Saturday 31 October 2015

Social determinants of health

Social determinants of health
  • By Padma Shri Awardee Dr Marthanda Pillai, Honorary National President Indian Medical Association and Dr KK Aggarwal, President HCFI & Honorary Secretary General Indian Medical Association
There are a series of factors that determine our health; access to social and economic facilities being the most prominent of all. For instance, factors like the conditions in which people are born and the conditions in which they live, work and grow old can impact an individual’s health to a greater extent. These factors directly influence the quality and length of life along with impacting the possibilities of disability-free life.
In most of the cases, medical professionals only evaluate the proximate causes of diseases like smoking, obesity, disrupted lifestyle and alcohol. But the real “causes of causes” are often ignored, which make up for the root of all the medical ills prevailing in the society. However, the effective social determinants approach goes beyond just focusing on proximate causes and seeks to address what actually aggravates premature ill health and the contributing factors.
For instance, the lower people are in the socioeconomic hierarchy, the more they smoke, the more incomplete their diet, and the less physical activity they engage in. Education dominates all the other factors like excessive alcohol consumption, taxation, price and availability, bans on advertising, smoking in public places and tobacco consumption.  
Examples of social determinants include:
  • Accessibility and availability of resources to fulfill daily requirements like shelter, food, cloth and much more
  • Access to educational institutions, medical establishments, economic opportunities like a job or any other source of earnings
  • Access to quality medical facilities and healthcare services
  • Quality education, learning and knowledge
  • Availability of community-based resources like recreational and leisure-time activities
  • Daily-life facilities like transportation and public safety options
  • Society’s attitude towards a person; it includes discrimination, racism or any other kind of bias
  • Prevailing conditions like crime, violence, lack of cooperation in a community and social disorder
  • Socioeconomic conditions like concentrated poverty and other stressful conditions
  • Literacy and culture
  • Access to mass media and emerging technologies like cell phones, the Internet, and social media
The world is witnessing a universal movement that seeks to address gross inequalities in health and length of life through action on the social determinants of health. This movement has involved the World Health Organisation, several national governments, civil society organization, and academics. Solutions are being sought and learnings shared.
WMA insists that doctors should be well-informed participants in this debate. The medical professionals can be advocates for action on those social conditions that have important effects on health. In addition to this, WMA has agreed to add significant value to the necessary actions being taken:
  • By helping doctors, other health professionals and National Medical Associations understand what the emerging evidence shows and what works, in different circumstances
  • By helping doctors to lobby more effectively within their countries and across international borders, and ensure that medical knowledge and skills are shared
  • Gathering data of examples that are working, and help to engage doctors and other health professionals in trying new and innovative solutions
  • Educating and inform their members and put pressure on national governments to take the appropriate steps to try to minimise these root causes of premature ill health
  • Drawing up new action plans of action, which include general practice that works across sectors to improve the quality of people's lives and hence reduce health inequalities
  • Gathering examples of good practice from its members and promoting further work in this area.

The dangers of excessive alcohol consumption especially during the festive season

The dangers of excessive alcohol consumption especially during the festive season
Awareness generation and adequate checks are crucial in order to save lives
New Delhi, October 30, 2015: Excessive alcohol consumption and underage drinking are common issues, which almost all countries globally continue to struggle with. India witnesses a sudden spike in the sale and consumption of alcohol, especially during the festive Diwali season. This particularly can prove to be extremely dangerous for those with existing lifestyle diseases, the elderly and young adults. It is extremely important that awareness is raised, and adequate checks are put in place to prevent the festivities from turning into disasters.
Increased alcohol consumption is directly proportional to a rise in the number of road accidents, obesity and hypertension levels and risk of heart disease. People often take to the wheel when under the influence of alcohol and often end up risking their lives and that of others due to decisions made under an impaired judgment. Similarly, the high-calorie levels of alcohol cause obesity put additional pressure on the heart and cause a spike in blood pressure. A few moments of fun can turn to be fatal if adequate precautions are not taken.
Speaking about this, Padma Shri Awardee, Dr. A Marthanda Pillai – National President IMA and Padma Shri Awardee – Dr. K K Aggarwal – Honorary Secretary General IMA and President HCFI in a joint statement said, “Alcohol consumption is a critical challenge that contributes to various social and economic problems. It is the cause of death of over 2.5 million individuals every year (almost 4% of all deaths worldwide), and the third leading risk factor for poor health globally, accounting for 5.5% of disability-adjusted life years lost. Awareness needs to be raised about the evils of alcohol consumption and the dangers of over-consumption especially during the festive month of Diwali. Parents need to be made aware of the problems of under-age drinking and the need to counsel their children, and patients about the consequences it can have on their overall health and well-being. In addition to this, the government must take stringent steps to curb the menace of drinking and driving. "  
The urgent need to raise awareness about the evils of alcohol consumption has been brought up by most National and International bodies during their annual meetings. The World Medical Association recently during its General Assembly launched a declaration, which focuses on reducing excessive alcohol consumption and framing new policies for harm reduction. The Indian Medical Association and the Heart Care Foundation of India endorse their points and believe that a problem such as this can only be tackled when collective steps are taken by all medical associations.
A few ways in which the Governments can help tackle the menace of alcohol consumption that plagues societies include
·         Increase alcohol prices, through volumetric taxation of products based on their alcohol strength, and other proven pricing mechanisms, to reduce alcohol consumption
·         Regulate access and availability of alcohol by limiting the hours and days of sale, the number and location of alcohol outlets and licensed premises, and the imposition of a minimum legal drinking age
·         Governments should tax and control the production and consumption of alcohol, with licensing that emphasizes public health and safety and empowers licensing authorities to control the total availability of alcohol in their jurisdictions
·         Public authorities must strengthen the prohibition of selling to minors and must systematically request proof of age before alcohol can be purchased in shops or bars
·         Practicing alcohol marketing in a restricted way, so as to prevent the early adoption of drinking by young people and to minimize their alcohol consumption
·         Imposing regulatory measures ranging from wholesale bans and restrictions on measures that promote excessive consumption to restrictions on the placement and content of alcohol advertising that is attractive to young people
·         Increase public awareness of harmful alcohol consumption through product labeling and public awareness campaigns. Practicing social marketing campaigns to educate the public about harmful alcohol use. Encouraging drink driving policies and regulating health-warning labels on alcohol products, mandated by an independent authorized body
·         Key drink-driving deterrents should be implemented like strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml, supported by social marketing campaigns and the power of authorities to impose immediate sanctions
The problem of excessive alcohol consumption is plaguing the entire country, and if appropriate measures are not implemented, the number of deaths caused due to alcohol-related causes will continue to rise at a high pace. In a country like India, which is home to 1.27 billion people and records one of the highest drinking and driving deaths yearly, stringent laws and checks are a must.

      


Friday 30 October 2015

Over 100 stage shows, 50,000 visitors, 60 hours of fun filled activities only at HCFI’s 22nd MTNL Perfect Health Mela



Over 100 stage shows, 50,000 visitors, 60 hours of fun filled activities only at HCFI’s 22nd MTNL Perfect Health Mela

To feature first of its kind daily live webcasts by leading dignitaries including Attorney General Mr. Mukul Rohatgi, Chairman Medanta Dr. Naresh Trehan

New Delhi, October 29, 2015: The festive season is here, and various exhibitions and fairs are sprucing up in every nook and corner of the city. Bringing a different flavor to the ever so popular events culture of Delhi comes Heart Care Foundation of India’s annual flagship event, the MTNL Perfect Health Mela. In its 22nd edition the Mela will take place on Nov 4-8, 2015 at the Talkatora Stadium in New Delhi from 8 am to 8 pm.

Organized by the Heart Care Foundation of India (HCFI), in association with the Indian Medical Association, Ministry of Science & Technology, Earth Sciences, Textile, and AYUSH – Government of India, NDMC, MCD and MTNL; the Perfect Health Mela is a mélange of entertainment, lifestyle exhibitions, competitions, workshops, health education and check-ups. The event is based on the concept that an extremely effective way of creating mass awareness about preventive health measures is through entertainment.

Speaking about this, Padma Shri Awardee Dr. K K Aggarwal, President HCFI & Honorary Secretary General IMA said, "Preventive health education is key in an era characterized by premature heart attacks and strokes and an increased incidence of lifestyle diseases such as hypertension, diabetes, heart disease and obesity. People are often oblivious to the severe damage they cause to their overall health by adopting unhealthy lifestyle choices like eating junk food, smoking, consuming alcohol, not exercising. In addition to this education about timely treatment especially in the cases of sudden cardiac arrest and strokes can help save numerous lives. This is the primary aim of HCFI's annual event, the MTNL Perfect Health Mela. The medium used to impart this education is a mix of on-ground health check-ups, entertainment, workshops, and competitions."
In its 22nd edition, the Perfect Health Mela will have some first of its kind activities such as a daily live webcast service being hosted by MTNL and coordinated by eMedinexus, a one of its kind social communications platform for the medical fraternity. Dr. KK Aggarwal will host a special webcast on medical negligence and legal issues with renowned dignitaries including the Attorney General of India – Mr. Mukul Rohatgi and the Chairman of Medanta – the Medicity – Mr. Naresh Trehan on November 5th as a part of this initiative. In addition to this, medical teams from Medanta and National Heart Institute will be providing live check-up and telemedicine facilities at the Mela venue.
Speaking about MTNL’s association with the event, Sh. A K Srivastava, Executive Director, MTNL Delhi said, “We are extremely happy to be associated with the Perfect Health Mela yet again as the title sponsor. This year in addition to providing tele-medicine facilities at the venue for patients with doctors from leading hospitals, we will also be providing free Wi-Fi facilities for all visitors.”
Supporting the event, Dr. P K Sharma, Medical Health Officer, NDMC and Dr. N K Yadav, Medical Health Officer SMCD in a joint statement said, “We believe that health and sanitation are key contributors to the overall health of a nation. And hence, special focus will be laid this year on how to ensure the water you use, the food you consume, the air you inhale, the earth where you live, are all pure and healthy. We encourage everyone to come and attend the event to learn about healthy lifestyle measures in a fun-filled way.”

Other features of the Mela will include:

·         Over 60 handlooms and craft stalls where visitors can shop for their Diwali gifts
·         The Indian Medical Association will be launching the UNESCO chairs in bioethics on November 7th in the presence of six health vice chancellors
·         A special focus will also be given at the Mela towards preventive education about dengue and swine flu
·         The Mela venue will be a completely no smoking zone
·         The chief guest for the inauguration ceremony on Nov 4th will be none other than Padma Vibhushan awardee Dr. Sonal Mansingh

Delivering preventive health advice on the occasion of World Stroke Day, Dr K K Aggarwal added, “A stroke occurs when the blood supply to your brain is interrupted or reduced. This deprives your brain of oxygen and nutrients, which can cause brain cells to die. The primary cause of this is a choked or leaked artery. Stroke is an acquired lifestyle induced ailment aggravated due to obesity, physical inactivity, regular heavy or binge drinking, smoking, hypertension, high cholesterol levels, diabetes, sleep apnea, family history and heart disease. Recognition of stroke symptoms through the F.A.S.T technique can help save a person’s life. If a person’s Face is dropping, has Arm weakness and Speech difficulty; Timely intervention is key by calling an ambulance. India is facing a stroke and heart disease epidemic, and we must work towards amending our high-stress lifestyle to reverse this trend and save lives."

For more information about the event, please visit www.perfecthealthmela.com. Entry to the Mela is free for all.

Sunday 25 October 2015

Doctors for Social Responsibility: Fight against Nuclear Weapons


Doctors for Social Responsibility: Fight against Nuclear Weapons
-          By Padma Shri Awardee Dr Marthanda Pillai, Honorary National President Indian Medical Association and Dr KK Aggarwal, President HCFI & Honorary Secretary General Indian Medical Association

The world has been a witness of the atomic bombings that took place 70 years ago at Hiroshima and Nagasaki. Those horrendous sights of the aftermath post bombing in August 6, 1945 haven’t been forgotten and easily stimulate fear in individuals till today. After the bombings, the land became absolutely ravaged and there wasn’t anything left that could be used for sustenance further. Lamenting the circumstances, doctors warned the world against the devastating effects of nuclear weapons way back then. And since that time, nothing has been able to deter the doctors from all across the world in coming together and standing against all kinds of nuclear tests and other activities.

The recent WMA Declarations of Geneva, of Helsinki and of Tokyo has shed light on how doctors from all across the globe have stood up for humanity and social responsibility. As the nations are proceeding towards development, doctors are being encouraged to act on their responsibilities beyond curing their patients. Given the importance and status doctors are given in our society, the medical professionals are being called to serve the world for the cause of humanity. The WMA has considered and recognized the importance of doctors and the respective medical establishments in fighting towards the cause of elimination of nuclear weapons.

The WMA took the declaration forward by:

·         Agreeing that the world together should condemn the development, testing, production, stockpiling, transfer, deployment, threat and use of nuclear weapons

·         Requesting all the respective governments to refrain from the development, testing, production, stockpiling, transfer, deployment, threat and use of nuclear weapons and to work in good faith towards the elimination of nuclear weapons;

·         Advising all governments that even a limited nuclear war would bring about immense human suffering and substantial death toll together with catastrophic effects on the earth’s ecosystem, which could subsequently decrease the worlds food supply and would put a significant portion of the world’s population at risk of famine; and

·         Requesting that all National Medical Associations join the WMA in supporting this Declaration, use available educational resources to educate the general public and to urge their respective governments to work towards the elimination of nuclear weapons

·         Inviting all National Medical Associations to join the WMA in supporting this Declaration and to urge their respective governments to work to ban and eliminate nuclear weapons

The world needs a strong support system of doctors to ensure the universal slogan of peace across the globe. These weapons are highly destructive in nature and pose an existential threat to humanity. If used, the nuclear weapon can destroy mankind and all traces of it, from economic infrastructure, public health system, communication network and the man itself. React before all is gone!


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How medical professionals can help in improving the conditions of children living on the streets

For the cause of the homeless: How medical professionals can help in improving the conditions of children living on the streets
-          By Padma Shri Awardees - Dr Marthanda Pillai, National President and Dr KK Aggarwal, Honorary Secretary General, Indian Medical Association
In the era of globalization and industrialization, it’s the economically backward who suffer the most, especially children. They are drawn to the streets due to the global financial and economic crisis, which has contributed to family break-ups, social upheaval and disruptions in healthcare and education. Some of them who can manage to find a daily income resource for themselves still continue to battle it out, but the ones who are too young and cannot find an appropriate source of income are frequently neglected and abused, remain on the streets. Although, there are many NGOs and other establishments working to decrease the numbers, but somehow we still find the innocent sauntering on the streets. This problem is prevalent in a variety of communities around the world, and has become a global phenomenon.
Street children are exposed to situations that make them vulnerable to a variety of health problems ranging from traumatic injuries to acute diseases. In a recent meeting held at Moscow, the World Medical Association stressed on raising awareness within civil and medical society about the fundamental role played by medical contact in improving the situation of street children.
To bridge the gap, it is important that medical professional try to establish contact with the street children keeping trust as the most important pillar in mind. The WMA has urged all the medical and social establishments to come together for socializing street children with physicians by building trust amongst them. And after that, a more lucrative global multidisciplinary and multidimensional approach should be adopted to improve the well being of street children further.
Additionally, it is important to implement equality in healthcare for ensuring that these street children avail the basic medical facilities.
WMA aims at address child homelessness by:
·         Condemning any violations of the rights of children living on the streets and any infringements of these rights, in particular discrimination and stigmatization and their exposure to abuse, violence, exploitation and manipulation, including trafficking
·         Eliminating the factors, which lead to children living on the streets and to take action to implement all applicable legislation and systems of protection to reduce the health implications for street children. National authorities have an obligation to provide care for all children and, where necessary, to support their return to a living environment appropriate for a child
·         Reducing health implications includes not only direct treatment of health issues but also protection of Street Children from health risks such as exposure to drugs, HIV infection, smoking and drinking
·         Calls upon governments, national medical associations and healthcare professionals to acknowledge the scale of this phenomenon and to instigate prevention and awareness campaigns. These children must be able to access the full range of necessary health and social protection
·         Urges all national medical associations to work with legal counterparts, governments, health care professionals and public authorities to ensure the fundamental rights of children, who are a particularly vulnerable population in need of protection, particularly access to healthcare and education. The right to food and housing should be guaranteed, and any form of discrimination or exploitation should be forbidden
·         Condemns any improper age-assessment practices that make use of insufficiently reliable clinical or Para clinical investigations. Until they reach adulthood, adolescents must be able to enjoy their status as minors, as recognised by the UN International Convention on the Rights of the Child
·         Urges physicians to remain vigilant in terms of delivering all the support required to provide suitable and comprehensive care for 'street children'. Physicians should be aware that homelessness is a pervasive problem
·         Maintains that every effort should be made to provide all children, and particularly those that are homeless, with access to a suitable and balanced psycho-social environment, in which their rights, including the right to health, are respected


Friday 23 October 2015

The dangers of excessive alcohol consumption

The dangers of excessive alcohol consumption
Excessive alcohol consumption and under-age drinking are common issues, which almost all countries globally continue to struggle with. The urgent need to raise awareness about the evils of alcohol consumption has been brought up by most National and International bodies during their annual meetings. The World Medical Association recently during its General Assembly launched a declaration, which focuses on reducing excessive alcohol consumption and framing new policies for harm reduction.
Alcohol consumption is a critical challenge that contributes to various social and economic problems. It is the cause of death of over 2.5 million individuals every year (almost 4% of all deaths worldwide), and the third leading risk factor for poor health globally, accounting for 5.5% of disability-adjusted life years lost.
The WMA Statement stresses on the following:
·         Chalking out various effective alcohol harm-reduction policies and measures that will target overall alcohol consumption by imposing some legal and regulatory measures
·         Innovating new health and social policy interventions that will target high-risk drinkers and other vulnerable groups and the resulting harms
·         Strengthening weak alcohol policies and prevention programmes that are ineffective at protecting health and safety, and preventing harm
·         Bringing in international public health advocacy and partnerships to strengthen and support the ability of governments and civil society worldwide to commit to, and deliver on, reducing the harmful use of alcohol
·         Educating and encouraging health professionals in preventing, treating and mitigating alcohol-related harm, using effective preventive and therapeutic interventions
The World Medical Association has taken a leadership role to encourage and support the development and implementation of evidence-based national alcohol policies by promoting and facilitating partnerships, information exchange and health policy capacity building. 
In addition to this, WMA insisted on bringing a transformation in the reform related to alcohol in the countries. These include:
·         Increase alcohol prices, through volumetric taxation of products based on their alcohol strength, and other proven pricing mechanisms, to reduce alcohol consumption
·         Regulate access and availability of alcohol by limiting the hours and days of sale, the number and location of alcohol outlets and licensed premises, and the imposition of a minimum legal drinking age
·         Governments should tax and control the production and consumption of alcohol, with licensing that emphasizes public health and safety and empowers licensing authorities to control the total availability of alcohol in their jurisdictions
·         Public authorities must strengthen the prohibition of selling to minors and must systematically request proof of age before alcohol can be purchased in shops or bars
·         Practicing alcohol marketing in a restricted way, so as to prevent the early adoption of drinking by young people and to minimise their alcohol consumption
·         Imposing regulatory measures ranging from wholesale bans and restrictions on measures that promote excessive consumption, to restrictions on the placement and content of alcohol advertising that is attractive to young people
·         Increase public awareness of harmful alcohol consumption through product labeling and public awareness campaigns. Practicing social marketing campaigns to educate the public about harmful alcohol use. Encouraging drink driving policies and regulating health-warning labels on alcohol products, mandated by an independent authorized body
·         Key drink-driving deterrents should be implemented like strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml, supported by social marketing campaigns and the power of authorities to impose immediate sanctions

The problem of excessive alcohol consumption is plaguing the entire country and if appropriate measures are not implemented, the number of deaths caused due to alcohol related causes will continue to rise at a high pace. In a country like India, which is home to 1.27 billion people and records one of the highest drinking and driving deaths yearly, stringent laws and checks are a must.

      


IMA demands amendments to the PCPNDT Act

IMA demands amendments to the PCPNDT Act

The PNDT Act came into being with the purpose of improving the altered sex ratio in India. It was further amended PCPNDT Act to regulate the technology used in sex selection. The Act banned preconception and prenatal sex determination. Its intent was to curb the actual act of sex selection and female feticide by regulating the use of ultrasound technology. 

WHO in its recent publication has clearly declared that restricting technology was not the way forward and there is a lot that still needs to be done in this direction. .

Despite the Act having been in existence for over 20 years, the altered sex ratio in India has not changed. Instead, the act has had two major negative consequences:

• In its current form, the implementation of the PCPNDT Act has deprived the community of life-saving and essential ultrasonography which has now become an extension of clinical practice for all specialties globally, being a well-known non-invasive, cost-effective and accurate diagnostic tool.

• The current PCPNDT Act has made it extremely difficult for ultrasound clinics to ensure complete enforcement. Doctors and other medical professionals are being put to extreme hardship while performing routine and essential scans. Due to this, many qualified doctors are opting not to do PNDT scans, thus creating a shortage of experts trained in ultrasonography.

Speaking on this issue, Padma Shri Awardee, A Marthanda Pillai – National President and Padma Shri Awardee, Dr K K Aggarwal – Honorary Secretary General and President HCFI in a joint statement said, “As the PCPNDT Act has not resulted in the improvement of the falling sex ratio, social rather than medical interventions will be required to handle this issue effectively. The Act is being used to punish doctors for minor offences such as clerical errors in the filling of forms, thereby resulting in doctors being prosecuted and ultrasound machines being seized and sealed. Collectively IMA has put together some amendments which are required to solve this crisis”.

IMA demands the following amendments:

• The Act needs urgent modification to allow unambiguous and easy interpretation. The “Rules” need to be simplified and implemented uniformly across the country, and adhoc changing of rules by each local authority should be strictly prohibited. New rules must be logical and should apply to the entire country only after due discussion with the representative bodies. Time should be given for implementation of the new rules.

• The Act is to be directed only towards Obstetric Ultrasound and not any other applications of ultrasonography.

• The word “Offence” under this act has to be clearly defined. The word Offence should only mean the “actual act of sex determination or female feticide”.

• All other clerical/administrative errors should be classified as non-compliance (and not an offence). Strict penalties can only be imposed for the actual act of sex determination or female feticide and not for other errors. There is a need to redefine “what amounts to sex determination” as mere evidence of clerical error does not amount to sex determination. “Imprisonment” rules should be for the offence (of sex determination or female feticide) & not for non-compliance.

• Inspections should be conducted yearly instead of every 90 days. No NGO can conduct “raids” on doctors’ premises and there should be no impediment to doctors doing their practice during inspections.

• Ultrasonologists should not be restricted to working in only two centers.

• The doctors should have the right to report on those seeking sex determinations and action must be initiated against them immediately.




How important it is to ensure physician’s wellbeing

For doctor’s cause: How important it is to ensure physician’s wellbeing and what can be its impacts on their patients?
Dr K K Aggarwal

The importance of physician’s wellbeing was the centre of discussion of the delegates at the annual General Assembly of the WMA in Moscow, which was held from 14th to 17th October. The expert panel saw the active participation of around 60 countries, stressing on how a few factors including biological, psychological and social problems experienced by physicians including mental illness, disabilities, occupational stress, burnout and any other chronic ailment can affect the efficiency of the doctor and as well as their patients.

As often discussed, a physician’s wellbeing is one of the most prominent factors contributing towards successful treatment of a patient. However, there is still not much clarity on this subject, but still this topic has been going back and forth in the discussions of the medical experts. They have spoken about the medical industry of each country needs to focus on encouraging ongoing research on physician’s health. Government should start supporting the conclusions based on the estimates and evidences that we already have. While it is always believed that physician’s follow the nitty-gritty of a healthy lifestyle, but some of them still suffer a lot of stress due to different reasons.

Reportedly, it has been observed that the highest rate of suicide is found amongst the medical professionals, especially physicians. Additionally, female doctor suicides significantly outnumber male doctor suicides.  The major factors accountable are the stress and strain one has go through in order to be a doctor and carry on in the medical profession. Due to the workload, doctors often end up getting managing and multi-tasking consistently. As a result, they get inadequate sleep, are forced to social isolation and are overworked. The government needs to take a step and start working on framing the necessary policies that will ease up the whole crisis for physicians and their patients as well.

Setting all the reasons aside, physicians tend to avoid seeking help in case they feel ill because they are concerned about the confidentiality of the information pertaining to them. They are seen as the role models by their patients and hence, they hesitate in opening up about their health problems. To eradicate this fear of information breach and excessive burden of external expectation on them, government should ensure that the physicians get the same right of confidentiality as any other patient when seeking and undergoing a treatment. The health care system may need to provide special arrangements for the care of physician-patients in order to uphold its duty to provide privacy and confidentiality. Prevention, early assistance and intervention should be available separately from any disciplinary process for them.

WMA states the factors that hinder the wellbeing of a physician:

·         The medical profession often attracts highly driven individuals with a strong sense of duty. Successfully completing the long and intense educational requirements often confers upon physicians a high degree of respect and responsibility in their communities. This external expectations burden often ends up burdening them with a lot more than an individual can take, hence, leading to stress. Also, the doctors, who are always looked up on as the ideals and role models prioritizing the care of others over care of self. And missing out on expectations often given them a feeling of guilt and selfish nature

·         Working conditions, including workload and working hours, affect physicians’ motivation, job satisfaction, personal life and psychological health during their careers. Sometimes, due to the extended working hours, they miss out on required sleeping hours and this eventually leads to their health deterioration

·         Physicians are often perceived as being immune to injury and diseases as they care for their patients. Physician who are employed by small organizations or who are self-employed may be at even a higher risk for occupational diseases and may not have access to health and safety programs provided by relatively large health care establishments. So, despite the size of a hospital or a clinic, the basic healthy practices and hygiene should be adopted for the help of both patients and doctors

·         Physicians in postgraduate education often confront emotionally challenging and traumatic situations including patients’ suffering, injury and death. Physicians may also be exposed to physical hazards like radiation, noise, poor ergonomics, and biological hazards like HIV, TB and hepatitis. All of this makes them more prone to the diseases which can degenerate their health both mentally and physically

·         Additionally, some of the physicians in postgraduate education and medical students, especially women can be victims of harassment and discrimination during their medical education.  And due to their position within the medical hierarchy, they may feel powerless to confront these behaviours. This leads to the frustration building up in their minds and causing a mental outbreak

·         Medical industry runners should work on potential obstacles, which restrict an ill physician from seeking care including denial, confidentiality issues, aversion to the patient role, practice coverage, fear of disciplinary action, potential loss of practice privileges, loss of performance based payment and the efficiencies of self-care.

·         Illnesses can include mental and behavioural health problems, burnout, communication and interpersonal issues, physical and cognitive problems and substance use disorders

According to WMA, a few steps immediately need to be followed including improved wellness promotion programs, prevention strategies and earlier intervention of symptoms in physicians can help mitigate the severity of mental and physical illnesses and help reduce incidence of suicide in physicians and medical students.