October 19   2015, Monday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
Do Not Employ AYUSH Doctors

MCI Code of Medical Ethics and Regulations 2002

“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.”

The above Regulation clearly prohibits taking assistance from any unqualified person for surgery, especially abortions.

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

The regulation again clearly says that any allopathic doctor shall not appoint any non-allopathic doctor for any allopathic services as appointing him/her, would amount to issuing a certificate of efficiency in modern medicine.

“2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care”.

The regulation clearly says that if there is any emergency, we have to take care of our patients ourselves. We cannot pass on this responsibility to an unqualified persons.

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

This regulation clarifies that because Ayush doctors do not have special qualification in allopathy they cannot be treated as allopathic practitioners.

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

As per this regulation we should not use touts or agents for procuring patients. Any non- modern medicine doctor, if assist us in procuring patients, it will be regarded as a violation of the above clause.

“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.”

This regulation clearly mentions that if any MBBS doctor, appoints any Ayush Doctor, the responsibility will be of the MBBS doctor and not of the Ayush doctor.

The Maharashtra FDA has recently issued guidelines regarding prescription where it clearly mentions that another doctor cannot sign on the prescription paper of treating doctor. There are many Supreme Court Judgments which has clearly mentioned that Ayush doctors cannot prescribe allopathic drugs

National Consumer Disputes Redressal Commission New Delhi Original Petition No.214 of 1997

“When a patient is admitted in a hospital, it is done with the belief that the treatment given in the hospital is being given by qualified doctors under the Indian Medical Council Act, 1956. It is not within the knowledge of the relatives of the patient that the patient is being treated by a Unani Specialist. We hold that it is clear deficiency in service and negligence by the hospital for leaving the patient in the hands of Unani doctor."

“As laid down by Apex Court in the above case (Jacob Mathew case), we feel it is high time that hospital authorities realize that the practice of employing non-medical practitioners such as Doctors specialized in Unani system and who do not possess the required skill and competence to give allopathic treatment and to let an emergency patient be treated in their hands is a gross negligence. We do not wish to attribute negligence on the part of Dr. Rehan alone while the patient was in his charge in terms of directing to pay compensation but solely on the hospital authorities for leaving the patient in his complete care knowing he is not qualified to treat such cases."

Supreme Court came down heavily in cases where Homeopathic Doctors treated the patients with allopathic medicines.

In Poonam Verma Vs. Ashwin Patel and Others (1996) 4 SCC 332 where a doctor holding Diploma in Homeopathic Medicine and Surgery (DHMS) and registered under Bombay Homeopathic Practitioners Act, caused the death of a patient due to administration of Allopathic medicine, the Supreme Court held him being not qualified to practice Allopathy, was a quake or pretender to the medical knowledge and skill as a charlatan and hence guilty of negligence per se. The facts being similar in this case, we hold that there is total negligence in treating the deceased patient."

"Thus, we feel that an amount of Rs.7, 50,000/- would be appropriate amount of compensation in face of peculiar facts and circumstances.”

Dr. Mukhtiar Chand & Ors. Vs. State Of Punjab & Ors., decided by the Supreme Court on 08/10/1998, reported as AIR 1999, SC 468, (1998 (7) SCC 579) K.T.Thomas, Syed Shah Mohammed Quadri

“A harmonious reading of Section 15 of 1956 Act and Section 17 of 1970 Act leads to the conclusion that there is no scope for a person enrolled on the State Register of Indian medicine or Central Register of Indian Medicine to practise modern scientific medicine in any of its branches unless that person is also enrolled on a State Medical Register within the meaning of 1956 Act."

Rajya Sabha Question

AYUSH practitioners prescribing allopathic medicines: Rajya Sabha, information given by the Minister for Health & Family Welfare, Dr. Anbumani Ramadoss in a written reply to a question in the Rajya Sabha. The matter regarding qualified practitioners of Ayurveda, Unani, Siddha and Homoeopathy systems prescribing allopathic medicines has been examined in depth by the Hon'ble Supreme Court of India in Civil Appeal No.89 of 1987 Dr. Mukhtiar Chand & Others versus State of Punjab & Others.

Representations have been received from time to time on this matter and accordingly Department of AYUSH entrusted the study of the contemporary acts on medical practice in the light of judgement of Hon'ble Supreme Court in 1987 Dr. Mukhtiar Chand & Others versus State of Punjab & Others and other similar judgements. Drugs can be sold and supplied by a Pharmacist or a Druggist only on a prescription of a Registered Medical Practitioner and who can also store them for treatment of patients.

According to Section 2 (ee) of the Drugs and Cosmetics Rules, 1995, Registered Medical Practitioner means a person –

(i) holding a qualification granted by an authority specified or notified under Section 3 of the Indian Medical Degrees Act, 1916 (7 of 1916), or specified in the Schedules to the Indian Medical Council Act, 1956 (102 of 1956); or

(ii) registered or eligible for registration in a medical register of a State meant for the registration of persons practicing the modern scientific system of medicine (excluding the Homoeopathy system of medicine); or

(iii) registered in a medical register (other than a register for the registration of Homoeopathic practitioners) of a State, who although not falling within sub-clause (i) or sub-clause (ii) is declared by a general or special order made by the State Government in this behalf as a person practicing the modern scientific system of medicine for the purposes of this Act.

Hon'ble Supreme Court upheld the validity of Rule 2 (ee) (iii) as well as the notifications issued by various State Governments there under allowing Ayurveda, Siddha, Unani and Homoeopathy practitioners to prescribe allopathic medicines.

In view of the above judgment, Ayurveda, Siddha, Unani and Homoeopathy practitioners can prescribe allopathic medicines under Rule 2 (ee) (iii) only in those States where they are authorized to do so by a general or special order made by the concerned State Government in that regard. Practitioners of Indian Medicine holding the degrees in integrated courses can also prescribe allopathic medicines if any State act in the State in which they are practicing recognizes their qualification as sufficient for registration in the State Medical Register.

KR/SK/95 – RS: http://pib.nic.in/newsite/erelease.aspx?relid=30117, 20th August 2007

IMA Stand

• IMA members should not appoint Ayush doctors to assist them in their medical/surgical operations.

• IMA should not assist Ayush doctors if they are performing any surgeries like giving Anesthesia, providing post-operative care and or using them as assistants in providing medical or surgical care.
Breaking news
FDA approves Sapien Valve-in-Valve

The FDA approved the Sapien XT aortic valve to replace failing bioprostheses in high surgical risk patients, a move based on good 1-year survival and safety results reported from the PARTNER II valve-in-valve registry at the Transcatheter Cardiovascular Therapeutics meeting. Danny Dvir, MD, of St. Paul's Hospital in Vancouver, announced the approval at the end of his presentation of the results at the TCT meeting.
Dr Good Dr Bad
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Specialty Updates
• New, evidence-based recommendations from the American Thyroid Association (ATA) focus on the diagnosis and management of differentiated thyroid cancer and will help guide clinicians in managing patients with thyroid nodules, interpret biopsy results and molecular marker studies, and initiate risk assessment and cancer screening. The new ATA guidelines are published in the journal Thyroid.

• A new study suggests that larger brain size could signal a reduced risk of cognitive impairment, including dementia. The findings are published in the journal Alzheimer's Research and Therapy.

• Pacemakers identify atrial fibrillation and enable initiation of anticoagulation to prevent strokes, suggests new research presented at Acute Cardiovascular Care 2015.

• The National Institute for Health and Care Excellence (NICE) recommends daclatasvir as a treatment option for adult patients with chronic hepatitis C virus (HCV) infection.

• A genetic variant near the KLF14 gene regulates hundreds of genes that govern how and where women's bodies store fat, thus affecting their risk of developing type 2 diabetes, suggests new research presented at the American Society of Human Genetics (ASHG) 2015 Annual Meeting.

• A new clinical practice guideline from the American Academy of Sleep Medicine promote high quality, patient-centered care and provide clinicians with updated recommendations for the treatment of intrinsic circadian rhythm sleep-wake disorders (CRSWDs). The guideline is published October 15 in the Journal of Clinical Sleep Medicine.

• Among immunocompromised patients admitted to the intensive care unit with hypoxemic acute respiratory failure, early noninvasive ventilation compared with oxygen therapy alone did not reduce the risk of death at 28 days, reported a study published in JAMA.

• A 2,259-person study conducted at 11 academic medical centers revealed that dietary supplementation with vitamin D and/or calcium after removal of pre-cancerous colorectal adenomas (polyps) did not reduce the risk of developing future adenomas. The findings were published in the New England Journal of Medicine.

• When a pregnant woman has gestational diabetes, her unborn child tends to react more slowly to sounds after the mother consumes sugary foods or drinks compared to the offspring of a woman without the disorder, suggests a new study published in the Journal of Clinical Endocrinology & Metabolism. The findings suggest that mother's metabolism can affect child's risk of diabetes, obesity later in life.

• An older tumor necrosis factor (TNF) inhibitor or secukinumab appear to work better than newer biologic agents in promoting response in patients with psoriatic arthritis (PsA) who have inadequate response to or do not tolerate disease-modifying antirheumatic drugs (DMARDs) or nonsteroidal anti-inflammatory drugs (NSAIDs), suggests a meta-analysis published in Seminars in Arthritis and Rheumatism.
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Media
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eSPIRITUAL
On the 7th Navratri, Enjoy a mind devoid of inner darkness
Kalaratri is worshipped on the 7th day of Navratri. She is dark and black like night. Her hairs are unlocked. SHE has three eyes and four hands.

She holds a sharp Sword in her right hand and blesses her devotees with her lower hand. HER vahana is a donkey, destroyer of darkness and ignorance (or shava). She spills out fire from her nostrils. She has put on necklaces shining like lightening. In Yoga Shastra, she represents the Sasahara Chakra

Spiritual mantra on the 7th Navratri

On the 7th day, control your aggression (lion), take right decisions (mudras) by controlling your ignorance (donkey) using your sharp intelligence (sword).
Legal Quote
Jacob Mathew v. State of Punjab SC / 0457 / 2005: (2005) 6 SCC 1 (iv)

“A doctor accused of rashness or negligence, may not be arrested in a routine manner (simply because a charge has been leveled against him). Unless his arrest is necessary for furthering the investigation or for collecting evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make himself available to face the prosecution unless arrested, the arrest may be withheld.”
Medicofinance
In addition to stripping out the equity, it is also possible to protect the residence by transferring ownership but retaining control and beneficial enjoyment. This can be done in a number of ways.

An arm’s-length cash sale is the best way to protect the residence (and the equity in the residence) because it is much easier to protect liquid assets than real estate. While this technique affords the doctor, the best possible protection for his home, it is also the most radical and may result in additional income taxes. This technique is usually reserved for doctors facing very determined plaintiffs, or doctors facing government agencies.

An alternative to an outright sale is the sale and leaseback of the residence to a friendly third-party on a deferred installment note. This allows the doctor to transfer the ownership of the residence without having to move out. This structure works only so long as the doctor can establish the legitimacy and the arm’s-length nature of the sale.

(Source: IJCP)
Industry News
Government panel seeks more CSR flexibility: A committee set up by the ministry of corporate affairs (MCA) has recommended that smaller companies get greater operational flexibility for meeting their corporate social responsibility (CSR) obligations. The committee has also suggested insertion of an 'omnibus clause', so that any activities that serve public purpose are covered as eligible CSR activities. It has also proposed a hike in the cap for administrative spends related to CSR activities. The committee has not recommended any penalty for non-compliance as of now, as the CSR obligation requirements are in their infancy. (The Times of India)

Nasscom launches new initiative for developers in partnership with Facebook: Nasscom along with Facebook has launched a new initiative to support developers building apps and mobile websites for “new-to-Internet” users. Under the ‘Leaders Building for the Next Billion Program’, Nasscom will invite developers and students through an application process. Of these, 10 developers will be selected who will be provided with technical, marketing, financial support and leadership skills to build their applications and businesses. (Financial Express – PTI)

Kerala to set up medical Devices Park: Kerala State Council of Science, Technology and Environment (KSCSTE) in collaboration with Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) and Kerala State Industrial Development Corporation will establish a medical devices park in the state. Suresh Das, Dept. of Science and Technology Secretary said, “The medical devices and equipment industry is valued at 2.5 billion US dollars. The growth rate of this industry is much higher than that of healthcare. Of the devices which are used in India, only 10 per cent are made here. Thiruvananthapuram has a high number of palliative care centres. All these point to the need for a medical devices park.” Its role will not be limited to encouraging start-ups. The medical devices park will function as an agency which will provide accreditation to medical device manufacturers especially from other countries. (Express News Service)

Health IT VC 'back on track' after dip: Venture capital funding for digital health rebounded in Q3 2015, up 32 percent quarter over quarter with $1.6 billion doled out across 148 deals, according to a new report from Mercom Capital Group. VC cash for health IT has piled up to the tune of $3.57 billion for 2015 so far. "VC funding into healthcare IT companies bounced back this quarter after a slow start this year," said Mercom Capital CEO Raj Prabhu. (Healthcareitnews - Mike Miliard)
Inspirational Story
Nothing is too big for God

Two men went fishing. One man was an experienced fisherman, the other wasn’t. Every time the experienced fisherman caught a big fish, he put it in his ice chest to keep it fresh. Whenever the inexperienced fisherman caught a big fish, he threw it back.

The experienced fisherman watched this go on all day and finally got tired of seeing this man waste good fish. "Why do you keep throwing back all the big fish you catch?" he asked. The inexperienced fisherman replied, "I only have a small frying pan."

Sometimes, like that fisherman, we throw back the big plans, the big dreams, the big jobs and the big opportunities that God gives us. Our faith is too small. We laugh at that fisherman who didn’t figure out that all he needed was a bigger frying pan; yet how ready are we to increase the size of our faith?

Whether it’s a problem or a possibility, God will never give you anything bigger than you can handle. That means we can confidently walk into anything God brings our way.
eMEDI QUIZ
All of the following are examples of traction epiphysis, except:

1. Mastoid process.
2. Tubercles of humerus.
3. Trochanters of femur.
4. Condyles of tibia.

Yesterday’s Mind Teaser: The nerve commonly damaged during McBurney's incision is:

1.Subcostal
2.Iliohypogastric.
3.11th Thoracic.
4.10th thoracic.

Answer for Yesterday’s Mind Teaser: 2.Iliohypogastric.

Answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Jainendra Upadhyay, dr poonam chablani, Dr.K.Raju, Avtar Krishan

Answer for 17th October Mind Teaser: 3. Left common carotid artery arising from brachiocephalic trunk

Correct Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr K V Sarma, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan.
eWELLNESS
How can you explain coronary artery disease to your patients?

The following is how I communicate with my patients and explain to them about coronary artery disease.

• There are three coronary arteries, which can be equated to three main roads of the city.

• Any road has shops on each side. The coronary artery has the endothelium on the sides.

• There are pavements in front of the shops. The pavements in coronary arteries are called intima-media.

• When the local municipal corporation does not maintain discipline, shopkeepers start encroaching the pavement. In terms of coronary arteries, this is equivalent to intima media thickness.

• The next to follow are temporary encroachments of the road, which is equivalent to several plaques in the coronary arteries.

• Then comes permanent encroachment, which is equivalent to heart plaques.

• With encroachment, the traffic slows down and heavy honking of horns starts. This denotes angina or chest pain.

• When the traffic congestion is heavy, motorists often blow their horn continuously. This can be equated to unstable angina.

• When the traffic stops, but the car engine is still working, this can be likened to a heart attack.

• When the car stops and the engine also stops, this is a cardiac arrest.
eMEDIPICS
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Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
MTNL Perfect Health Mela 2015.

Pls click here for details
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Humor
A boss asked one of his employees, "Do you believe in life after death?"

"Yes, sir," replied the new employee.

"I thought you would," said the boss. "Yesterday after you left to go to your grandmother's funeral, she stepped in to see you!
Medicolegal
Bioethical issues in medical practice

Defensive Medicine

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
New Delhi

The rate of cesarean section deliveries is growing all over the country. Obstetricians are often accused of using cesarean section to increase their income. On the other hand, issues such as increasing maternal age, precious babies, mothers’ insistence, safety and ease, parents’ schedule preferences, and preferences for doctor’s and hospital’s office hour delivery all result in increasing operative deliveries. However all doctors believe that ‘natural is the way to go’ in pregnancy. Yet operative deliveries are undertaken to avoid the smallest risk to mother or child. What do you think?

a. Is caesarean section a part of defensive medicine?

b. Do you agree to cesarean section deliveries in general?

c. Can such sections lead to complications for the baby such as prematurity and therefore, should they be always avoided?

d. If no to cesarean section, then what is the alternative?

e. Should there be definite essential requirements for cesarean section?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
WMA News
NEW GUIDELINES FOR PHYSICIANS ON TRANSGENDER HEALTHCARE

New guidelines for physicians to enable them to increase their knowledge and sensitivity towards transgender people and the unique health issues they face have been approved by the World Medical Association.

At its annual General Assembly in Moscow, the WMA emphasised that everyone has the right to determine their own gender and that gender incongruence is not in itself a mental disorder. Delegates from almost 60 national medical associations agreed that every effort should be made to make individualised, multi-professional, interdisciplinary and affordable transgender healthcare available to all people who experience gender incongruence. They approved guidelines explicitly rejecting any form of coercive treatment or forced behaviour modification and said that transgender healthcare aims to enable transgender people to have the best possible quality of life.

The guidelines were proposed by the German Medical Association, which said they acknowledged the inequities faced by the transgender community and the crucial role played by physicians in advising transgender people and their families about treatment.

Delegates said they were aware of the cultural sensitivities in some parts of the world about this issue, but also said it was important for the WMA to stress that cultural, political or religious considerations must not take precedence over the rights, health and well-being of transgender people.

WMA President, Sir Michael Marmot, said: We condemn all forms of discrimination, stigmatisation and violence against transgender people and want to see appropriate legal measures to protect their equal civil rights.

And as role models, physicians should use their medical knowledge to combat prejudice in this respect. We would like national medical associations to take action to identify and combat barriers to care.

It is important that there is appropriate expert training for physicians at all stages of their career to enable them to recognise and avoid discriminatory practices, and to provide appropriate and sensitive transgender healthcare.'
Breaking news
Top consumer court orders tests on Maggi

The apex consumer court on Thursday for the first time ordered tests on 13 samples of Maggi noodles from nine batches to determine lead and "MSG stock glutamate" content. The decision was taken by a bench of the National Consumer Disputes Redressal Commission (NCDRC). The NCDRC said the Maggi samples should be sent to the Central Food Technological Research Institute (CFTRI) in Mysore in Karnataka after verifying the seal and samples in the court's presence. "The 13 out of 25 total samples be sent to CFTRI in Mysore for analysis to determine the quantity of lead and 'Monosodium glutamate (MSG) stock glutamate' in the aforesaid samples," the bench said. "All the samples will be packed in a box by a special magistrate, duly signed and sealed by him. The box will be sent to the laboratory by a special messenger and the recipient will have to compare both seal and signature on the box and the forwarding letter to ensure there is no tampering during transit."…On June 5, the FSSAI ordered Nestle India to withdraw and recall all nine Maggi variants, halt production and stop exports, saying samples were found to be unsafe and hazardous for human consumption. (The Pioneer - IANS)
MAKE SURE
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IMA Satyagraha, suggested slogans
• Writing prescription drugs by a non-MBBS is injurious to health of the community.

• Writing prescription drugs by unqualified people can be dangerous.

• Allow doctors to treat patients irrespective of patients’ income.(If compensation is not capped, we can't do this)

• When there is capping of Rs 2 lakh for a sterilization death, why not for other procedures?

• When there is a compensation of Rs 30,000/- for a sterilization failure, why not for other procedures?

• Allow us to treat poor and rich equally.

• Non pelvic ultrasound providers should be out of PCPNDT Act.

• Unless caught doing sex determination, no criminal offence shall be registered.

• If any prospective parent asks for sex determination, they should be booked under a non bailable offense.

• More patients will die if doctors are not provided protection during duty hours.

• Death does not mean negligence.

• Money spent does not mean you will get a cure.

• Including single clinic and small establishments under Clinical Establishment Act will make treatment costly.

• How can we treat patients using outdated standard treatment guidelines made by government?

• How can government decide the charges of a clinical establishment?
Increasing number of healthcare professionals top priority
India faces a shortfall of two million doctors and four million nurses for its population and therefore increasing the number of healthcare professionals has to be a top priority for the country, according to the healthcare representative body, NATHEALTH. Improvement and advances only in medical technology is insufficient for improving the quality of service delivery as India's doctor-to-population ratio is at an abysmal 0.65 per 1,000 as against WHO benchmark of 2.5, it added. "Currently, there is a shortfall of nearly two million doctors and four million nurses in the Indian healthcare system. The doctor-to-population ratio of India is an abysmal 0.65 per 1,000," NATHEALTH Secretary General Anjan Bose said. The biggest paradox in Indian healthcare is its very large differences in deliverables. He added, "On the one hand, we have some of the 'best in class' healthcare delivery systems which can even attract medical tourists from all over the world, largely because of the lower costs involved.” Sushobhan Dasgupta President NATHEALTH said: "Increasing the number of healthcare professionals is a top priority for the country. Healthcare as a sector is largely dependent on information and manpower… With judicious plans and efficient implementation, the private sector and government need to work hand in hand as one collaborative team to make further progress and make India one of the global hubs of innovation and manufacturing in healthcare, particularly medical technology." (Business Standard – PTI)
AAOS: Orthopedic surgeons can help stem opioid epidemic
Orthopedic surgeons are the third-highest prescribers of opioids, behind physicians and dentists. An information statement released October 12 by the board of directors of the American Academy of Orthopedic Surgeons (AAOS) shows specialists how they can decrease opioid use, misuse, and abuse by retooling the way they prescribe these painkillers, limiting prescriptions before surgery, and improving transparency in prescription tracking. David Ring, MD, PhD, a member of the AAOS Patient Safety Committee, said in an AAOS news release, “A culture change has created the current opioid epidemic, and only a culture change — led by physicians unafraid to limit opioid prescriptions — will solve the epidemic," "It's up to us to treat pain with less dependence on opioids.” (Medscape)
Most patients forget colonoscopy results as time goes by
Findings from a new study presented at the ACS Clinical Congress 2015 suggest that patient recall of colonoscopy findings and follow-up procedures fades quickly. According to study investigator Mark Tarakji, MD, a surgical resident at the St. John Hospital and Medical Center in Detroit, most patients were not able to recall the number of polyps detected if the colonoscopy was performed 2 years earlier, even if they recalled having polyps. More than one year after colonoscopy, less than 40% of patients remembered whether they had polyps removed, and by 4 years, 72% of patients could not remember when the procedure was performed. They indicate that surgeons and other physicians performing colonoscopies should examine previous endoscopy reports before making clinically significant decisions. (Medscape)
MCI Code of Ethics Regulations, 2002
3.5 Treatment after Consultation: No decision should restrain the attending physician from making such subsequent variations in the treatment if any unexpected change occurs, but at the next consultation, reasons for the variations should be discussed/explained. The same privilege, with its obligations, belongs to the consultant when sent for in an emergency during the absence of attending physician. The attending physician may prescribe medicine at any time for the patient, whereas the consultant may prescribe only in case of emergency or as an expert when called for.
IMA JIMA
IMA Digital TV
GP Tip: The cough of congestive failure

A persistent night cough can be a symptom of subtle congestive heart failure, especially in the elderly.
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Readers column
Dear Sir, Very Informative news. Regards: Dr Shantanu

Sir the emedinews provides very useful information. Regards: Dr krishan
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Over 50 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Davangere
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Digital IMA
Press Release
One can reduce stress by changing their interpretation of the situation

We live in the age where stress has become an integral part of our lives. While some amount of stress motivates us to be better at what we do and put in just that extra effort to achieve our goals, too much stress has a drastic impact on our health.

Stress promotes overindulgence in comfort foods, which are high in trans fats, sodium and sugar making us prone to obesity, diabetes, heart disease and hypertension. It encourages us to depend on evils such as smoking, alcohol/drugs and may lead to substance abuse. It causes a lack of sleep, and promotes a sedentary lifestyle. Stress may also affect our mental health, which may manifest as anxiety and depression.

In view of the fact that stress has been implicated in many lifestyle diseases that are prevalent today, stress management is of paramount importance.

Speaking about effective stress management techniques, Padma Shri Awardees, Dr A Marthanda Pillai, National President Indian Medical Association (IMA) and Dr K K Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India said, “Stress is the reaction of the body or the mind to the interpretation of a known situation. So, stress can be managed by either changing the situation, changing the interpretation or taming the body the yogic way in such a manner that stress does not affect the body. Every situation has two sides. Changing the interpretation means looking at the other side of the situation. It is something like half a glass of water, which can be interpreted as half empty or half full.”

But, removing the known situation may not be possible all the time. For example, if your job is too stressful, resigning may not always be feasible.

The modality, therefore, is to change your interpretation towards the stressful situation for which one should start thinking positively and different and choose the resultant options within, which do not hurt the heart.

Changing of the interpretation is what in allopathic terms is described as cognitive behavior therapy, the origin of which comes from Ayurveda. In the Bhagavad Gita, Lord Krishna counsels Arjuna following the principles of Cognitive Behavioral Therapy.

Apart from counseling, one can also prepare the body in such a way that stress does not bother them. This can be done by learning the art of pranayam, relaxation, meditation, regular exercise.

Research has shown anger, hostility and aggression to be the new risk factors for heart disease. Even recall of anger has been shown to precipitate a heart attack. Various studies have shown that if doctors talk positively in front of unconscious patients in the ICU, their outcome is better than those in whose presence doctors talk negatively.”

The best way to practice spiritual medicine is to experience silence in one’s thoughts, speech and actions. Simply walking amidst nature with silence in the mind and experiencing the sounds of nature can be as effective as 20 minutes of meditation. Twenty minutes of meditation provides the same physiological parameters as that of seven hours of deep sleep.