Majority of doctors fear violence and are stressed out, reveals IMA study

The all-India survey highlights the unsatisfactory nature of the job and the urgent need to create awareness

New Delhi, 01 July 2017: A landmark all-India survey released by the Indian Medical Association (IMA) on the occasion of Doctors Day has found that about 82.7% of doctors in India feel stressed out in their profession. While fear of violence is the main stressor in many doctors (46.3%) followed by fear of being sued (24.2%) and fear of criminal prosecution (13.7%). The findings come in the light of the many atrocities faced by the medical fraternity today, the most disturbing of which include violence against doctors and their criminal prosecution. The anxiety of doctors over the issues plaguing the profession is evident by the fact that about 56% of them do not get a comfortable 7-hour sleep most days of the week.

Conducted online over a period of 15 days, the survey received responses from 1681 doctors including general practitioners, physicians, surgeons, gynecologists and super specialists working in private OPDs, nursing homes, corporate hospitals or government hospitals. It is an eye-opener on the extent to which doctors have been affected. About 62.8% of the doctors surveyed are unable to see their patients without any fear of violence and 57.7% have thought of hiring security in their premises.

Speaking about the survey, 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 medical profession is undergoing some of the toughest times today with its nobility and integrity at stake. Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future. This survey was aimed at analysing how happy and satisfied doctors are with their profession. The results prove the fact that doctors are not very happy with what they are doing and a large part of it is due to lack of patient trust in them. The emotional, mental, and physical attacks on doctors are at an all-time high. More than half of the doctors surveyed indicate that they suffer from increasing anxiety.  A sizeable chunk does not want their children or grandchildren to take up this profession. Most doctors are of the opinion that while they chose medicine because it was worthwhile and noble, the profession has been reduced to nothing but a charade today."

It is pertinent to note that a large number of doctors suffer from blood pressure and diabetes. Another notable factor is that about 76.3% also get anxiety quite often. As per a nationwide study conducted by IMA earlier, doctors face maximum violence while providing emergency services, with as many as 48.8% of such incidents reported from intensive care units (ICUs) or after a patient undergoes surgery. The main reason reported behind such violence is unnecessary investigations or delay in attending to a patient.

Adding further, Dr Aggarwal, said, "On this Doctor's Day, it is important to make people aware that this growing discontent and anxiety among doctors can have serious consequences for patients. Unhappy doctors will make for unhappy patients. The fear of lawsuits; runaway malpractice liability premiums; and last but not the least, loss of professional autonomy has led to many physicians looking at themselves as mere pawns. This survey is a definite proof of that."

The 'Doctor–Patient' relationship is a sacred one and this survey points to the fact that the dignity of the profession should be maintained. Doctors are also human beings and not healing angels. Victimizing the medical practitioner if the patient does not respond to treatment is unacceptable as are other atrocities against doctors.

Another study conducted by the Indian Medical Association (IMA) highlighted the significance of soft skills for doctors. The survey showed that patients expect their doctors to be courteous; almost 90% of patients wanted their doctors to introduce themselves to patients, acknowledge the patient, give every patient a patient listening, impart complete information about the diagnosis, investigations, and treatment and revise and review what the patient has understood. About 40% of the patients said that the doctor should also thank them for giving an opportunity to treat. So, stay ALERT: Acknowledge and Ask, Listen, Explain, Revise and Review, and say Thank you to the patient.

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

Positive reinforcement key to help patients quit smoking

Doctors should say 'Thank you for not smoking' to patients and avoid the use of discouraging remarks

New Delhi, 30 June 2017: As part of its commitment to working closely with all National Health Programmes alongside the government, the IMA has urged individual doctors to counsel their patients who smoke about quitting smoking. It has, however, said that such counseling should be done in a manner that turns a negative situation into a more positive action. According to statistics, more than one-third (35%) of Indian adults use tobacco in some form or the other. Of these, 21% adults use only smokeless tobacco, 9% only smoke and 5% smoke as well as use smokeless tobacco. Additionally, about 52% of the adults are exposed to second-hand smoke at home.

The National Tobacco Control Programme aims at making the public aware of the harmful effects of tobacco use, controlling tobacco consumption, and minimizing related deaths. Tobacco use has many adverse health effects and is a major preventable cause of morbidity and mortality. Smoking not only increases the risk of various diseases but also reduces the quality of life, and increases health care utilization and cost.

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, "Campaigns on tobacco control convey the message 'smoking kills' with the intention of highlighting the potentially life-threatening health consequences of this habit based on the assumption that this would deter people from smoking or using tobacco products. However, many of these campaigns do not reinforce these messages in a positive manner. It is time to alter the tone of such public health campaigns from negative to positive. Quite often, we rebuke patients for failing in their efforts to quit smoking and tell them they may die if they do not quit. A statement worded in this manner can inadvertently sound discouraging to the patient."

People should know the dangers of smoking or using tobacco products. However, rather than adopting a critical approach, this message should be conveyed through positive communication for a more fruitful impact. Any violent communication should also be avoided.

Adding further, Dr Aggarwal, said, "It is best to avoid the 3Cs of violent communication - Condemn, Criticize, and Complaint. A nonviolent communication approach should be used instead to help and support patients in their efforts to quit smoking. It is important to say 'Thank you for not smoking' to the patients. Appreciate their hard work and perseverance in trying to quit this deadly habit. This way, they would know that they have your support and will in turn have trust and faith in you. Empathetic and supportive communication can increase the chances of patients adhering to lifestyle modifications."

There is a very strong relationship between a doctor's communication skills and the patient’s capacity to follow through with medical recommendations, self-manage their medical condition, and adopt preventive health behaviors. It is imperative for a doctor to adopt a positive approach to explain, listen, and empathize with the patient. This in turn can have a profound effect on the biological and functional health outcomes.  

Ensure single-window accountability for registration, urges IMA

A decision to this effect will help doctors concentrate better on their professional work

New Delhi, 03 June 2017: The IMA will flag off the Dilli Chalo movement on 6th June 2017 as part of its clarion call against the atrocities faced by the medical fraternity. The silent satyagraha, as it is being called, will be joined by thousands of doctors from all over India in person or digitally through a webcast. One of the issues being highlighted as part of the movement is the lack of a single-window registration for doctors and medical establishments.

The  IMA has stated that it is not against regulations and accountability, but the manner in which it has been put into the Law is contradictory to the Central Establishment Act. The Association demanded a single-window accountability, a single-window regulation, which is missing in the Act currently.

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 very fact that 80% of health care services are handled by the private sector means either the services of the government are not up to the mark or they do not have enough infrastructure. The private sector is doing the job of the government. Then why are there so many exams for the medical students and so many registrations for opening a new medical establishment as also so many windows for accountability? Why can’t we have single-window registration and single-window accountability? Doctors also want single-window accountability for registration for license to practice and registration of their medical establishment. Let doctors concentrate on their professional work and not divert their energies in permissions and administration matters."

A single-window accountability for doctors will reduce the scope of harassment and eliminate any differentiation between private and government doctors.

Adding further, Dr Aggarwal, said, "These are testing times with the nobility and dignity of this profession at stake. Only if these issues are addressed at the right time will we be able to restore the faith that humanity has on doctors. The urgent need of the hour is to expose the black sheep which is the cause for all trouble. The medical profession was, is, and will always remain noble."

The last few months have seen several other initiatives by the IMA on this front such as STOP NMC Sathyagraha, two National Protest Days against violence on doctors, NO to NEXT strike in medical colleges, and the National Black Day against West Bengal Clinical Establishments Act. Other than this, 3 action committee meetings and 2 meetings of FOMA were also conducted. The IMA is also initiating a signature campaign on the issues at hand on social media and has urged all doctors to join and collect hundreds of thousands of signatures to demand justice from the government.

IMA to flag off the Dilli Chalo movement

IMA to flag off the Dilli Chalo movement

·         Doctors unified in their stand against the many issues faced by the medical profession

·         This huge movement is the need of the hour to urge the government to take strong action

New Delhi, 02 June 2017: In what will probably be the largest movement against the atrocities faced by the medical profession, the IMA will be organizing the Dilli Chalo movement on 6th June 2017 and has urged the entire medical fraternity to join in large numbers. The Association has already undertaken an intensive month-long campaign to raise awareness on and bring to light the issues faced by the medical profession today. IMA is a unified voice and the collective consciousness of the medical profession in the country.

The medical profession is facing one of the toughest times today. Repeated pleas and appeals by the medical fraternity have not materialized into anything except reassurances time and again, to the extent that states are now coming out with draconian acts like the West Bengal Clinical Establishment Act. It is after having decided that enough is enough that the IMA has given this clarion call, Dilli Chalo.

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, "This is probably one of the toughest phases in the history of medicine. Doctors around the country are agitated and not at mental peace. This is not in the interest of the society. The Protest March will start at 8:00 AM from Rajghat and reach the Indira Gandhi Indoor Stadium by 11:00 AM. Over 50,000 doctors from all over India will join the movement and a large number will gather in Delhi at the Indira Gandhi Stadium. Doctors from over 50 cities including all the 30 states will be participating in the deliberations at the stadium and the remaining will be connected digitally over a live webcast."

The last few months have seen several other initiatives by the IMA on this front such as STOP NMC Sathyagraha, two National Protest Days against violence on doctors, NO to NEXT strike in medical colleges, and the National Black Day against West Bengal Clinical Establishments Act. Other than this, 3 action committee meetings and 2 meetings of FOMA were also conducted.

Adding further, Dr Vijay Malhotra, President, DMA and Dr Satish Tyagi, Secretary General, DMA, in a joint statement, said, "This is a peaceful Satyagraha and not a strike. All doctors will gather at Rajghat and start with the blessings of Mahatma Gandhi. Doctors (senior and junior), students, and the entire medical fraternity will participate in the deliberations. There will be three tableaus moving in and around Delhi to create awareness on these issues. The IMA is also initiating a signature campaign on the issues at hand on social media and has urged all doctors to join and collect hundreds of thousands of signatures to demand justice from the government."

The Dilli Chalo movement aims to address the following demands by the medical fraternity.

·         Criminal prosecution of medical negligence and clerical errors

·         Stringent central act against violence on doctors

·         Capping the compensation in CPA on doctors

·         Professional autonomy in treatment and prescriptions

·         Amendments in PC PNDT, Central CEA, West Bengal CEA Acts

·         No unscientific mixing of systems of medicine

·         Empower MBBS graduates

·         One drug - One company - One price

·         Implement inter-ministerial committee recommendations in six weeks

·         Single window accountability

·         Single window registration of doctors and medical establishments

·         No to NMC: Amend IMC act to maintain professional autonomy

·         Uniform final MBBS exam instead of ‘NEXT’

·         Uniform service conditions for service doctors & faculty

·         Same work - Same pay - Pay parity - No to adhocism

·         Fair conduction of NEET exam

·         IMA member in every government health committee

·         Central anti-quackery law

·         Reimbursement of emergency services provided by private sector

·         25000 family medicine PG seats

·         Aided hospitals and retainer ship in general practice

·         Health budget of 5 % of GDP for universal health coverage

Amend the IMC Act to ensure professional autonomy, says IMA

Amend the IMC Act to ensure professional autonomy, says IMA

Calls the National Medical Commission Act as undemocratic

New Delhi, 01 June 2017: Demanding professional autonomy for doctors, the IMA raised another boiling issue leading up to the nationwide Dilli Chalo movement that it is going to undertake on the 6th of June 2017. Dubbing the move to introduce NMA (National Medical Commission Act) as undemocratic, the IMA intensified its month-long campaign to highlight the problems faced by the medical fraternity today.

Demanding the protection of professional autonomy, the IMA feels that there is a need to amend the present IMC Act as opposed to the introduction of the NMA. The WMA (World Medical Association) has also supported the IMA on their stand.

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, "Doctors are professionals and professional autonomy is their right.  The autonomy of the medical profession is under threat throughout the world and what is happening in India can happen elsewhere too. It is imperative that physicians everywhere speak out against marginalization of the medical profession and in support of professional autonomy, as this is a prerequisite for high-quality patient care as well. The new Commission proposed by the government effectively means that non-doctors handpicked by the government will regulate the medical profession without any autonomy. This is unacceptable."

Currently, the MCI has 130 members, having a representative character with two-thirds elected and one-third nominated professional members representing the entire spectrum of professional stakeholders.

Adding further, Dr Aggarwal, said, "The proposed National Medical Commission will have 19 handpicked members nominated by the government. It will be a 100% nominated Commission with no representative character, mostly comprising non-doctors without any autonomy. This is not acceptable."

The Dilli Chalo march will be joined by over a lakh doctors in the country, both digitally and physically, and followed by deliberations on issues ailing the medical profession, one of them being the drug pricing policy. The IMA is also initiating a signature campaign on the issues at hand on social media and has urged all doctors to join and collect hundreds of thousands of signatures to demand justice from the government.

Air pollution can lead to preterm birth in asthmatic mothers

Air pollution can lead to preterm birth in asthmatic mothers

With the soaring pollution levels in the Capital, IMA urges citizens to do their bit to reduce air pollution

New Delhi, March 3, 2016: The ill effects of air pollution on respiratory health are well-known. Now, a study from the National Institutes of Health (NIH) says that when pregnant women with asthma are exposed to high levels of certain traffic-related air pollutants, they face a greater risk of preterm birth.

The increased risk is associated with both ongoing and short-term exposure to nitrogen oxides and carbon monoxide particularly when women were exposed to those pollutants just before conception and in early pregnancy.

An increase of 30 parts per billion in nitrogen oxide exposure in the three months prior to pregnancy increased preterm birth risk by nearly 30 percent for women with asthma, compared to 8 percent for women without asthma. Greater carbon monoxide exposure during the same period raised preterm birth risk by 12 percent for asthmatic women, but had no effect on preterm birth risk for non-asthmatics. The last six weeks of pregnancy was another critical window for women with asthma. Exposure to high levels of particulate matter — very small particles of substances like acids, metals, and dust in the air — also was associated with higher preterm birth risk.

The study was published online in the Journal of Allergy and Clinical Immunology.

Sharing details, Dr SS Agarwal, National President IMA & Padma Shri Awardee Dr KK Aggarwal, President HCFI and Honorary Secretary General IMA said, “People with asthma who are concerned about exposures to air pollution may want to limit their outdoor activity during periods when the air quality is forecast to be unhealthy for sensitive groups. It is the responsibility of each and every citizen to work towards the reduction of environmental pollution given its serious effects on one’s overall health and well being. If each one of us takes simple environmental friendly steps such as carpooling, discouraging the use of fire-crackers, planting more trees around our houses, the pollution levels can be brought down and several diseases prevented.”

Other Harmful Effects of Air Pollution:

1.      Air pollution affects respiratory system causing breathing difficulties and diseases such as bronchitis, asthma, lung cancer, tuberculosis and pneumonia.

2.      Air Pollution affects the central nervous system causing carbon monoxide poisoning. CO has more affinity for hemoglobin than oxygen and thus forms a stable compound carboxy haemoglobin (COHb), which is poisonous and causes suffocation and death.

3.      Air pollution causes depletion of ozone layer due to which ultraviolet radiations can reach the earth and cause skin cancer, damage to eyes and immune system.

4.      It causes acid rain, which damages crop plants, trees, buildings, monuments, statues and metal structures and also makes the soil acidic.

5.      It causes greenhouse effect or global warming which leads to excessive heating of earth's atmosphere, further leading to weather variability and rise in sea level. The increased temperature may cause melting of ice caps and glaciers, resulting in floods.

6.      Air pollution from certain metals, pesticides and fungicides causes serious ailments.

·         Lead pollution causes anemia, brain damage, convulsions and death.

·         Certain metals cause problem in kidney, liver, circulatory system and nervous system.

·         Fungicides cause nerve damage and death.

·         Pesticides like DDT (Dichloro diphenyl trichloroethane) which are toxic enter into our food chain and gets accumulated in the body causing kidney disorders and problems of brain and circulatory system.