IMA End TB Initiative: 10 points what every doctor should know about TB

IMA End TB Initiative: 10 points what every doctor should know about TB

Dr KK Aggarwal

1.    Tuberculosis is a public health emergency in view of the rising number of cases of MDR (Multi-Drug-Resistant) and XDR (Extensively-Drug-Resistant)TB, especially in Delhi and Mumbai.

2.    The prevalence of MDR TB is more than 2% in primary TB cases.

3.    Every sputum should be tested with GeneXpert test. It not only diagnoses the presence of TB, but also detects rifampicin resistance. No treatment should be started without first confirming rifampicin resistance. Rifampicin resistance indicates primary MDR TB.

4.    Treatment for MDR TB should be taken for the required 2 years to prevent conversion from MDR TB to XDR TB. Treatment of MDR TB in India is available free of cost. 

5.    All doctors/health establishments should register themselves with Nikshay, the online tool for monitoring of TB patients developed by the Central TB Division, Ministry of Health & Family Welfare (https://nikshay.gov.in/HFUSER/HFLogin.aspx). If you register with Nikshay, you can get free medicines for your TB patients.

6.    Every patient of TB has to be notified as required by the MCI Code of Medical Ethics under Regulations 5.2 and 7.14. Not doing so is professional misconduct.

“5.2 Public and Community Health: Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs a physician should not abandon his duty for fear of contracting the disease himself.”

“7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except –

·         in a court of law under orders of the Presiding Judge;

·         in circumstances where there is a serious and identified risk to a specific person and / or community; and

·         notifiable diseases.

In case of communicable / notifiable diseases, concerned public health authorities should be informed immediately.”

7.    In sputum-positive cases, re-test sputum with GeneXpert test after 2 months of treatment to assess response and screen for drug-resistant TB.

8.    “Lekin TB Kis se hua?” Trace contacts of your patients with infectious TB and screen them for latent TB infection. Put them on full course of anti-tuberculosis treatment (ATT), if required. This will prevent further spread of TB, including MDR TB.

9.    Fixed-dose combination (FDC) drugs are now available for drug-sensitive TB. Treatment has to be as per body weight of the patient.

10. Preferably get a 6-month course of ATT at one time, so that the patient knows he/she has to take treatment for at least this duration of time.

IPC Sections 88 and 92 protect doctors against any professional liability for acts done in good faith

IPC Sections 88 and 92 protect doctors against any professional liability for acts done in good faith

The Indian Penal Code (IPC) has provisions for defenses for doctors under sections 88 and 92, which protect doctors from allegations of negligence, for instance, when treatment given in an emergency or a cardiopulmonary resuscitation (CPR) done is not successful.

Section 88 IPC provides for exemption for acts not intended to cause death, done by consent in good faith for person’s benefit: “Nothing which is not intended to cause death, is an offence by reason of any harm which it may cause, or be intended by the doer to cause, or be known by the doer to be likely to cause, to any person for whose benefit it is done in good faith, and who has given a consent, whether express or implied, to suffer that harm, or to take the risk of that harm”.

The illustration accompanying this section explains it further: “A, a surgeon, knowing that a particular operation is likely to cause the death of Z, who suffers under a painful complaint, but not intending to cause Z’s death and intending in good faith, Z’s benefit performs that operation on Z, with Z’s consent. A has committed no offence”.

Section 92 provides for acts done in good faith for benefit of a person without con­sent but with provisos: “Nothing is an offence by reason of any harm which it may cause to a person for whose benefit it is done in good faith, even without that person’s consent, if the circumstances are such that it is impossible for that person to signify consent, or if that person is incapable of giving consent, and has no guardian or other person in lawful charge of him from whom it is possible to obtain consent in time for the thing to be done with benefit: Provided—

·         (First) That this exception shall not extend to the intentional causing of death, or the attempting to cause death;

·         (Secondly) That this exception shall not extend to the doing of anything which the person doing it knows to be likely to cause death, for any purpose other than the preventing of death or grievous hurt, or the curing of any grievous disease or infirmi¬ty;

·         (Thirdly) That this exception shall not extend to the voluntary causing of hurt, or to the attempting to cause hurt, for any purpose other than the preventing of death or hurt;

·         (Fourthly) That this exception shall not extend to the abetment of any offence, to the committing of which offence it would not extend”.

Illustration ‘c’ of this section is important for doctors. “A, a surgeon, sees a child suffer an accident which is likely to prove fatal unless an operation be immediately performed. There is no time to apply to the child’s guardian. A performs the operation in spite of the entreaties of the child, intending, in good faith, the child’s benefit. A has committed no offence”.

In Kusum Sharma & Ors vs Batra Hospital &Med Research on 10 February, 2010, the Hon’ble Supreme Court also observed as follows:

“The Indian Penal Code has taken care to ensure that people who act in good faith should not be punished. Sections 88, 92 and 370 of the Indian Penal Code give adequate protection to the professional and particularly medical professionals… It is our bounden duty and obligation of the civil society to ensure that the medical professionals are not unnecessary harassed or humiliated so that they can perform their professional duties without fear and apprehension. The medical practitioners at times also have to be saved from such a class of complainants who use criminal process as a tool for pressurizing the medical professionals/hospitals particularly private hospitals or clinics for extracting uncalled for compensation. Such malicious proceedings deserve to be discarded against the medical practitioners… The medical professionals are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals”.

Both Sections 88 and 92 protect the doctor against any professional liability or allegations of medical negligence, in situations when acts done for the benefit of the patient, with or without his consent, do not have the desired outcome. These sections provide that any act done in good faith is not negligence. Doctors should be aware of these sections as a defense against cases of negligence filed against them.

Straight from the Heart: I am proud of being a "Doctor with a Stethoscope"

Straight from the Heart: I am proud of being a "Doctor with a Stethoscope" During my MBBS at MGIMS, Wardha, I was exposed to Vedantic medicine. Later, I also began to write and speak on Vedantic medicine, the science behind vedas. Because, most of my talks include a vedic prescription, I started wearing a stethoscope so that I was not mistaken to be a non-allopathic doctor. I have now been wearing the stethoscope around my neck over the last several years. And, people have often asked me the reason for doing so. I can recall having saved at least 20 unknown lives, just because I was wearing a stethoscope. There are ‘n’ number of instances, where I have done CPR outside the sanctuary of hospitals. I have also handled first aid during air travel dozens of time. I would like to share with you some stories of my experience of wearing the stethoscope. This Monday, I was traveling from Trivandrum to Delhi via Kochi. At Kochi airport, while the aircraft was on the runway and taking off, a lady passenger became breathless. She had a history of deep vein thrombosis (DVT) and had taken heparin one hour before. I checked her oxygen saturation (I always carry a home pulse oximeter with me), which was normal. She was unfit medically to undertake the 3-hour journey and needed medical assistance. The crew saw that I was wearing a stethoscope and they approached me for help. She was off loaded from the flight at the airport under medical care. In March this year, I was in Cyprus to attend the Bioethics 12th World Conference. A car ahead of us had met with an accident. One of the lady passengers was trapped in that car. We stopped and approached the car to offer medical help. We were allowed to intervene only because I was wearing a stethoscope. Once, while we were traveling to Dubai, my wife, suddenly developed air hunger. She almost collapsed but managed to say “Call my doctor, he is the one wearing a stethoscope”. The crew could immediately recognize me. Titles of distinction and honor like Diwan, Raja, Maharaja, Rai Bahadur, etc. were abolished under Article 18 of the Constitution of India as being against the principle of equal status of all. However, we are still allowed the privilege to write ‘Dr’ before our names. But, simply adding the prefix ‘Dr’ before your name does not confer status. Being a doctor means being available 24x7 and ready to help in all emergencies. Use the new emblem when writing a prescription or sport a stethoscope always. There is a Good Samaritan law to protect those who voluntarily come forward to help victims of accidents. It applies to us doctors also. In April 2016, the Govt. notified guidelines regarding protection and examination of “good Samaritans” i.e. bystanders and passers-by who render help to the victims of road accidents. I love being a doctor. It is extremely satisfying and rewarding. All the hard work and long hours put in are worth the effort. Wearing a stethoscope reminds me of my medical dharma, which is to treat and save the life of a person at any cost. This is why we chose to become doctors. We know medicine to be a noble profession. Sporting a stethoscope has now become my signature style. People now identify me as “a Doctor with Stethoscope”. I always wear a stethoscope, will you consider it?

Unconditional beneficence and absolute non maleficence: The hallmarks of a doctor

Unconditional beneficence and absolute non maleficence: The hallmarks of a doctor “Doctors are next to God”, “Doctors heal, God treats”. These are some oft-repeated well-known phrases. And, much has been written about how doctors have been accorded a ‘God-like’ status in society, which places them “on a pedestal” at a level higher than other profession, though this image of a doctor seems to have slowly eroded over the years. God is omniscient, omnipotent and omnipresent. We seek His refuge in our hard times all the time and have absolute trust in him because he is all-knowing, all-powerful and present everywhere. God is the person in whom one has blind belief and faith. He is there for all of us. Doctors are professionally trained to take care of the sick, look after the health of their patients and also of the community. During illness or in a life-threatening situation, doctors remain the last hope for families and patients put the same belief and faith in doctors to help them as they do in God. Non-maleficence (do no harm) and beneficence (do good) are the two of the four major principles of medical ethics, the other two being respect for autonomy and justice. These are the guiding values of medical practice. Doctors act in the best interests of the patients for their well-being and prevent harm to the patients i.e. treat the patient in a way that does not harm the patient. But, patients are more than just their disease. Doctors should have unconditional compassion and empathy towards their patients to give the best possible care to them, without being judgemental or biased or prejudiced. These are factors that influence patients’ perception of their doctor, sometimes even more than the actual science of medicine. Therefore, I add two adjectives “unconditional” and “absolute” to the two guiding bioethics principles i.e. “unconditional beneficence” and “absolute non maleficence”… just as God loves us all unconditionally and anybody can seek Him. A doctor who has these two qualities perhaps can be said to be God-like. Almost a century ago, in 1927, Dr FW Peabody wrote in an article in JAMA “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient”. This is as relevant today as it was then. Dr KK Aggarwal National President IMA & HCFI

Complications are bound to happen, what is important is how you tackle them

Complications are bound to happen, what is important is how you tackle them Medicine is an art, based on science, yet it is not an exact science. And it is the skills that the doctor picks up first during his education and then as part of his training, which help him to safely and effectively practice medicine. Years of clinical practice then further his knowledge and add to the skills. No two patients are alike; every patient is different and clinical decisions are tailored to individual patients. Therefore, probability and uncertainty are part of the practice of medicine where complications are bound to occur. But what is of the utmost importance here is to anticipate potential complications and manage them quickly. When any complication is anticipated, one is prepared accordingly to handle it. It is this ability to anticipate, recognize and the quickness shown in managing any complication that marks a distinguishing characteristic of a “good” doctor and sets him/her apart from others. To acquire these clinical and procedural skills, a doctor undergoes years of rigorous study and training. Only then, do they acquire adequate knowledge, discernment and develop skills to take the right decision for the patient and adapt to changing practices. But, today quacks are flourishing in our society. They are obviously untrained and lack the ability to diagnose or treat patients, in particular any emergency or complication. They cannot render timely first aid. Although it is their routine practice to refer patients to hospitals or higher centers, but precious time is lost. They can hardly be expected to be aware of the concepts of the “Golden hour” or the “Platinum 10 minutes”. And, the outcome often is patient succumbing to his illness. Quacks also prescribe antibiotics, which are Schedule H1 drugs. Misuse of antibiotics by quacks fails the very objective of Schedule H1, which is to control the rampant use of antibiotics and anti-TB drugs to check the epidemic of antibiotic resistance. Schedule H1 drugs, along with Schedule H and Schedule X drugs, are restricted drugs and cannot be sold to just anybody OTC. A valid prescription from a doctor of modern system of medicine is required before they can be dispensed to the patients. The Govt. is promoting AYUSH doctors to practice modern medicine. Scheduled drugs should only be allowed to be written by MBBS or BDS doctors. The prescription of Schedule H, H1 and X drugs by non-MBBS, non-BDS doctors can cause large-scale harm. Interpretation of a situation or judgment in the body is governed by chemical reactions and is controlled by the balance of autonomic balance system, which in turn is governed by the interaction of parasympathetic and sympathetic nervous systems. Sympathetic mode releases stress hormones and may trigger panic or nervousness, the “flight or fight” response. This prevents a person from taking the correct and decisive decision and increases the chances of mistakes, which in the case of a doctor may be costly. It may mean life or death for this patient. A parasympathetic state of mind, on the other hand, is quiet and composed enabling rational and Right conscious–based decisions and just the right frame of mind to tackle complications. Doctors should practice medicine in a parasympathetic mode. 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 Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)

Doctor as a Giver

Doctor as a Giver Today is Doctors’ Day and on this occasion, I take this opportunity to revisit the role of a doctor. Chapter 10, shloka 21 of the Bhagawad Gita gives the definition of God, when Krishna reveals himself to Arjuna by saying, “Adityanam ahaṁ viṣhṇur jyotiṣhaṁ ravir anśhuman, marichir marutam asmi nakṣhatraṇam ahaṁ śhaśhi”, which translates as “Of the twelve Adityas, I am Vishnu, of all luminaries, the radiant sun, of the seven Maruts, I am Marichi and of the constellations, I am the moon.” All these phenomena are the manifestations of Krishna. All the forms that Krishna used to define himself, give something. Moon gives peace of mind, sun gives light etc. Devta is someone who gives. Anybody who gives can be said to be like a devta. But this giving has to be unconditional and loving. A common man’s perspective of God is of a force that can do and undo anything, for whom nothing is impossible, who is the final decision maker, whose decision cannot be challenged, who can give an instantaneous relief, who can punish and reward and he who overcomes miseries. He can also answer the unknown as he is supposed to know everything. In Bhagawad Gita and other Vedic texts, God is equated to consciousness, a network of energized information, a force which cannot be burnt by fire, wet by water, dried by air or cut by weapon; a force which is omnipotent, omnipresent and omniscient and still ever-pervading. A trained qualified medical doctor who has his understanding based on the mind, body and soul has nearly similar characteristics. He overcome miseries as soon as he touches the patient, gives immediate relief which starts at the time he gives a healing touch to the patient. God resides in each one of us. In his book ‘How to Know God’, Deepak Chopra has explained different levels of God. According to him a God is a person from amongst the society with one step higher level of consciousness. He describes, as per the Vedic text, seven different levels of consciousness that a person can possess. 1. Flight & fight 2. Reactive consciousness 3. Restful alertness consciousness 4. Intuitive consciousness 5. Creative consciousness 6. Sacred consciousness 7. Visionary consciousness A person who has achieved sainthood, who sees the same consciousness in everybody, treats individuals without caste, creed and religion and who overcome miseries of people irrespective of their age, status or paying capacity is God. Doctors fulfil these criteria as they have a duty to heal the sick irrespective of their caste, creed, race or financial status. Even the MCI Code of Ethics has said, “The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration (1.1.2).” The MCI Declaration, which a doctor is required to sign at the time of registration, also says “I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient (d).” Today with evidence-based medicine being the norm, mental and spiritual health has taken a backseat. This may be one reason why doctors are losing the status of God, which they were accorded since Vedic times. But, we should remember that doctors are messengers of God to remove miseries of the sick individuals and so should always act in the best interests of the patient. “Doctors treat, but God heals” is a well-known saying. My best wishes to you on this Doctor’s Day … 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 Medallist Nagpur University Limca Book of Record Holder in CPR 10 Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand Editor in Chief IJCP Group of Publications & eMedinewS Member Ethics Committee Medical Council of India (2013-14) Chairman Ethics Committee Delhi Medical Council (2009-15) Elected Member Delhi Medical Council (2004-2009) Chairman IMSA Delhi Chapter (March 10- March 13) Director IMA AKN Sinha Institute (08-09) Finance Secretary IMA (07-08) Chairman IMAAMS (06-07) President Delhi Medical Association (05-06)

Indian Penal Code & Criminal prosecution of medical doctors

Indian Penal Code & Criminal prosecution of medical doctors According to the provisions of Indian Penal Code 1860 (IPC) any act of commission or omission is not a crime unless it is accompanied by a “guilty mind” or mens rea. If it can be established without reasonable doubt that death was the result of malicious intention/gross negligence or with the knowledge that the act could cause harm and patient was not informed about the same, only then can a doctor can be charged with criminal negligence. No doctor treats a patient with an intention to harm or without taking an informed consent. Doctors must be aware of the Indian Penal Codes, under which they can be charged for negligence. They should know whether the act undertaken by them amounts to rash or gross negligent action under the provisions of the law of the country. This is very relevant today, where doctors are increasingly being subject to criminal prosecution. Is the act done in good faith with proper consent? IPC 88: Act not intended to cause death, done by consent in good faith for person’s benefit Nothing which is not intended to cause death, is an offence by reason of any harm which it may cause, or be intended by the doer to cause, or be known by the doer to be likely to cause, to any person for whose benefit it is done in good faith, and who has given a consent, whether express or implied, to suffer that harm, or to take the risk of that harm. Illustration A, a surgeon, knowing that a particular operation is likely to cause the death of Z, who suffers under a painful complaint, but not intending to cause Z’s death and intending in good faith, Z’s benefit performs that operation on Z, with Z’s consent. A has committed no offence. Has the consent taken by frightening the patient or without scientific data? IPC 90: Consent known to be given under fear or misconception A consent is not such a consent as it intended by any section of this Code, if the consent is given by a person under fear of injury, or under a misconception of fact, and if the person doing the act knows, or has reason to believe, that the consent was given in consequence of such fear or misconception; or Consent of insane person.—if the consent is given by a person who, from unsoundness of mind, or intoxication, is unable to understand the nature and consequence of that to which he gives his consent; or Consent of child.—unless the contrary appears from the context, if the consent is given by a person who is under twelve years of age. Is there any violation of a special act? IPC 91: Exclusion of acts which are offences independently of harm caused: The exceptions in sections 87, 88 and 89 do not extend to acts which are offences independently of any harm which they may cause, or be intended to cause, or be known to be likely to cause, to the person giving the consent, or on whose behalf the consent is given. Illustration Causing miscarriage (unless caused in good faith for the purpose of saving the life of the woman) is an offence independently of any harm which it may cause or be intended to cause to the woman. Therefore, it is not an offence “by reason of such harm”; and the consent of the woman or of her guardian to the causing of such miscarriage does not justify the act. Was the act done without consent? IPC 92. Act done in good faith for benefit of a person without con¬sent: Nothing is an offence by reason of any harm which it may cause to a person for whose benefit it is done in good faith, even without that person’s consent, if the circumstances are such that it is impossible for that person to signify consent, or if that person is incapable of giving consent, and has no guardian or other person in lawful charge of him from whom it is possible to obtain consent in time for the thing to be done with benefit: Provisos—Provided— (First) — That this exception shall not extend to the intentional causing of death, or the attempting to cause death; (Secondly) —That this exception shall not extend to the doing of anything which the person doing it knows to be likely to cause death, for any purpose other than the preventing of death or grievous hurt, or the curing of any grievous disease or infirmi¬ty; (Thirdly) -— That this exception shall not extend to the voluntary causing of hurt, or to the attempting to cause hurt, for any purpose other than the preventing of death or hurt; (Fourthly) —That this exception shall not extend to the abetment of any offence, to the committing of which offence it would not extend. Illustrations (c) A, a surgeon, sees a child suffer an accident which is likely to prove fatal unless an operation be immediately performed. There is no time to apply to the child’s guardian. A performs the operation in spite of the entreaties of the child, intending, in good faith, the child’s benefit. A has committed no offence. How was the patient communicated? IPC 93: Communication made in good faith: No communication made in good faith is an offence by reason of any harm to the person to whom it is made, if it is made for the benefit of that person. Illustration A, a surgeon, in good faith, communicates to a patient his opin¬ion that he cannot live.The patient dies in consequence of the shock. A has committed no offence, though he knew it to be likely that the communication might cause the patient’s death. Was it a culpable homicide? Was there any intention or knowledge? IPC299: Culpable homicide: Whoever causes death by doing an act with the intention of causing death, or with the intention of causing such bodily injury as is likely to cause death, or with the knowledge that he is likely by such act to cause death, commits the offence of culpable homicide. Explanation 1.—A person who causes bodily injury to another who is labouring under a disorder, disease or bodily infirmity, and thereby accelerates the death of that other, shall be deemed to have caused his death. Explanation 3.—The causing of the death of child in the mother’s womb is not homicide. But it may amount to culpable homicide to cause the death of a living child, if any part of that child has been brought forth, though the child may not have breathed or been completely born. What is the punishment for culpable homicide? IPC 304: Punishment for culpable homicide not amounting to murder: Whoever commits culpable homicide not amounting to murder shall be punished with [imprisonment for life], or imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine, if the act by which the death is caused is done with the intention of causing death, or of causing such bodily injury as is likely to cause death, or with imprisonment of either description for a term which may extend to ten years, or with fine, or with both, if the act is done with the knowledge that it is likely to cause death, but without any intention to cause death, or to cause such bodily injury as is likely to cause death. IMA View: This penal code is not applicable to doctors unless there was intention to harm in the treatment provided or there was knowledge that the treatment can harm but the patient was not informed about the likely harm. Was it a case of gross negligence? IPC 304A: Causing death by negligence: Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.] Who certified the gross negligence? Statutory Rules or Executive Instructions incorporating certain guidelines need to be framed and issued by the Government of India and/or the State Governments in consultation with the Medical Council of India (MCI). So long as it is not done, we propose to lay down certain guidelines for the future which should govern the prosecution of doctors for offences of which criminal rashness or criminal negligence is an ingredient. A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor. The investigating officer should, before proceeding against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice who can normally be expected to give an impartial and unbiased opinion applying Bolam's test to the facts collected in the investigation. A doctor accused of rashness or negligence, may not be arrested in a routine manner (simply because a charge has been levelled against him). Unless his arrest is necessary for furthering the investigation or for collecting evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make himself available to face the prosecution unless arrested, the arrest may be withheld. [Jacob Mathew vs State of Punjab & Anr on 5 August, 2005: Author: R Lahoti: Bench: Cji R.C. Lahoti, G.P. Mathur, P. K. Balasubramanyan: Case No.: Appeal (crl.) 144-145 of 2004] Dr KK Aggarwal National President IMA & HCFI

Trust makes patients adhere to prescribed treatment

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