IMA starts 80:80 Anti-Pollution Campaign

IMA starts 80:80 Anti-Pollution Campaign Air pollution is a major health and environmental hazard causing about 1.2 million deaths every year New Delhi, 29 July 2017: As per statistics obtained from a report published early this year, about 1.2 million people die due to air pollution in India every year. And, of the 168 cities assessed, none were found to comply with the air quality standards as prescribed by the World Health Organization (WHO). Air pollution is now a matter of great concern as it is affecting not only the health of our citizens but also medical tourism in India, says IMA. Keeping this in consideration, the IMA is starting a campaign “Kahin aapke area mein pollution to nahi?” Under this campaign, all state/local branches as well as medical professionals are requested to make efforts to bring down the atmospheric pollution level to less than 80 μg/m3 on normal days and to less than 90 μg/m3 during festivals such as Diwali. 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, “Air pollution is not only a major environmental hazard but also a major health hazard. It is one of the major causes of non-communicable diseases such as cardiovascular diseases, stroke, chronic obstructive pulmonary disease, lung cancer, and other acute respiratory problems. The need of the hour is to bring out stringent guidelines against inefficient modes of transport, household fuel and waste burning, coal-fired power plants, and industrial activities, as these are some of the major sources of air pollution. At any given time, the PM 2.5 levels should be less than 80 μg/m3 and noise level should be less than 80 dB. We expect all medical professionals to also educate their patients on a daily basis about the hazards of air pollution. Additionally, there is also a need to follow some measures at an individual level because every small contribution can lead to a big change.” Evidence suggests that household air pollution in developing countries can increase risk conditions such as low birth-weight and perinatal mortality (still births and deaths in the first week of life), asthma, otitis media (middle ear infection) and other acute upper respiratory infections, tuberculosis, nasopharyngeal cancer, laryngeal cancer, and cervical cancer. Adding further, Dr Aggarwal, said, “Although there is a provision for environmental protection in our Constitution and steps have been taken by the government to address this issue, there is still a long way to go before the country can breathe clean air. The need of the hour is dedicated and sustained efforts which involve the public as well. And IMA’s current campaign is a first step towards this effort.” Here are some ways in which you can help reduce air pollution at an individual level. • Get your vehicle pollution checked regularly. • Use eco-friendly products at home. • Plant trees around your house. • Avoid smoking inside the house although it is better to quit the habit altogether. • Choose and buy sustainable and recycled products. • Use energy-efficient devices at home.

“Time Churao” campaign: “Steal” time out of your busy schedule

“Time Churao” campaign: “Steal” time out of your busy schedule Almost everybody today complains of lack of time… “There is so much to do and too little time to do”. Everybody seems to be busier than ever. Well, being a doctor is not an easy job, it’s also a busy job. Being a doctor also means multifaceted responsibilities. A doctor not only has to treat his patients, he is also a teacher, researcher, manager, communicator, community leader. Health education is an important component of the duties and responsibilities of a doctor. It has a direct link to patient satisfaction. However, in a busy practice, doctors often lack the time to educate their patients and families about different health-related issues. Juggling both practice and home often leaves doctors with no time left for community health activities. Here is what I do. Whenever I am invited to a function and the chief guest is running late, I ask the organizers for the mike and start ‘zero hour’. Instead of sitting on the dais, I like to walk around the room, among the audience and interact with them. Being on the same level as the audience breaks a barrier and people may find it less intimidating to raise questions. During Zero hour in the Parliament, members can raise any important matter that is relevant to the public. These questions do not require any prior notice. Similarly, I ask them questions on any health-related topic – of current interest or any other - and try to engage them in discussion. I find that a lively Q &A session is a good way to disseminate information and educating the people as I also come to know their level of awareness about a topic. I avoid speaking too much of medical jargon or scientific terms because the audience soon loses interest. This is how I “steal” time out of my busy schedule to converse with the public. I encourage all of you to do such activity to educate your patients, their families and friends and the public. Dr KK Aggarwal National President IMA & HCFI Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO) Past Honorary Secretary General IMA Past Senior National Vice President IMA President Heart Care Foundation of India Gold Medalist 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)

Forget me Not: IMA Campaign for the Elderly

Forget me Not: IMA Campaign for the Elderly The global demography is changing with a considerable increase in the older population in almost all countries. A greater understanding of etiopathogenesis of many diseases leading to newer and more effective treatment options has improved life expectancy. Not just medical advances, economic growth and social development too have contributed to the rising aging population. “According to Population Census 2011 there are nearly 104 million elderly persons (aged 60 years or above) in India” (Elderly in India 2016 Report). “The global share of older people aged 60 years or over is expected to increase from 11.7% in 2013 to 21.1% by 2050. Presently, about two thirds of the world’s older persons live in developing countries. By 2050, nearly 8 in 10 of the world’s older population will live in the less developed regions. An Indian born in 1950 could expect to live for 37 years, whereas today India’s life expectancy at birth nearly doubled to 68 years, by 2050, it is projected to increase to 76 years. As a result, India’s population will rise from 1.3 billion today to an estimated 1.7 billion by 2050, with a much larger elderly share of around 340 million” (Press Information Bureau, March 22, 2016). Heart disease, dementia, diabetes, arthritis, cataract, sleep problems, depression, anxiety are some of the common health conditions prevalent in the elderly. And, most of these conditions co-exist, giving rise to polypharmacy, which has its own associated set of problems. In addition to these are the issues of disability, financial insecurity, isolation, loneliness, neglect. Left alone at home, they are also exposed to crime. From being usefully occupied for most part of their lives, they find themselves with plenty of time on their hands post-retirement. Hence, the challenges are not just health related but also economic and social. The elderly are a vulnerable group and need to be looked after. They can still contribute to the society. By neglecting them, we are losing out on their skill and years of experience. Efforts need to be made to improve quality of their lives and integrate them in the society. Health care for this population group in particular should be accessible and affordable; they need to be protected from ill-treatment and neglect. Those who wish to be productively engaged should be encouraged to do so. “Article 41, a Directive Principle of State Policy, provides that the State shall, within the limits of its economic capacity and development, make effective provision for securing the right of public assistance in cases of old age. The Maintenance and Welfare of Parents and senior Citizen Act, 2007, also known as “Senior Citizens Act” explicitly states that it should be the duty of the children to maintain their parents.” (Press Information Bureau, October 1, 2015). “The National Policy on Older Persons (NPOP) announced in 1999 envisages State support for the elderly to ensure financial and food security, health care, shelter, protection against abuse and exploitation, and training of human resources for their care and support etc. The policy also covers issues like social security, intergenerational bonding, family as the primary caretaker, role of Non-Governmental Organizations, training of manpower, research and training.” (Press Information Bureau, August 5, 2014) The “National Programme for the Health Care of Elderly” (NPHCE) was launched in the year 2010 to address health related problems of elderly people. Last year, the Ministry of Health & Family Welfare launched the Longitudinal Ageing Study in India (LASI) to generate data on various issues of the elderly. It will survey more than 60,000 elderly over 25 years plan. October 1 has been designated as the International Day of Older Persons by the United Nations to raise awareness about issues affecting the elderly. “Forget me Not” is a campaign proposed by the Indian Medical Association (IMA) for the elderly population enabling them to lead a healthy and productive life with dignity. Doctors need to be trained to take care of the special needs of the older people. As doctors, we should not only provide them medical care, but also be a support to them. Dr KK Aggarwal National President IMA and HCFI

Move Move and Move: IMA Campaign to control NCDs

Move Move and Move: IMA Campaign to control NCDs Noncommunicable diseases (NCDs) are a major cause of premature and preventable deaths worldwide. According to a WHO Global Survey Report “Assessing National Capacity for the Prevention and Control of Noncommunicable Diseases Global Survey 2015”, NCDs currently account for almost 70% of global deaths; majority of which occur in low- and middle-income countries. India too is not untouched by this. Due to rapid urbanization, India is experiencing an epidemiological transition moving away from a predominantly communicable or infectious to a predominantly non communicable disease pattern. Along with tobacco, harmful use of alcohol and unhealthy diet, physical inactivity has been implicated in NCDs as a major risk factor. All these are behavioral risk factors and are modifiable through lifestyle changes. Modern and advanced technology has certainly made life easy and convenient for us – online shopping, online payments, accessing information, etc., all of which can be done from the comfort of our homes. But, has technology really made our life better? What it has also done is change our lifestyle pattern at the cost of health; we are less physically active now - sitting at a desk for a long time working on the computer, using social media on smartphones, watching TV or sitting in a meeting, all these activities promote sedentary behavior. The benefits of exercise on physical health as well as mental health are well-established and know to us all. But, the level of physical activity among all age groups has decreased, either due to lack of initiative or lack of safe open spaces. A heavy work schedule is often a deterrent to physical activity for many of us. Walking is the best form of exercise, which requires no investment, no special training. Walking in natural environments such as parks also reduces mental stress and fatigue and improve mood via the release of the ‘feel good’ endorphins. This proximity to nature also helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode manifested by lowering of blood pressure and pulse rate. This is also why most of our temples are located in distant places. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey. It is important to remember here that ‘exercise’ is not synonymous with ‘physical activity’. Exercise is a planned, structured and repetitive activity while any other physical activity that is done during leisure time, for transport to get to and from places, or as part of a person’s work, also has a health benefit (WHO Fact Sheet, February 2017). To control non-communicable diseases and promote physical activity, IMA has proposed a campaign “Move Move and Move”. People should move around more often all through the day in addition to regular exercise. Here are a few simple ways to increase physical activity both at home and your workplace. • Take the stairs as often as possible. • Get off the bus one stop early and walk the rest of the way. • Have “walk-meetings” instead of "sit-in" meetings. • Walk to the nearby shops instead of driving. • Stand up and walk while talking on the phone. • Walk down to speak to your colleague instead of using the intercom/phone. • Walk around your building for a break during the work day or during lunch. • Buy a pedometer. Walk 80 minutes each day; brisk walk 80 minutes a week with a speed of 80 steps per minute. This is a ‘Formula of 80’ that I have devised and which I recommend to all my patients. Dr KK Aggarwal National President IMA & HCFI

“Sorry I cannot oblige you for...”: IMA Campaign against issuance of false medical certificates

“Sorry I cannot oblige you for...”: IMA Campaign against issuance of false medical certificates Dr KK Aggarwal National President IMA & HCFI Doctors are required to issue medical certificates and/or certificate for fitness to work or resume duty. The Medical Council of India (MCI) has provided a list of certificates, reports, notifications etc. issued by doctors for the purposes of various acts / administrative requirements in Appendix 4 of its Code of Ethics Regulations, 2002: • Under the acts relating to birth, death or disposal of the dead. • Under the Acts relating to Lunacy and Mental Deficiency and under the Mental illness Act and the rules made thereunder. • Under the Vaccination Acts and the regulations made thereunder. • Under the Factory Acts and the regulations made thereunder. • Under the Education Acts. • Under the Public Health Acts and the orders made thereunder. • Under the Workmen’s Compensation Act and Persons with Disability Act. • Under the Acts and orders relating to the notification of infectious diseases. • Under the Employee’s State Insurance Act. • In connection with sick benefit insurance and friendly societies. • Under the Merchant Shipping Act. • For procuring / issuing of passports. • For excusing attendance in courts of Justice, in public services, in public offices or in ordinary employment. • In connection with Civil and Military matters. • In connection with matters under the control of Department of Pensions. • In connection with quarantine rules. • For procuring driving license. At times, they may be urged by friends, or other individuals to provide certificates with falsified information to take medical leave, claim financial benefits, compensations, etc. And, they may find it difficult to say no. The Indian Medical Association (IMA) is against issuing or obliging for false certificates. The IMA campaign in this regard “Sorry I cannot oblige you for...” is directed at learning to say no to issuing false certificates. Medical certificates are legal documents. Doctors therefore must be aware of the implications of signing a medical certificate, to themselves, the patient and the organization to which the certificate would be submitted and act according to the regulations defined by the MCI relating to the Professional Conduct, Etiquette and Ethics. Any certificate issued by a doctor not as per the requirements defined in the Regulation 1.3.3 of the MCI Code of Ethics Regulations, 2002 (as follows) is not a valid certificate: “A Registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report.” In Ram Narain Gupta vs Smt. Rameshwari Gupta on 12 September, 1988 AIR 2260, 1988 SCR Supl. (2) 913, the Supreme Court of India observed: “… Neither in the first certificate (Ext. 4) nor in the second certificate (Ext. 3) … stated that the schizophrenia, the defendant is suffering from, was of the third variety, namely, Catatonia, when the patient becomes wild, destructive and violent. In this statement also … does not state that the schizophrenia was of Catatonia variety. He does not say even a word about the danger, arising from the mental disorder of the defendant. The certificate Ext. 3 does not bear the thumb impression or signature of the defendant and, therefore, it cannot be said with certainty that the said certificate was issued by … after having examined the defendant.” If you issue a false certificate, you can lose your license (permanently) to practice as per Regulation 7.7, which says “Any registered practitioner who is shown to have signed or given under his name and authority any such certificate, notification, report or document of a similar character which is untrue, misleading or improper, is liable to have his name deleted from the Register.” Issuing a false document is forgery, which is an offence liable to imprisonment under Section 468 of the Indian Penal Code and has been defined under Section 463 of the IPC. “468. Forgery for purpose of cheating: Whoever commits forgery, intending that the 1[document or electronic record forged] shall be used for the purpose of cheating, shall be punished with imprisonment of either de¬scription for a term which may extend to seven years, and shall also be liable to fine.” “463. Forgery. Whoever makes any false documents or false electronic record or part of a document or electronic record, with intent to cause damage or injury], to the public or to any person, or to support any claim or title, or to cause any person to part with property, or to enter into any express or implied contract, or with intent to commit fraud or that fraud may be committed, commits forgery.” The Delhi Medical Council has framed guidelines for issuance of medical certificate in its order DMC/DC/F.14/Comp.1107/2/2014/ dated 17th October, 2014 a. “Medical certificates are legal documents. Medical practitioners who deliberately issue a false, misleading or inaccurate certificate could face disciplinary action under the Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations, 2002. Medical practitioners may also expose themselves to civil or criminal legal action. Medical practitioners can assist their patients by displaying a notice to this effect in their waiting rooms. It is, therefore, a misnomer to state that medical certificate is “not valid for legal or Court purposes”, and should be avoided. Registered medical practitioners are legally responsible for their statements and signing a false certificate may result in a registered medical practitioner facing a charge of negligence or fraud. b. The certificate should be legible, written on the doctor’s letterhead and should not contain abbreviations or medical jargon. The certificate should be based on facts known to the doctor. The certificate may include information provided by the patient but any medical statements must be based upon the doctor’s own observations or must indicate the factual basis of those statements. The Certificate should only be issued in respect of an illness or injury observed by the doctor or reported by the patient and deemed to be true by the doctor. The certificate should: i. indicate the date on which the examination took place ii. indicate the degree of incapacity of the patient as appropriate iii. indicate the date on which the doctor considers the patient is likely to be able to return to work iv. be addressed to the party requiring the certificate as evidence of illness e.g. employer, insurer, magistrate v. indicate the date the Certificate was written and signed. vi. Name, signature, qualifications and registered number of the consulting Registered Medical Practitioner. vii. The nature and probable duration of the illness should also be specified. This certificate must be accompanied by a brief resume of the case giving the nature of the illness, its symptoms, causes and duration. When issuing a sickness certificate, doctors should consider whether or not an injured or partially incapacitated patient could return to work with altered duties. c. The medical certificate under normal circumstances, as a rule, should be prospective in nature i.e. it may specify the anticipated period of absence from duty necessitated because of the ailment of the patient. However, there may be medical conditions which enable the medical practitioner to certify that a period of illness occurred prior to the date of examination. Medical practitioners need to give careful consideration to the circumstances before issuing a certificate certifying a period of illness prior to the date of examination, particularly in relation to patients with a minor short illness which is not demonstrable on the day of examination and should add supplementary remarks, where appropriate, to explain the circumstances which warranted the issuances of certificate retrospective in nature. d. It is further observed that under no circumstances, a medical certificate should certify period of absence from duty, for a duration of more than 15 days. In case the medical condition of the patient is of such a nature that it may require further absence from duty, then in such case a fresh medical certificate may be issued. e. Record of issuing medical certificate -Documentation should include : • Patient to put signature / thumb impression on the medical certificate • Identification marks to be mentioned on medical certificate • that a medical certificate has been issued • the date / time range covered by the medical certificate • the level of incapacity (i.e. unfit for work, light duties, etc. within scope of practice) An official serially numbered certificate should be utilized. The original medical certificate is given to the patient to provide the documentary evidence for the employer. The duplicate copy will remain in the Medical Certificate book for records. The records of medical certificate are to be retained with the doctor for a period of 3 years from the date of issue.”