WMA approves Modern Physicians Pledge

WMA approves Modern Physicians Pledge

Dr KK Aggarwal

A modern successor to the Hippocratic Oath for physicians around the world has been approved by the World Medical Association.

Physician leaders, meeting at the WMA’s annual General Assembly in Chicago approved revisions to the Declaration of Geneva, which was adopted by the Association in 1948.

The revised Declaration, to be called a pledge, refocuses the text to reflect changes over the decades in the relationship between physicians and their patients and between physicians themselves. As a result, the new pledge makes specific reference for the first time to respecting the autonomy of the patient, which is not included in the current text. It also includes a new obligation for respect between teachers, colleagues and students.

The present Declaration says students must respect their teachers, but there is no reciprocity. There is a new obligation on physicians to share medical knowledge for the benefit of their patients and the advancement of healthcare.

Also added is a requirement for physicians to attend to their own health, well-being and abilities in order to provide care of the highest standard.

The current Declaration of Geneva is used across the world by physicians. In many countries it is actually part of the medical professional code and in some it is legally binding. However, in other countries it is either not used at all or is adapted in some way.

The WMA is now expecting that the revised pledge, agreed following a two-year revision process, including a period for public consultation, will become a global ethical code for all physicians.

WMA President Dr. Yoshitake Yokokura said: ‘The new wording respects the unique character and significance of this Declaration, but focuses more on important ethical principles not in the current version and not expressed explicitly.

‘The life of physicians today is completely different to what it was in 1948 when the original Declaration of Geneva was adopted. Since then, the Declaration has become a core document of medical ethics and a modern version of the 2,500-year old Hippocratic Oath.

‘We hope that the Declaration approved today will be used by all physicians around the world to strengthen the profession’s determination to maintain the highest standard of health care for patients’

(Source: WMA News Release, October 14, 2017)

IMA stresses on the importance of reviving family physicians

IMA stresses on the importance of reviving family physicians The need is imminent in the wake of a rising shortage of doctors, establishments, and beds in the country New Delhi, 26th June 2017: According to statistics, India has one doctor for every 1700 people against the WHO recommended norm of 1 doctor for every 1,000 people. With a population of more than a billion, India is facing a shortage of doctors, establishment and beds. There are not enough doctors to take care of the health needs of all. Adding to this, is the issue of unqualified quacks who dupe people in the name of medical practice. Research shows that about 80% of the population in India turns to private caregivers and more than 75% of their health care spending is out of their own pocket. All this makes it imperative to bring back the concept of a 'family physician'. Family doctors can help restore the faith of patients in medical professionals, which currently is seeing a downward trend. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "In earlier days, family physicians looked after all the health needs of a family, even many generations of a family, regardless of their specialization. They treated and provided preventive health care to a family as a whole because they were aware of the family history and served as a link between the patient and the specialist. The situation is different today: lack of communication has fostered distrust among patients which is evident in the form of rising litigations or often violence against doctors. The need of the hour, therefore, is to reintroduce the family physician system. They are the first link in health care delivery for the population and play a pivotal role in preventive health, early diagnosis, and timely referral including maintaining health details of all family members." A physician should be aware of the social determinants of health such as the conditions in which people are born, grow, work, live, and age, for good health outcomes. An organized chain of qualified family doctors will help in substantially easing the burden on large hospitals by detecting primary-stage ailments, and reducing cases that require complicated procedures. The society should be educated on the benefits of getting treatment through a family doctor. Adding further, Dr Aggarwal, said, "Family physicians offer several advantages. Some of them are familiarity, trust, and ease of communication. As a result, the patient is more likely to open up about his/her problems and adhere to the treatment prescribed. Family physicians provide a continuum of care at all levels of care, including emergency care. While specialization is required today keeping in mind the medical advancements, the psychological impact of a family doctor on the patients is invaluable, particularly due to the stressful and busy life people lead today." As part of its efforts to update the older lot of general practitioners (aged 45 years and above) with the latest medical advancements, the IMA is already offering a series of continuing medical education programmes with short courses in diabetes, ECG, oncology, etc. to keep them abreast of the latest developments. It is important to encourage more practitioners to undertake the diploma courses in family medicine so that they no longer deal with mundane and routine health issues.

Family physicians are the need of the hour

Family physicians are the need of the hour With a population of more than a billion (~1.32 billion), India is facing a shortage of doctors, establishment and beds. Presently, India has one doctor for every 1700 people against the WHO recommended norm of 1 doctor for every 1,000 people. There are not enough doctors to take care of the health needs of all. This is the time to bring back the age-old concept of ‘Family physician’. Unlike a General Practitioner, a family physician looked after all the health needs of a family, even many generations of a family, regardless of his/her specialization. They not only treat, but also provide preventive health care to the family being aware of the family history and was the link between the patient and the specialist. Considered a part of the family, he was an integral part of all important family functions and events. All in all, he was a ‘friend, philosopher and guide’ of the family. For good health outcomes, a physician has to be aware of the social determinants of health i.e. the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. It is important to know the socio-economic circumstances of a patient, because these influence outcomes. Family physicians address the social determinants of health. Family physicians also offer several advantages; most important are familiarity, trust, and ease of communication due to a long-lasting relationship. As a result, patient is more likely to open up about his problems and adhere to the treatment prescribed. Family physicians provide a continuum of care at all levels of care, including emergency care. Medicine has become highly specialized today leading to isolation among different specialties as well as from patients. Lack of communication has fostered distrust among patients becoming evident as rising litigations or often as violence against doctors. Hence, instead of destroying the family physician system, re-introducing the ‘traditional concept’ of family physician is the need of the hour. They are the first link in health care delivery for the population and play a pivotal role in preventive health, early diagnosis and timely referral including maintaining health details of all family members. Their services can be used on a retainership basis. One of our demands in the Dilli Chalo Movement on 6th of this month was that we need more than 25,000 additional PG seats in Family Medicine. Dr KK Aggarwal National President IMA & HCFI

ACP releases new guidelines on the treatment of osteoporosis

ACP releases new guidelines on the treatment of osteoporosis The American College of Physicians (ACP) has released new guidelines on the treatment of osteoporosis, which have been published in the Annals of Internal Medicine. The recommendations for treating osteoporosis were last published in 2008. • Physicians should treat women with osteoporosis with bisphosphonates (alendronate, risedronate, or zoledronic acid) or denosumab, a biologic agent for five years. Continuing treatment after the initial five years may be beneficial for some patients and may be appropriate after reassessing the risks and benefits of continuing therapy. • Bisphosphonates are also recommended in men with osteoporosis to reduce fracture risk. • Bone density monitoring during the five-year treatment period is not recommended due to lack of evidence of the benefit of monitoring. • Use of hormone-replacement therapy (HRT), either estrogen alone or estrogen + progestin or raloxifene for the treatment of osteoporosis in women is not recommended. The serious adverse effects of estrogen treatment such as increased risk for cerebrovascular accidents and venous thromboembolic events outweigh the potential benefits. • The decision to treat osteopenic women 65 years of age or older at a high risk for fracture should be based on fracture risk profile; and the benefits, harms, and costs of medications and patient preference. • Most women with normal bone density measurements do not progress to osteoporosis within 15 years; hence, ACP does not support frequent monitoring of women with normal bone density for osteoporosis At the same time, the ACP does not recommend physicians use, (Source: ACP Press Release, May 9, 2017)