Thursday 31 March 2016

A healthy diet is key for a long and healthy life

A healthy diet is key for a long and healthy life

A balanced and healthy lifestyle is the key to preventing and reversing common lifestyle disorders such as a high blood pressure, diabetes, obesity, cancers, osteoporosis, heart attack, metabolic syndrome, fatty liver and polycystic ovarian disease amongst others. And the first step towards living a healthy life is to maintain an ideal weight.

A fad of going on crash diets, stressful work environments encouraging people to eat comfort foods, all day desk jobs and size zero concept have increasingly distorted a person’s definition of an ideal weight and wholesome eating. What most people do not understand is that a healthy diet not just requires consuming calories equivalent to thirty times their current weight; it also means that the right balance of macro and micronutrients should be eaten.

While macronutrients are the chemical components of food such as carbohydrates, proteins and fats that provide the body with energy and are needed in large quantities; micronutrients are required in small amounts and include several minerals and vitamins. When consumed in the right quantities and balanced with adequate physical exercise, these can help a person prevent most common lifestyle disorders.

Speaking about the same, Dr SS Agarwal – National President IMA & Padma Shri Awardee Dr KK Aggarwal – Honorary Secretary General IMA and President HCFI said, “An ideal diet should also be low in sodium and no person should consume more than 6 gm of sodium chloride in a day. The consumption of trans fat, which is found in hydrogenated oils or vanaspati ghee, should be minimal as it is bad for the heart and reduces the good HDL cholesterol levels and increases the bad LDL cholesterol. It is recommended that heart patients in particular should avoid eating out as much as possible since the food in most restaurants and hotels is high on trans fat and usually will be bad for the heart. Refined carbohydrates like white bread, white flour, white rice and refined sweetened cereals and white sugar should be consumed in minimal quantities and replaced with options like whole grain flour, healthy green cereals and oat meal.”

Earlier this week, the Public Health England (PHE) launched the new Eatwell Guide to a healthy diet, which should now include more fruit, vegetables and starchy carbohydrates and have fewer sugary foods and drinks.

The guide replaces the Eatwell plate and has been refreshed to reflect updated dietary recommendations, including those on sugar, fiber and starchy carbohydrates from the Scientific Advisory Committee on Nutrition (SACN) report on Carbohydrates and Health in 2015.
The new Eatwell Guide emphasizes on fruit, vegetables and starchy carbohydrates, preferably wholegrain. Sugary soft drinks have been removed from the image and foods that are high in fat, salt and sugar have been moved to the periphery of the guide, reflecting advice that they are not an essential part of a healthy and balanced diet.

Adults should have less than 6 grams of salt and 20 grams of saturated fat for women or 30 grams for men a day. The consumption of sugar, for example from sugary drinks and confectionery should be limited.

The Eatwell Guide now displays drinks recommendations which make clear that adults should be aiming to have 6 to 8 glasses of fluids per day ideally from water, lower fat milks and unsweetened tea or coffee.


Wednesday 30 March 2016

What is Chronic Obstructive Pulmonary Disease and how does it affect your lungs?

What is Chronic Obstructive Pulmonary Disease and how does it affect your lungs? As per the WHO reports, more than 65 million people are suffering from moderate to severe COPD in India India’s population accounts for a significant percentage of COPD mortality, which is estimated to be amongst the highest in the world, coming down to about 556,000 in case of India (>20%) out of a world total of 2,748,000 annually New Delhi, 29th March 2016: COPD or chronic obstructive pulmonary disease has been characterized as one of the most common lung disorders. Individuals suffering from COPD develop chronic bronchitis, which causes them to develop a persisting cough with mucus. Additionally they may suffer from emphysema, which stimulates lung issues in an individual over time. In this disease, a person suffers from a restricted flow of air to the lungs causing them to develop one or both the diseases. Coming to the causes, smoking has been talked about as one of the most prominent causes for the development of COPD among the population. It is because more than a third of the population in India consumes tobacco products and other variety of alternatives. While cigarettes and chewable tobacco products are common in urban areas, the rural population smokes conventional tobacco alternatives like bidi, hookah, and chillum. COPD is prevalent among individuals who don’t smoke or consume tobacco products as well. In such cases, the lack of a protein called alpha-1 antitrypsin can stimulate emphysema. Apart from this, factors like excessive exposure to gasses that harm the lungs, air pollution affecting the quality of breath and lack of proper ventilation can worsen the health of lungs. People with existing COPD disease are considered to be at an increased risk of developing morbidities like cardiovascular issues, lung cancer and a variety of other medical anomalies. Stressing on the issue, Dr. S.S. Agarwal, National President and Padma Shri Awardee Dr. K.K. Aggarwal, Honorary Secretary General IMA & President HCFI in a joint statement said “There is little awareness about the fact COPD is treatable, and an individual can be relieved of the disease once the disease has been identified and the necessary precautionary measures have been taken. We recommend individuals to start up an alternative regime that entails fixing lifestyle irregularities. The first and most important way to slow lung damage is to quit smoking. In addition to this it is also recommended that a regular exercise routine is put in motion to help build one’s strength and stamina. It is essential to keep your surroundings clean and ensure proper ventilation. Fireplaces and areas where there is excessive pollution should be avoided since they can aggravate respiratory issues. And lastly, eat healthy so that you can live disease free,” Individuals suffering from the disease are prescribed inhalers to open the airways so that the air can thoroughly pass; oral medicines are prescribed to decrease lung inflammation reduce swelling and control infection in the lungs. In severe circumstances, injective medicines, using a nebulizer, oxygen therapy, and breathing assistance through a mask or endotracheal tube is preferred. Medical assistance is available to decrease the severity of the disease, but nothing can compare to the precautions and individual takes like saying no to smoking. A person suffering from COPD might notice symptoms like: • Short of breath or complete breathlessness • Chest congestion • Wheezing • Coughing Mucus • Excessively scratchy throat • Presence of sputum • Recurring moderate to severe respiratory infections • Blue tinge in the fingernails and lips • Feeling lethargy • Abrupt weight loss Prevention is always better than cure and this COPD Day IMA will be educating all its 2.5 lakh members on the proper patient counseling techniques in this regard.

Type 2 diabetes is reversible

Type 2 diabetes is reversible Type 2 diabetes is potentially reversible using 8-week, very low-calorie diet followed by careful weight management. According to an online report published March 21, 2016 in the journal Diabetes Care by Dr Sarah Steven of Newcastle University, UK, at the time of diagnosis, everyone should be told that type 2 diabetes is potentially reversible by way of substantial weight loss. In the study, 30 overweight diabetics reduced their weight following an 8-week mostly liquid diet of 600 to 700 calories a day and 40% of them achieved an average fasting plasma glucose level of less than 126 mg/dL. This can be equated to medical bariatric surgery. Subjects were allowed to eat non-starchy vegetables and drink at least 2 liters per day of calorie-free beverages and to maintain normal activities.

Tuesday 29 March 2016

An Aging World: 2015

An Aging World: 2015
The world’s older population continues to grow at an unprecedented rate. Today, 8.5 percent of people worldwide (617 million) are aged 65 and over. According to a new report, An Aging World: 2015 this percentage is projected to jump to nearly 17 percent of the world’s population by 2050 (1.6 billion).
Highlights of the report include
America’s 65-and-over population is projected to nearly double over the next three decades, from 48 million to 88 million by 2050.
By 2050, global life expectancy at birth is projected to increase by almost eight years, climbing from 68.6 years in 2015 to 76.2 years in 2050.
The global population of the “oldest old” — people aged 80 and older — is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million. The oldest old population in some Asian and Latin American countries is predicted to quadruple by 2050.
Among the older population worldwide, noncommunicable diseases are the main health concern. In low-income countries, many in Africa, the older population faces a considerable burden from both noncommunicable and communicable diseases.
Risk factors — such as tobacco and alcohol use, insufficient consumption of vegetables and fruit, and low levels of physical activity — directly or indirectly contribute to the global burden of disease. Changes in risk factors have been observed, such as a decline in tobacco use in some high-income countries, with the majority of smokers worldwide now living in low- and middle-income countries.

CDC Zika Updated Recommendations

CDC Zika Updated Recommendations
  • Women with confirmed cases of the Zika virus or who have had symptoms of the virus should wait at least eight weeks after the start of their symptoms before trying to get pregnant
  • Men with confirmed cases of the virus or who have had symptoms of the virus are now advised to wait at least six months after their symptoms begin before having unprotected sex.
  • Women and men without symptoms who have travelled to or had sex with someone who has traveled to a Zika-infected area are now advised to wait at least eight weeks after possible exposure to the virus before the woman tries to become pregnant
  • Men who have traveled to a Zika-infected area who have not had symptoms of the virus are now advised to abstain from sex or use a condom for at least eight weeks after returning from the area.
  • Men who live in a Zika-infected area should use condoms or abstain from sex as long as the Zika virus is circulating there.
  • Women and men who do not have the virus but who live in areas where the virus is being transmitted are now advised to talk with their health care providers about plans for pregnancy during the ongoing outbreak.
  • The virus can remain in semen for as long as two months
  • The guidelines apply to sexual intercourse, as well as oral and anal sex.

Monday 28 March 2016

IMA urges the Health Minister to ensure timely implementation of 85% pictorial health warnings on both sides of tobacco packages from April 1, 2016

IMA urges the Health Minister to ensure timely implementation of 85% pictorial health warnings on both sides of tobacco packages from April 1, 2016

New Delhi, March 28, 2016 – The Indian Medical Association, India's largest representative voluntary association of doctors of Modern Scientific Medicine with over 260,000 members has urged the Hon’ble Minister for Health & Family Welfare Shri JP Nadda to implement the 85% Pictorial Health Warnings on both sides of tobacco packages from April 1, 2016. In this context, the IMA has also written to the Prime Minister, President, Vice President, Health Minister and the Finance Minister.

IMA is leading the ‘Doctors for Tobacco Control in India’ (DFTCI) forum incorporating organizations like the Cardiological Society of India, Association of Physicians of India, Indian Academy of Pediatrics, Indian Dental Association, Public Health Foundation of India, and HRIDAY.

With 275 million adult users, India is the second largest consumer of tobacco products, globally. Doctors and medical professionals, witness the debilitating and terminal effects of tobacco use on a daily basis. Tobacco causes a gamut of serious diseases including cancer, cardiovascular diseases, chronic pulmonary diseases and stroke.

Pictorial health warnings (PHWs) are the most effective way of communicating the ill effects of tobacco use, particularly among those with low literacy or no formal education. They are more effective than audio and text communication. In a country like India, where one-third of the population is illiterate, pictorial health warnings communicate health messages effectively and can influence decisions. Large and effective PHWs discourage non-users, particularly youth from initiating, encourage current users to stop and prevent relapse of those who have already quit. 

India will be hosting the Conference of Parties (COP7) to the WHO Framework Convention on Tobacco Control in November. Given the unbalanced report of the Committee on Subordinate Legislation submitted in Parliament during the Budget session, any reduction in size of Pictorial Health Warnings from 85% will appear as the government succumbing to tobacco industry pressure and backtracking from the commitment made at COP6 in Moscow.

Commenting on the report of the Committee on Subordinate Legislation, Dr. S.S. Agarwal, National President and Padma Shri Awardee Dr. K.K. Aggarwal, Honorary Secretary General IMA in a joint statement said, “The report is not binding on the government. The medical fraternity strongly favors large pictorial health warnings as an effective measure. The COP7 to be held in Delhi in November is a perfect opportunity for India to take the lead and demonstrate commitment to Pictorial Health Warning. We are confident that the Hon’ble Health Minister will uphold his commitment to safeguarding the lives of Indians rather than allowing the tobacco companies to have their way. Tobacco is devastating without doubt, so decisions that can protect people from the perils of tobacco must override any efforts to vitalize the commercial interests of a few”. 

Dr. K.K. Aggarwal added, “The Indian Medical Association has published an evidence based white paper on tobacco control and will continue to assist in creating a repository of innovative and effective health messages conveying the multiple health effects of tobacco use”.


Tobacco control advocates in India are hopeful that the implementation date of April 1, 2016 for the 85% pictorial health warnings will be upheld since the Health Minister, during this Parliament Session, has confirmed that the notification first issued on October 15, 2014 will be implemented as planned.

WORLD MEDICAL ASSOCIATION ISSUES HEALTH WARNING OVER REFUGEE DEAL

WORLD MEDICAL ASSOCIATION ISSUES HEALTH WARNING OVER REFUGEE DEAL

Concern that refugees fleeing to Europe are receiving inadequate health care has been expressed by the World Medical Association.

WMA President Sir Michael Marmot said the recent EU agreement signed with Turkey failed to address the humanitarian concerns facing the thousands of refugees making the perilous journey from Turkey to Greece.

‘We appeal to the national leaders to put the needs of the individuals at the heart of this mass migration. Their needs for housing, food, regular medical care and simple dignity have been largely overlooked so far. As
physicians we have a duty to speak out about the risks to the health of these desperate people.

‘We are concerned about the social determinants of health, illness prevention, the availability of health care and other areas to prevent abuse, neglect and exploitation.'

Dr. Bayazit Ilhan, President of the Turkish Medical Association, said: ‘Our concern is that the deal reached with Turkey does not do enough to meet the demands that civil, military and political authorities provide safe transit routes for the victims of local, regional and national conflicts and strife. This must include the provision of safe, secure facilities to house migrants, whether they are in transit or have reached their final destination country. It must also include treating migrants, including at borders, with respect, ensuring that their dignity is not affected.

IMA urges the Health Minister to ensure timely implementation of 85% pictorial health warnings

IMA urges the Health Minister to ensure timely implementation of 85% pictorial health warnings on both sides of tobacco packages from April 1, 2016

New Delhi, March 28, 2016 – The Indian Medical Association, India's largest representative voluntary association of doctors of Modern Scientific Medicine with over 260,000 members has urged the Hon’ble Minister for Health & Family Welfare Shri JP Nadda to implement the 85% Pictorial Health Warnings on both sides of tobacco packages from April 1, 2016. In this context, the IMA has also written to the Prime Minister, President, Vice President, Health Minister and the Finance Minister.

IMA is leading the ‘Doctors for Tobacco Control in India’ (DFTCI) forum incorporating organizations like the Cardiological Society of IndiaAssociation of Physicians of India, Indian Academy of Pediatrics, Indian Dental Association, Public Health Foundation of India, and HRIDAY.

With 275 million adult users, India is the second largest consumer of tobacco products, globally. Doctors and medical professionals, witness the debilitating and terminal effects of tobacco use on a daily basis. Tobacco causes a gamut of serious diseases including cancer, cardiovascular diseases, chronic pulmonary diseases and stroke.

Pictorial health warnings (PHWs) are the most effective way of communicating the ill effects of tobacco use, particularly among those with low literacy or no formal education. They are more effective than audio and text communication. In a country like India, where one-third of the population is illiterate, pictorial health warnings communicate health messages effectively and can influence decisions. Large and effective PHWs discourage non-users, particularly youth from initiating, encourage current users to stop and prevent relapse of those who have already quit. 

India will be hosting the Conference of Parties (COP7) to the WHO Framework Convention on Tobacco Control in November. Given the unbalanced report of the Committee on Subordinate Legislation submitted in Parliament during the Budget session, any reduction in size of Pictorial Health Warnings from 85% will appear as the government succumbing to tobacco industry pressure and backtracking from the commitment made at COP6 in Moscow.

Commenting on the report of the Committee on Subordinate Legislation, Dr. S.S. Agarwal, National President and Padma Shri Awardee Dr. K.K. Aggarwal, Honorary Secretary General IMAin a joint statement said, “The report is not binding on the government. The medical fraternity strongly favors large pictorial health warnings as an effective measure. The COP7 to be held in Delhi in November is a perfect opportunity for India to take the lead and demonstrate commitment to Pictorial Health Warning. We are confident that the Hon’ble Health Minister will uphold his commitment to safeguarding the lives of Indians rather than allowing the tobacco companies to have their way. Tobacco is devastating without doubt, so decisions that can protect people from the perils of tobacco must override any efforts to vitalize the commercial interests of a few”. 

Dr. K.K. Aggarwal added, “The Indian Medical Association has published an evidence based white paper on tobacco control and will continue to assist in creating a repository of innovative and effective health messages conveying the multiple health effects of tobacco use”.

Tobacco control advocates in India are hopeful that the implementation date of April 1, 2016 for the 85% pictorial health warnings will be upheld since the Health Minister, during this Parliament Session, has confirmed that the notification first issued on October 15, 2014 will be implemented as planned.

Heart Care Foundation of India organizes a hands-only CPR 10 camp in Munirka Enclave

Heart Care Foundation of India organizes a hands-only CPR 10 camp in Munirka Enclave Trains over 100 adults and children in the essential life-saving technique which can help revive a clinically dead person for up to 10 minutes after they suffer a sudden cardiac arrest New Delhi, March 27, 2015: Heart Care Foundation of India, a leading National non-profit organization working towards spreading health awareness in the country and making it a healthier one successfully organized a CPR training camp at the Munirka Enclave Hall today. The key purpose behind the initiative was to spread awareness about the increasing incidence of sudden cardiac arrest in the country and how a simple to learn yet effective method such as hands-only CPR 10 can help revive a person till 10 minutes after their death. Over 100 adults and children attended the camp, Speaking about the initiative, Padma Shri Awardee Dr KK Aggarwal - President Heart Care Foundation of India & Honorary Secretary General IMA said, “Around 240,000 people die every year due to heart attacks and we believe that 50% of them can be saved if 20% of the population learns hands only CPR. The technique is easy to learn, can be performed by anyone and is extremely effective. What people need to remember is two things, one CPR must not be practiced on a person who is breathing, has a pulse rate and is clinically alive. It must be administered within ten minutes of someone's death and continued till the ambulance arrives or the person is revived. A cardiac arrest can happen to anyone at any time and a simple formula can help save a loved one's life. We have successfully trained over 1.2 lakh people in this life-saving technique in the past 1 year. We also hold three world records in the Limca Book for the maximum number of people trained in this technique in one place, in one hour and at the same time”. “The Heart Care Foundation of India Hands- Only CPR 10 mantra is: Within 10 minutes of death (earlier the better), for a minimum of 10 minutes (adults 25 minutes and children 35 minutes), compress the center of the chest of the deceased person continuously and effectively with a speed of 10×10 = 100 per minute” he added A sudden cardiac arrest occurs when the electrical conducting system of the heart fails and the heart beats irregularly and very fast (more than 1000 times, technically called as ventricular fibrillation). Soon after the heart suddenly stops beating and the blood flow to the brain stops. As a result, the person becomes unconscious and stops normal breathing. A cardiac arrest is not the same as a heart attack, but it may be caused by a heart attack. In most cases, sudden cardiac arrest may be reversible in the first 10 minutes. This is possible because the brain remains alive during this period when the heart and respiration have stopped, a situation called clinical death. Continuous compression only CPR compresses the heart between the sternum and the backbone and builds up the pressure that keeps the oxygenated blood flowing to the brain and keeps the person alive until a defibrillator becomes available or expert medical help arrives. Therefore, if you see someone collapse from sudden cardiac arrest, acting promptly can save his or her life. It is important to act quickly for every minute lost reduces the chances of revival by 10%. So, if you wait 5 minutes, the chances of surviving are 50% less. The earlier you give CPR to a person in cardiac arrest, the greater the chance of a successful resuscitation. To know more or to organize a training camp in your locality, please call the NGO’s helpline number 9958771177.

Four major lifestyle factors that endanger health

Four major lifestyle factors that endanger health

Four major lifestyle factors that endanger health are smoking, being overweight, inactivity and avoiding exposure to sun.

Non-smokers, who stay out of the sun, have a life expectancy similar to smokers according to a study of 30,000 Swedish women conducted over a period of 20 years. The life expectancy for those who avoided sun dropped by 0.6 to 2.1 years vs those with the highest sun exposure.

Avoiding the sun "is a risk factor for death of a similar magnitude as smoking," write the authors of the article by Pelle Lindqvist, MD, of Karolinska University Hospital in Huddinge, published March 21 in the Journal of Internal Medicine.

Women who seek out the sun are generally at lower risk for cardiovascular disease (CVD) and noncancer/non-CVD diseases such as diabetes, multiple sclerosis and pulmonary diseases, than those who avoided sun exposure.

In the study results were dose-specific, sunshine benefits went up with amount of exposure. While it is true that women should not overexpose themselves to sun, underexposure may be even more dangerous than people think.

Sunday 27 March 2016

IMA educates its 2.5 lakh members on the ethics that govern them

With the suspension of two doctors by the Maharashtra Medical Council: IMA educates its 2.5 lakh members on the ethics that govern them New Delhi, March 26, 2016: With the suspension of two doctors by the Maharashtra Medical Council (MMC) for three months on account of putting up advertisements; the IMA educated its 2.5 lakh members about what is allowed and what is a clear violation of medical ethics under the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. As per Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, doctors cannot solicit patients directly or indirectly. No doctor can make high claims about any procedure. The Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954 is an Act of the Parliament of India. It prohibits advertisements of drugs and remedies that claim to have magical properties, and makes doing so a cognizable offence. According to the recent decision of the MMC, both suspended the doctors provided infertility treatment and claimed guarantee of treatment and offered to return money to patients if they don’t not get the results. Last September, MMC issued show-cause notices to 40 doctors for putting up advertisements on print, TV and social media. After a hearing, some doctors were issued warning letters and some were suspended. The MCI also took actions against many Delhi hospitals for putting up advertisements. Speaking about the same, Dr SS Agarwal – National President and Padma Shri Awardee Dr KK Aggarwal – Honorary Secretary General IMA in a joint statement said, “The IMA is committed to making the medical system in our country more transparent and efficient. It is for this reason that we constantly strive to educate our members about the ethics that govern the profession. We urge the entire medical fraternity to abide by the MCI regulations and be cautious about anything being released by others in their name.” According to the MCI Regulations 6. UNETHICAL ACTS: 6.1 Advertising 6.1.1 Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organizations is unethical 6.1.2 Printing of self-photograph, or any such material of publicity in the letter head or on sign board of the consulting room or any such clinical establishment shall be regarded as acts of self-advertisement and unethical conduct on the part of the physician. However, printing of sketches, diagrams, picture of human system shall not be treated as unethical. 7.12 An institution run by a physician for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation center or any type of training institution etc. may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees. 7.13 It is improper for a physician to use an unusually large sign board and write on it anything other than his name, qualifications obtained from a University or a statutory body, titles and name of his specialty, registration number including the name of the State Medical Council under which registered. The same should be the contents of his prescription papers. It is improper to affix a sign-board on a chemist’s shop or in places where he does not reside or work. IMA advice to doctors An announcement is allowed in the press, when one starts their practice, changes the type of their practice, their address, on temporary absence from duty, = resumption of another practice, succeeding to another practice and public declaration of charges. In all such announcements the doctors photo should not be published In announcements pertaining to the setting up of a new hospital, the doctors photographs should not be published Sign boards for directions to one’s clinics or as advertisements are not allowed to be put up on the road or in chemist shops The doctors clinic should contain only details such as the doctors name, qualifications, medical college, university, titles type of specialty and State medical council registration number. Doctor owned and run establishments (maternity home, nursing home, private hospital, rehabilitation center or any type of training institution) can be advertised for by mentioning the name of the institution, type of patients admitted, type of training provided, other facilities offered and the fees.

Impulsive behaviour

Impulsive behaviour

Dr K K Aggarwal

Yet another incidence of impulsive behaviour and another life, this time of a dentist in Vikas Puri lost. The trigger, cricket ball hitting a bystander.
Impulsive behaviour are impulsive acts without thinking.
Sometimes acting on impulse may make a difference between life and death. If you’re walking across a road and a car is speeding toward you, you have to cat without thinking.
But in most situations one must Think First, Act Later. The situations can be when you are angry with someone; listening to a friend’s emotional secrets; taking an exam; you are on the job; you are on a first date; you are drinking or with people who are drinking; you are shopping or gossiping.

Remedies
·         In distress, open your eyes of the mind and ask yourself, options
·         When having multiple options, open the eyes of your heart, and chose the one which gives you comfort, conscience based decision
·         Buddha principle of right speech: before you speak, ask yourself: is it the truth, is it necessary and is it kind. If the answer to any is no, do not speak
·         Buddha principle of right action: before doing any action ask yourself: is it the truth, is it necessary, will it bring happiness to me and will it bring happiness to other. If the answer to any is no, do not do that action
·         You can also choose three different ways: think an opposite solution, think a different solution or think a positive solution
·         Stress is the acute or chronic reaction of the body and/or the mind to the interpretation of a known situation. So either change the situation, or make it not known to you, or practice a lifestyle in a way that stress does not react on you
·         Do not get upset. Remember that even in people growing in higher states of consciousness, the experience of anger can be frequently triggered by minor incidents
·          Practice STOP principle.
·         S: Stop
·         T: Take a deep breath and smile 
·         O: Observe how you feel
·         P: Proceed with awareness
·         The best solution is to practice chanting of ‘UUUUMMMM” with a speed of 4-5 per minute (slower and deeper parasympathetic breathing)


Saturday 26 March 2016

It is obligatory for hospitals to provide copy of the case record to patient or his legal representative: IMA

It is obligatory for hospitals to provide copy of the case record to patient or his legal representative: IMA New Delhi, March 25, 2016: Not many are aware of is that it is obligatory for doctors, hospitals to provide the copy of the case record or medical record to the patient or his legal representative. With an aim of raising awareness, IMA educated its 2.5-lakh members about the rights of patients and the laws that govern the area. Public health information was also released. The preamble to the Constitution of India coupled with the Directive Principles of State Policy strives to provide a welfare State with socialist patterns of society. It enjoins the State to make the “improvement of public health” a primary responsibility. Furthermore, Articles 38, 42, 43 and 47 of the Constitution provide for promotion of health of individuals as well as health care. The Constitution of India also enumerates the separate and shared legislative powers of Parliament and State Legislatures in three separate lists: the Union List, the State List and the Concurrent List. The Parliament and State legislatures share authority over matters on the Concurrent List, which include criminal law and procedure. Consumer Protection Act is another legislation, which is aimed at preventing negligence and deficient services besides assuring right to information about medical treatment given to the patient at the threat of imposing compensation. The Medical Council of India has imposed an obligation on Hospitals as per the regulations notified on 11th March 2002, amended up to December 2010 to maintain the medical record and provide patient access to it. According to them every physician shall maintain the medical records pertaining to his/her indoor patients for a period of three years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India. If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours. Speaking about the same, Dr SS Agarwal – President IMA and Dr KK Aggarwal – Honorary Secretary General IMA said, “Every patient has a right to claim medical records pertaining to his treatment and the hospitals are under obligation to maintain them and provide them to the patient on request.As per the MCI ethics regulations, not giving records can amount to professional misconduct.” For how long should the records of patients be maintained? • As per the proposed / draft “Clinical Establishments (Registration and Regulation) Rules, 2010, “Copies of all records and statistics shall be kept with the clinical establishment concerned for at least 3 or 5 years or in accordance with any other relevant Act in force at the time”. • As per Regulation 1.3.1 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, “Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3”. • As per Rule 6F (3) of the Income Tax Rules, 1962, doctors in private practice are required to preserve the daily case register as per Form 3C for a period of six years from the end of the relevant assessment year. That would ordinarily mean for seven years from the close of the accounting year. • As per Punjab Medical Manual (1934), the medicolegal record is to be preserved for 12 years. • As per the DGHS vide letter No. 10-3/68-MH dated 31-8-68, records should be maintained as follows: For inpatient medical records (case sheets)……………….10 years For medico-legal registers…………………………………….10 years For outpatient records………………………………………….5 years The above requirement can be found in the “Hospital Manual” published in 2002 by the Directorate General of Health Services, MOHFW, GOI, in chapter 12 titled “Medical Record Services”. In summary, medical records belong to the medical professionals / entities but patients generally have a right to review them, demand copies of them, and to demand their confidentiality as per the MCI ethics regulations.

Two docs suspended for putting up ads

Two docs suspended for putting up ads
Dr KK Aggarwal
 
Maharashtra Medical Council has suspended the registration of two city doctors for three months for putting up advertisements, which is a violation of medical ethics under the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 as reported in DNA India yesterday. Both the doctors provide infertility treatment.  These two claimed guarantee of treatment and offered to return money to patients if they don’t not get the results.
Last September, MMC had issued show-cause notices to 40 doctors for putting up advertisements on print, TV and social media. After a hearing, some doctors were issued warning letters and some were suspended.

Last year, the MCI too had taken suo moto action against many Delhi hospitals for putting up advertisements.
As per Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, doctors cannot solicit patients directly or indirectly.

No doctor can make high claims about any procedure. The Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954 is an Act of the Parliament of India. It prohibits advertisements of drugs and remedies that claim to have magical properties, and makes doing so a cognizable offence.

MCI Code of Ethics Regulations
6. Unethical Acts: 6.1 Advertising

6.1.1 Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical………………………
6.1.2 Printing of self-photograph, or any such material of publicity in the letter head or on sign board of the consulting room or any such clinical establishment shall be regarded as acts of self-advertisement and unethical conduct on the part of the physician. However, printing of sketches, diagrams, picture of human system shall not be treated as unethical.
7.12 An institution run by a physician for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation centre or any type of training institution etc. may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees.
7.13 It is improper for a physician to use an unusually large sign board and write on it anything other than his name, qualifications obtained from a University or a statutory body, titles and name of his speciality, registration number including the name of the State Medical Council under which registered. The same should be the contents of his prescription papers. It is improper to affix a sign-board on a chemist’s shop or in places where he does not reside or work.

IMA Advice
  • An announcement is allowed, in press, when starting practice; on change of type of practice; on changing address; temporary absence from duty; on resumption of another practice; on succeeding to another practice and public declaration of charges.
  • Photographs of doctor/s should not be published in such announcements.
  • Similarly, photographs of doctor/s should not be published when announcing opening of hospitals. 
  • Do not put sign boards on chemist shop.
  • Do not put road directions leading to your clinic.
  • Clinic should contain only name, qualifications, name of medical college, name of university, titles and name of speciality, and state medical council registration number.
  • Doctor-owned and run establishment (maternity home, nursing home, private hospital, rehabilitation center or any type of training institution) can be advertised mentioning the name of the institution, type of patients admitted, type of training and other facilities offered and the fees

Friday 25 March 2016

Is it obligatory for hospitals to provide copy of the case record to patient or his legal representative?

Is it obligatory for hospitals to provide copy of the case record to patient or his legal representative? Dr SS Agarwal, Dr KK Aggarwal, Ira Gupta, Rahul Gupta Yes, it is obligatory for doctors, hospitals to provide the copy of the case record or medical record to the patient or his legal representative. The preamble to the Constitution of India coupled with the Directive Principles of State Policy strives to provide a welfare State with socialist patterns of society. It enjoins the State to make the “improvement of public health” a primary responsibility. Furthermore, Articles 38, 42, 43 and 47 of the Constitution provide for promotion of health of individuals as well as health care. The Constitution of India also enumerates the separate and shared legislative powers of Parliament and State Legislatures in three separate lists: the Union List, the State List and the Concurrent List. The Parliament and State legislatures share authority over matters on the Concurrent List, which include criminal law and procedure. Health service includes securing citizen from medical negligence by punishing concerned for crime of medical negligence and compensating the damage caused by doctor or hospital through negligence under tort action or securing the enforcement of contractual obligation under law of contract. Consumer Protection Act is another legislation which is aimed at preventing negligence and deficient services besides assuring right to information about medical treatment given to the patient at the threat of imposing compensation. The Medical Council of India has imposed an obligation on Hospitals as per the regulations notified on 11th March 2002, amended up to December 2010 to maintain the medical record and provide patient access to it. These regulations were made in exercise of the powers conferred under section 20A to be read with section 33(m) of the Indian Medical Council Act, 1956 (102 of 1956), by the Medical Council of India, with the previous approval of the Central Government, relating to the Professional Conduct, Etiquette and Ethics for registered medical practitioners, namely: Maintenance of Medical Records: 1.3.1. Every physician shall maintain the medical records pertaining to his/her indoor patients for a period of three years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3. 1.3.2. If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours. MCI ethics regulations 7.2 further clarifies that not giving records can amount to professional misconduct. Misconduct: “7.2 If he/she does not maintain the medical records of his/her indoor patients for a period of three years as per regulation 1.3 and refuses to provide the same within 72 hours when the patient or his/her authorised representative makes a request for it as per the regulation 1.3.2.” With the enforcement of the MCI Regulations, 2002 it is made clear that the patient has a right to claim medical records pertaining to his treatment and the hospitals are under obligation to maintain them and provide them to the patient on request. In Kanaiyalal Ramanlal Trivedi v Dr. Satyanarayan Vishwakarma 1996; 3 CPR 24 (Guj); I (1997) CPJ 332 (Guj); 1998 CCJ 690 (Guj), the Hon’ble High Court of Gujarat has held that the hospital and doctor were guilty of deficiency in service as case records were not produced before the court to refute the allegation of a lack of standard care. In Raghunath Raheja v Maharashtra Medical Council, AIR 1996 Bom 198, Bombay High Court upheld the right of patient to medical record very emphatically. Judges M. Shah and A. Savanth stated: “We are of the view that when a patient or his near relative demands from the Hospital or the doctor the copies of the case papers, it is necessary for the Hospital authorities and the doctors concerned to furnish copies of such case papers to the patient or his near relative. In our view, it would be necessary for the Medical Council to ensure that necessary directions are given to all the Hospitals and the doctors calling upon them to furnish the copies of the case papers and all the relevant documents pertaining to the patient concerned. The hospitals and the doctors may be justified, in demanding necessary charges for supplying the copies of such documents to the patient or the near relative. We, therefore, direct the first respondent Maharashtra Medical Council to issue necessary circulars in this behalf to all the hospitals and doctors in the State of Maharashtra. We do not think that the hospitals or the doctors can claim any secrecy or any confidentiality in the matter of copies of the case papers relating to the patient. These must be made available to him on demand, subject to payment of usual charges. If necessary, the Medical Council may issue a press note in this behalf giving it wide publicity in all the media.” In the matter titled as P.P. Ismail v K.K. Radha 1997 (2) CPR 171 (NC); I(1998) CPJ 16 (NC); (1997) 5 CTJ 685 (CP) (NCRDC); 1999 CPJ 99 (NC), the Hon’ble National Commission for Consumer Dispute Redressal Forum held the hospital vicariously liable for the negligent action of the doctor on the basis of the bill showing the professional fees of the doctor and the discharge certificate under the letterhead of the hospital signed by the doctor. In S. A. Quereshi v Padode Memorial Hospital and Research Centre II 2000. CPJ 463 (Bhopal), it was held that the plea of destroying the case sheet as per the general practice of the hospitals appeared to the court as an attempt to suppress certain facts that are likely to be revealed from the case sheet. The opposite party was found negligent as he should have retained the case records until the disposal of the complaint. In case of Dr. Shyam Kumar v Rameshbhai, Harmanbhai Kachiya 2002;1 CPR 320, I (2006) CPJ 16 (NC), the Hon’ble National Commission of Consumer Dispute Redressal Forum has held that not providing medical records to the patient prevents the complainant from seeking an expert opinion and it is the duty of the person in possession of the medical records to produce it in the court and adverse inference could be drawn for not producing the records. The Hon’ble Kerala High Court in the matter titled as “Rajappan Vs. Sree Chitra Tirunal Institute for Medical Science and Technology [ILR 2004 (2) Kerala 150]” has held that: “It is also to be noticed that Regulations do not provide any immunity for any medical record to be retained by any medical practitioner of the hospital from being given to the patient. On the other hand it is expressly provided that a patient should be given medical records in Appendix 3 with supporting documents. Therefore in the absence of any immunity either under the Regulations or under any other law, the respondent Hospital is bound to give photocopies of the entire documents of the patient. Standing counsel for the respondent Hospital submitted that the documents once furnished will be used as evidence against the hospital and against the doctors concerned. I do not think this apprehension will justify for claiming immunity against furnishing the documents. If proper service was rendered in the course of treatment, I see no reason why the hospital, or staff, or doctors should be apprehensive of any litigation. A patient or victim's relative is entitled to know whether proper medical care was rendered to the patient entrusted with the hospital, which will be revealed from case sheet and medical records. There should be absolute transparency with regard to the treatment of a patient and a patient or victim’s relative is entitled to get copies of medical records. This is recognized by the Medical Council Regulations and therefore petitioner is entitled to have copies of the entire medical records of his daughter which should be furnished in full. The Hon’ble Central Information Commission has examined the issue of right of patient to have the medical records in the matter titled as Nisha Priya Bhatia v Institute of Human Behaviour and Allied Sciences GNCTD, bearing File No.CIC/AD/A/2013/001681SA vide order dated 23.07.2014 has held that “The Patient has a right to his/her medical record and Respondent Hospital Authorities have a duty to provide the same under Right to Information Act, 2005, Consumer Protection Act, 1986, The Medical Council Act as per world medical ethics. The Commission recommended the Public Authority to develop a timeframe mechanism of disclosure of medical records to patients or their relatives with safeguards for privacy and confidentiality of the patient”. In the matter titled as Shri Prabhat Kumar versus Directorate of Health Services, GNCTD, Delhi, the Hon’ble Central Information Commission vide order dated 07.04.2015 has held that: “The Commission recommends the Government of India, states and Union Territories, besides the respondent authority in this case, to take necessary steps to enforce the right to information, i.e., forcing the private hospitals to give medical records of the patients on day to day basis, because this daily disclosure will prevent undesirable practices of altering records after damage caused to patient. Forcing the private hospitals to provide daily wise medical records will also act as a check on some hospitals from resorting to CIC/SA/A/2014/000004 Page 30 extortionist, inhuman and ruthless business of prescribing unnecessary diagnostic tests, unnecessary surgical operations, caesarean deliveries, unwarranted angioplasties, inserting stents, without need, or of substandard nature, or putting low quality stent while collecting price of high quality stent, and several such malpractices amounting to medical terrorism, etc. They should not be allowed to such malpractices with all impunity and get away without any legal consequences as if there is an absolute immunity. The Government, Medical Council of India and the health regulatory has to see that licence to practice medicine will not become licence to kill and extort and come to the rescue of helpless patients.” A Bombay High Court ruled against Ruby Hall clinic and said that patient has a right over his record with the hospital and hospital should provide copy of it within a reasonable time (MMC says 3 days) and hospital is entitled to charge a reasonable amount for the same. A hospital should provide a copy of the patient's medical record when requested by the patient. But the above right cannot be enforced under the MCI, 2002, Regulations. The patient's indoor medical case sheet is a property of the hospital and the patient has only a right to get a copy, not the original record. In Medi. Supri. Loknayak Jaiprakash Narayan Hospital & Ors. V/s. K.M. Santosh. F.A. No. 244/2008, decided on 14/03/2016, the National Commission observed: “5. It is the primary responsibility of the hospital to maintain and produce patient records on demand by the patient or appropriate judicial bodies. However, it is the primary duty of the treating doctor to see that all the documents with regard to management are written properly and signed. An unsigned medical record has no legal validity. The patient or their legal heirs can ask for copies of the treatment records that have to be provided within 72 hours. The hospital can charge a reasonable amount for the administrative purposes including photocopying the documents. Failure to provide medical records to patients on proper demand will amount to deficiency in service and negligence. It is the duty of doctor or hospital to preserve, maintain the medical record for certain specified period under different laws like Limitation Act, Consumer Protection Act and the Directorate General of Health Service (DGHS), Prenatal Diagnostic Test Act, 1994, the Clinical Establishments (Registration and Regulation) Act, 2010 (Central Act No. 23 of 2010). These records are required in medical negligence, accident, insurance claims and in criminal cases also in the Labour Courts. Hon’ble Supreme Court and the National Consumer Commission in various judgments held the hospitals/doctors liable for medical negligence for non-production of medical record.” 6. “Smart people learn from their mistakes. But the real sharp ones learn from the mistakes of others.” I have explained previously also about umpteen no of judgments which underlines the importance of keeping proper record & documentation and also the ill effects of failure. There is no escape for proper documentation. Always remember POOR RECORD IS POOR DEFENSE AND NO RECORD IS NO DEFENSE. For how long should the records of patients be maintained? • As per the proposed / draft “Clinical Establishments (Registration and Regulation) Rules, 2010, “Copies of all records and statistics shall be kept with the clinical establishment concerned for at least 3 or 5 years or in accordance with any other relevant Act in force at the time”. • As per Regulation 1.3.1 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, “Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3”. • As per Rule 6F (3) of the Income Tax Rules, 1962, doctors in private practice are required to preserve the daily case register as per Form 3C for a period of six years from the end of the relevant assessment year. That would ordinarily mean for seven years from the close of the accounting year. • As per Punjab Medical Manual (1934), the medicolegal record is to be preserved for 12 years. • As per the DGHS vide letter No. 10-3/68-MH dated 31-8-68, records should be maintained as follows: For inpatient medical records (case sheets)……………….10 years For medico-legal registers…………………………………….10 years For outpatient records………………………………………….5 years The above requirement can be found in the “Hospital Manual” published in 2002 by the Directorate General of Health Services, MOHFW, GOI, in chapter 12 titled “Medical Record Services”. In summary, medical records belong to the medical professionals / entities but patients generally have a right to review them, demand copies of them, and to demand their confidentiality as per the MCI ethics regulations.