IMA launches ALERT campaign

IMA launches ALERT campaign About 90% of the 1300 odd surveyed want more attention from the doctor New Delhi, April 14, 2017: As per a recent survey conducted by IMA among a sample size of 1325 people, it was found that 71.2% of the patients wanted the doctor to greet them and introduce himself/herself in the very first meeting. About 90.2% of the patients want the doctor to listen to them in great detail during the first consultation; 84.4% want the doctor to explain everything about the illness, investigation, and drugs; 75.3% of the doctors want to understand what the patient has grasped; and 38.8% of the patients want the doctor to thank them after the consultation. As an outcome of these insights gathered, the IMA has launched the ALERT campaign where: A - to acknowledge the patient and introduce oneself L - to listen to the patient E – to explain everything about the illness and investigation R – To re-listen to patient to gather what he has understood T – (doctor) thanking the patient after the consultation is over Speaking about the launch of this campaign, 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, "Healthcare delivery has become more personalized today. Unlike olden days, where the patient was convinced by the diagnosis done and treatment given out, the patients of today want to understand what is bothering their health and take a participatory approach to getting well and healing. This way they feel more involved in their treatment plan. Keeping this in mind, the IMA has launched the ALERT campaign, which aims to address these patient concerns in a systematic manner. We are sure that with the help of ALERT, both the doctors and the patients will be in a better position to understand and trust each other." A physician working in a patient care setting may have many things on their mind. However, the most important of these is their patients’ health and the patient is thus the real boss who has to be kept happy and in good humor. Dr Aggarwal further says, "A physician-patient alliance is of utmost importance during any treatment. Working together helps improve the patient's quality of life and health. Patients look up to the doctor to get their problems resolved. And when they are aware of who is doing what, and what condition they are suffering from, it takes the guesswork out and makes the entire process less confusing. The ALERT campaign is a step in that direction." As part of this campaign, several approaches can be used to facilitate open communication. • Sit down • Attend to patient comfort • Establish eye contact • Listen without interrupting • Show attention with nonverbal cues, such as nodding • Allow silences while patients search for words • Acknowledge and legitimize feelings • Explain and reassure during examinations • Ask explicitly if there are other areas of concern

IMA Campaign: Katwayega to nahi

IMA Campaign: Katwayega to nahi Ask before visiting a place “Is your place free of mosquitoes?” Cases of dengue and Chikungunya have started to appear in the capital of India. Unfortunately, no alert has been issued and in sporadic cases, no surgical strikes have been attempted openly in selected breeding places. Napoleon Hill once said, “Most great people have attained their greatest success just one step beyond their greatest failure.” It’s time for all of us to convert our biggest last year’s failure of controlling the mosquito menace into a success. We must all agree that collectively we failed last year in controlling the mosquito menace and consequently Delhi again is showing cases. This is again a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs and Private sector. The mosquito container index (the percentage of water-holding containers infested with larvae or pupae) now in Delhi is over 5% and had crossed 40% last year. Any index above 5% requires a community-integrated cluster approach to reduce mosquito density together with effective anti-larval measures. Last year, 3 lakh mosquito repellent impregnated mosquito nets were distributed by MCD but what about this year. Last year, these nets were not available to actual patients. Even this year anti-larval measures, Temephos, an organophosphate larvicide and/or mosquito fish or Gambusia, a freshwater fish are not available to a common man. Last year I wrote that we needed a paradigm shift in our thinking. We need to over report and act in time. There is no point acting when the cases have started. But even this year, cases have started without alerts and involvement of private sector. Are we again waiting to act in monsoon season? Public awareness and public involvement must start if not started today. We need to act against all the mosquitos, Aedes, Culex and Anopheles. Action against only the Aedes mosquito will not work. The campaign that Aedes mosquito is a day biter and only breeds in indoor fresh water will not work. Even if it is true, killing Aedes would increase the density of Culex and malaria causing Anopheles mosquitoes. Culex mosquito, which causes filarial and Japanese encephalitis is already rampant in the city. Even Aedes mosquito, which causes Chikungunya, West Nile, Zika and Dengue can spread by the bite of infected female indoor Aedes aegypti or outdoor Aedes albopictus mosquito. It is true that Aedes aegypti are more dangerous because they can fly up to 200 meters and only feed on human blood, whereas the Aedes albopictus that thrives outdoors can only fly as far as 80 meters and feed on animal blood other than human blood. The outdoor Aedes mosquito cannot be ignored. The entire campaign up till now has been focused on Aedes as a day biter, wearing long sleeves shirt and pants during the day and using night mosquito nets. But precautions need to be taken throughout the day as the mosquitoes only recognize ‘light’ and not whether it is day or night. The fact that the mosquito only breeds in clear water also needs to be relearnt. The Aedes mosquito breeds in stagnant water anywhere inside or outside the house. Rain water is the most important source and can collect in any plastic container inside or outside the house. Even collected garbage in open areas can have left over plastic cups or tiny bottle caps with rain water collections providing an ideal atmosphere for mosquito breeding. It is true that disease spreading mosquitos do not make noise but the ‘noise-producing’ nuisance mosquitos unless addressed will not create a public movement. The law says that dengue or Chikungunya cases must be notified, but one can notify them within 7 days of diagnosis. Aedes mosquito takes up to three meals in a day and within 7 days will bite over 21 people in the vicinity. Municipal anti-mosquito and anti-larval actions must occur within hours of its detection. The very purpose of notification is lost if the disease is not notified within hours of even suspecting a diagnosis of Chikungunya. So, all suspected cases must be reported without waiting to confirm the diagnosis. We have failed because the government has been insisting that only ELISA-confirmed cases be notified. An SMS should be sent to all doctors practicing in that PIN code area with a case so that they can become a part of the public health action chain. All public health measure should have started, right when the first case was suspected in Delhi. An SMS should go to local councilor, MLA, MPs, all practicing doctors, local chemists, NGOs, RWAs, local IMA Branch, State IMA Branch, IMA Headquarters and other Specialty Organizations to join the public health chain efforts. It has taken over a decade for us doctors to understand that dengue 1 and 3 strains are not dangerous and cause only platelet deficiency with thinning of blood, while dengue 2 and 4 strains are dangerous as they destroy platelets and thicken blood due to capillary leakage and rise in hematocrit. Also, that platelet transfusion is not required in absence of active bleeding and it is the timely fluid resuscitation that is more important and not platelet resuscitation. Dengue becomes serious when the fever is subsiding. Earlier, dengue patients with high fever were hospitalized and there was always an urgency to discharge them when fever was subsiding. Now we know that the machine reading of platelet count can be defective. There can be an error of 20%. A platelet count of 10,000 by machine reading can mean it is actually 50,000. Hospital beds should be reserved only for severe dengue and severe Chikungunya cases. Being able to claim reimbursement in Mediclaim or PSU, should not be the factor to decide on hospital admission. If it was US, Medicare by now would have come out with admission guidelines. The message that is being transmitted is that fogging has no answer. But when the container index is high, aerial fogging is also required and not just ground fogging. When Zika threat came up in Brazil they deployed the army to join and make it a public movement. All political parties reach every house during election process, then why can’t each one of them reach every house and make the anti-mosquito and anti-larval measures effective. Breeding checkers are only with Municipal Corporations and they also have regulatory powers to impose fine. We need breeding checkers in the private sector. The Skill development Ministry should start courses so that anyone can hire a breeding checker on weekly basis to check their premises. Community approach involves that 100% of the society talks about dengue. Every premise must write that their premises are 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”.’ Even today most hospitals do not provide mosquito nets to dengue or Chikungunya patients. While they may be having anti-larval mesh doors or mesh windows but for secondary prevention of dengue or Chikungunya, we need to ensure that medial establishments are certified mosquito-free. Many of us live in flats and the mosquitoes may be breeding on the roof top belonging to one of the owners of the flats and if he/she is out of station for a holiday, the anti-larval measures may remain deficient. RWAs should use their powers to check all unoccupied or closed premises including hostels, hotels and construction places in that premises. One of the five great vows of Jainism is Non-attachment/Non-possession or Aparigraha. It talks about not storing unwanted things. But in today’s era, our roofs and verandahs are littered with left over tires, utensils, plastic utensils etc. We buy new car tires and keep the old ones on our roof top. We need to change this habit. We have forgotten to plant Tulsi and Peepal in our premises and stopped the daily Yagna, all of which have anti-mosquito properties. The new strategy has to focus on small collections of water such as bottle caps, finding mosquitoes lower in the room under the table or the bed, to look for them in all three parts of the house - roof tops, verandahs and inside the rooms including unused toilets accessories. The slogan “Check your house once a week” needs a change. One should be alert every day. It should be a part of your routine. You do not clean your premises once a week. Make it a habit to look for the breeding places. IMA approach is mosquito war against indoor or outdoor mosquitoes; fresh stagnant or dirty water mosquitoes; small containers like bottle caps or large containers like overhead tankers; made of mud or plastic; throughout the day (early morning fogging when pupa hatch for Aedes, late night for malaria); scrubbing clean the utensils Slogan Ghar ke andar maro and ghar ke bahar maro … Din me maro, sham me maro and raat me maro … Deewaron ke niche maro or upar maro … Chote or bade pani ke collection me maro … Eggs ko maro, larvae ko maro, pupae ko maro aur mosquitoes ko maro … Chaat me maro, kamre me maro, veranda me maro … Pani ke niche maro, pani ke upar maro … Aedes ko maro, Culex ko maro aur Anopheles ko maro …

Dengue and chikungunya hit the capital again

Dengue and chikungunya hit the capital again IMA warns of a possibly larger breakout unless immediate action is taken along with community participation New Delhi, April 13, 2017: A recent report by the South Delhi Municipal Corporation (SDMC) on vector-borne diseases has revealed about 79 cases of chikungunya in the national capital this year. In the last three months, 24 cases of dengue have been reported, of which 11 patients acquired the infection from one of the neighbouring states. According to the SDMC, there were 9 new cases of chikungunya this week. All these patients were from the neighbouring states. Although chikungunya and dengue cases had tapered off by the first week of December last year, this year has again brought back many such cases. 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, "IMA had already indicated that the cases of vector-borne diseases in the capital will be as predicted last year. Dengue and chikungunya cases in Delhi so far have been a matter of great concern. Dengue cases create panic among the public every year. We must all agree that collectively we have failed in controlling the mosquito menace and consequently, Delhi today is in the midst of an increasing number of dengue and malaria patients. This is a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the Private sector. Dengue is preventable and the very first step towards this is its management. However, to make this possible, community participation is a must." Both dengue and chikungunya are viral diseases transmitted by Aedes mosquitoes. The Aedes mosquito breeds in stagnant water anywhere inside or outside the house. Most of the symptoms associated with both diseases are the same, with some key differences. High fever is the primary symptom of dengue along with the at least two of the following: severe headache, severe eye pain, joint, muscle or bone pain, rash, mild bleeding from the nose or the gums, small spots caused by bleeding into the skin, and low white cell count. In severe cases, plasma leakage can lead to shock, hemorrhage (internal bleeding), and organ impairment. At this stage, the disease is potentially fatal. On the other hand, chikunguniya symptoms include high fever, severe joint pain, joint swellings, muscle pain, headaches, and rashes and this disease is mostly non-fatal. Highlighting the importance of community participation in taking action against vector-borne diseases, Dr K K Aggarwal added, "Individuals, families, and communities need to be more involved in the planning and conduct of local vector control activities. It is not possible for the government to employ enough people to search every backyard and identify and destroy breeding sites. At IMA, we are committed to raising awareness amongst the medical fraternity and the public in general about the prevention and management of vector-borne diseases.“ Some do's and dont's for the prevention and management of these diseases are as follows. Do's Take plenty of rest and avoid getting dehydrated if you have any of the above-mentioned symptoms. Get tested immediately. In case of high-grade fever for more than 24 hours, it is a must to go and visit the doctor. Use mosquito nets and cover yourself well to avoid being bitten by mosquitoes. Keep the surroundings clean, and dispose of waste and stagnant water regularly. Don'ts Aedes mosquitoes breed in clean water. Therefore, don't let water stagnate anywhere in or near your home. Don't use mosquito repellents on children below two months of age. Use insect repellents containing 10% DEET on children older than two months. Don't apply mosquito repellent on your palms, or near your eyes or mouth. Avoid dark-colored clothing as it attracts mosquitoes. Avoid wearing tight clothes as it is easier for the mosquitoes to bite through such garments.

Dengue and chikungunya hit the capital again

Dengue and chikungunya hit the capital again IMA warns of a possibly larger breakout unless immediate action is taken along with community participation New Delhi, April 13, 2017: A recent report by the South Delhi Municipal Corporation (SDMC) on vector-borne diseases has revealed about 79 cases of chikungunya in the national capital this year. In the last three months, 24 cases of dengue have been reported, of which 11 patients acquired the infection from one of the neighbouring states. According to the SDMC, there were 9 new cases of chikungunya this week. All these patients were from the neighbouring states. Although chikungunya and dengue cases had tapered off by the first week of December last year, this year has again brought back many such cases. 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, "IMA had already indicated that the cases of vector-borne diseases in the capital will be as predicted last year. Dengue and chikungunya cases in Delhi so far have been a matter of great concern. Dengue cases create panic among the public every year. We must all agree that collectively we have failed in controlling the mosquito menace and consequently, Delhi today is in the midst of an increasing number of dengue and malaria patients. This is a collective failure of Municipal Corporation, Delhi Government, Central Government, LG office, Medical Associations, CSR departments, Media, NGOs, and the Private sector. Dengue is preventable and the very first step towards this is its management. However, to make this possible, community participation is a must." Both dengue and chikungunya are viral diseases transmitted by Aedes mosquitoes. The Aedes mosquito breeds in stagnant water anywhere inside or outside the house. Most of the symptoms associated with both diseases are the same, with some key differences. High fever is the primary symptom of dengue along with the at least two of the following: severe headache, severe eye pain, joint, muscle or bone pain, rash, mild bleeding from the nose or the gums, small spots caused by bleeding into the skin, and low white cell count. In severe cases, plasma leakage can lead to shock, hemorrhage (internal bleeding), and organ impairment. At this stage, the disease is potentially fatal. On the other hand, chikunguniya symptoms include high fever, severe joint pain, joint swellings, muscle pain, headaches, and rashes and this disease is mostly non-fatal. Highlighting the importance of community participation in taking action against vector-borne diseases, Dr K K Aggarwal added, "Individuals, families, and communities need to be more involved in the planning and conduct of local vector control activities. It is not possible for the government to employ enough people to search every backyard and identify and destroy breeding sites. At IMA, we are committed to raising awareness amongst the medical fraternity and the public in general about the prevention and management of vector-borne diseases.“ Some do's and dont's for the prevention and management of these diseases are as follows. Do's Take plenty of rest and avoid getting dehydrated if you have any of the above-mentioned symptoms. Get tested immediately. In case of high-grade fever for more than 24 hours, it is a must to go and visit the doctor. Use mosquito nets and cover yourself well to avoid being bitten by mosquitoes. Keep the surroundings clean, and dispose of waste and stagnant water regularly. Don'ts Aedes mosquitoes breed in clean water. Therefore, don't let water stagnate anywhere in or near your home. Don't use mosquito repellents on children below two months of age. Use insect repellents containing 10% DEET on children older than two months. Don't apply mosquito repellent on your palms, or near your eyes or mouth. Avoid dark-colored clothing as it attracts mosquitoes. Avoid wearing tight clothes as it is easier for the mosquitoes to bite through such garments.

IMA Guideline: Whom to give oral oseltamivir in flu?

IMA Guideline: Whom to give oral oseltamivir in flu? People with confirmed influenza or with influenza symptoms who are very sick or who are at high risk for influenza complications require rapid treatment. Hence, doctors are advised to quickly treat suspected influenza with antiviral drugs in high-risk outpatients, those with progressive disease and all hospitalized patients, regardless of a negative rapid influenza diagnostic test (RIDT) and without waiting for results of reverse-transcriptase polymerase chain reaction (PCR). Treatment should not be withheld on the basis of results of RIDTs, as these tests have a high potential for false-negative results. Tamiflu, oral oseltamivir, known as neuraminidase inhibitor has activity against both influenza A and B viruses. Early antiviral treatment can shorten the duration of fever and illness symptoms, reduce the risk for complications from influenza, including otitis media in young children and pneumonia requiring antibiotics in adults and also reduce the mortality among hospitalized patients. Clinical benefit is greatest with early administration of oseltamivir. When indicated, oseltamivir should be started as soon as possible after illness begins, ideally within 48 hours of onset of symptoms. However, antiviral treatment might still provide some benefit in hospitalized patients when started after 48 hours of illness onset. Guideline Treatment with oseltamivir is recommended as early as possible for any patient with confirmed or suspected influenza who is (1) hospitalized, (2) has severe, complicated, or progressive illness, or (3) is at higher risk for influenza complications, including the following: • Children aged younger than 2 years • Adults aged 65 years and older • Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematologic (including sickle cell disease), and metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle, such as cerebral palsy, epilepsy, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury) • Persons with immunosuppression, including that caused by medications or by HIV infection • Women who are pregnant or postpartum (within 2 weeks after delivery) • Persons aged younger than 19 years who are receiving long-term aspirin therapy • Persons who are morbidly obese (BMI ≥ 40 kg/m2) • Residents of nursing homes and other chronic-care facilities. [Source Medscape] Arrange school lectures Prevention of Swine flu mainly involves implementation of respiratory hygiene, cough etiquettes and hand hygiene. • Respiratory hygiene: Maintain a distance of at least 3 feet from the person who is coughing and sneezing. • Cough etiquettes: Cover the mouth and nose with a tissue when you cough and sneeze and put the used tissue in a waste basket. If you do not have a tissue, then cough and sneeze into the upper sleeves and not hands or handkerchief. • Hand hygiene: This should be frequently performed including before and after every patient contact; contact with potential infectious material and before putting on and after taking of personal protective equipment including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol based hand rubs. If hands are visibly soiled, then wash with soap and water. In a survey conducted by Heart Care Foundation of India, of 63 schools, both Public and Govt., involving 6047 students (2817 girls and 3230 boys), 76% of the students (4576) did not know about the role of cough etiquettes in preventing flu. They answered that the best way to cough was either in the hands or in the handkerchief. Flu is diagnosed when the person suffers from cough and cold. Only sore throat is not a sign of flu. Flu patients do not require antibiotics. Unless cough and cold is associated with breathlessness, it does not require hospital admission. Treat swine flu like ordinary flu • Swine flu is like ordinary flu, symptoms of which are fever, coryza, cough, sore throat, bodyache and malaise. Occasionally, nausea, vomiting, diarrhea and rash may also be present. • Severe breathlessness, blood on coughing are ominous signs and need investigation and/or hospitalization. Symptoms ordinarily last for 1-2 weeks. • Cases of fever with coryza and breathlessness should not be neglected, and need admission in isolation and investigation for influenza (swine or otherwise). Influenza normally has its outbreaks intermittently especially seasonal outbreaks are common. • Influenza vaccines can prevent flu caused by human strains, which is recommended for children above 6 months; adults > 50 years of age; patients with pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic disorders and diabetes mellitus; pregnant females and health care providers. • The inactivated vaccine can be given to the above groups. The Live attenuated influenza vaccine (intranasal spray) can be given only to persons aged 2-49 years (not to pregnant females). • Current seasonal influenza vaccines are not expected to provide protection against human infection with avian or swine influenza A viruses. However, reducing seasonal influenza risk via influenza vaccination of persons who might be exposed to nonhuman influenza viruses (e.g. H5N1 viruses) might reduce the theoretical risk for recombination of influenza A viruses of animal origin and human influenza A viruses by preventing seasonal influenza A virus infection within a human host.

Swine flu resurfaces in India

Swine flu resurfaces in India 103 deaths reported in Pune, Nashik, Ahmedabad and 160 nationally in the past three months; prevention through hygienic practices is key according to experts New Delhi, 12 April 2017: The first three months of the year 2017 have already seen a four-fold increase in swine flu deaths across Maharashtra. Between January 1 and April 10, more than 100 deaths have been recorded compared to a total of 25 in 2016, in major cities in the country. According to experts, 7,581 suspected cases have been reported and more than 23,000 people have been vaccinated against the H1N1 influenza. A respiratory disease caused by influenza viruses, swine flu infects the respiratory tract leading to barking cough, decreased appetite, and nasal secretions.It can be transmitted easily through the air, skin, saliva, and contaminated surfaces. Among other reasons, experts have attributed this sudden surge in swine flu cases due to the huge difference in day and night temperatures over the last few days. Viruses thrive in environments where there is a large difference between the minimum and maximum day temperatures. Speaking about the outbreak, 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, "Swine flu is a respiratory illness that originated in pigs. However, it is now a human disease that spreads by coughing and sneezing. The symptoms resemble those in a seasonal flu such as fever, cough, sore throat, body aches, and chills. Occasionally, nausea, vomiting, diarrhea, and rash may also be present. Pregnant women, children under five, elderly and those with serious medical conditions are most vulnerable to this disease.Only sore throat is not a sign of swine flu. Patients with normal flu don't require antibiotics. However, severe breathlessness and blood on coughing are ominous signs and need investigation and/or hospitalization. The symptoms usually last for 1 to 2 weeks." Respiratory hygiene, cough etiquette, and hand hygiene are the three aspects of prevention from swine flu. Respiratory hygiene involves maintaining a distance of at least 3 feet from the person who is coughing and sneezing. Cough etiquettes involve covering the mouth and nose with a tissue while coughing and sneezing and disposing off the used tissue in a waste basket. Hand hygiene is a very critical aspect of prevention from this disease. Hand hygiene involves washing hands with soap and water or using alcohol-based hand rubs. As per a survey conducted by Heart Care Foundation of India, involving 63 schools both public and government, with 6047 students (2817 Girls and 3230 Boys), 76% of the students (4576) were not aware of the role that cough etiquettes play in the prevention of flu. "Some of the same antiviral drugs that are used to treat seasonal flu also work against H1N1 swine flu. Oseltamivir (Tamiflu), peramivir (Rapivab), and zanamivir (Relenza) seem to work best. Influenza vaccines can prevent flu caused by human strains, which is recommended for children above 6 months; adults over 50 years of age; patients with pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic disorders, and diabetes mellitus; and pregnant females and health care providers. The inactivated vaccine can be given to the above groups. The live attenuated influenza vaccine (intranasal spray) can be given only to persons aged 2 to 49 years (not to pregnant females),"Dr Aggarwal added. Doctors also advise against self-medication. As the symptoms of swine flu can overlap with other viral infections, it is imperative to visit a health facility for correct diagnosis before any treatment options are considered.

ab initio: From the first act
The meaning of the term “ab initio” in Latin is “from the beginning; from the first act; from the inception”.
An agreement is said to be "void ab initio" if at no time, it had any legal validity. A marriage or act can be unlawful, ab initio. The illegality of the conduct or the revelation of the real facts makes the entire situation illegal ab initio (from the beginning), not just from the time the wrongful behavior occurs. In case of any complications during treatment, the court may find doctors ‘illegal ab initio’ guilty of negligence, if reports from illegal laboratories have been accepted and the doctors may be prosecuted under appropriate sections of Indian Penal Code for medical criminal negligence. What this means is that if the first act itself is illegal, then all other subsequent acts need not be taken into consideration.
According to Medical Council of India (MCI) Code of Ethics Regulations, 1.2.1, the physician (registered practitioner) should not associate professionally with persons violating the prescribed code of ethics.
“1.2.1 The Principal objective of the medical profession is to render service to humanity with full respect for the dignity of profession and man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Physicians should try continuously to improve medical knowledge and skills and should make available to their patients and colleagues the benefits of their professional attainments. The physician should practice methods of healing founded on scientific basis and should not associate professionally with anyone who violates this principle. The honoured ideals of the medical profession imply that the responsibilities of the physician extend not only to individuals but also to society.”
For example, if any doctor refers patients to an illegal laboratory and treats the patients relying on those reports, it is breach of the Code of Medical Ethics. Another example to explain this is as follows: As per MCI, Pathology is a part of modern scientific medicine, the practice of the same is permissible only to registered medical practitioners with post graduate qualifications in pathology.
The Hon’ble High Court of Mumbai has passed an interim order in PIL No. 28/2005 on 10/10/2007, which clearly states that only a qualified pathologist recognized by Maharashtra Medical Council & MCI can certify pathology laboratory reports.
Doctors (non-pathologists) running in-house illegal laboratory run by technicians or referring patients to the laboratory run by non-pathologists and treating patients relying on those reports. In both these situations, the patients get reports that are not prepared and certified by a pathologist, which is illegal and unethical. This leads to the misdiagnosis, delayed diagnosis and affects treatment and health of patients.
Dr KK Aggarwal National President IMA & HCFI