact with daily, be it family or friends, also influence healthy behaviors. If your family and friends exercise regularly, it is more than likely that you will also pick up this healthy habit. But remember, bad habits are also catching, for example, alcoholism, substance abuse, smoking, etc. A research published in the May 22, 2008 issue of the New England Journal of Medicine had shown that when one person quits smoking, than others are likely to follow. One person quitting can cause a ripple effect, making others more likely to kick the habit. • If your spouse stops smoking, you’re 67% less likely to continue smoking. • If your friend kicks the habit, it’s about 36% less likely that you’ll be smoking. • When a sibling gives up cigarettes, your risk of smoking decreases by 25%. • Risk of smoking drops by 34% if a coworker in a small office quits smoking. So, have positive influences around you. Keep the company or “sangat” of good people to spend time with. Adi Shankaracharya has described Sangat as the main force for living a spiritual life. India is facing the double burden of infectious diseases and non communicable diseases, undernutrition and overnutrition (overweight and obesity). This is a reflection of the health inequities in the country. Therefore, achieving the desired health outcomes is not just dependent on treating the disease alone. Addressing the social determinants of health is equally important, first to achieve the desired results and then to sustain them. A healthy person is more productive and contributes to the growth and development of society. The concept of “One Health” recognizes that the health of people, animals and the environment are connected. Many diseases in humans or zoonoses are spread from animals. Treat the person in totality and not just the disease. As Sir William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.” Dr KK Aggarwal National President IMA & HCFI