IMA as on today

A meeting of the IMA Action Committee & State Presidents’ & Secretaries’ Annual Review Meeting was held on 27^th August, 2017 at New Delhi where following issues were deliberated and passed:

·         IMA is planning an IMA fast for nonviolence on 2^nd October where every doctor will fast from Dusk to Dawn and will continue its efforts in persisting with its demands with the government, the nonviolent way.

·         IMA is against criminal prosecution of doctors unless mens rea or an intention to harm can be established.

·         IMA takes strong objection to the application of Section 308 on doctors of Gorakhpur Medical College for administrative lapses. The concerned officers could have been suspended/transferred, as is usually done, so that a fair inquiry can be conducted, but not to charge them with penal provisions until the report of the inquiry. The recent widespread violence in Haryana after Ram Rahim was convicted was also due to a system failure. But, only the DSP was suspended. Also, Section 308 was not applied in this case.

·         IMA has requested that all health care providers (interns, PG, doctors) to be mandatorily given vaccination by their employers. 

 ·         All IMA members will conduct school health program under Aao School Chalen programme on the 5^th of every month.

·         All IMA members should either conduct Aao Gaon/Slum Chalen Project for the community or participate in antenatal services camp as the case may be on the 9^th of every month.

·         To build up the professional image of IMA and to raise various issues, IMA is coming out with series of advertisements. IMA brought out 14 half page advertisements in Indian Express during the monsoon parliament session and will bring out 15 full page advertisements in the winter parliament session. IMA also regularly releases advertisements in newspapers regarding public health.

·         Past is past. IMA does not want to go into the controversy whether or not the practice of “cuts and commissions” is prevalent in the society. IMA has issued a circular to all its member doctors informing them that they are only entitled to charge for consultation, skilled procedure and medical services provided to their patients.

·         Doctors are brand ambassadors for the society and IMA has decided that over 1 lakh members of IMA will pledge their organ donation on NOTTO website before 2^nd October.

·         IMA has declared MDR TB as a public health emergency and the new IMA campaign, which is the 2nd freedom struggle will be IMA TB Initiative: GTN. G is for diagnosis of TB using GeneXpert test, T is for tracing the contacts and treat them and N stands for Notifying (mandatory) TB patients.

·         IMA Adverse action reporting has been made mandatory by IMA for all its members at helpline Number 9717776514.

·         IMA has also appointed Honorary IMA Professors as academic Brand Ambassadors of the profession all over the country.

·         IMA is also campaigning to check the menace of Antimicrobial Resistance, which is a new epidemic of the society.

·         IMA has also offered to the Govt. to adopt a few different tribal areas on a PPP Model.

·         IMA has also written to all its members to promote Digital Payment while dealing with their patients.

·         IMA has also directed all its State Branches to make use of all public events in their respective states like Melas and Fairs and conduct public health activities in the same.

·         IMA has also written to the ministry to consider risk hazard allowances for all doctors working in various hospitals starting from their internship.

·         IMA is against any hospital (Govt. or Private) having more than 85% bed occupancy rate. All patients getting admitted where the occupancy is more than 85% should be referred to the nearest empanelled hospitals and in case of Government, the expenses should be borne by the government. IMA can, in no way, justify or support the Government’s move for not denying any admission and keeping two patient on one bed. To maintain quality and safety, such cases should be referred to the nearest hospitals where facilities are available and the expenses should be borne by the hospitals on predefined terms and conditions. 

·         Residents of the hospitals should not be allowed to work more than 48 hours in a week and the practice of moonlighting should be introduced in Govt./Private Hospitals where doctors from outside can be appointed as an ad hoc locum on hourly basis.

·         IMA has also decided to promote Khadi, our cultural heritage.  During its CWC meeting, all doctors should wear a Khadi Apron and will support the campaign for Swadeshi Khadi as a healthy cloth.

·         IMA new policy for Blood Donation is to collect blood in multiple bags to facilitate separation of components.

·         IMA is coming out with sustained campaign on Swachh Bharat.  

Indian men increasingly suffering premature hair loss

Men in 20s and 30s are opting for hair restoration surgery

New Delhi, 30 August 2017: According to statistics, there has been an increase in the number of people with premature hair loss in the last few years. Of every 10 people complaining of hair loss, about 8 are men. As per the IMA, a sizeable number of young men in their 20s and 30s are opting for hair restoration surgery. Premature hair loss is a problem that is increasing in incidence among young Indian men due largely to stress and lifestyle factors.

It is normal for a person to lose about 50 to 100 strands of hair a day. However, serious hair loss is a sign that something is not right with the body and is called alopecia. The four major factors responsible for premature hair loss include stress, certain habits such as smoking and drinking, pollution, and poor nutrition.

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, “Alopecia is usually genetic. However, thanks to the lifestyle changes and stress today, younger men are becoming prone to this problem. Hair fall can be a reaction to extreme mental or physical stress. The body typically starts shedding hair after a gap of three months. Other than this, certain diseases which cause mal-absorption of nutrients such as food poisoning can also lead to hair loss. With increasingly stressful jobs, consumption of junk food that is devoid of nutrients and fibre, inadequate consumption of water, and habits such as smoking and drinking, premature hair loss is becoming a major cause of concern among young men.”

Nutrition is vital for hair growth. No other part of the human body grows at the rate of half an inch per month, except the bone marrow. It is therefore important to feed it right.

Adding further, Dr Aggarwal, said, “Unless the problem becomes severe and requires treatment, it is possible to bring about an 80% change through lifestyle changes only. One can bring about some simple lifestyle changes such as getting seven hours of sleep, drinking enough water (strands are made up of minerals, which only water can replenish), and eating protein-rich foods at regular intervals, as these can prevent premature hair loss.”

Some tips to prevent premature hair loss include the following.

• Massage your scalp with lukewarm oil as this will help in improving blood circulation and stimulate hair follicles.
• Try and avoid stress through techniques such as yoga and meditation. The stress hormones, epinephrine and cortisol, interfere with the natural growth of hair.
• Eat fresh fruits and vegetables as they help in promoting healthy hair growth. It is good to consume food rich in iron, zinc, proteins, and omega three fatty acids.
• Quit smoking and drinking. Not only do these habits result in hair loss but also prevent hair growth.

IMA Fast for Non Violence on 2nd October

Dear Colleague

During the recent meeting of IMA National Action Group, it has been decided to observe "IMA Fast for Non Violence", a Dawn to Dusk Fast by every Branch and every member of IMA on the occasion of Gandhi Jayanti, October 2, 2017 from 6.00 am to 6.00 pm, to mark our continuing Satyagraha to the Government to take action on our demands.

All Medical Organizations and Associations (FOMA) and all members of IMA are requested through our State & Local Leaders to observe the fast on 2^nd October 2017, in support of our pending demands.

The broad guidelines for observing the above Fast shall be as follows:-

·         Pandals to be erected near the District Collectorate in all the Districts of the country.

·         Prominent leaders of the district to take part in the Fast.

·         Necessary banners, backdrops and Placards to be prepared and displayed in the Pandal (content will be made available soon on IMA website).

·         All medical students to be involved in the Fast and they will organize their Fasts in respective Medical Colleges in specially erected dedicated pandals (necessary backdrops, banners to be arranged).

·         All practicing doctors to observe “Dawn to Dusk Fast” in their Clinics/Medical Institutions while working.

·         All fasting participants to wear badges (content of badge to be provided by IMA HQs).

·         Proper reporting to be done to IMA HQs on the proforma (to be provided by IMA HQs.) along with digital copies of photographs of the event.

·         Special venues for the Fast are:

o    Rajghat

o    Sabarmati Ashram, Gujarat

o    Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha

You are requested to kindly take suitable necessary action at your Branch level to ensure utmost success of the event, which will go a long way in acceptance of our demands by the Govt.

Dr KK Aggarwal National President, IMA

Dr RN Tandon Hony. Secretary General, IMA

Dr RV Asokan Chairman, IMA National Action Cell

Disclaimer: The views expressed in this write up are entirely my own.

Skewed doctor-patient ratio and quackery major issues in public healthcare today

Rural areas have only 1.1 lakh doctors and many unqualified professionals masquerade as doctors

New Delhi, 29 August 2017: As per recent statistics, India has only about 1 million allopathic doctors to treat its population of over 1.3 billion people. Of this, only 1.1 lakh doctors work in the public health sector and therefore, about 900 million people in the rural areas are dependent on this small number of doctors for their healthcare requirements. According to the IMA, in such a situation, patients must share beds and doctors face severe burnout due to the skewed doctor-patient ratio in these areas.

India lacks adequate number of hospitals, doctors, nurses, and public health workers. There is a wide gap in the quality of and access to healthcare. This is not just between states but also urban and rural areas. The issue is further compounded by quackery with unqualified people masquerading as doctors. In the absence of doctors, people have no choice but to visit such quacks for treatment.

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, “The recent infant deaths in UP bring to light, two very pertinent issues in healthcare delivery today: one is the skewed doctor-patient ratio and the other is that of quackery in the profession. It is a sad fact that in rural areas, the sick are first taken to the ‘so-called’ faith healers offering treatment in the garb of doctors, before they are brought in to a hospital for actual treatment. These quacks are at times educated only up to Class 12 and lack any medical qualification whatsoever. What is disturbing further is that there are not enough trained doctors in the country. Many do not wish to opt for entering the public healthcare system and this results in even ward boys proclaiming themselves as doctors in rural areas.”

As per surveys, only 1 out of 5 doctors in the rural areas are qualified to practice medicine. The IMA has taken a strong stand against quackery. This was also one of the issues raised by the association in a movement called Dilli Chalo conducted in June this year.

Adding further, Dr Aggarwal, said, “There is a need to conduct an updated assessment of quackery at both the state and district levels. Instead of training Ayush practitioners and quacks in prescribing allopathic medicine, there is a need to strengthen the traditional systems of medicine in offering first line of treatment and care.”

IMA urges one and all to beware of quacks as they indulge in cuts and commissions, will never refer the patient in time, invariably give steroids in every case, and will over investigate the patient to appear genuine. On the other hand, people should have faith in registered and qualified doctors as they do not indulge in unethical practices, do not take or give commissions, work with the primary aim and dharma of healing and not financial gain, believe in Karma and not Kriya, and will always guide patients with the best of interest. 

IMA Campaigns to build up the image of the medical profession

Dr KK Aggarwal

National President IMA

Dear Colleague

To build up a strong image of the medical profession, the Indian Medical Association (IMA) is starting the following campaigns:

• MDR TB now a public health emergency as it is now a threat to community as well as health care providers. IMA: 2nd freedom struggle to end TB IMA TB Initiative: GTN, where G stands for sputum GeneXpert test for all suspected cases, T stands for trace and treat all contacts and N stands for notify (mandatory) at Nikshay http://nikshay.gov.in.
• Doctors are brand ambassadors for the society and unless they pledge their organs, the society will not follow. All doctors are requested to pledge their organs at: http://notto.nic.in/Admin/Login.aspx
• Charity begins at home. The general public will not follow preventive health advice unless doctors themselves follow the same. All IMA members are requested to get their annual checkup done once a year under the IMA campaign: Physician’s Health first. All doctors should get themselves get fully vaccinated.
• To build the community image of the profession all doctors are requested to visit a school assembly on 5^th of every month and conduct a 5-minute (or more) school children health education advisory program under “IMA Aao School Chalen” project.
• All IMA members are required to report adverse reactions to drugs (serious or non-serious), devices, vaccines, herbs, blood transfusion to IMA PvPI number 9717776514 under IMA PvPI Initiative.
• All designated IMA Professors  should spread the positive image of medical profession under the IMA campaign “Jiska Koi Nahi Uska IMA”.
• Each state or local branch of IMA should adopt slums/ villages / elderly homes and conduct an activity of 9^th of every month under IMA Aao Gaon Chalen project
• Each state or local branch of IMA should on conduct antenatal awareness and check-up program on the 9th of every month in support of the Pradhan Mantri Surakshit Matritva Yojana.
• All state and local branches are directed to file complaints to IMA headquarters against all doctors indulging in female feticide, unethical medical practices or tarnishing the name of IMA in media or social media.    
• All members should resort to digital transactions with the patients
• Past is Past: We do not want to go into controversy whether or not there were cuts and commissions in the medical practice, now onwards medical practice will be 100% ethical and doctors will charge only for consultation, skills and medical services provided.
• All IMA CMEs should have the following slide inserted before every lecture

IMA PvPi number 9717776514 IMA CMEs are tobacco-free, noise and air pollution-friendly, IMA CME lectures must cover a question each on mental health, bioethics, legal medicine and rational use of antibiotics and investigations Pledge organs at http://notto.nic.in/Admin/Login.aspx Report every TB case at nikshay.gov.in IMA has zero tolerance for cuts, commissions without service, female sex determination and female feticide. Do not criticize your colleagues in social media or news media. Join IMA Fast for Non-Violence on 2nd October.

Disclaimer: The views expressed in this write up are entirely my own.

Severe psoriasis may trigger heart attack

It is imperative to prevent triggers to avoid the symptoms from becoming worse

New Delhi, 28 August 2017: A study that followed over half a million people for about 5 years has indicated that psoriasis may increase the chances of getting a heart attack. The risk of a heart attack was related to the severity of psoriasis in people. The overactive immune system that triggers psoriasis can cause inflammation which can further infiltrate the arteries of the heart. As per the IMA, patients with one illness may be stricken by another condition which may seem unrelated and sometimes more serious. This is known as a ‘shadow disease’.

Psoriasis is an immune-mediated condition affecting the skin and causes red, flaky, crusty patches of covered with silvery scales. The condition occurs when the immune system mistakes a normal skin cell for a pathogen, and sends out faulty signals that cause overproduction of new skin cells.

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, “Psoriasis is an incurable, long-term (chronic) inflammatory skin condition. The severity of the condition varies --- periodically improving and worsening. At times, the condition may not appear for years and stay in remission. In some people, the symptoms can aggravate in the winter months. The spectrum of this disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface. There are multiple clinical subtypes of psoriasis. Plaque psoriasis, the most common presentation of psoriasis, most commonly presents with sharply defined erythematous plaques with overlying silvery scale. The scalp, extensor elbows, knees, and back are common locations for plaque psoriasis lesions.”

Psoriatic arthritis occurs in about 30 percent of patients with psoriasis, and precedes the skin manifestations in approximately 15 percent of patients. A diagnosis of psoriasis can be made by history and physical examination in majority of the cases. Occasionally, a skin biopsy is needed to rule out other conditions.

Adding further, Dr Aggarwal, said, “Numerous topical and systemic therapies are available for the treatment of psoriasis. Treatment modalities are chosen on the basis of disease severity, relevant comorbidities, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response.”

Some tips to prevent psoriasis flare up are as follows.

• Reduce stress Stress can have a negative impact on people with psoriasis. The body tends to have an inflammatory reaction to stress in turn leading to a flare-up.
• Avoid certain medications Some medications can interfere with the body’s autoimmune response and cause inflammation, thus triggering psoriasis.
• Prevent skin injuries Injuries to the skin can trigger psoriasis in some people. This is known as the Koebner phenomenon.
• Eat a healthy diet Being obese or overweight appears to make psoriasis symptoms worse. Thus, it’s important to manage your weight by exercising and eating a healthful diet.

Communicating with patients may motivate them to adhere to prescribed treatment

Dr KK Aggarwal

A new research reports that low-income patients with high blood pressure are less likely to take their medications as directed if their healthcare providers do not use a collaborative communication style or ask them about social issues.

The three-month study published in the journal Circulation: Quality and Outcomes examined the impact of patient–provider communication on medication adherence among a sample of primary care providers and their patients who had hypertension. Most of the participants were black, unemployed and reported some college education. The study found that:

·         Patients were three times less likely to take their high BP medications when their providers did not possess a collaborative communication style such as asking open-ended questions and checking their understanding of instructions.

·         Patients were also six times less likely to take their medications as prescribed when a healthcare provider did not ask them about social issues such as employment, housing and partner relationships.

This study demonstrates the negative impact of poor communication on adherence to treatment and highlights the need for better doctor-patient communication to improve compliance to treatment and achieve desired treatment outcomes. The study says that “such discussions signal to the patient genuine caring and concern by the doctor, which strengthens patient’s ability to cope with their life and illness, along with motivation and confidence related to self-management of their disease”.

Listening is very important skill for doctors. The concerns of patients should be addressed without being judgemental. Therefore, in addition to prescribing medicine, doctors should also take note of the social determinants of health when managing their patients, as they have significant role to play in the health and wellbeing of the patient.

Patients want support and encouragement to take their prescribed medications, especially in case of chronic illnesses such as hypertension, diabetes, heart disease, etc. They either often forget to take their medication or may not realize the need for adherence to treatment.

Low income patients usually may not be well educated. This group of patients must be explained the need of compliance to the treatment prescribed. They have to be educated about the disease and why medication is important. This reassures the patient and he/she is motivated to follow your instructions more willingly.

On the other hand, high income patients sometimes may be too busy to remember to take their medications. It may not be a priority for them, at that time. Adherence to medications in such high income patients can be improved by SMS reminders.

As Sir William Osler famously said, “The good physician treats the disease; the great physician treats the patient who has the disease.” 

(Source: AHA News Release, August 22, 2017)

Disclaimer: The views expressed in this write up are entirely my own.

Indian males at a risk for developing Metabolic Syndrome due to fault lifestyle

Healthy eating and timely assessment of vital statistics are some preventive measures

New Delhi, 27 August 2017: Statistics indicate that people with metabolic syndrome (MS) are at a three times higher risk for heart attack and stroke. They are also at a five-fold risk of developing Type II diabetes. According to the IMA, the urban male is likely to develop MS largely due to faulty lifestyle. Abdominal or central obesity is a common occurrence in India and such individuals have thin limbs but fat around the abdomen.

A person is said to have MS when along with Waist Circumference of more than 90 cm (men), 80 cm (women), any two of following five are present:triglycerides of more than 150 mg/dl, HDL Cholesterol less than 40 mg (male) and 50 mg (female), fasting sugar (glucose) of more than 100 mg or presence of Diabetes and Hypertension of more than 130 mm Hg systolic or 85 diastolic.

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, “Increasing inactivity and a diet consisting of processed food are some primary reasons for MS. MS refers to a cluster of conditions namely increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. When these occur together, the chances of heart disease, stroke, and diabetes automatically increase. MS is also linked to insulin resistance. In this condition, the cells don't respond normally to insulin, and glucose can't enter the cells as easily. This makes the glucose levels in blood rise despite the body's attempt to control it by churning out more and more insulin.”

Some risk factors for MS include age, race, obesity and weight around the abdomen, diabetes, and other conditions such as cardiovascular disease, nonalcoholic fatty liver disease or polycystic ovary syndrome.

Adding further, Dr Aggarwal, said, “The best way to prevent the risk of MS is to make aggressive lifestyle changes such as diet and exercise.If these do not work, the doctor might prescribe medications to help control your blood pressure, cholesterol levels, and blood glucose.Studies have indicated that individuals who consume a vegetarian diet have a lower risk for developing MS than those who do not.”

Here are some tips to prevent MS.

·  Exercise for about 30 to 60 minutes every day. Make a slow start but ensure that your continue physical activity thereafter.

·  Eat a healthy diet rich in fruits and vegetables, lean protein, whole grains, and low fat dairy. Go easy on saturated fats, trans fat, cholesterol, and salt.

·  Those who are overweight should lose weight and people with a normal weight should aim at maintaining the same.

·  Quit smoking right away.

·  Schedule regular checkups with your doctor to assess your blood pressure, cholesterol, and blood sugar.