Thursday, 25 June 2015

Doctor-patient relationship: What do doctors expect from their patients

Doctor-patient relationship: What do doctors expect from their patients

1st July in India is observed as Doctor’s day in memory of Bharat Ratna Dr B C Roy whose birthday and death anniversaries fall on the same day.

Although well-informed choices have raised the expectations of patients from their doctors, the medical professionals too have some expectations from their patients.

·         Just like a patient has the right to choose his doctor so does a doctor. MCI Code of Ethics Regulations 2.1.1 states: “A physician is not bound to treat each and every person asking his services.” In non emergent situations, the doctor has a right to choose his patients.
·         As per MCI Code of Ethics Regulations 3.3 Punctuality in Consultation, a patient expects his doctor should be punctual. The doctor expects the same from his/her patient.
·         A doctor has a right to choose his fee as long as it is transparent and displayed, says Regulation 3.7.1 of MCI Code of Ethics. 
·         Regulation 6.4.1 does not allow a doctor to give rebates.
·         Patients should be truthful about their past medical history, about smoking, alcohol, drugs and high risk behaviors etc.
·         Patients should pay doctor’s fee in time.
·         Patients should bring all their medical records each time they come for a check up or follow up.
·         It is ethical to charge a fee each time a patient is seen.
·         Patients should know that if a doctor has referred them to a particular lab for a test, it does not mean that it is linked to commission. Different labs have different facilities.
·         Doctors do not like to be disturbed by calls on mobiles in non emergent situations.
·         Patients should always have a designated person to take briefings from the doctor in a hospital setting.
·         If the doctor fills wrong information in the Mediclaim form, he/she can be imprisoned in jail.
·         A doctor can be imprisoned if he/she gives a false medical certificate.
·         A doctor can be imprisoned if he/she gives a false medical certificate for your child for not attending classes.
·         Patients should know that error of judgment is not negligence.
·         Patients should know that difference of opinion is not negligence.
·         Patients should know that deviation from standard practice is not negligence.
·         Sudden death in a hospital does not mean negligence.
·         Patients should know that a doctor is not required to possess maximum skill and knowledge. He/she is only supposed to possess an average degree of skill and knowledge.
·         Patients should know that medical accidents do not mean negligence.
·         The very fact that insurance companies allow doctors to be covered under indemnity insurance for deficiency of service or medical negligence, it means that every case of negligence is not criminal in nature.
·         One has to pay a price for quality in life. For example, if you get a fracture and do not get surgery done, then there may be no risk to life. But getting a surgery done for early recovery and better quality of life will always carry some risk.
·         Costly drugs do not mean that they are better. All drugs cleared by federal agencies are safe for human consumption.
·         Hospitals are run by doctors appointed by management. It is not possible for consultants to be physically present in every emergency.
·         No drug is 100% safe
·         Patients should take their medicines as directed and visit as advised by their doctors.

Wednesday, 24 June 2015

Heart Care Foundation of India organizes a hands-only CPR 10 camp in Neeti Bagh Club

Heart Care Foundation of India organizes a hands-only CPR 10 camp in Neeti Bagh Club

Trains over 65 adults and children in the essential life-saving technique which can help revive a clinically dead person for up to 10 minutes after they suffer a sudden cardiac arrest

New Delhi, June 24, 2015: Heart Care Foundation of India, a leading National non-profit organization working towards spreading health awareness in the country and making it a healthier one successfully organized a CPR training camp at the Neeti Bagh Club Hall last evening. The key purpose behind the initiative was to spread awareness about the increasing incidence of sudden cardiac arrest in the country and how a simple to learn yet effective method such as hands-only CPR 10 can help revive a person till 10 minutes after their death. Over 65 children and their parents attended the camp, which was organized in conjunction with Mr. Promod Aggrwala the current President of the club.

Speaking about the initiative, Padma Shri Awardee Dr KK Aggarwal who is the President of Heart Care Foundation of India said, “Around 240,000 people die every year due to heart attacks and we believe that 50% of them can be saved if 20% of the population learns hands only CPR. The technique is easy to learn, can be performed by anyone and is extremely effective. What people need to remember is two things, one CPR must not be practiced on a person who is breathing, has a pulse rate and is clinically alive. It must be administered within ten minutes of someone's death and continued till the ambulance arrives or the person is revived. A cardiac arrest can happen to anyone at any time and a simple formula can help save a loved one's life. We have successfully trained over 1.2 lakh people in this life-saving technique in the past 1 year. We also hold three world records in the Limca Book for the maximum number of people trained in this technique in one place, in one hour and at the same time”.

“The Heart Care Foundation of India Hands- Only CPR 10 mantra is: Within 10 minutes of death (earlier the better), for a minimum of 10 minutes (adults 25 minutes and children 35 minutes), compress the center of the chest of the deceased person continuously and effectively with a speed of 10×10 = 100 per minute” he added

A sudden cardiac arrest occurs when the electrical conducting system of the heart fails and the heart beats irregularly and very fast (more than 1000 times, technically called as ventricular fibrillation). Soon after the heart suddenly stops beating and the blood flow to the brain stops. As a result, the person becomes unconscious and stops normal breathing. A cardiac arrest is not the same as a heart attack, but it may be caused by a heart attack. In most cases, sudden cardiac arrest may be reversible in the first 10 minutes. This is possible because the brain remains alive during this period when the heart and respiration have stopped, a situation called clinical death.

Speaking about the camp, Mr. Pramod B Agarwala, President of the Neeti Bagh Club said,” Continuous chest compression CPR is an emergency technique that is used to treat patients who have gone into a sudden cardiac arrest. It  is easy to learn and easy to perform and is more effective than traditional CPR. A person does not need to be a doctor to perform this life-saving technique. I am thankful to the Heart Care Foundation of India for organizing this training camp for the residents of the society.”

Continuous compression only CPR compresses the heart between the sternum and the backbone and builds up the pressure that keeps the oxygenated blood flowing to the brain and keeps the person alive until a defibrillator becomes available or expert medical help arrives. Therefore, if you see someone collapse from sudden cardiac arrest, acting promptly can save his or her life. It is important to act quickly for every minute lost reduces the chances of revival by 10%. So, if you wait 5 minutes, the chances of surviving are 50% less. The earlier you give CPR to a person in cardiac arrest, the greater the chance of a successful resuscitation. To know more or to organize a training camp in your locality, please call the NGO’s helpline number 9958771177.

On the occasion of Doctors Day, IMA will organize blood donation camps all over the country

A Doctors Day initiative

On the occasion of Doctors Day, IMA will organize blood donation camps all over the country

Celebrate the success of the IMA Mediation, Conciliation & Grievance Redressal Cell

New Delhi, June 24, 2015: “The Indian Medical Association on the occasion of Doctors day falling on the 1st of July will organize at least 30 blood donation camps across the country, one in each state" said its National President, Dr. A Marthanda Pillai and Honorary Secretary General, Dr. KK Aggarwal in a press conference today. In addition to this, they will also make a directory of rare blood donors and pledge to continue to organize blood donation camps in the future. The blood donation camps will be organized from 28th June to 1st July.

The success story of the IMA Mediation, Conciliation & Grievances Redressal Cell at the IMA headquarters in New Delhi was also discussed. The concept of the cell has seen great successes one or two cases getting solved every month. Till today, more than 40 cases have been sorted out by the IMA Mediation, Conciliation & Grievances Redressal Cell.  IMA has also written to all its State and local branches to start similar initiatives their respective States.

"Most of the complaints that we receive are an outcome of a communication gap between doctors and patients," said Dr. KK Aggarwal & Dr. A Marthanda Pillai.

Cases received by the IMA Mediation, Conciliation & Grievances Redressal Cell
Four cases out of the 40 received were of a financial dispute. To solve the problem, the IMA Mediation Cell called upon the Medical Superintendent of the respective hospitals and along with the relations of the patient and thereafter settled the issue between the parties amicably.
In one case, the IMA Mediation Cell opined that the patient should have the right to choose the type of medicine or medical device to be used. The hospital must not make it compulsory and force the patients to buy medicine from their own pharmacy.  If the patient can get a substitute to the medicine at an economical price from elsewhere, they have full rights to do so and the hospital must allow them to use it during the treatment
Ever since Jacob Mathew Judgment of the Supreme Court was passed, people have started filing cases against doctors under section 304A of IPC. In five cases, IMA could intervene and provide the expert opinion to the families of the patients. All the patients were satisfied with IMA’s opinion and subsequently cases were not filed in 304 A.

In four cases, there existed a mediclaim dispute with various hospitals.  The main dispute was that the insurance company denied them mediclaim and the hospital had not communicated effectively to the families of the patients that the denial of cashless mediclaim did not mean that the entire claim was denied. The IMA mediation cell helped and guided all the families and subsequently all of them got their mediclaim.

In one of the cases, the patient wanted to consult a doctor on the PSU Panel. The panel reimburses the specialist consultant with only Rs 150.  Given that the specialist was not available, the patient requested to be directed to another consultant.   As the other consultant was not on the penal of BHEL, he could not provide this service.  Counseling was done and explained that only an empanelled doctor can see a patient on PSU fees.

One typical complaint was that the doctor purposefully referred him to a particular CT Scan Imaging Centre so that he can fleece money from the patient.  The mediation cell having gone through the records found that the patient was sent to the center with minimal X-ray radiation exposure.  The cost of CT at such center would be higher. Once the patient was given the underlying explanation, his complaint was withdrawal.

One Patient complained that he got his platelet count done from three different laboratories and all reports were different.  He filed a complaint against the hospital on the ground that they purposefully gave the wrong reports so that they could admit him. The IMA mediation cell heard both the parties and explained to the patient that platelet count using different machines can give different results and variation can be up to a count of 40,000. As per new recommendations, platelet counts are no more the deciding factors for admissions. It is the difference between the upper and lower blood pressure, if lower than 40, which is the indicator of seriousness
In another case, the patient complained that he was overcharged for stents. The party was explained that the cost of the stent would depend upon the metal and which type of drug is used in the stent. Also, whether the stent will stay in the body for the six months or not etc.

Another interesting case, which came, was that of a patient who complained that that a particular doctor had given drugs , which cost him, Rs.3000 for a month and the same were available at IMA Jan Aushudhi Store at the cost of Rs.300/-. He suspected a doctor chemist nexus.  Counseling was done and the patient was made to understand that the prices of drugs may vary depending on their packaging, size, taste, aftertaste, dosage form, etc.

All drugs approved by DCGI can be administered to patients and that the DCGI approves both cheaper and costly versions of drugs and both are equally safe. Cheaper drugs do not mean they are fake or bad and costly drugs do not mean that they are more effective.  All drugs will have the same efficacy, but one may pay less if the drug is given three times a day and pay more for a drug if it is to be used only once daily

 Other members of the mediation cell are  Dr. V.C.P Pillai from Kerala and Dr.Harish Grover from Delhi.

Monday, 22 June 2015

Precautions for diabetic patients during Ramadan fast

Precautions for diabetic patients during Ramadan fast

“Patients with type 1 diabetes should avoid fasting. However, those type 2 diabetes can fast,” said Padma Shri, Dr B C Roy & DST National Science Communication Awardee Dr K K Aggarwal, President, Heart Care Foundation of India and Hony. Secretary General, Indian Medical Association (IMA).

All diabetic patients who fast should be aware of certain facts if they fast during Ramadan,he further added.

·         All patients with diabetes should consult with their family physician regarding the Ramadan fast and learn the warning symptoms.

·         Type 2 diabetes will be controlled by diet and may require no special precautions.

·         Patients at risk of diabetes should avoid overeating to prevent post meal high blood pressure, after the predawn and/or sunset meal.

·         The exercise program for patients with diabetes on diet control should be modified to avoid lower blood sugar level.  Exercise should be done 2 hours after the sunset meal.

·         Food restriction and dehydration may cause some cardiac risk in the elderly.

·         The choice of drugs in diabetes may require consultation with a doctor. Drugs that act by increasing the production of insulin are to be preferred. Some patients on metformin may fast safely with minimal complications. However, two-thirds of the total daily dose should be given just before the sunset meal and rest one-third before the predawn meal. Patients on pioglitazone may require no change in dose. Patients on sulfonylureas may require medical clearance before commencing fast.

·         Insulin dose also needs to be modified during the fast.  Usually two doses of insulin, one before each meal, are sufficient.

·         If the blood sugar falls below 60, then the fast should be immediately broken.

·         Fast should also be broken if blood sugar rises to more than 300.

·         Patients should avoid fasting on sick days.

Sunday, 21 June 2015

The cost of drugs may vary

The cost of drugs may vary

Quite often doctors are blamed of prescribing costly drugs to their patients. Every patient must know that convenience comes for a cost. The same drug molecule with same Efficacy may cost more if it gives you convenience. Remember cheap does not mean low quality or low efficacy.
Its like the basic model of a car, all accessories comes for a prize.

The cost of a drug may vary depending on the following parameters
1.       If the bitterness is removed
2.       If it does not emit an odd smell
3.       If it's aftertaste is better
4.       If it looks soothing to the eyes due to specific shape or color
5.       If the size of a tablet is small
6.       If it is in a capsule form
7.       If it provides instant relief
8.       If it is to be used only once in day or it is a slow-, continuous- or delayed-release formulation
9.       If the packing is better
10.   If the preservative used is not sodium
11.   If it does not contain any non vegetarian ingredients
12.   If it is in liquid formulation
13.   If it uses nanotechnology
14.   If it is a scored tablet
15.   If it does not interfere with food
16.   If it does not interfere with juices (grape)
17.   If it is a combination of two or three drugs (as a single tablet)
18.   If the drug is numbered in the strip (day-wise)
19.   If the drug contains multiple drugs in the same strip so that the patient does not miss the dose
20.   If it is not dispensed as loose tablets
21.   The drug has not come out of patent
22.   If it is water soluble
23.   If the drug salt granules are small or tiny
24.   If it can be absorbed from the tongue
25.   If it can be absorbed from the skin
26.   If the drug - drug interaction is less
27.   If it can be taken once a week or once a month
28.   If the injection is with a prefilled syringe
29.   If the injection is less painful
30.   If the injection can be given directly in the vein vs in a drip
31.   If the injection is in the form of a vial or single dose
32.   If the shelf life of a drug is longer
33.   Duration of action of a drug and its half life
34.   If the difference between therapeutic dose and toxic dose is narrow
35.   If it does not cause pill esophagitis

Saturday, 20 June 2015

Patients can practice yoga but with precautions

Patients can practice yoga but with precautions

Yoga is a science, which shifts one from sympathetic to parasympathetic mode. It is a combination of Hatha Yoga (asanas or postures), breathing and meditation. Meditation means concentrating on the object of concentration and giving preference to the object of concentration over thoughts. Mindfulness meditation, breathing awareness can shift from sympathetic to parasympathetic mode.

Breathing exercises in yoga can be both slow & deep breathing and fast breathing. Kapalbhati and bhastrika are fast breathing exercises.

In modern system of medicine, every movement in an exercise is accompanied by the opposite movement. The same is true for yoga. For every movement, there is a reverse movement.

Often when patients come to us for consultation or follow up, they ask if it is safe for them to do yoga. Yes, patients can do yoga but they should do it under the guidance of a trained yoga instructor. Teaching yoga is the job of an expert. In the hands of an untrained person, yoga may be risky. Also, it is important that patients observe specific precautions pertaining to their illness while doing yoga. They should practice yoga slowly and take care to not overdo any asana and avoid some postures that may aggravate their health problems

Here are some precautions, which patients should follow while doing yoga:

·         Yoga is not included as an aerobic exercise.
·         Fast breathing exercises stimulate the sympathetic system. Slow breathing stimulates the parasympathetic system. Therefore, cardiac clearance needs to be taken for all breathing exercises.
·         In three situations in Hatha Yoga (headstand, handstand, shoulderstand), the total body weight is put on head, wrist and shoulder. This requires medical clearance, especially for heart patients.
·         When you get up from a sitting position, nine times weight is put on the knees. Hence, patients of osteoarthritis should avoid sitting down, low height bed or chair or Indian toilets. Yoga may prevent osteoarthritis, but once developed, Hatha Yoga practices need to be modified.
·         The Lotus position, forward and backward bends need orthopedic clearance in selected patients .
·         Forward spine exercises may require orthopedic clearance in selected cases as they may precipitate sciatica, if done incorrectly.
·         Painful and/or difficult yoga postures should be avoided
·         Patients with cervical disc disease, glaucoma should avoid doing inversion postures (head stand, shoulder stand).
·         In case of worsening pain or paresthesia, stop and consult a doctor

Friday, 19 June 2015

B12 deficiency can present with recent memory loss

B12 deficiency can present with recent memory loss

If you are forgetting things, get your vitamin B 12 levels done instead of worrying that you are going towards dementia, said Padma Shri, Dr. B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General IMA.

Animal products (meat and dairy products) provide the only dietary source of B12 (cobalamin - Cbl) for humans. Strict vegans avoid all animal products, and are at risk of developing nutritional Cbl deficiency. The usual western diet contains 5 to 7 micrograms of cobalamin per day, while the minimum daily requirement is 6 to 9 micrograms per day. Total body stores of Cbl are 2 to 5 mg and one-half of this is in the liver. It takes years to develop vitamin B12 deficiency after absorption of dietary B12 ceases.

There is a link between infection with Helicobacter pylori (as seen in peptic ulcer) and low serum B12 levels.  Mild and usually subclinical cobalamin deficiency can also occur in 24% of the elderly.
People taking metformin, such as obese, those with diabetes, polycystic ovarian disease, may be at risk of developing B12 deficiency, which can be reversed with oral calcium supplementation.

Prolonged use of omeprazole (given for acidity) can result in Cbl deficiency. Women who are only moderate vegetarians may become Cbl deficient during pregnancy and lactation; their infants may also be Cbl deficient.

Thursday, 18 June 2015

IMA as Knowledge Partner

IMA as Knowledge Partner

1.       IMA logo on backdrop and all other promotional material.
2.       No endorsement or promotion of any brand during the conference.
3.       Conference to be accreditated by state medical council.
4.       Final program to be discussed and finalized jointly.
5.       IMA President / HSG on the stage during inauguration.
6.       IMAS office bearers to get complimentary registration ( maximum 25).
7.       IMA stage guest to get complimentary hospitality and travel.
8.       Joint press conference.
9.       IMA to be given one session in main hall during the conference on issues of national importance.
10.   No violation of MCI or pharma code of conducts during the conference.
11.   No financial liability to IMA.

IMA Rare Blood Group Online Blood Bank Directory

14th is Blood Donors Day: IMA Rare Blood Group Online Blood Bank Directory Launched

IMA has started an online voluntary rare group blood bank, where a list of all rare blood groups will be displayed. 

IMA has appealed to all 2.5 lac member doctors and their patients with rare blood groups, especially the Bombay blood group to pass on their name, address, email and mobile numbers so that the same can be uploaded on the IMA website. Tjhey directly also can log in and submit at IMA website under section econnect

Giving details Padma Shri Awardee Dr A Marthanda Pilli National president and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary general IMA, said that people with rare blood groups can often be given a blood, when needed, only from people with the same blood group. And in life threatening such a website will come handy to save lives. 

A rare blood is the one that, on the basis of the blood group characteristics, which is found in a frequency of 1: 1000 random samples in a given population. From blood transfusion point of view, a rare blood is the one with red cells lacking a high-frequency blood group antigen. 
Besides, a blood that lacks multiple common antigens may also be considered as a rare since such donor's blood may be useful for the transfusion recipient who has developed multiple antibodies to corresponding antigen. 

Rare nature of a blood type may vary from one country to another and therefore a blood type rare in one country may not be considered rare in another.  The commonest rare blood group in India is Bombay blood group.  The Bombay phenotype is found almost exclusively in individuals from India, with an incidence of 1/10,000. These patients are universal (ABO) donors. 

For detection, tests would show them to be O, unless further tests are performed. Cross matching of blood from an individual with this phenotype will show hemolysis with all group O screening cells and panel cells, alerting the blood bank to the need for further investigation. 

If an individual with the Bombay phenotype needs blood in an acute emergency and blood from a Bombay phenotype donor is not available what are the options? 
• Look at IMA website for potential donor in that city 
• Get blood tests done of all your relatives one of them may be Bombay Blood Group. 
• Use artificial blood could be used instead. 
• Autologous blood can be obtained by apheresis prior to a surgical procedure
Other IMA guidelines

·          Defer blood donation if hemoglobin is less than 12.5 g/dL for both men and women, temperature is above 37.5°C, blood pressure is above 180 mmHg systolic or 100 mmHg diastolic, pulse is outside the established limits of 50 to 100 beats/minute, certain arrhythmias are detected on pulse examination, and if a systemic disease is present.

·         One may consider for certain groups of donors (pre-menopausal females, frequent repeat donors) oral iron supplementation.

·         To minimize post-donation reactions one should restrict donation to less than 15 percent of a donor's estimated blood volume (for younger donors, estimated blood volume must be >3500 mL in order to be accepted for donation), encourage applied muscle tension during donation, provide 500 mL of water before donation, make sure the donor feels well before being allowed to walk to the refreshment table, and encourage the donor to stay at the table for at least 10 to 15 minutes for observation and fluid replenishment.  

Saturday, 13 June 2015

Heart patients on aspirin should not donate platelets

Today is World Blood Donor Day

Heart patients on aspirin should not donate platelets 

Most medications taken by blood donors pose no known risks to recipients. In most cases, only small quantities of drugs are present in a unit of blood and the drugs will undergo significant dilution in the recipient's plasma volume. However, every donor must disclose what drugs he or she is taking as some of them may not be friendly with the recipients, said Padma Shri Awardees Dr A Marthanda Pillai, National President Indian Medical Association (IMA) and Dr K K Aggarwal Honorary Secretary General IMA on the occasion of World Blood Donor Day.

In December 2007, the US FDA made recommendations that apheresis platelet collections should not occur from donors who have taken aspirin, aspirin-containing drugs, or piroxicam in the previous 48 hours, or from donors who have taken clopidogrel or ticlopidine in the previous 14 days. This restriction is specific to plateletpheresis donors and does not apply to whole blood donors unless platelets made from that unit of whole blood will be the sole source of platelets for a given patient. This is especially for platelet transfusions designated for neonatal and young pediatric recipients.

Donors who are taking warfarin, heparin, or another anticoagulant are temporarily deferred (up to seven days).

Five drugs pose a teratogenic risk: etretinate and acitretin used for severe psoriasis, isotretinoin used for severe acne and finasteride and dutasteride used for prostate enlargement.

For isotretinoin and finasteride, the deferral period is one month and for dutasteride, it is 3 years. Deferral period is permanent for etretinate. Donors are permanently deferred if they have taken bovine or human growth hormone derived from pituitary glands due to the risk of Creutzfeldt-Jakob disease.

The deferral period for donors who have received hepatitis B immunoglobulin or an unlicensed vaccine is one year.

IMA to organize Blood Donation Camps across the country

IMA to organize Blood Donation Camps across the country

New Delhi 12 June, 2015: IMA will be organizing a minimum of 30 Blood Donation Camps across the Nation between 14th June - 1st July, 2015.  The first blood donation drive will be held on 14th June which is World Blood Donor Day and the last drive on 1st July which is Doctors Day.
Speaking about the initiative, Padma Shri Awardees and National President & Honorary Secretary General of the Indian Medical Association, Dr. A. Marthanda Pillai & Dr K K Aggarwal in a joint statement said, "In addition to the 30 Blood Donation Camps that we will be organizing across the Nation starting on World Blood Donation Day and concluding on Doctor's Day, IMA will also make a directory of people with Rare Blood Groups and initiating a pledge to encourage people to donate blood. Blood donation can help save numerous lives and every healthy adult should be encouraged to donate blood"

IMA will also be sensitizing its 2.5 lacs doctors through 30 State Branches and 1700 Local Branches about how the donated blood should be viewed in light of its components as compared to whole blood. There are four types of transfusable products that can be derived from blood: red cells, platelets, plasma and cryoprecipitate. Typically, two or three of these are produced from a unit of donated whole blood – hence each donation can help save up to three lives.

DO donate blood, only if:

You are between age group of 18-60 years.
Your weight is 45 kgs or more.
Your hemoglobin is 12.5 gm% minimum.
Your last blood donation was 3 or more months earlier.

DO NOT donate blood, if you have have:

 Cold / fever in the past 1 week.  Under treatment with antibiotics or any other medication.  Cardiac problems, hypertension, epilepsy, diabetes (on insulin therapy), history of cancer, chronic kidney or liver disease, bleeding tendencies, venereal disease etc.  Major surgery in the last 6 months.  Vaccination in the last 24 hours.  Had a miscarriage in the last 6 months or have been pregnant / lactating in the last one year.  Had fainting attacks during last donation.  Have regularly received treatment with blood products.  Shared a needle to inject drugs/ have history of drug addiction.  Had sexual relations with different partners or with a high risk individual.  Been tested positive for antibodies to HIV.

Thursday, 4 June 2015

IMA demands the Govt. for withdrawal of Fast Food Product “Maggi” with immediate effect

IMA demands the Govt. for withdrawal of Fast Food Product “Maggi” with immediate effect

IMA has requested the Ministry of Health and Family Welfare (MoHFW), Govt. of

India to instruct the withdrawal of fast food product “Maggi” from the market till it is

given a clearance by the investigative agencies.

National President, IMA, Padmashri Awardee, Prof (Dr) A Marthanda Pillai and

Honorary Secretary General, IMA, Padmashri Awardee, Dr K K Aggarwal said that in

a letter written to the Ministry, IMA has demanded that the Government should take

pro-active measures by appointing an investigative FDA agency to test the samples

of the above product and suspend the sale of batches of “Maggi” in question till the

clearance is received from the investigative agency.

 IMA has demanded from the Government that the investigating agency must be

able to differentiate whether a particular batch of the product was adulterated or the

whole of the product was adulterated.It is the duty of the Government to ensure that

the general public receives quality food in the market.

Nepal Earthquake: Indian Branding Missing

Nepal Earthquake: Indian Branding Missing 

Dr K K Aggarwal
Padma Shri Awardee and Honorary Secretary General IMA @
President Heart Care Foundation of India

At IMA when we heard about the  Nepal Earthquake incidence, we at IMA HQs immediately decided to help the victims of Nepal Earthquake.  Under the leadership of our National President Padma Shri Awardee Dr A Marthanda Pillai, a group of 13 doctors led by Padma Shri Awardee Dr. Ashok Kumar, Padma Awardee was sent to Nepal.

Heart Care Foundation of India, a national NGO, joined IMA in this cause and its Senior Boarad Member Mr. Harsh Garg, an Industrialist managed all the local arrangements through DIG Police. 

The team stayed over there for a week and saw over 1500 patients, did complicated surgeries and saved one person from developing Gangrene. 

In the meantime, Health Ministry of  Nepal wrote to us that they do not need more  medical teams, therefore our team was withdrawn.

In between, we contacted Dr. Anjani Kumar Jha, President and Dr. Mukti Ramshrestha, General Secretary, Nepal Medical Association and they requested us to supply medicines.  Due permissions were taken from respective Health Ministries and Indian Ambassador to Nepal for transfer of necessary drugs.

Udyog Development Foundation led by Shri Amitav Joyprakash Choudhury joined the movement of HCFI & IMA and medicines over Rs. 42 lacs (Nepalese currency) were collected and dispatched, courtesy Indigo Airlines.

On 27th May, 2015, Dr Pillai, Myself, along with Dr. Chetan Patel, Chairman, Disaster Cell, IMA  and Imitav reached Nepal to assess the actual situation.

At the airport, we had meetings with the President and Secretary of Nepal Medical Association.  We also met Shri. Ranjit Rae, Ambassador of India to Nepal and we were told that we could  only work through Nepal Medical Association or Nepal Govt. We were also told that Indian Govt. has donated over 4 lacs Tarpaulin tents and also donated Vans, money and food material to Nepal.

Next we addressed a Press Conference which was organized in Tarpaulin tent with no branding as a make shift reporters club.

We also met Dr. Senendra Upreti, Director General Health Sciences and Shri Shanta Badure Shrestha, Health Secretary and  Shri Khagraj Adhikari,  Minister of Health & Population,  Nepal Govt.  All help was offered to them by IMA through Nepal Medical Association.

After that we went to various affected areas and also interviewed many victims, local leaders and families.  We were shocked to see the amount of  disaster but we were happy to see the large efforts to rehabilitate those people.

We could differentiate the efforts of China from that of India.  The efforts of China were visible everywhere.  Their tents were made of  a better quality material and were branded prominently with name of China everywhere. In one of the area where there were 40 tents, out of them 10 tents were of China but were prominently displayed with their branding in the front and visible from the main road.

While speaking with the people of Nepal, they were of the opinion that only China Govt. was helping the Nepal victims.  When we talked about the help of Indian Govt., their answer were negative.

In Bhaktapur, a nearby district of Kathmandu, we saw a rehab tent of 1700 people.  They all were living in 40 tents.  In this area, Indian branding was not visible. Only visible branding was of China tents

To help victims of post trauma stress disorder (PTSD), we saw a two-hours Musical Therapy programme being organized by them, supported by China Mission again.

We also saw meals being prepared by the local Nepalese people and when we asked them, they informed us that the raw material lunch was sponsored by China.

We interviewed one of the Noodles Company who said that for Rs.14,000/-, they were providing 2000 bunches of ready-made Noodles for these people, which meant for a total value of less than 5 lacs, 2000 people were sponsored for lunch by China for over a month.

I personally believe in the philosophy "Jo Dikhta Hai, Vo Bikta Hai" / "Jangal main mor Nacha, sabne dekha" ( not kisne dekha).

If you are a true believer of Vedanta, it is Okay to do charity and not talk about it.  But in today’s world, it is important to not only do the charity but to make it visible also.

In contrast to India where most of us probably believe in "Guptdaan or secret charity), China was visible in showing its charity towards the people of Nepal Earthquake.

Our day ended with meeting with Office Bearers of Nepal Medical Association where they requested us to donate a Van to them, which IMA hope to provide but not in Indian Vedanta way: the van will have the IMA branding on it.

Surgical site infections not covered under CGHS reimbursement policy

Surgical site infections not covered under CGHS reimbursement policy
Dr K K Aggarwl

F.No.2-1/2012/CGHS/VC/CGHS(P): Dated the 1st August, 2013:
Subject : Clarification regarding admissible non-admissible items under CGHS.

e) Package rates envisage up to a maximum duration of indoor treatment as follows: 12 days for Specialized (Super Specialties) treatment; 7 days for other Major Surgeries; 3 days for Laparoscopic surgeries/normal deliveries; and 1 day for day care / Minor (OPO) surgeries.

However, if the beneficiary has to stay in the hospital for his /her recovery for a period more than the period covered in package rate, in exceptional cases, supported by relevant medical records and certified as such by hospital, the additional reimbursement shall be limited to accommodation charges as per entitlement , investigations charges at approved rates, and doctors visit charges (not more than 2 visits per day per visit by specialists / consultants) and cost of medicines for additional stay).

No additional charge on account of extended period of stay shall be allowed if that extension is due to infection on the consequences of surgical procedure or due to any improper proceed.

Hospital Acquired Infections may mean medical negligence also

Avoidable hospital acquired infections may involve medical negligence. HAI are infections that occur after 48 hours after admission.

As per CDC 100,000 patients died of HAI in 2002.  Over 20 lac people become ill as a result of HAI annually.

In March of this year, the CDC reported that 200 Americans still die daily as a result of HAI.

Staff members who failed to observe sanitary hand hygiene passed many of these infec­tions from patient to patient.

Until 2004, hospitals were not required to inform the public of spread of infection. Since that time, many states have required hospitals to report their infection rates to the public.

In the case of hand washing, the hospital that does not enforce firm infection control policies may be liable and may be found negligent.

A recent article in the New England Journal of Medicine found that, in 2011, after obtaining data from 183 US Hospitals pneumonia and surgical site infections were the most prevalent hospital infections accounting for 22% with blood stream infections comprising 11%

Organisms involved are clostridum difficile and Methicillin-resistant staph

It has become easier to link a particular infec­tion to a facility by sequencing the genome of the organism.

Risk factors include length of stay, severity of illness and immunity of the patient, cleanliness of the hospital, use of antibiotics policy and infection control measures.

Medicare also does not cover hospital acquired infection

The CMS ( Centers for Medicare and Medicaid Services') exercised its authority under section 5001(c) of the DRA by announcing that Medicare will no longer pay the extra cost of treating the following categories of conditions that occur while the patient is in the hospital: Surgical site infection after bariatric surgery for obesity, certain orthopedic procedures, and bypass surgery (mediastinitis); Vascular-catheter associated infection; Catheter-associated urinary tract infection etc.