India has the highest number of TB patients across the world

India has the highest number of TB patients across the world

Missing doses can defeat the purpose of DOTS therapy

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

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

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “TB is a major public health concern in India. Not only is it a major cause of morbidity and mortality but also poses a huge economic burden on the country. Elimination, which is defined as restricting new infections to less than one case per 100,000 people, is possible only when patients get diagnosed and cured without any break in treatment. Any interruption in treatment can exponentially raise the patient’s risk of developing MDR-TB, which is harder to treat. Missing doses defeats the very purpose of DOTS therapy, which is meant to ensure strict compliance through supervised consumption of medicines. As many as 900,000 people with TB do not have access to proper treatment, which means they risk developing drug-resistant TB and infecting others.”

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

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

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

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

Communicating with patients may motivate them to adhere to prescribed treatment

Communicating with patients may motivate them to adhere to prescribed treatment Dr KK Aggarwal A new research reports that low-income patients with high blood pressure are less likely to take their medications as directed if their healthcare providers do not use a collaborative communication style or ask them about social issues. The three-month study published in the journal Circulation: Quality and Outcomes examined the impact of patient–provider communication on medication adherence among a sample of primary care providers and their patients who had hypertension. Most of the participants were black, unemployed and reported some college education. The study found that: • Patients were three times less likely to take their high BP medications when their providers did not possess a collaborative communication style such as asking open-ended questions and checking their understanding of instructions. • Patients were also six times less likely to take their medications as prescribed when a healthcare provider did not ask them about social issues such as employment, housing and partner relationships. This study demonstrates the negative impact of poor communication on adherence to treatment and highlights the need for better doctor-patient communication to improve compliance to treatment and achieve desired treatment outcomes. The study says that “such discussions signal to the patient genuine caring and concern by the doctor, which strengthens patient’s ability to cope with their life and illness, along with motivation and confidence related to self-management of their disease”. Listening is very important skill for doctors. The concerns of patients should be addressed without being judgemental. Therefore, in addition to prescribing medicine, doctors should also take note of the social determinants of health when managing their patients, as they have significant role to play in the health and wellbeing of the patient. Patients want support and encouragement to take their prescribed medications, especially in case of chronic illnesses such as hypertension, diabetes, heart disease, etc. They either often forget to take their medication or may not realize the need for adherence to treatment. Low income patients usually may not be well educated. This group of patients must be explained the need of compliance to the treatment prescribed. They have to be educated about the disease and why medication is important. This reassures the patient and he/she is motivated to follow your instructions more willingly. On the other hand, high income patients sometimes may be too busy to remember to take their medications. It may not be a priority for them, at that time. Adherence to medications in such high income patients can be improved by SMS reminders. As Sir William Osler famously said, “The good physician treats the disease; the great physician treats the patient who has the disease.” (Source: AHA News Release, August 22, 2017) Disclaimer: The views expressed in this write up are entirely my own.

Urinary incontinence is a silent problem in many Indians

Urinary incontinence is a silent problem in many Indians Those with the disorder face much stigma, with people isolating such patients due to lack of awareness New Delhi, 10 August, 2017: Statistics indicate that as many as 24 million Indian adults suffer from urinary incontinence and another 27 million suffer from fecal or bowel incontinence. Although the loss of bladder and bowel control is common in people over the age of 40, it can start at the age of 20 as well. As per the IMA, people are not very kind towards those who lose bladder control and can even go to the extent of isolating such people. Old people, in particular, suffer much stigma due to this condition. Urinary incontinence is a condition in which a person suffers from leaking of urine especially while coughing or sneezing loudly. They may also have a strong urge to urinate, which leads to leakage. However, the condition can be managed or even eliminated altogether with some simple lifestyle changes or medical treatment. 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, “Urinary incontinence can be an outcome of many other conditions. In women, the causes could include weak bladder muscles, pregnancy, child birth, forceps delivery, and removal of uterus. Some general reasons are complications from surgery, stroke, or chronic diseases like diabetes, multiple sclerosis (MS), and Parkinson's disease. Diseases that weaken the bladder nerves or spinal cord can also lead to this condition. Incontinence is a disorder and can be treated and managed. Body shaming a person for this or isolating them can lead to embarrassment for them, and sometimes, even depression in the longer run. The fact, however, is that not many people are aware of this condition and need to be educated on the causative factors.” Urinary incontinence is more common among women than men. About 30%of women between the age of 30 and 60 are thought to suffer from it, compared to 1.5% to 5% of men. Two of risk factors for this condition are obesity and smoking. Adding further, Dr Aggarwal, said, “Treatment for urinary incontinence depends on factors such as the type of incontinence, patient's age, general health, and mental state. Bladder training can help people get back their bladder control. In some cases, medication is prescribed in combination with exercises for the pelvic muscle. Surgery is done if other treatments are not effective. Some simple steps can help maintain bladder and urinary health. • Behavioural therapies This includes educating patients about how urine is formed, stored, and expelled. • Pelvic floor muscles exercises These are called Kegels and they help strengthen the muscles that control urination. • Dietary changes Avoid caffeine, alcohol, and acidic drinks. Some things like chocolates, artificial sweeteners, and spices can irritate the bladder. • Weight control Excess weight can put added pressure on the bladder and surrounding muscles. Therefore, maintain an ideal weight or lose weight if you are overweight. • Fluid intake Drink at least eight glasses of water a day to keep the bladder healthy. Drinking less water makes the urine more concentrated and this can irritate the lining of the urethra and bladder.

Communication key to building trust between doctors and patients

Communication key to building trust between doctors and patients Includes informing patients about travel plans and putting the interest of the patients before everything else New Delhi, 28 June 2017: According to research, patient dissatisfaction and many other complaints are due to breakdown in the doctor-patient relationship. Communication is the key to developing and nurturing the trust between a doctor and the patient. The main goals of current doctor-patient communication are: creating a good interpersonal relationship, facilitating exchange of information, and including patients in decision making. On the occasion of the upcoming Doctors Day, IMA sheds some light on ways in which the doctor-patient relationship can be strengthened. According to the MCI Regulation, "A physician is required to be 'diligent in caring for the sick' (MCI Regulation 1.1.2). Once he/she undertakes a case, the physician should not neglect them or withdraw from the case without giving adequate notice to the patient and his family (MCI Regulation 2.4)." Also, as per the rules, a doctor is at the risk for a medical malpractice in the event that he/she fails to do the aforementioned. 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, "The relationship between a doctor and patient is sacrosanct. It forms right from the time a patient visits the doctor, who in turn agrees to treat him/her. This ‘implied contract’ imposes on the doctor a legal duty to exercise due skill and care in providing medical treatment. Once a patient comes to the doctor, he/she becomes duty bound to provide continuity of care even while on travel or when unable to attend to the patient. So, before undertaking a case, if a doctor is planning a visit out of town or a vacation, he/she still needs to take care of the patients." Patients rely on doctors for help in the time of need. Regulation 1.2.1 of MCI Code of Ethics requires that “…Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion.” The trust that the patient reposes in his/her doctor places an ethical obligation on the doctor to always put the interests of the patient first, including when the doctor is travelling. Adding further, Dr Aggarwal, said, "Inform the patient about the duration of time you would be away and the dates of your departure and return. If you have arranged for another physician to take care of the patients in your absence, it is a good idea to share his/her name, along with the credentials and training, with your patients. This will enable them to make an informed decision on whether to continue with you as their doctor. If your patient is about to undergo surgery, he/she must know that you would not be there for the post-op care. Take an informed consent of the patient or else avoid the surgery." Doctors with better communication and interpersonal skills can detect problems earlier, prevent medical crises and expensive intervention, and provide better support to patients. There is a need to tailor medical education in a way that it goes beyond skills training to encourage physicians' responsiveness to the patients' unique experience.

Patients who trust their doctors more likely to follow treatment

Patients who trust their doctors more likely to follow treatment • Important to restore confidence and trust for the profession in patients • Stringent action must be taken against quacks who are damaging the nobility of the profession New Delhi, 27 June 2017: According to a study conducted recently this year, patients with high blood pressure who had more trust in the medical profession were more likely to take their medication than those with less trust. People with higher levels of trust took their blood pressure medicine 93% of the time versus 82% of the time for those who had lower levels of trust. Additionally, having trust in the medical profession has been linked to greater resilience (ability to adapt to difficult life circumstances) and better health-related quality of life.
In medical practice, the very foundation of the relationship between a doctor and his patient is trust. It is a fiduciary (derivative of the Latin word for 'confidence' or 'trust') relationship. Both sides need to have mutual trust for positive treatment outcomes. However, in the present scenario, this trust is waning away and the doctor–patient relationship is no longer held sacrosanct as before.
Speaking on this issue, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "A recent survey conducted by the IMA showed that patients expect their doctors to be courteous; almost 90% of patients want their doctors to introduce themselves to patients, acknowledge the patient, give every patient a patient listening, impart complete information about the diagnosis, investigations, and treatment and revise and review what the patient has understood. Patients who do not trust their doctors will not confide in them nor will they be motivated to adhere to the prescribed treatment plan. Modern medicine is patient-centric and based on partnership, where the patient is an equal partner in the diagnostic and therapeutic process. Patients rely on doctors to take care of their health, so trusting the doctor assumes paramount importance. It is essential that doctors are courteous with their patients and explain the management plan in a language that they are able to understand. This is the concept of informed consent."
Lack of communication is a major cause of disputes between doctors and patients today. This can be tackled by the triad of ‘Plan, Communication, and Documentation’, where ‘Plan’ means observations and treatment decided by the doctor. If the same is ‘Communicated’ to the patient, ‘Documented’, and then implemented, there can never be a dispute. Any disparity between a plan and the outcome leads to a dispute.
Defining the ABC of a doctor, Dr Aggarwal further added, "Three components of a good doctor are: Available, Behavior, and Competency. It is important to remember that an available and a well-behaved doctor is much more important than a doctor who is competent. With medical diseases becoming more complex and lifespan increasing, there has never been a more appropriate time for patients to trust their doctors fully. Doctors must remember their oath and make their patients the center of their work. Additionally, the medical community must also take a stand against quacks in order to restore the nobility and integrity of this profession."
To build a successful doctor-patient relationship: • Do what you say: For example, if you have told your patient that you would be late by one hour, make sure that it is only one hour and not later than that • Document what you speak • Preserve what you document

Inform your patients before traveling

Inform your patients before traveling The doctor-patient relationship is a sacred relationship. This relationship is initiated when the patient comes to the doctor, who in turn agrees to treat him. This ‘implied contract’ imposes on the doctor a legal duty to exercise due skill and care in providing medical treatment. Once a doctor takes on the care of the patient, he also has a duty to provide continuity of care when he is traveling or is unable to attend to the patient. The ‘fiduciary’ nature of the relationship, one that is based on trust, which the patient reposes in his doctor also places an ethical obligation on the doctor to always put the interests of the patient first. Patients rely on doctors for help in their time of need. Regulation 1.2.1 of MCI Code of Ethics requires that “…Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion.” So, before you undertake a case, if you are planning a visit out of town or a vacation, you still need to take care of your patients. Communication is the key to developing and nurturing the trust in a doctor-patient relationship. So, if you are going to be away on a vacation or for a conference etc. also convey the same to your patient. Inform them about the duration of time you would be away and the dates of your departure and return. If you have arranged for another physician to take care of your patients in your absence, then share the names, along with his or her credentials and training, with your patients also. This enables the patient to make an informed decision, whether to continue with you as his doctor. Before doing a surgery, the patient must know that you would not be there for his postop care. Take an informed consent of the patient, otherwise avoid doing the surgery. A physician is required to be “diligent in caring for the sick” (MCI Regulation 1.1.2). Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family (MCI Regulation 2.4). Failing to do so might put you at risk for a medical malpractice claim. Dr KK Aggarwal National President IMA & HCFI Dr K K Aggarwal Recipient of Padma Shri, Vishwa Hindi Samman, National Science Communication Award, Dr B C Roy National Award & FICCI Health Care Personality of the Year Award National President IMA Vice President Confederation of Medical Associations of Asia and Oceania Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)

Rational use of medicines: What does the word ‘rational’ mean?

Rational use of medicines: What does the word ‘rational’ mean? As doctors taking care of patients, our guiding principles remain ‘beneficence (act in the best interest of the patient)’ and ‘non maleficence (do no harm)’. Medicines cure, control and prevent disease. Hence, rational use of medicines is a very important aspect of patient care as it impacts patient outcomes. What does the word ‘rational’ mean? The dictionary meaning of the word ‘rational’ as defined in the Oxford English Dictionary is that which is “based on reasoning or reason” or that which is “sensible, sane and moderate”. In 1985, the World Health Organization (WHO) convened a Conference of Experts on the Rational Use of Drugs in Nairobi in 1985, which defined the rational use of medicines as “The rational use of drugs requires that patients receive medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and the community”. The ‘Five Rights’ of safe medication administration by the Institute of Healthcare Improvement also advocate the same: Right patient, Right drug, Right time, Right dose and Right route. Four more ‘Rights’ have been added to this: Right documentation, Right action (reason for prescribing the medication), Right form and the Right response. So, why is rational use of drug important? Globally, medicines are being overused, underused or misused. Common types of irrational medicine use include: • Polypharmacy i.e. use of too many medicines in a patient • Use of antimicrobials, often in inadequate dosage, for non-bacterial infections • Over-use of injections when oral formulations would be more appropriate • Not prescribing drugs as per clinical guidelines • Inappropriate self-medication, often of prescription-only medicines Irrational use of drugs may cause adverse drug reactions, wastes precious resources and results in health hazards, most notable being antimicrobial resistance, which has now become a major public health problem, one which will leave us practically with no options to treat infections, if not checked in time. Lack of knowledge or being unaware about drugs and their adverse effects has often been cited as a prime reason for irrational use of medicines, which also has legal implications. Ignorance therefore is not a defense. Doctors should be aware of the drugs used in the National List of Essential Medicines (NLEM). They should appreciate that drugs included in the NLEM are comparable to non-NLEM drugs; they are also significantly cheaper. Doctors should also know about the concept of ‘Price to Retailer’ i.e. the price of a drug at which it is sold to a retailer which includes duties and does not include local taxes. This ‘Price to Retailer’ is fixed by the government. My definition of rational use of medicine is “Optimal drug, optimal duration, minimum time, earliest IV to oral switch and affordable”. Indian Medical Association (IMA) has launched a series of initiatives in this regard. “Jaroorat Bhi Hai Kya” is one such campaign to promote rational use of drugs and/or rational ordering of investigations and hospitalizations. Off-label use of drugs and/or procedures should be used very carefully and not without the approval of the Ethics Committee. We have planned similar campaigns “Use Wisely not Wildly”, “Will it benefit” and “Think Before you Ink”. Dr KK Aggarwal National President IMA & HCFI

New guidelines for ‘deprescribing’ PPIs

New guidelines for ‘deprescribing’ PPIs Proton pump inhibitors (PPIs) are a very commonly prescribed class of drugs for patients with acid peptic disorders. They have been generally regarded as safe and well tolerated. And, their long-term use is common. However, recently, there have been concerns about the use of PPIs, especially long-term use. PPIs have been linked to increased risk of osteoporotic fractures, pneumonia, Clostridium difficile infection and rebound acid hypersecretion, especially in the older population. Long-term use may also affect patient compliance to the prescribed treatment. Evidence-based recommendations published in the May 2017 issue of Canadian Family Physician to help the physician decide when and how to safely stop the PPIs or reduce their dose, called ‘deprescribing’ PPIs. This can be done in three ways: • Reducing the dose by ‘intermittent’ use for a fixed duration; ‘on-demand’ use or using a lower ‘maintenance’ dose. • Stopping the drug can be done by abruptly discontinuing the drug or via a tapering regime. • Stepping down means abrupt discontinuation or PPI tapering followed by an histamine-2 receptor antagonist (H2RA) These guidelines recommends deprescribing PPIs in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease (GERD) or esophagitis, and whose symptoms are resolved. • Decrease the daily dose or stop and change to on-demand use. This has been given a strong recommendation. • Or, an H2RA can be considered as an alternative to PPIs. This alternative has been given a weak recommendation due to the higher risk of symptoms recurring. These recommendations are not applicable to patients who have severe esophagitis grade C or D, or a documented history of bleeding gastrointestinal ulcers or have Barrett esophagus. (Source: Can Fam Physician. 2017 May;63(5):354-364) Dr KK Aggarwal National President IMA & HCFI

IMA supports insurance for death due to mosquito bite

IMA supports insurance for death due to mosquito bite Recommends an all-encompassing effort from the community as a whole to address this issue New Delhi, 15 May 2017: According to the South Delhi Municipal Corporation, 79 cases of chikungunya and 24 cases of dengue have been reported in Delhi just three months since 1 January 2017. Of these, 11 patients acquired the infection from neighboring states. It is a fact that we have collectively failed last year in controlling the mosquito menace and consequently, the mosquito menace is back this year. There is a need to over report and act in time and not only when the cases start appearing. Failure to act can be attributed collectively to Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the private sector. It is time that last year's failure is converted into success this year. Speaking on this issue, 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 "The mosquito menace requires a community approach which involves every component of the society. Every premise must display that it is mosquito-free. When you are invited to somebody’s place, you should ask 'I hope your premises are mosquito-free' and when you invite somebody, write 'Welcome to my house and it is mosquito-free. This should become a routine in a premises. Just like we do not clean our premises once in a week, it is important to look for and clean the breeding places daily." The fact that mosquito bites are a serious issue has been reiterated via a recent judgement by the National Consumer Disputes Redressal Commission (NCDRC) which ruled that the wife of a man who died due to a mosquito bite was eligible for claiming insurance. The commission ruled that 'It can hardly be disputed that a mosquito bite is something which no one expects and which happens all of a sudden without any act of omission on part of the victim'. It further said that death caused by mosquito bite is an accident, and directed the insurer to honor its policy to the widow. Adding further, Dr Aggarwal, said, "The need of the hour is a paradigm shift in the approach towards the dengue menace. We need to follow the formula of 20 to identify dengue fever: if there is a rise in pulse by 20; there is fall in upper blood pressure by 20; if there is a rise in hematocrit by 20%; there is a rapid fall in platelets to less than 20,000 with a rapid rise in hematocrit by 20%; if there is a petechial count of more than 20 in one inch after tourniquet test and a difference of less than 20 between the upper and lower blood pressure, then such patients should be given at least 20 ml of fluid per kg immediately followed by continuous fluids till they pass urine. This is one of the most immediate steps to combat the condition." IMA recommends the following approach to target the mosquito menace: Ghar ke ander maro aur ghar ke bahar maro; din me maro, sham me maro aur raat me maro; deewaron ke niche maro aur deewaron ke upar maro; chote pani ki collection me aur bade pani ke collection me maro; eggs ko maro, larve ko maro, pupa ko maro aur mosquito ko maro; chath me maro, kamre me maro, veranda me maro; container me pani ke niche maro aur container me pani ke upar maro, aedes ko maro, culex ko maro aur anopheles ko maro.

Osteoarthritis prevalence showing an upward trend in India

Osteoarthritis prevalence showing an upward trend in India • India expected to become the osteoarthritis capital by 2025 • Weight loss key to managing this condition New Delhi, 10 May 2017: Statistics indicate that India records more than 10 million cases of osteoarthritis on an annual basis. With over 60 million cases, the country is expected to turn into the osteoarthritis capital of the world by 2025. Osteoarthritis is the most common musculoskeletal disorder with major health and socioeconomic impact in older people. It usually progresses slowly, but some patients experience a more rapid progression. Osteoarthritis is also called the degenerative joint disease or degenerative arthritis, and can affect any joint. However, it mostly affects the knees, hips, lower back, neck, and small joints of the fingers. Medication and physiotherapy are the common treatment modes and if the pain is not relieved, the person may be bedridden as well. Currently, acute cases are treated through a surgery involving a transplant. 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, "Osteoarthritis is a debilitating condition and the common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes. The symptoms build up gradually, the most common being pain and stiffness especially in the morning. Being overweight or obese can cause rapid deterioration of the cartilage in the knee, leading to osteoarthritis. With every one unit increase in the body mass index (BMI), the chances of rapid cartilage loss increase by 11%. Weight loss is probably the most important factor to slow disease progression. Danger of developing osteoarthritis is another reason to control weight. Dr Aggarwal opined, "Do not let yourself get heavy or overweight. Keeping your weight under control through diet and exercise or weight-loss surgery could prevent the need for knee-replacement surgery." Exercise can help reduce weight and therefore the risk of acquiring osteoarthritis. The simplest exercises are often the best. One can try these three kinds of exercises to manage weight and keep the joints free of pain. • Stretching: helps ease aches and pains and provides movement to the joints • Strengthening exercises: help the muscles in supporting the joints and keep them in the right position during movement. • Fitness exercises: can help in weight management and reduce the risk of osteoarthritis.

Straight from the heart

Straight from the heart Krishan Kumar in conversation with Dr KK Aggarwal Dr KK Aggarwal National President IMA & HCFI Krishan Kumar: The earlier medical days of Dr KK Aggarwal. Dr KK: Krishan, now a days, there is a lot of mistrust between patients and doctors. Was it there in your era also? Krishan: No, during my PG and early post PG days we had very cordial relationship with our patients. We used to get full respect from the patients and we used to take decisions on their behalf. There was no question of any violence. But why are you asking this question? Dr KK: Today when we cross the ICU corridors, relatives do not get up. And when we enter the room of the patient, the relatives talk to us sitting on the sofa. We do not get the same respect you are talking about. Krishan: But during our times most of the hospitals in private were trust non- profit hospitals and not profit making corporate hospitals. That perception that the hospital is not-for-profit was sufficient for the public to trust the hospitals and their billing. Also, in 1995, full one week treatment in ICU for a heart failure patient was Rs 12000/- only. Dr KK: But why are the patients are violent today? What was in your era that this violence was missing? Krishan: In our time, there were no mobile smart phones and internet services right at our hands. The patient was dependant on information provided by us. Today your patients are well-informed and want to be a part of treatment unlike our times when we used to take their decisions. Dr KK: In your time, were the patients a potential litigant? Krishan: No, we never heard of that. Only occasionally we used to hear about cases going to consumer courts. We used to have a very efficient and good patient and relatives redressal mechanisms. Dr KK: Who used to refer patients? Krishan: Mostly family physicians referred the patients. The association was on merit. Once the patient was discharged, they (family physicians) followed up with the patients. Dr KK: Was there an allegation that doctors used to get referral fee for referring patients? Krishan: No, the first CT scan in Delhi was put by someone named Dr Gupta, he started the scheme “refer four and get one poor patient free”. There was no concept of referral fee without a service. Dr KK: Did you ever see dengue patients in that era? Krishan: Yes, in late nineties, for up to ten years, we used to see a mysterious viral illness with low platelet count. Most will recover by themselves. Later, this was named by AIIMS as dengue. Because we used to treat them as simple virus fever, there was no panic. We never repeated platelets counts. No platelet transfusions were given. Dr KK: Are you happy, that you did your MBBS in 1975-79? Krishan: Yes. I learnt how to treat patients without investigations. We used to treat heart patients with lifestyle management with very satisfactory results. My fee at medical college was only Rs 100/- per month. I do not think I could have afforded studying at a private medical college at that time. Krishan: Are you not happy that I never started smoking or taking alcohol in my college days? Dr KK: Yes, I am very thankful to you. I know today how difficult it is, even for doctors, to stop addiction. Krishan: I have heard you always wear a stethoscope? Dr KK: You are right. I love my profession. A stethoscope, all the time, reminds me of my medical dharma. Krishan: You are known to be deep into Vedic Philosophy then why are you planning the campaign Dilli Chalo on 6th June? Dr KK: I am a Vedic medicine student and believe in both Rama and Krishna. Both taught us to fight for our Dharma in the interest of the community. We need to fight for the rights of the patients, community and our profession. How can we allow second grade treatment to our patients by quacks and government sponsored quackery through AYUSH? How can I allow criminalization of medical practice on my doctor colleagues? How can I allow my doctors to go to jail for clerical errors? How can I allow my medical students to go for one more exam once they have cleared their MBBS? How can I allow my MCI to be replaced by a nominated body? I believe in my conscience and I will do what is good for the profession. I do not think so you would have done differently if the same situation was in your era. Krishan: I agree with you. I think IMA is doing a humane job for the community. ---------------- About Krishan Kumar Right from the age of four, Krishan wanted to become a heart specialist. Born in an average family of nine brothers and sisters he did his schooling at ASVJ higher secondary government school, Darya Ganj Delhi, pre-medical from Desh Bandhu College Delhi and in 1975 joined Mahatma Gandhi Institute of Medical Sciences Sevagram Wardha and did MBBS and MD Medicine from there getting a medal in every subject, topping all three MBBS and getting Nagpur University Gold Medal. About Dr KK Aggarwal: At Moolchand Hospital, his boss was Dr K L Chopra (Krishan Lal Chopra), father of new age Guru Dr Deepak Chopra. To avoid confusion, Krishan Kumar now became Dr KK Aggarwal. At Moolchand, he joined as a consultant in Medicine and Cardiology, went to US for Fellowship in Non-Invasive Cardiology and Color Doppler Echocardiography, started Echo institute and Heart Care Foundation of India, received Padma Shri in 2010 and currently is the National President of IMA.

Trust makes patients adhere to prescribed treatment

Trust makes patients adhere to prescribed treatment Study finds lack of communication as a major cause for dispute between doctors and patients New Delhi, 20 April 2017: According to a new study of 101 Hispanics and 100 non-Hispanics from the University of California, patients with high blood pressure who had more trust in the medical profession were more likely to take their high blood pressure medicine than those with less trust. The study was presented at the recent American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2017 in Arlington, Virginia. The doctor–patient relationship is the foundation in the practice of medicine. It is a fiduciary relationship; the word "fiduciary" derives from the Latin word for "confidence" or "trust", which forms the basis of an effective doctor–patient relationship. The study conducted also showed that mutual trust is important for positive treatment outcomes. However, in recent times, it is being seen that this trust is slowly eroding away and a doctor–patient relationship is no longer held sacrosanct as it once was. Speaking on this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "A patient who does not trust his doctor will not confide in him nor will he be motivated to adhere to the prescribed treatment plan. Modern medicine today is patient-centric and based on partnership. The patient is an equal partner in the diagnostic and therapeutic process. Patients rely on doctors to take care of their health, and therefore, it is important that patients trust their doctors. Doctors must be courteous with their patients and explain the management plan in a language that they are able to understand. This is the concept of informed consent. Patients must in turn show respect towards their doctors and trust their judgment." The study also concluded that patients who had higher levels of trust in their doctor, and the treatment plan, took their blood pressure medicine 93% of the time versus 82% of the time for those who had lower levels of trust. Additionally, placing trust in the medical profession was linked to greater resilience (ability to adapt to difficult life circumstances) and better health-related quality of life. It also deduced that trust had an equally protective effect on the health of both groups studied regardless of race or ethnic origin. Dr K K Aggarwal further opined, "Lack of communication is a major cause of disputes between doctors and patients today. This can be tackled by the triad of ‘Plan, Communication, and Documentation’, where ‘Plan’ means observations and treatment decided by the doctor and if the same is ‘Communicated’ to the patient, ‘Documented’ and then implemented, there can never be a dispute. Any disparity between your plan and the outcome leads to a dispute." The following points are key to a successful doctor–patient relationship. • Do what you say. For example, if you have told the patient that you would be late by one hour, make sure that it is only one hour and not later than that. • Document what you speak • Preserve what you document

Never tell patients to reduce their stress… tell them how to reduce the stress instead

IMA Detox President Secretaries Meet

Never tell patients to reduce their stress… tell them how to reduce the stress instead

Doctors very commonly advise patients to reduce their stress. But, what we don’t tell them is how they can do so.

A Detox Leadership Meet was recently organized by IMA HQs at Om Shanti Retreat Centre at Manesar in Gurgaon (Haryana). At the meet, when asked to define stress, every doctor had a different answer to the question.

Under the IMA 1 Voice Program, all IMA members should be clear and speak in one language.

The correct definition of stress is “the reaction (evident or silent) of the body and/or the mind to the interpretation of a known situation”.

The components of stress therefore include:

·         A known situation, which may or may not be alterable

·         An interpretation, which may be natural, positive or negative

·         A reaction, often modifiable, which can be at the level of mind and/or the body and this reaction can be evident or silent. 

Stress management, therefore involves changing or modifying the situation, modifying the interpretation of a given situation or living a lifestyle, which prepares the body and the mind in such a way that the stress alerts or modifies the reaction or does not allow the body to react. This can be done by proper diet, regular physical exercise, pranayama, meditation and relaxation techniques.

Patients should be educated that while a certain amount of stress does motivate us to perform better by putting in extra efforts and do a good job, too much stress or long-standing stress can be detrimental to health.

People overeat (comfort foods), start smoking, drinking or use drugs etc. as means to deal with their stress. These factors, by themselves, increase the risk of many lifestyle diseases such as heart disease, diabetes, obesity, hypertension. Anger or emotional stress, has been known to precipitate a heart attack or trigger arrhythmias.