Friday, 15 December 2017

Stuttering may be developmental or neurogenic

Stuttering may be developmental or neurogenic
In some people, this problem can persist lifelong

New Delhi, 14 December 2017: As per estimates, about 11 to 12 million people in India stammer/stutter. Although this condition usually goes away by adulthood, it does persist in about 1% of the adult population and might lead to a decreased quality of life, depending on its severity. This condition is five times more common in boys than girls. In most people in whom the problem persists, professional help and speech therapy might be required.

The WHO defines stuttering/stammering as ‘Speech that is characterized by frequent repetition or prolongation of sounds or syllables or words, or by frequent hesitations or pauses that disrupt the rhythmic flow of speech. It should be classified as a disorder only if its severity is such as to markedly disturb the fluency of speech.’

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 person who stutters often repeats words or parts of words, and tends to prolong certain speech sounds. They may also find it harder to start some words. Some may become tense when they start to speak, they may blink rapidly, and their lips or jaw may tremble as they try to communicate verbally. Their speech may be completely ‘blocked’. This happens when their mouths are in the right position to say the word, but virtually no sound comes out. This may last several seconds. Sometimes, the desired word is uttered, or interjections are used to delay the initiation of a word the speaker knows causes problems.”
There are two common types of stuttering: developmental and neurogenic. While developmental stuttering is more common in children, neurogenic stuttering may occur after a stroke, head trauma, or other type of brain injury.

Adding further, Dr Aggarwal, said, “There is currently no cure for stuttering. However, there are a variety of treatments available depending upon a person’s age, communication goals, and other factors. It is important to work with a speech-language pathologist to determine the best treatment options.”

The following tips can help in managing a child who stutters or stammers.
Provide a relaxed home environment including setting aside time to talk to one another.
Refrain from negative reactions when the child stutters. Praise him/her for being able to speak without stammering at times.
Be less demanding on the child to speak in a certain way
Speak in a slightly slowed and relaxed manner.
Listen attentively when the child speaks and wait for him or her to say the intended word.

Straight from the Heart: GST Update

Straight from the Heart: GST Update

·                The effective tax on input services has gone up from 15% to 18%. This has led to inflation in cost of healthcare services since most of the services like Housekeeping, GDA, Security, F&B and Repair & Maintenance are typically outsourced in the hospital.
·                GST should be altered for diagnostic (viral transport media and culture media) from 18% to 12% as is applicable for all other diagnostic kits and reagents.
·                Ancillary medical procedures and diagnostics, which play a key role in treatment, have been put under the 12% and 18% slab.
·                With disposables, drugs and reagents being bracketed under 12% GST, the cost of surgeries and other procedures (that involve use of disposables and reagents) has gone up considerably. The old tax rate for these items varied between 2% to 5.5%
·                For most of the medical devices and implants, which were importable at 0% duty, consequent to the imposition of GST, the 5% VAT has gone up to 12% IGST. The items covered in this are medical devices, cardiac implant and other high-end items like pacemakers, LVAD etc. The Ministry should intervene and reduce GST on all medical equipments, devices, medicines & consumables to 5% as against 12% that it has been increased to. If government takes definition of life saving as per income tax act, very few devices will be included. Consumables can be equated with surgical items which at present attract 5% GST.
·                Hospitals were issued Scrips under Served from India Scheme (SFIS) earlier. These scrips were usable for the payment of various duties/taxes to Central Govt on importation including CVD etc. Now the scrips can be used only to pay custom duty, which makes the whole equation uneconomical and the very purpose of scrip is defeated. We request the Ministry to allow for the payment of IGST against the Scrips.
·                Landed cost of imported equipment has significantly gone up with the implementation of IGST. Since earlier the imports did not have VAT the equipment, the landed cost of equipments, which were not manufactured in India has now come under IGST regime which in turn increased the landed cost from 8% to 10%. The Ministry should review the situation especially regarding medical equipments not manufactured in India so that the investments in technology are optimized.
·                Reverse charge: The purpose of reverse charges was to pay GST and take credit. For healthcare, where the end services are exempt, this is added costs and efforts. The provision of reverse charge so far applicable to healthcare should be dispensed with.
·                Health insurance: In Direct taxes (Income tax) there is an exemption under Section 80D on payment for Health Insurance. But in Indirect taxes there is a GST tax of 18% on payment for Health Insurance. Health Insurance GST should be at the slab of 5 %.
·                Clinic furniture: Equipment such as furniture, examination chair and operating table will now fall in the 18% bracket.
·                Some items like blood collection bags with integral filters earlier tax was just 5% has gone up to 12%
·                Medical oxygen earlier had VAT of 4.5%. It was put under slab of 18% and is now reduced to 12%. 

 Some common questions

What is meant by health care services under GST?

Under the ambit of GST, healthcare services may refer to any service by way of diagnosis or treatment or care for illness, injury, deformity, abnormality or pregnancy in any recognised system of medicines in India, and includes services by way of transportation of the patient to and from a clinical establishment, but does not include hair transplant or cosmetic or plastic surgery, except when undertaken to restore or to reconstruct anatomy or functions of body affected due to congenital defects, developmental abnormalities, injury or trauma.

In what manner is the GST going to impact the health and family welfare sector?

Healthcare sector has been exempted from GST as the government has accorded healthcare the due importance and impetus that this sector needs to accelerate progress towards achieving the national goals in our endeavour towards achieving health for all as per the Sustainable Development Goals (SDGs), to which India is committed. This will contribute to the process of the transformation of India, its people and the economy.

How are health care services to be impacted by GST?

Under GST, duty charged on the import of technical machinery and equipment needed by the health sector would be allowed as a credit. This benefit of the overall reduction in the cost of technology is due to implementation of GST.

How will GST impact lifesaving drugs and equipment?

Life-saving drugs, healthcare services and medical devices would continue to be tax-free under GST.

What are the services that are likely to face increased taxation due to GST?

Dialysis (5% to 12%), pacemaker (5.5% to 12-18%), support devices in orthopaedics (5% to 12%) and all support devices for cancers except blood cancer (5% to 7-12%) are the services that shall face increased taxation due to GST.

Is medical tourism likely to be affected by GST?

With the roll out of GST, the cost of insurance, pharmaceuticals, and international travel together with quality health care is expected to reduce which would culminate into better prospects of medical tourism in the country

Dr KK Aggarwal
Dr Ravi Wankhedkar
Dr R N Tandon

With inputs from:  Dr Shubnum, Dr RV Asokan

Thursday, 14 December 2017

Seasonal flu to hit India hard in the coming year

Seasonal flu to hit India hard in the coming year
It is imperative to get vaccinated in a timely manner to avoid getting infected

New Delhi, 13 December 2017: Seasonal influenza outbreaks each year cause 3 million to 5 million severe cases and 300,000 to 500,000 deaths globally, estimates the WHO. Recent predictions by flu-trackers have indicated that seasonal flu will hit India and the rest of the northern hemisphere hard next year. This prediction is based on outbreak trends in the winter of the southern hemisphere, where Australia has reported record-high numbers of cases, hospitalizations and deaths.

Seasonal flu shows a minor peak from December to February in India. It causes symptoms of fever, cough, breathlessness, lethargy, headache and nausea. Most people recover within a week without ill-effects, but complications such as pneumonia and multi-organ failure can kill people at risk, such as young children with respiratory problems, pregnant women, older adults above age 65 years, and those with chronic disorders such as asthma, lung diseases, heart disease and diabetes.

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, “Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness. Serious outcomes of flu infection can result in hospitalization or death. Most flu outbreaks happen in late fall and winter. The symptoms may not show up for a couple of days and thus, it is possible for a person to pass on the flu to someone even before this. Flu is usually caused by influenza viruses A and B. The strains vary each year. One may often confuse flu with a common cold as the symptoms are very similar. It is imperative to get a shot of the flu vaccine every year to prevent any incidence particularly in children, pregnant women, and older citizens.”

As viruses adapt and change, so do those contained within the vaccines – what is included in them is based on international surveillance and scientists’ calculations about which virus types and strains will circulate in a given year.

Adding further, Dr Aggarwal, said, “Flu is primarily treated with rest and fluid intake to allow the body to fight the infection on its own. Paracetamol may help cure the symptoms but NSAIDs should be avoided. An annual vaccine can help prevent the flu and limit its complications.”

Here are some tips to prevent spreading of seasonal flu.

Those who are not sick should avoid close contact with people who are sick.
People with flu should cover their mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.
Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Straight from the Heart: Some Facts on Max-Fortis Cases

 Straight from the Heart: Some Facts on Max-Fortis Cases

IMA got an access to part inquiry reports in the Fortis and the Max case, respectively. Here are some excerpts which should also be known to the medical fraternity

Fortis case: IMA Notes Based on inquiry report

·         “The committee found that the patient was suffering from Dengue Shock Syndrome, not mere dengue fever”.
·         “The mortality is high ranging from 6 to 30%. Most deaths occur in children”.
·         “The Committee found that the family had to spent Rs. 15.00 lakh for emergency ICU treatment for 15 days, not for dengue fever”
·         “There is prima facie no evidence of negligence in the management of the child during her stay in the PICU.”
·         “It is unlikely that conducting MRI earlier would have affected the course of treatment.”
·         “There are no guidelines on how many consumables are to be used per day in a PICU patient. However, general guidelines state that a liberal use of consumables for example syringes, gloves etc. must be made to decrease the risk of hospital acquired infections in these patients.”
·         “After perusal of above statements, I am of opinion that the father of the baby Adya was well informed about the consequences of LAMA.”
·         “However, at the end of the complete documents in all cases, one original signature of the parents is there.”
·         “It is again reiterated, the consent for so-called LAMA was obtained from the parents of the victim at the strong insistence of the treating doctors who gave a professional opinion stating that the MRI Scan Report revealed irreparable brain damages. It is again repeated that the "cost of the treatment" was never a consideration or deterrent for the parents.”

IMA Comments

IMA is developing a LAMA policy so that these types of disputes do not occur when a case reaches a state of no recovery.

Max Case: Some excerpts from the government report

·         “.. report concluded that the hospital have not kept any proper temperature and vital sign monitor record of the period of comfort care provided to the live male newborn”

IMA Comments: Not keeping record is a misconduct and not a criminal offence.

·         “….committee also concluded that the staff nurses on duty were also at fault as they handed over the bodies of the newborns without any written direction from the pediatrician and they also missed the signs of life in the male newborn while handing over the 'body' to the attendants”

IMA Comments: The very fact they also missed signs of life confirms the newborn was clinically dead (when the brain is alive and heart can get revived later when the body temperature increases due to warmth. Clinical death period is 10 minutes in every death and up to 4 hours in hypothermia)

·         “WHEREAS, the committee also concluded that the hospital has entered the name of live male newborn baby in the still birth register.”

IMA Comments: This is a record keeping mistake and not criminal negligence.

Wednesday, 13 December 2017

India has the highest number of TB patients across the world

India has the highest number of TB patients across the world
Missing doses can defeat the purpose of DOTS therapy

New Delhi, 12 December 2017: According to recent reports, with 2.79 million cases, 4.23 lakh deaths, and an average of 211 new infections diagnosed per 100,000 people, India currently has the highest number of tuberculosis (TB) patients across the globe. India also has the most number of MDR-TB patients in the world as well as the largest number of ‘missing’ TB patients. There are several million who have not been identified, notified, or treated and these people remain off radar.

TB is a highly infectious disease cured by providing proper medication at the right time for the full duration of the treatment. The drug regimen is called DOTS and is provided free under the Revised National TB Control Programme (RNTCP). It is based on the principle that a regular and uninterrupted supply of high-quality anti-TB drugs must be administered to cure the disease and prevent the occurrence of the MDR-TB.

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, “TB is a major public health concern in India. Not only is it a major cause of morbidity and mortality but also poses a huge economic burden on the country. Elimination, which is defined as restricting new infections to less than one case per 100,000 people, is possible only when patients get diagnosed and cured without any break in treatment. Any interruption in treatment can exponentially raise the patient’s risk of developing MDR-TB, which is harder to treat. Missing doses defeats the very purpose of DOTS therapy, which is meant to ensure strict compliance through supervised consumption of medicines. As many as 900,000 people with TB do not have access to proper treatment, which means they risk developing drug-resistant TB and infecting others.”

Reporting is important to trace contacts of the person with infectious TB. All contacts of the patient should be screened for TB and put on treatment if required. This cascade of screening of contacts, at home and workplace, identifies individuals at risk and prevents further spread of TB, including MDR TB.

Adding further, Dr Aggarwal, said, “The approach to all notifiable diseases should be based on DTR: Diagnose, Treat, and Report. Diagnose early, using sputum Gene Xpert test; Treat: Complete and effective treatment based on national guidelines, using FDC; and Report: Mandatory reporting.”

Here are some tips that can help avoid TB infection from spreading.

Wash your hands after sneezing, coughing or holding your hands near your mouth or nose.
Cover your mouth with a tissue when you cough, sneeze or laugh. Discard used tissues in a plastic bag, then seal and throw it away.
Do not attend work or school.
Avoid close contact with others.
Sleep in a room away from other family members.
Ventilate your room regularly. TB spreads in small closed spaces. Put a fan in your window to blow out air that may contain bacteria. 

Straight from the Heart: IMA-FOMA Resolutions

Straight from the Heart: IMA-FOMA Resolutions

Members: Indian Medical Association, All India Ophthalmological Society, Urological Society of India, Geriatric Society of India, Indian Radiology & Imaging Association, Indian Academy of Echocardiography, Heart Care Foundation of India, Cardiological Society of India, Association of Surgeons of India, Indian Psychiatric Society, Delhi Psychiatrist Society, Indian Orthopaedic Association, The Federation of Obstetric & Gynaecological Societies of India, Indian Association of Dermatologists, Venereologists and Leprologists, Association of Physicians of India, Indian Academy of Echocardiography, FFPAIA, Indian Society of Hospital waste Management,  Academy of Hospital Administration,

IMA- FOMA (Federation of Medical Associations) Resolutions

April 6, 2017

  • IMA will be the mother NGO for FOMA (Federation of Medical Associations).
  • All Major-Medical Associations in India will be invited to become Hony. Member of FOMA through their President/Secretary or their nominee.
  • IMA FOMA members will physically meet at least twice in a year and through e-connect as and when required.
  • National President of IMA or its nominee (one of the past Presidents) shall be the President of IMA-FOMA.
  • Hony. Secretary General of IMA or its nominee (one of the past HSGs) shall be the Secretary of IMA-FOMA.
  •  Presidents and Secretary Generals of various Organizations/Associations shall be the member of Management Board of IMA-FOMA.
  • IMA will provide local hospitality for all the meetings and the travel arrangements shall be made by the respective Organizations/Associations, unless a meeting is hosted by one of the member association.
  • IMA-FOMA will have IMA FOMA Action committee with representatives of all member Organizations/Associations.
  • IMA-FOMA shall work on national issues of importance to medical profession.
  • IMA-FOMA shall come out with Declarations/Statements/White Papers/Policies, Standard Treatment Guidelines etc. on regular basis endorsed by all member Organizations/Associations.
  • IMA-FOMA Action Committee will interact with Govt. of India, Ministry of Health on regular basis on subject of common interest.
  • IMA-FOMA shall create a local Google group to communicate on daily basis with all its members.
  • IMA-FOMA will come out with joint initiatives with individual Organizations/ Associations and also group of organizations under IMA-FOMA on various health issues.

IMA-FOMA Delhi Resolutions

Prescription of Generic Name of the Drugs by Medical Professionals

IMA and FOMA appreciate the concern of the Hon’ble Prime Minister, Shri Narendra Modi about the availability, accessibility and affordability of quality economical drugs to the society.

  • The judgement to choose a rational drug and its format vests only with the Registered Medical Practitioners. This right of the medical profession is sacrosanct.
  • IMA-FOMA also wants the Government to strengthen Quality control mechanisms to ensure adherence to Good Manufacturing Practices (GMP) for patient safety.
  • For a rational prescription, doctors should choose drugs generic-generic or generic - brand based on quality, efficacy and economy and write legibly and preferably in capital letters.
  • IMA-FOMA recommends that Government should ban differential pricing of a drug under different brand names (generic-generic, generic- trade or generic- brand) by one company. (one chemical drug, one company, one price)
  • IMA-FOMA will be meeting the President of MCI, Union Health Minister and Prime Minister of India about the views of the medical fraternity on this issue. All the constituent members of IMA-FOMA shall communicate these IMA-FOMA Delhi Resolutions to its members.


MCI Ethics Regulations Clause No. 1.5 states “All physicians SHOULD prescribe medicines with generic names, legibly and preferably in capital letters and he or she SHALL ensure rational prescription and use of drugs."

IMA- FOMA Delhi Declaration 2017

  • IMA- IMA-FOMA stands for ethical practice of medicine and has zero tolerance for unethical practices. Any payment where a service is not involved is deemed unethical.
  • Sex selection and female feticide leading to conviction will invite disciplinary action by IMA- FOMA members. Any members, so convicted, will forfeit the membership of all IMA-FOMA organisations.
  • IMA- FOMA advocates decriminalisation of medical practice. All legislations from IPC to POCSO should recognise absence of mens rea in medical practice or an intention to harm and jurisdiction of criminal prosecution of medical practice and medical negligence has to be discontinued.
  • Doctors should be provided a single accountability window withdrawing the jurisdiction of multiple forums. Similarly medical establishment s should have single window registration facility.
  • Practice of modern medicine and prescription of modern medicine scheduled drugs shall vest only with doctors of modern medicine.
  • IMA-FOMA demands that Central legislation against violence on doctors, staff and hospitals be enacted.
  • IMA-FOMA reiterates that the professional autonomy of MCI has to be retained. While amendments to the IMC Act are essential, NMC is unacceptable.
  • IMA-FOMA endorses a common All India Final MBBS Exam and rejects NEXT.
  • Standard Treatment Guidelines will emanate from the professional organisations led by IMA-FOMA.
  • Clinical Establishments Act (CEA) has to be hospital-friendly eschewing License Raj for accreditation.

Tuesday, 12 December 2017

The Indian Medical Association announces bold steps aimed at restoring faith in doctors and the medical profession

The Indian Medical Association announces bold steps aimed at restoring faith in doctors and the medical profession
Proposes certain self-regulatory procedures for doctors and hospitals to adopt

New Delhi, 11 December 2017: The Indian Medical Association (IMA), the largest voluntary organization of Doctors of Modern Scientific Medicine today announced certain self-regulation procedures for hospitals and doctors. This comes in light of the recent incidents involving the lives of a pair of twins, and a 7-year-old girl. The doctor-patient trust in the country, which was already experiencing a downward spiral, has deteriorated further. Doctors, hospitals, the health industry, patients, media, and politicians all are unhappy. Doctors do not have the intent to be the cause for public unrest or loss of public trust. At the same time patients must understand that to err is human and one incident does not mean that there will be more such cases in future as well.

Trust is the foundation of a doctor and patient relationship. The medical profession is undergoing certain changes. While violence against doctors is on the rise and they are being held accountable, at times, for deeds not committed, it is also true that there is some introspection needed on the part of doctors and hospitals, failing which this trust may take a long time to reestablish. Today, the private sector looks after 80% of the patients that too with highest quality. In the absence of state subsidy private sector providing quality care  invariably will come at a cost which is still at fraction of a cost compared to that in advanced countries.

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, "We represent the collective consciousness of the largest medical association of modern doctors of the country, the IMA. A profession, which has been considered as second to none, & it will remain noble is today, being looked at with suspicion. However, the medical profession is the noblest profession. It is disheartening to see the erosion in trust and we want to make it more transparent. IMA is and will continue to work towards improving doctor-patient relationship. IMA is committed to practicing with humility and pledges to reform the existing system. We will also take the opportunity to say here that the doctor to patient ratio in India is skewed due to which doctors are under a lot of stress. Doctors are also human beings and not healing angels. Once treatment is administered, the recuperation of a patient depends upon physical and organic factors. It is unacceptable and absurd to victimize the medical practitioner if the patient does not respond to treatment.”

All doctors shall practice with compassion and follow IMA ALERT policy (Acknowledge, Listen in detail, Explain, Review and Thank you). The IMA has also announced formation of an IMA Medical Redressal Commission at the state level (in each state) to engage in social, financial, and quality audits of health care (Suo moto or on demand). The commission will have a public man, an IMA office bearer, one former state medical council representative, and two subject experts. The commission shall consider every grievance in a time bound manner. An appeal to the state commission will be heard by the "Head-quarters IMA Medical Redressal Commission" which will have the powers to take suo moto cases also. The headquarters shall also suggest reforms in healthcare on periodic basis.

Adding further, Dr Aggarwal, said, “What happened was most unfortunate. However, not all doctors are wrong, and the public must have faith in them. Such errors happen by accident and not intentionally. Having said this, it is also time for the medical profession to introspect and come out with self-regulation procedures. We are often blamed for prescribing costly drugs. From today onwards, all doctors in the country shall choose affordable drugs. We also appeal to the government to come out with an urgent ordinance for one drug-one company-one price policy. Doctors should actively participate in ensuring that no hospital sells any item priced higher than the MRP. No service charges should be added to procure drugs from outside. MRP shall not be dictated by the purchaser.”

The other points announced by IMA are as follows.
  • IMA recommends that all doctors should prescribe preferably NLEM drugs.
  • All doctors shall promote Janaushidhi Kendras.
  • We appeal to the government to classify all disposables under both NLEM and non-NLEM categories and cap the price of essential ones. Till then all medical establishments should sell the disposables at procurement prize after adding a predefined fixed margin.
  • Hospitals and doctors are often blamed of overcharging and over investigations. Billing should be transparent, and all special investigations should be well informed & explained.
  • Every doctor should ensure that it becomes mandatory on the part of the hospital administrator to give options at the time of admission to choose cost-effective treatment room and treatment (single room, sharing room, and general-ward) and explain the difference in total bill estimates.
  • All doctors should ensure that hospital estimates at the time of admission are near to actual.
  • The treating doctor must explain the chances of death and unexpected complications and resultant financial implication at the time of admission.
  • Once doctors take charge of a patient, the patient should not be neglected. They should look after the patient till discharge.
  • Emergency care is the responsibility of the state government and the government should subsidize the costs of all emergencies in private sector & create a mechanism for reimbursement.
  • Every medical prescription must include counseling on the cost of drugs and investigations.
  • IMA has zero tolerance to doctors indulging in female feticide.
  • IMA has zero tolerance to cuts and commissions. Medical establishment should revisit their referral fee system. Billing paid to doctors should be transparent and reflected in the bill.
  • No hospital can force their consultants to work on targets. Contractual agreements should be in such way in which of both parties that is consultant and the hospital is equally protected. All hospitals should consider not charging service charges from the consultants.
  • Choice of drugs and devices rests with the doctors based on the affordability of the patient and not on the profitability.
  • All hospitals must comply to the commitment towards EWS, BPL, and poor patients without any discrimination.
  • All patient complaints should be addressed in a timely manner through an internal redressal mechanism with a chairman from outside the hospital.
  • All medical establishments must ensure that their business ethics comply with the MCI ETHICS.
  • IMA LAMA policy is being developed as there are no clear guidelines at present.
  • Every dead body needs to be treated with respect and dignity.
  • All charitable hospitals should do their free work as assigned.
  • All needy patients must be routed through the social worker of the establishment and guided and directed to the appropriate place.
  • At least one more equally experienced but unrelated surgeon should be involved in the consent form during elective LSCS.
  • The patient has a right to get medical records within 72 hours of request. Acknowledge their request.
  • The patient has the right to go for a second opinion from an appropriately qualified medical doctor. The primary doctors have should not  get offended.
  • A hospital has no right to stop life-saving investigations or treatment for non-payment of bills if the patient is still admitted in the hospital. The government should make a mechanism for the reimbursement for the above for poor patients.
  • Ensure for us all are equal. BPL, APL, EWS, rich, or poor all should get the same attention and treatment.
  • IMA policy: With no National Guidelines on viability of fetus issue ,it is being looked upon by IMA, FOGSI, IAP and NNF.
  • We are not against any regulations and accountability, but we should all ask for a single window accountability at the state level. The state medical council should be proactive and take timely decisions. We should also ensure a single window registration.
  • We must ensure that our establishment has a transgender policy.
  • All government hospitals should be upgraded and have facilities like those in the private hospitals. All public, private or charitable hospitals should have quality accreditation.
  • No doctors should issue false certificates.
“All the above will & should be implemented with immediate effect”, said Dr Ravi Wankhedkar, National President Elect IMA, in his message.
The above have approval from most stakeholders. A copy of this is being sent to the Health Secretary, Govt of India and Health Minister, Govt of Delhi. Both President and Registrar, Delhi Medical Council, are requested to help in circulating this message to all doctors in Delhi.

We are thankful to the society for raising the issues and will request them to work with the medical fraternity to make IMAs project "Cure in India" a success.