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Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Member Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


2nd June, 2010, Wednesday

What Constitutes Professional Misconduct? (Part 3)

Dear Colleague

CHAPTER 7:  MISCONDUCT:
The following acts of commission or omission on the part of a physician shall constitute professional misconduct rendering him/her liable for disciplinary action

7.1 Violation of the Regulations: If he/she commits any violation of these Regulations.

7.2 If he/she does not maintain the medical records of his/her indoor patients for a period of three years as per regulation 1.3 and refuses to provide the same within 72 hours when the patient or his/her authorised representative makes a request for it as per the regulation 1.3.2.

7.3 If he/she does not display the registration number accorded to him/her by the State Medical Council or the Medical Council of India in his clinic, prescriptions and certificates etc. issued by him or violates the provisions of regulation 1.4.2.

7.4 Adultery or Improper Conduct: Abuse of professional position by committing adultery or improper conduct with a patient or by maintaining an improper association with a patient will render a Physician liable for disciplinary action as provided under the Indian Medical Council Act, 1956 or the concerned State Medical Council Act.

7.5 Conviction by Court of Law: Conviction by a Court of Law for offences involving moral turpitude / Criminal acts.

7.6 Sex Determination Tests: On no account sex determination test shall be undertaken with the intent to terminate the life of a female foetus developing in her mother's womb, unless there are other absolute indications for termination of pregnancy as specified in the Medical Termination of Pregnancy Act, 1971. Any act of termination of pregnancy of normal female foetus amounting to female foeticide shall be regarded as professional misconduct on the part of the physician leading to penal erasure besides rendering him liable to criminal proceedings as per the provisions of this Act.

7.7 Signing Professional Certificates, Reports and other Documents: Registered medical practitioners are in certain cases bound by law to give, or may from time to time be called upon or requested to give certificates, notification, reports and other documents of similar character signed by them in their professional capacity for subsequent use in the courts or for administrative purposes etc. Such documents, among others, include the ones given at Appendix –4. Any registered practitioner who is shown to have signed or given under his name and authority any such certificate, notification, report or document of a similar character which is untrue, misleading or improper, is liable to have his name deleted from the Register.

7.8 A registered medical practitioner shall not contravene the provisions of the Drugs and Cosmetics Act and regulations made there under. Accordingly, Prescribing steroids/ psychotropic drugs when there is no absolute medical indication; selling Schedule ‘H’ & ‘L’ drugs and poisons to the public except to his patient; in contravention of the above provisions shall constitute gross professional misconduct on the part of the physician.

7.9 Performing or enabling unqualified person to perform an abortion or any illegal operation for which there is no medical, surgical or psychological indication.

7.10 A registered medical practitioner shall not issue certificates of efficiency in modern medicine to unqualified or non–medical person.

(Note: The foregoing does not restrict the proper training and instruction of bonafide students, midwives, dispensers, surgical attendants, or skilled mechanical and technical assistants and therapy assistants under the personal supervision of physicians.)

7.11 A physician should not contribute to the lay press articles and give interviews regarding diseases and treatments which may have the effect of advertising himself or soliciting practices; but is open to write to the lay press under his own name on matters of public health, hygienic living or to deliver public lectures, give talks on the radio/TV/internet chat for the same purpose and send announcement of the same to lay press.

7.12 An institution run by a physician for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation centre or any type of training institution etc. may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees.

7.13 It is improper for a physician to use an unusually large sign board and write on it anything other than his name, qualifications obtained from a University or a statutory body, titles and name of his speciality, registration number including the name of the State Medical Council under which registered. The same should be the contents of his prescription papers. It is improper to affix a sign–board on a chemist's shop or in places where he does not reside or work.

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.

7.15 The registered medical practitioner shall not refuse on religious grounds alone to give assistance in or conduct of sterility, birth control, circumcision and medical termination of Pregnancy when there is medical indication, unless the medical practitioner feels himself/herself incompetent to do so.

7.16 Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may result in sterility the consent of both husband and wife is needed.

7.17 A registered medical practitioner shall not publish photographs or case reports of his / her patients without their permission, in any medical or other journal in a manner by which their identity could be made out. If the identity is not to be disclosed, the consent is not needed.

7.18 In the case of running of a nursing home by a physician and employing assistants to help him / her, the ultimate responsibility rests on the physician.

7.19 A Physician shall not use touts or agents for procuring patients.

7.20 A Physician shall not claim to be specialist unless he has a special qualification in that branch.

7.21 No act of in vitro fertilization or artificial insemination shall be undertaken without the informed consent of the female patient and her spouse as well as the donor. Such consent shall be obtained in writing only after the patient is provided, at her own level of comprehension, with sufficient information about the purpose, methods, risks, inconveniences, disappointments of the procedure and possible risks and hazards.

7.22 Research: Clinical drug trials or other research involving patients or volunteers as per the guidelines of ICMR can be undertaken, provided ethical considerations are borne in mind. Violation of existing ICMR guidelines in this regard shall constitute misconduct. Consent taken from the patient for trial of drug or therapy which is not as per the guidelines shall also be construed as misconduct.

7.23 If a physician posted in rural area is found absent on more than two occasions during inspection by the Head of the District Health Authority or the Chairman, Zila Parishad, the same shall be construed as a misconduct if it is recommended to the Medical Council of India/State Medical Council by the State Government for action under these Regulations.

7.24 If a physician posted in a medical college/institution both as teaching faculty or otherwise shall remain in hospital/college during the assigned duty hours. If they are found absent on more than two occasions during this period, the same shall be construed as a misconduct if it is certified by the Principal/Medical Superintendent and forwarded through the State Government to Medical Council of India/State Medical Council for action under these Regulations.

 

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor

 

Photo Feature (From file)

Campaign to Eradicate Evils from the Society

 

As the female ratio drops, it also destabilizes the society and leads to lack of progress. Heart Care Foundation of India had instigated a campaign to eradicate this evil practice from the society by highlighting leading women who made us proud of their achievements and are role models to many. This campaign was conducted in close association with Department of Health and involved many celebrities.

Dr k k Aggarwal
Health Minister Dr Kiran Walia, Kathak exponent Ms. Nalini, Padma Shri Dr KK Aggarwal, Mr G.D. Geha,
Ex–CMD TCIL releasing a message against female feticide

International Medical Science Academy Update (IMSA): New FDA Drug Update

Ecallantide — A genetically engineered recombinant kallikrein inhibitor, that blocks the production of bradykinin, has been approved by US FDA for acute attacks of hereditary angioedema. It is administered by subcutaneous injection.

References:

  1. http:// www.accessdata.fda.gov/ scripts/ cder/ drugsatfda/ index.cfm? fuseaction=Search.Label_ApprovalHistory#apphist.
 

Mnemonics of the Day (Dr Prachi)

Causes of Impotence – PLANE

Psychogenic: performance anxiety
Libido: decreased with androgen deficiency, drugs
Autonomic neuropathy: impede blood flow redirection
Nitric oxide deficiency: impaired synthesis, decreased blood pressure
Erectile reserve: can’t maintain an erection

News and Views

1. Radiation vs watching for prostate cancer: one is not better than the other

A study from investigators at Tufts University in Boston for the Centers for Medicare and Medicaid Services (CMS) says that it cannot be said for certain that radiation therapy for localized prostate cancer is better than surveillance due to inadequate data. Only retrospective analyses have compared radiation treatment with no treatment or no initial treatment. According to the report, data comparing the relative efficacy of different types of radiation therapy also are insufficient to permit definitive conclusions regarding efficacy, safety, and toxicity.

2. FDA issues liver injury warning for weight loss drug

According to FDA release, Orlistat, the weight–loss drug, marketed both by prescription as Xenical (120 mg) and over–the–counter as Alli (60 mg), will carry a warning about the potential for severe liver injury; although it did state that such injury has been reported rarely and that a cause–and–effect relationship has not been established.

3. Stenting equals surgery for carotid stenosis

The randomized controlled CREST trial has shown carotid stenting to be as effective as endarterectomy in patients with carotid stenosis. According to Thomas Brott, MD, of the Mayo Clinic in Jacksonville, Fla., and colleagues, no significant difference in the primary composite endpoint –– the 4–year rate of periprocedural stroke, myocardial infarction, or death, or postprocedural ipsilateral stroke were observed between stenting and endarterectomy; 7.2% vs 6.8%.

4. Omega–3s may help reduce aspirin resistance

Adopting two approaches, omega–3 fatty acids plus low–dose aspirin or using a higher dose of aspirin in aspirin–resistant patients led to improved response to the drug, finds research published in the Jan. 12 issue of the Journal of the American College of Cardiology.

Quote of the day (McMahon Pharmacy Practice News, November 2009)

Portfolio Life – Where can it take you?
David Corbett’s book, "Portfolio Life, The New Path to Work, Purpose and Passion after 50."
"Attitude is everything." Corbett lists five habits of attitude:
1. Be optimistic and embrace change
2. See things in a new light
3. Take it slow, as the boss of your life
4. do what you want to do to create change
5. Cultivate an attitude of curiosity

Question of the Day

What is the advantage of inactivated polio vaccine (IPV) over oral polio vaccine (OPV)?

OPV is the recommended vaccine for routine immunization and pulse polio program. IPV is yet to become part of national immunization schedule. But, it has various advantages.
1. IPV can be given to children with immunosuppression (congenital or drug induced) where OPV is contraindicated .
2. The seroconversion after primary vaccination with IPV ranges from 89% to 100% for poliovirus type 1, from 92% to 100% for poliovirus type II, and from 70% to 100% for poliovirus type III. The corresponding seroresponse with OPV ranges from 61% for polio virus type 1, 71% for polio virus type 2, and 40% for polio virus type 3.The seroconversion is increased after giving five or more doses of OPV.
3. There is a risk of vaccine associated paralytic poliomyelitis (VAPP) which is 1 per 2.8 million children receiving first dose of OPV. Fortunately this risk reduces with subsequent doses. There is no risk of VAPP when IPV is given. 4. IPV is not likely to lead to circulating vaccine derived poliovirus (cVDPV), which has caused poliomyelitis in some countries.

Liver Fact

If SGOT/SGPT rises more than 25 times normal, it is invariably a hepatic cellular illness.

Women Safety Tips

A few notes about getting into your car in a parking lot, or parking garage:

  • Be aware: look around you, look into your car, at the passenger side floor, and in the back seat.
  • If you are parked next to a big van, enter your car from the passenger door. Most serial killers attack their victims by pulling them into their vans while the women are attempting to get into their cars.
  • Look at the car parked on the driver’s side of your vehicle, and the passenger side… If a male is sitting alone in the seat nearest your car, you may want to walk back into the mall, or work, and get a guard/policeman to walk you back out.

IT IS ALWAYS BETTER TO BE SAFE THAN SORRY. (And better paranoid than dead.)

7 Myths About Bipolar Disorder (1)

People with Bipolar Disorder alternate between extreme Depression or Mania.

eMedinewS Try this it Works

Help with nasogastric tube placement

Placing a nasogastric tube requires patient cooperation, especially in initiating swallowing at the correct moment when the tube has to advance beyond the pharynx. Problems arise when a patient has an altered sensorium or totally refuses to accept the idea of swallowing the tube.

Instead of asking the patient to swallow, wait until the tube has reached a point beyond the nasopharynx. Then place a finger at the patient’s larynx. When the next natural swallowing reflex is initiated for accumulated salivary secretions, the larynx will move cephalad and the tube can be gently negotiated in the correct direction.

Dr Good Dr Bad

Situation: A patient suffered A TIA.
Dr Bad: You are fine, no follow up is required.
Dr Good: Come for regular follow–up atleast for one year.
Lesson: During the first year after a TIA, the risk of developing a stroke increases by 13–14 fold and during the first FIVE years, a 7–fold increase in stroke is seen.

Make Sure

Situation: A patient with large intestinal diarrhea developed sepsis after he was given anti–motility drugs.
Reaction: Oh my God, Why was an antibiotic not given?
Lesson: Make sure that if anti–motility drug is given in a large intestinal diarrhea, it is always given with an antibiotic.

IMANDB Joke of the Day

Son asked his mother the following question: Mom, why are wedding dresses white?’ The mother looks at her son and replies: Son, this shows your friends and relatives that your bride is pure.

The son thanks his Mom and goes off to double-check this with his father.

Dad why are wedding dresses white?

The father looks at his son in surprise and says: Son, all household appliances come in white

Formulae in Clinical Practice

Predicted A–a gradient for age
Formula: A–a = 10 + (age/10)
Comment: There is no known correction for smoking.

Milestones in Urology

1815–1898: Leopold Ritter von Dittel, an Austrian urologist, is best known for his pioneer diagnostic work with the cystoscope for endoscopic detection of bladder tumors and other urinary disorders. A medical instrument known as a Dittel sound is named after him, which is used for treatment of stenosis of the urethra.

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

QuantiFERON test (QFT)

Results can be available within 24 hours, compared to 48 to 72 hours for the Tuberculin Skin Test Not believed to boost responses measured by subsequent tests, which can happen with TST, causing incorrect interpretations.

MCI Update : The Board extends date for clearance of cases

The Board of Governors of the MCI has extended, from June 15 to July 15, the date for consideration of giving the Letter of Permission for new colleges and renewal of permission for colleges already approved under Section 10A of the MCI Act 1956. The Board has been evaluating 87 recommendations. However, the extension is applicable only for the academic session 2010-11 as an exceptional case. The Board has been requested to give wide publicity to the decision for the benefit of medical colleges and the general public. The Ministry has also clarified to the Board that as far as postgraduate courses in the broad-speciality are concerned, the last date for grant of permission for the academic year 2010-11 already ended on March 31 and no further extension was possible. However, with regard to postgraduate medical courses in the super-speciality, the last date for grant of permission continues to be July 15 for the academic year 2010-11 as per existing regulations. (Source The Hindu)

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

DCI Approval Date

Abacavir Sulfate Tablet 60mg

For the treatment of HIV–1 infection in combination with other antiretroviral agents

1.08.2009

 

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eMedinewS–revisiting 2010

The second eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited .

 

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Public Forum (Press Release for use by the newspapers)

Tableau on World Environment Day

To earmark the World Environment Day falling on June 5, Heart Care Foundation of India jointly with Department of Environment, Government of Delhi would be creating awareness about safe environment throughout the city by way of a tableau. The tableau will be flagged off by the Chief Secretary of Delhi on 4th June at 2 PM, which will then move through the city of Delhi distributing pamphlets and answering queries from the public. The tableau will focus on the following:

1. Say No to Plastic Bags
2. Adopt Rain Water Harvesting
3. Recycling Water and Paper
4. Segregating Waste at Source
5. Using Car pools
6. Saying no to Posters in Public Areas
7. Not Waste Electricity and Water
8. Planting Saplings and Preserving Old Trees
9. Disposing e–waste properly
10. Using Solar Energy

Addressing a press conference here, Dr KK Aggarwal, Padma Shri and Dr BC Roy Awardee and President Heart Care Foundation of India and Shri Dharmendra, Secretary (Environment), Govt. of Delhi in a joint statement said that one should live in accordance with the laws of nature. Protecting the environment, ultimately, protects the mankind. All religions talk about preserving environment, said Acharya Sadhnaji Maharaj. We must respect plants as our own siblings.

Dr Anil Kumar, Director environment said that the theme of World Environment Day 2010 is Many Species One Planet One Future. It echoes the urgent call to conserve the diversity of life of our planet. A world without biodiversity is a very bleak prospect. Millions of people and millions of species share the same planet and will together enjoy a safer and more prosperous future.

The star attraction of the press conference was the presence of Olympic Bronze Medal winning wrestler Shri Sushil Kumar and his coach Shri Ramphal. In a joint statement the celebrities said that we should treat every garden in the city as our farmhouse, Metro as our personal limousine, low floor DTC bus our personal car and Yamuna Nadi as our swimming pool.

Talking about CFC-free world, Dr. KK Aggarwal said that India is a signatory to 2010 deadline for a100% CFC-free world. Most of the inhalers currently in use in the country use CFC and need to be changed to HFA inhalers.

CFC is also present in phone, refrigerators and air–conditioners.

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

Share eMedinewS

If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. Dear Dr Aggrawal The process for admissions to MBBS course starts around month of Nov./ Dec. with issuance of application forms of AIPMT conducted by CBSE. The entrance tests are usually held in the months of April and May and admissions start by 2nd week of June. As maximum numbers of students, around 1800, are admitted through AIPMT the number of seats available should be known before start of counselling. For entrance tests, especially of Private Medical Colleges, which are for about 50 to 200 general category seats it should be known at the time of filling the form so that candidate can decide about applying or not on that basis and his/her capability. The Establishment of Medical College Regulations, 1999, were amended by notification dated 26 august 2009. The last date for Issue of Letter of Permission by the Central Government is 15th June and BOG has extended this date to 15 July for this year. Cases of 93 institutes are pending for Establishment of new Medical Colleges/ Renewal of Permission/ Increase of Seats under Section 10 A under MCI Act. It will not be fair to start AIPMT counselling before total number of available seats are known, as there are some govt. colleges also which have applied for renewal or increase in number of seats. Dr Kamlesh Kanodia