Thursday, 15 June 2017

Zero tolerance to quackery

Zero tolerance to quackery "I am proud to be a qualified and registered doctor" "I am not a quack who lives on cuts and commissions" The Indian Medical Association (IMA) has zero tolerance to quackery. A stringent central anti-quackery law is one of the major demands of the Association in the Dilli Chalo Satyagraha. Anyone who is not qualified or not registered, if practices a system of medicine, should be punishable for a term, which should extend up to ten years and with stringent fine. The recognized and registrable systems of medicine are modern medicine or Allopathy, Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. All other unrecognized systems of medicine are illegal and cannot be practiced without permission of the institutional ethics committee and a registry under a clinical trial as prescribed in the Drugs and Cosmetics Act. It is a settled law that quacks are untrained and cannot diagnose or treat routine and emergency situations. They will invariably miss diagnosis of acute heart attack, paralysis, meningitis, early cancer, early rheumatoid arthritis, appendicitis, acute abdomen, acute pregnancy situations, dissection of aorta, pulmonary embolism etc. leading to a high mortality and morbidity. Their modus operandi is based on referral practice to corporate set ups with a desire of getting commissions. IMA Campaign: Beware of quacks • Quacks are the ones who indulge in cuts and commissions. • They will never refer the patient in time. • They will invariably give steroids in every case. • They will over investigate the patient to appear genuine. Have faith in registered and qualified doctors • They do not indulge in unethical practices. • They do not take or give commissions. • Their primary aim and dharma is to heal and not financial gain. • They believe in Karma and not Kriya. • They will always guide you in your best interest. In all the following conditions, quacks are guilty of medical negligence and put the life of the patient in danger: 1. Missing the golden hour: In emergency medicine, the “golden hour” refers to the first hour following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death. If bleeding can be stopped and person can be infused enough fluids within first hour, most trauma deaths can be avoided. 2. Not able to give timely first aid: “Platinum ten minutes” refers to first 10 minutes after trauma and refers to the importance of starting first aid within ten minutes to reduce chances of death. 3. Not doing ECG in time: Door to ECG (electrocardiogram) Time is an important terminology in the treatment of heart attack. An ECG should be obtained within 10 minutes of chest pain. A prolonged door-to-ECG time increases risk of adverse patient outcomes in cases of "ST elevation heart attack". 4. Not attempting CPR and defibrillation: Effective time for cardiopulmonary resuscitation (CPR) is less than 10 minutes. After 10 minutes, the chances of successful survival are negligible. 5. Ignoring paralysis: Door-to-Doctor Time in Stroke (paralysis) is another term. In emergency department, arrival to initial physician evaluation should be less than 10 minutes in stroke or chances of death are high. Also, door-to-neurologist time is for the specialist. In emergency department, arrival to Paralysis Stroke Team Notification time should be less than 15 minutes. 6. Ignoring CT scan: Door to CT scan time is the time before which the CT should be done in suspected paralysis. In the emergency department, arrival to CT scan initiation in stroke should be less than 25 minutes. Door-to-CT scan Interpretation by the doctors in stroke should be < 45 minutes. 7. Door to tPA (a clot dissolving drug) time is the treatment window in paralysis: 80% of eligible paralysis patients presenting to the ER should be treated with tPA within 60 minutes. 8. Not diagnosing pneumonia in time: Door to antibiotic time in community-acquired pneumonia is the time to start antibiotics. Practice guidelines suggest that all patients hospitalized with community-acquired pneumonia should receive antibiotics within 4 hours of admission 9. Ignoring meningitis: Door to antibiotic time in meningitis (infection of the brain) of more than 6 hours is associated with high (8.64 times) mortality. 10. Door to needle time in acute heart attack is the time before which the clot dissolving drug should be given: In ST elevation heart attack, it is recommended that the door-to-needle time should be less than 30 minutes. 11. Ignoring acute heart attack: Door to balloon time is for angioplasty. Primary percutaneous coronary intervention (balloon dilatation of blocked heart artery) is now preferred for most patients if it can be performed by an experienced operator with less than a 90-minute delay from presentation to the emergency department. 12. Missing cerebral malaria leading to high mortality 13. Treating rheumatic sore throat as flu 14. Missing early HIV 15. Spreading HIV, hepatitis B and hepatitis C by unsafe injection practices 16. Damaging kidney by giving kidney toxic drugs 17. Damaging liver by giving liver toxic drugs 18. Missing diagnosis of acute hepatic encephalopathy 19. Missing MDR and XDR TB. 20. Indiscriminate use and/or giving wrong antibiotics leading to antibiotic resistance It takes over a decade for a modern medicine doctor to acquire sufficient knowledge to decide which antibiotic should be prescribed in a certain situation and which should be avoided. It’s not mathematics. One cannot learn medicine via Google or following the prescriptions of modern medicine doctors. Every case is different; hence, we say individualize treatment according to that particular patient. Most preventable deaths can be traced to ignoring warning signals or self-prescriptions or relying on medicines by quacks or chemists

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