Thursday, February 15, 2018

Should we compare ourselves with CAs, Lawyers and Architects?


    
Dr K K Aggarwal

Recipient of Padma Shri

Quiet often we argue that medical profession cannot be treated in isolation.

All other professions, be it law, CA, sportspersons, actors, hotels, musicians, social lecturers, astrologers may charge recklessly without doing as much, even one-tenth of doctors, with sincerity and seriousness.

But remember we are different.

We, and not they, are considered next to God. We, and not they, are social business houses.

We, and not they, are given permission to suffix Dr. before their names.

We, and not they, are bound by professional ethics.

MCI Code of Ethics Regulations 6.3 Running an open shop (Dispensing of Drugs and Appliances by Physicians):A physician should not run an open shop for sale of medicine for dispensing prescriptions prescribed by doctors other than himself or for sale of medical or surgical appliances. It is not unethical for a physician to prescribe or supply drugs, remedies or appliances as long as there is no exploitation of the patient. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.”

Supreme Court of India: Samira Kohli vs Dr. Prabha Manchanda & Anr on 16 January, 2008:28. But unfortunately not all doctors in government hospitals are paragons of service, nor fortunately, all private hospitals/doctors are commercial minded. There are many a doctor in government hospitals who do not care about patients and unscrupulously insist upon 'unofficial' payment for free treatment or insist upon private consultations. On the other hand, many private hospitals and Doctors give the best of treatment without exploitation, at a reasonable cost, charging a fee, which is reasonable recompense for the service rendered.

Of course, some doctors, both in private practice or in government service, look at patients not as persons who should be relieved from pain and suffering by prompt and proper treatment at an affordable cost, but as potential income-providers/ customers who can be exploited by prolonged or radical diagnostic and treatment procedures. It is this minority who bring a bad name to the entire profession.”

The word exploitation in the first reference and reasonable in the second reference bind us different from other professions.

Opinions may differ but my personal opinion is that for medical professionals, earning is a byproduct and not the first objective.



Dr KK Aggarwal


Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA


Wednesday, February 14, 2018

The 7-year itch: Redefining a relationship

Boy meets girl…girl meets boy…sparks fly and they live happily ever after. This is the classic notion of romantic love, but which happens only in fairy tales.

Real life relationships don’t just happen. Every relationship evolves over time and has to work its way through five stages before it settles down to last a lifetime. These five stages, in order of their appearance, are:

1.    Euphoria
2.    Reaction
3.    Adjustment
4.    Liking
5.    Love

The first phase in any relationship is that of euphoria. Everything appears rosy in this first flush of love. All flaws are overlooked and the relationship is wonderful and easy. Both partners feel great, light and on the air. The amphetamine-like substance called phenyl-ethylamine is the neuromodulator in this phase. 

The excitement soon starts wearing off and then reality hits. This is the phase of reaction wherein both partners start reacting to each other’s behavior and lifestyle. Disillusionment sets in. Arguments begin to occur. It is during this stage that most break-ups occur. The reactions are based on release of adrenaline and noradrenaline.

The phase of reaction is dependent on the changes in our needs. Every person has five types of needs and they are Physical, Mental, Intellectual, Egoistic and Spiritual Needs. Physical needs are needs for physical and sexual intimacy; mental needs are to share one’s emotions and need for a shoulder when in the need of a cry; intellectual needs are the needs to discuss about future, decision making etc.; egoistic needs are the needs to acquire power and spiritual needs are the needs to acquire inner happiness.  Husbands and wives who fulfil all the above needs of each other are called “made for each other”.

Next is the phase of adjustment. The two partners start adjusting to reality and start accepting each other’s differences. They are able to overcome the power struggle in the relationship.

Both phases of reaction and adjustment may carry on for up to 7 years. During this period, both partners are compelled to stay with each other and they start adjusting to each other’s needs and lifestyle. It is not an easy time for many. This is also the time when a relationship is redefined.

Liking develops by the 7th year. This is the phase when the two partners learn to trust each other and start feeling dependent on each other. They are able to deal with and resolve their differences bringing to an end all the misunderstandings that have so far plagued their relationship. 

The last phase is phase of love or soul-to-soul relationship ‘soul mate’. This phase may start decades after the marriage and is the basis of 25th, 50th & 75th marriage anniversary. People in this phase of marriage are totally dependent on each other and cannot face separation. If one person dies, the other may go into depression and also die within a short period of time. The neurochemicals involved in this phase are endorphins.

These five stages apply to not just romantic love, but also to every relationship, be it with your job, friends, coworkers etc. It is unconditional love.

Which stage are you in your relationship?


Dr KK Aggarwal


Padma Shri Awardee
Vice President CMAAO
Group Editor-in-chief IJCP Publications
President Heart Care Foundation of India

Immediate Past National President IMA

Tuesday, February 13, 2018

If we don’t self-regulate, then the govt. will



There has always been a dispute whether healthcare is a commercial business or a social business. The first step in regulation of the medical profession was taken when the medical profession was brought under the Consumer Protection Act (CPA). Consequently, any medical service provided to the patient in the form of consultation, diagnosis and treatment came to be under the ambit of ‘service’ as defined in the CPA.

In several of its judgements, the Hon’ble Supreme Court of India has stated that costs/charges in the medical profession must be reasonable. In the matter of Samira Kohli vs Dr. Prabha Manchanda & Anr on 16 January, 2008, the Apex Court said, “28. But unfortunately not all doctors in government hospitals are paragons of service, nor fortunately, all private hospitals/doctors are commercial minded. There are many a doctor in government hospitals who do not care about patients and unscrupulously insist upon 'unofficial' payment for free treatment or insist upon private consultations. On the other hand, many private hospitals and Doctors give the best of treatment without exploitation, at a reasonable cost, charging a fee, which is reasonable recompense for the service rendered. Of course, some doctors, both in private practice or in government service, look at patients not as persons who should be relieved from pain and suffering by prompt and proper treatment at an affordable cost, but as potential income-providers/ customers who can be exploited by prolonged or radical diagnostic and treatment procedures. It is this minority who bring a bad name to the entire profession.”

The word to be taken note of here is “exploitation”. You cannot charge more in an emergency. If you do, this may mean that you are exploiting the patient.

Earning a profit is required for sustenance. But should this justify profiteering? A very fine line separates the two, which must never be crossed.

The word “reasonable” needs to be defined. The govt. always wanted to cap pricing in the medical profession. Towards this end, the govt. introduced the Clinical Establishments Act (CEA) to regulate prices in health care, which was opposed by the IMA.

The govt. is now trying to control prices via TPA, CGHS, state government health scheme and now through the newly launched “National Health Protection Scheme” under the Ayushman Bharat initiative announced in the Budget on Feb.1, 2018. The National Health Protection Scheme will provide coverage of Rs 5 lakh rupees per family per year for secondary and tertiary hospitalization, but only under the ‘general ward’ category to about 50 crore beneficiaries. This scheme may be taken advantage of or exploited.

This means that the govt. may cap the prices for each procedure as it did under the Rashtriya Swasthya Bima Yojana (RSBY), a health insurance scheme for the Below Poverty line (BPL) families, which provided a coverage of Rs 30, 000/- per annum to beneficiaries on a family floater basis. Under this scheme, the govt. has framed indicative package rates for several interventions or procedures.

The only way health sector can be controlled is by way of re-imbursement.   Just as the HMOs have controlled healthcare costs in the US, insurance companies in India too may control pricing in India.

Two types of costs may be worked out; one, a reasonable’ cost, one which could be covered under the ‘general ward’ category as directed by the govt. and the other a ‘private’ cost, which is not capped and allows charging as per the paying capacity of the patient.

If we don’t self-regulate, then the govt. will. Then we may have no choice but to comply with the price cap that has been put by the govt.

Dr KK Aggarwal


Padma Shri Awardee
Vice President CMAAO
Group Editor-in-chief IJCP Publications
President Heart Care Foundation of India

Immediate Past National President IMA

Tuesday, January 9, 2018

H3N2 Aussies Flu, a near epidemic in Australia, UK and USA: H1N1 in Rajasthan India

H3N2 Aussies Flu, a near epidemic in Australia, UK and USA
H1N1 in Rajasthan India

The flu is rapidly spreading across the US, UK and Australia.

Not only did it start early, but it seemed to occur all over the country more or less simultaneously.
The predominant flu strain is H3N2. Vaccine effectiveness typically ranges from 40 to 60 percent in a good year. Preliminary estimates from last year show the vaccine was 40 percent effective in the U.S., similar to 2014-2015. But concerns have been raised about this year’s vaccine after an editorial published in the New England Journal of Medicine last Thursday said it was only 10 percent effective against H3N2 in Australia.

Additionally, years in which H3N2 is the predominant influenza strain tend to have higher death rates, with approximately 20,000 deaths in the 2012-2013 and 2014-2015 seasons when H3N2 predominated.

Good news is that H3N2 flu is quite susceptible to the available flu medications, like Tamiflu, also known as oseltamivir. Remember, it is most helpful if taken within 48 hours of the start of the flu. It can take up to two weeks for the body to build up defences against the virus.

It is especially important for pregnant women to get the vaccine. There is dual benefit for the pregnant woman to get vaccinated. Not only will she get protection, but she’ll also pass those antibodies along to her infant, which will protect them for the first 6 months of life when the infant is too young to get the vaccine. And the vaccine is safe for pregnant women and the fetus.

For those who contract the flu, it could make symptoms less severe. Next, make sure to wash hands carefully to limit the spread of the virus and try to avoid close contact with sick people.

People who get sick should also keep up with fluids — and seek medical attention if they start to feel worse or develop shortness of breath, worsening congestion or cough.

Public Health Concerns

1.       Trace the first case of H3N2 in India
2.       High risk people to consider vaccinations
3.       Do not allow any person suffering from flu to enter public places
4.       Give compulsory off to people suffering from flu

5.       Learn cough etiquettes and respiratory hygiene

Sunday, January 7, 2018

New strain of H1N1 virus in Rajasthan

New strain of H1N1 virus in Rajasthan
Doctors should follow the national flu guidelines; people should follow basic hygiene 

New Delhi, 07 January 2018Recent estimates have indicated that there have been more than 100 cases of flu in Jaipur, Rajasthan with over 10 deaths within a one-week duration. The cases are due to a new strain in the H1N1 virus called the Michigan strain. H1N1 is associated with increased hospitalizations and deaths among elderly adults and young children.The Rajasthan government on January 3 sounded an alert in the state after more than 400 people were diagnosed positive for the swine flu virus in December 2017.

About 241 swine flu deaths have occurred in the state since January 2017. Apart from this, 3,033 hospitals have swine flu screening centres, 1,580 isolation beds, 214 ICU beds, and 198 ventilators for patients affected by the swine flu virus.

Speaking about this,Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) andImmediate PastNational President Indian Medical Association (IMA), said, “Though the virus may be less dangerous, it is certainly more contagious. As the virus has undergone a change, it is likely to infect more people who have not developed immunity to it yet.Flu (influenza) viruses are divided into three broad categories: influenza A, B or C. Influenza A is the most common type. H1N1 flu is a variety of influenza A.H1N1 indicates the viral serotype.It is a kind of shorthand for characteristics that identify the virus to your immune system and allow the virus to enter your cells. There are many different strains of H1N1 flu.The virus spreads through droplet infection and spreads with a person coughs, sneezes, sings or speaks. The virus can cover only a distance of 3 to 6 feet.”

Some symptoms of H1N1 include: muscle pain; dry cough; diarrhea, nausea, or vomiting; chills, fatigue, or fever; headache, shortness of breath, or sore throat.
Adding further, Dr AggarwalVice President CMAAO, said, “All Rajasthan doctors are advised to administer antiviral drugs to all hospitalized, severely ill and high-risk patients with suspected or confirmed influenza. It is also imperative to follow the national flu guidelines.”

Some take home messages
  • No fever no flu; cough, cold, and fever indicate flu unless proved otherwise
  • No breathlessness no admission
  • People with co-morbid conditions, pregnant women and the elderly should not ignore flu
  • For both hospitalized patients and those managed in the outpatient setting, isolation precautions should be implemented.
  • Hygienic techniques such as handwashing have been shown to prevent the spread of respiratory viruses, especially from younger children.
  • Health care workers in Asia often wear surgical-type face masks to prevent their acquisition of respiratory tract infections. Such masks are increasingly used by travelers for the same purpose.Wear a mask when within three feet of the patient.Health care workers should also use gloves, gowns, and eye protection, as appropriate, when in contact with infected patients
  • Gargling with water three times daily or gargling with povidone-iodine is recommended.
  • Patients and visitors should cover their nose or mouth when coughing, promptly dispose used tissues, and practice hand hygiene after contact with respiratory secretions.
  • Let the patient remain in a single room. All contacts should wear simple masks when within three feet reach. Hand wash after coming in contact with respiratory secretions. Consider flu vaccines for contacts.

Friday, January 5, 2018

Now blood donors can avail official leave on the day of donation



India faces a shortage of 10% relative to its blood requirements


The Heart Care Foundation of India (HCFI), which is celebrating 25 years of Perfect Health Mela   this year, lauded the order from DoPT approving 4 days special casual leave each year for blood donation or apheresis donation at any licensed blood bank for all Central Government employees. The aim is towards ushering in 100% voluntary blood donation by 2020.


Every year India requires about 5 crore units of blood, out of which only a meager 2.5 crore units of blood are available. India faces a shortage of 10% relative to its blood requirements. In absolute terms, this means covering a shortfall of over 12 lakh units. Given that the eligible donor population of India is more than 512 million, this deficit is alarming.


Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “India has huge population of more than 1.3 billion, but is still short of blood. Blood donation is a requirement of the society. All donations should be voluntary. One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion. The move by DoPT is a very positive one and will hopefully encourage more and more people to come forward and donate blood. My humble suggestion is that all private sector establishments should also adopt this rule.All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.”


Under the new National Blood Transfusion Council regulations, no blood is to be wasted. The surplus left over plasma is fractionated to manufacture products like albumin and intravenous immunoglobulins (IVIG). The blood that is donated in voluntary blood donation should be maximally utilized.


Adding further, Dr AggarwalVice President CMAAOsaid, “Now no camp should be organized for ‘whole blood donation’. Instead components-only blood donation camps should be organized. One unit of blood collected can be used to help 3 to 4 patients, instead it is being wasted as whole blood depriving another patient in need. And, voluntary blood donation camps should be now called ‘blood component donation’ camp and not just blood donation camp. So, if the blood being donated is collected in a single bag, do not give blood. Usually two component bags are used. 100 ml bags should be promoted for pediatric use.”


Some things to consider for donating blood are as follows.

  • Prepare yourself by having enough fruit juice and water in the night and morning before you donate blood.
  • Avoid donating blood on an empty stomach. Eat three hours before you donate blood. Avoid fatty foods. Eat food rich in iron such as whole grains, eggs, and beef, and spinach, leafy vegetables, orange and citrus.
  • Don’t consume alcohol or caffeine beverages before donating blood.
  • Avoid donating blood for 6 months if you had any major surgery.

Monday, January 1, 2018

WHO first-ever list of antibiotic-resistant “priority” pathogens



  • A new study by researchers at Harvard University of all 48 million Americans aged 65 and older on Medicare found people were dying after just a single day of breathing air that met federal standards, but was somewhat dirty. The study was published Tuesday in JAMA. Environmental Protection Agency sets safety standards and if pollution is below that standard, everyone is safe but the same is not correct. There is no safe level of exposure to either pollutant.
  • Decades of research, including a new study published December 26 in JAMA has failed to find substantial evidence that vitamins and supplements do any significant good.
  • Delhi LG gave a nod to three big health schemes of the Delhi government – treatment for road and fire accident and acid attack victims, outsourcing of high-end diagnostic tests and surgeries. He has given a nod to the amendment in the Delhi Arogya Kosh (DAK), which would help pay for the free diagnostic tests and surgeries. LG, however, asked the government to maintain an income ceiling for the people who would be allowed to avail the benefits of the scheme “so that the resources of the government are used to help the poor and the needy and the poor are not crowded out by the well-to-do”. With recent cases of medical negligence and malpractices in private hospitals, the LG also urged the government to have a mechanism to penalize institutions in case of malpractice or even poor quality of services.
  • Nabarangpur: A district consumer forum has ordered a doctor of the Christian Hospital here to pay a compensation of Rs 20 lakh for “deficiency of service and medical negligence”, which left a pregnant woman paralysed on the lower part of her body (paraplegia), seven years ago. Sabina, a Bachelor of Physiotherapy was administered anesthesia as many as seven times by Dr Nag on May 19, 2010 while performing cesarean delivery, even though the latter was not qualified as MD (Anesthetist) and did so after her repeated refusal.
  • In a shocking case from Argentina, doctors accidentally tore off an infant’s head during a delivery. The incident occurred as they were trying to deliver a premature baby when the child got stuck inside.
  • WHO published its first ever list of antibiotic-resistant "priority pathogens" – a catalogue of 12 families of bacteria that pose the greatest threat to human health. The WHO list is divided into three categories according to the urgency of need for new antibiotics: critical, high and medium priority. The most critical group of all includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They include Acinetobacter, Pseudomonas and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus). They can cause severe and often deadly infections such as bloodstream infections and pneumonia. These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria. The second and third tiers in the list – the high and medium priority categories – contain other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhea and food poisoning caused by salmonella.
  • Drugs banned in 2017: Fixed dose combinations of nimesulide + levocetirizine; fixed dose combinations of ofloxacin + ornidazole injection; fixed dose combinations of gemifloxacin + ambroxol; fixed dose combinations of glucosamine + ibuprofen and fixed dose combinations of etodolac + paracetamol.
  • In a new essay publishing 28 December in the open access journal PLos Biology, Kristofer Wollein Waldetoft and Sam P. Brown of Georgia Institute of Technology propose that development of alternative therapies for mild infections could help slow the development and spread of antibiotic resistance, thereby preserving the drugs' effectiveness for use in severe infections.
  • Do not routinely administer prophylactic antibiotics in low-risk laparoscopic procedures: The use of prophylactic antibiotics in women undergoing gynecologic surgery is often inconsistent with published guidelines. Although the appropriate use of antibiotic prophylaxis for hysterectomy is high, antibiotics are increasingly being administered to women who are less likely to receive benefit. The potential results are significant resource use and facilitation of antimicrobial resistance.
  • Avoid the unaided removal of endometrial polyps without direct visualization when hysteroscopic guidance is available and can be safely performed: Endometrial polyps are a common gynecologic disease. Though conservative management may be appropriate in some patients, hysteroscopic polypectomy is the mainstay of treatment. Removal without the aid of direct visualization should be avoided due to its low sensitivity and negative predictive value of successful removal compared to hysteroscopy and guided biopsy.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Group
President Heart Care Foundation of India

Immediate Past National President IMA