eMedinewS 1st July 2013, Monday

     Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at
www.facebook.com/Dr KKAggarwal

cpr10 Mantra The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

Ringtone - CPR 10 Mantra Hindi

Ringtone - CPR 10 Mantra English

From the Desk of Editor in Chief

eMedinewS wishes all Doctors “Happy Doctors Day”

Happy Doctors Day

100 ways to improve patient doctor relationship

In India doctors has always been considered and given the status of God but with the inclusion of medical services under consumer protection act consumer relationship has started between a patient and a doctor.

In the US and UK the patient is considered God and in Japan a King. In India the patient is now considered as a boss. As the boss can fire his employee so can the patient in today’s consumer health industry. The patient, therefore, should never be taken for a ride or for granted.

Patient should, therefore, be treated like a consumer and all the principles of consumer industry should apply to medical fraternity. Unfortunately, the medical professionals are not taught how to attend, treat and provide services.

Following are a gist of the principles which can help better patient doctor relationship.

1. In a consumer industry, consumer is always given the top importance and in health industry, therefore, the patient should be given the top importance.

2. Follow the principle. “Patient is always right”. He may or may not like arguments and can walk away if not satisfied.


3. The famous marketing law also applies to patient-doctor relationship. A satisfied patient (customer) will talk about you to 10 more people but an unsatisfied patient will talk to 100 people against you.

4. Patients like customers can be equated to sheep. They blindly follow each other. Generally, all sheep follow a particular one & so does the patients.

5. Patients like customers require very little to get satisfied. In one of our survey 90% of patients were satisfied when waiting for their turn when the doctor came & said “that I will be with you in a minute”.

6. As a part of medical training always do self role-play studies. Imagine yourself as a patient and imagine what wouldyou expect from a doctor. Give the same to your patients. Always put yourself in the patient’s shoe and then take actions. This is what Bharat in Ramayana did with Ram’s shoes.

7. Patient like a customer is the profit. Rest everything is overhead. Without patients no establishment has any value. He is your asset.

8. Believe in excellence: Eliminate all those in the establishment who are not related to or are not going to help the patients. The purpose of medical practice should be to create more patients. No patients no business. Carpets, chrome and chandeliers do not impress patients. They want good service. In one of our survey sixty percent of the people put their faith in the capabilities of their doctor and not on their dress code.

9. Patients do not want to be over charged: They don’t want to be over charged both in terms of money and time.

10. Patients want your 100% all the time. They are not bothered whether you are tired, not slept the previous night or have been busy the whole day. If you are attending they want your 100%.

11. Do not loose old patients: Remember, getting a new patient may cost you six times more than to serve the existing one. Always make sure that your existing patients are satisfied. The easiest way to get new patients is to look after your existing patients well.

12. Always meet your patients personally, greet them shake hands with them and try to call them by name. The law is ”If I don’t go I don’t get”.

13. Communicate continuously with your patients. This can be through phone, email, letters, post cards, your personal newsletters and updating their knowledge with updates and warnings.

14. In a medical establishment always insist that each of your healthcare providers visits the patient.

15. Always talk to a patient in a language they can understand and never talk in front of them with a colleague in a language, which they cannot understand.

16. Always look after your regular patients with special care. Give your patients the best service. Always anticipate their problems and provide them early solutions.

17. Patients like to have answers for their queries. Always get the facts from them. Analyze the facts and arrive at a decision. Never forget to listen, listen & listen to your patients.

18. Remember, success in life as a journey and not a destination. Be consistent in your behavior and efforts in long run you will be the winner. Always improve your CGR (character, goodwill and reputation).

19. A good doctor always follows ABC in sequence. Where A stands for Availability, B for Behavior and C for Competence. Without availability competence has no value.

20. While talking a decision remember, 3H. Head, Heart & Hand. Always think from your Head, then listen from the Heart (take a conscious decision), and then take an action (Hand). For example you are facing a problem. The head will give you 6 options but the heart will choose only one.

21. In an establishment always fight for your patients.

22. It is a good idea checking about the attitude of your health care providers on a regular basis from the patients.

23. Prompt action: Always solve the small problems of your patient now. Never wait for the problems to become urgent.

24. A dissatisfied patient is the best teacher. Listen to him He or she may have a solution or a suggestion. Most people who complain are educated and have an answer to the question they are raising.

25. Never have a meeting with dis-satisfied patients together. It may be detrimental to your interest.

26. Do not promise anything, which you cannot give. Learn when to say “No”.

27. Learn patience: When listening to patients try not to interpret them. Be sympathetic to them. Listen patiently, do not confront and always find a solution or give them alternative suggestions. While finding a solution, seek & discuss alternatives.

28. Always help patients in analyzing a problem and solving it.

29. Always compare yourself with yourself and not with other doctors. Remember GOD never made junks. Have confidence in yourself.

30. Instead of making people change, change yourself.

31. Do small things greatly. And do different things differently.

32. Instead of firing your employee put fire in him and motivate him.

33. Always build good thoughts. Always be positive. Remember, mistakes can always be better teachers. Treat every adversity as an opportunity to improve further.

34. Stress is the body reaction to the interpretation of a situation. Change the situation, change your interpretation or prepare your body to withstand the stress.

35. Stress is absence of ideas. Devote time to yourself and have a flow of ideas.

36. The age of your patient is not number of years lived but 100-number of years lived. He has come to you for the future and not for what he ahs lived already. Always be positive in life.

37. Always look at the positive aspects in life. Be happy that the glass is still half full and not worry that it has become half empty.

38. You may be correct in your argument but the other may not be wrong from his or her perceptive. 6 or 9 depends from which direction you are looking at.

39. Do not get angry with errant patients. Find out their end of story too. Remember, the system may be wrong in your training.

40. Never get angry with your employees. If a worker was as good as you he would not have been your worker.

41. Eustress is positive stress. It’s required for life. Always accept challenges. Distress is negative stress. It’s harmful. Learn to manage it.

42. Do not believe in KFP but in BFP. KFP is kee pharak penda hae (what difference it makes) and BFP is bada pharak penda ha (it makes a lot of difference). The “chalta hae” attitude is not good for any establishment.

43. Remember, Parkinson’s Law. “the more people you have, less will be the output”. Do not believe in making committees or appointing new people under the existing ones. Have a horizontal chain with many people reporting to the same head.

44. You are a role model to the society and your employees. Do not do any thing in public, which you asking them not to do. Do not smoke or drink in front of your patients.

45. Always train your juniors. Learn to spend 6 hours in sharpening an axe and 1 hour in cutting it. So that next time you save 6 hours.

46. Be a uniter and not a divider. Do not believe in the divide and rule politics. Remember you can only build house on rocks and not sands.

47. What do you want to become? An ape or a monkey? Be an ape and not a monkey. Monkey represents wandering mind and ape the intellect.

48. Washbasin vs. vacuum: The washbasin cleans the dirt while a vacuum sucks the dirt. The approach in life should be the washbasin one.

49. Understand the word NURSE: you are basically nursing a patient. Nobility, Understanding, Responsibility, Simple and Efficiency. A nurse is a noble, understanding, responsible, simple and efficient health care provider.

50. SERVICE, remember the word SERVE: Service, Excellent, Respect, Value and Enthusiasm. Provide excellent service full of value and respect in an atmosphere of enthusiasm.

51. A matchstick has a head but no intelligence. Always think. Take a conscious decision. Do not just be a follower.

52. When ever you are making a statement ask your self: is it the truth, is it necessary and is it kind. If any one of the answer is no do not speak.

53. When ever you are going to take a action ask your self, Is it true, is it necessary, will it bring happiness to me and to others? If the answer is no to any one do not attempt.

54. Always believe in non-violent communication. The principles are observation, feelings, need and request.

55. When narrating or conversing always use “quote unquote”. Always give the actual observations and not your interpretations.

56. Give your feelings and not the analysis. Instead of saying he hurt me say I got hurt.

57. Put a board “thanks for not smoking ” instead of“ any smoking”.

58. In your office write a sign board “ my answer is yes, now tell me your problem”

59. Satisfy your needs and not what you want.

60. You get what you deserve and not what you want. Be contended.

61. Always request and not order. Even a safai karamchari has self-esteem.

62. Creativity is diversity. The cycles involve intended intention, information gathering, information reshuffling, break (incubation period), insight, inspiration and implementation.

63. Smile it costs nothing. Always greet with a smile. A smiling photo in the clinic always helps.

64. Never criticize others in their absence: have the courage to speak in their presence. Your criticism will reach them in no minutes.

65. Do not believe in gossip. Tell a sentence and ask the person to pass it on till it comes back to you. And see how much it has been distorted. Gossip is something talked about a third person in his or her absence and not based on truth or without a reference.

66. Dirty linen or a dirty fish. Take it out. Do not keep people who create nuisance in the organization.

67. Do not believe new comers at first instance. Think before making a deal. Do not get attracted with new proposals. They may not get finalized.

68. Do not make patient as friends. Always keep a distance. When visiting their house do not sit with them and have a dinner on the dining table.

69. Always have a female attendant when examining a female patient.

70. Respect patient privacy. Do not talk about the illness to others without patients consent.

71. Never resist second opinion. The patient has the right for the same

72. Never deny case records to the patient. Every patient has a right to receive them legally within 72 hours.

73. Never ignore an emergency. You cannot refuse to see or attend an emergency. Weather you get your fees or not. It can have criminal implications.

74. Never give telephonic or email consult: You are legally bound as if it was a regular consult.

75. If prescribing a medicine on phone pronounce the alphabets. Remember two drugs may sound similar.

76. Write legibly. Write drugs in bold letters so that there are no mistakes.

77. Never write 4U insulin. In one instance he received 40 units. Always write units and not U.

78. Never write .25 mg always write as 0.25 mg. Other wise there are chances the patient may take 25 mg in the first instance.

79. Never write a prescription “paracetamol 8-2-8” instead write “paracetamol 8am 2pm 8pm”. There are chances the person may take 8 tab in the morning, 2 in the afternoon and 8 at night.

80. Give the option of generic named drugs from a standard company to the patient. They may be cheaper.

81. When writing a prescription write the most important drugs on the top and not otherwise. This is how the patient is used to.

82. Write clearly when you want the patient to take the medicines. Otherwise his assumption will be not to take empty stomach.

83. Explain the patient about the charges. They think hospital as a hotel not realizing that all charges vary according to the category chosen in a hospital.

84. Never argue with you seniors in others presence. You may win arguments but loose relationships.

85. Never criticize your colleagues in front of the patient. Even if they have made a mistake.

86. Negligence is not error of judgment but inability to provide average degree of care.

87. Remember the magnitude of care may vary but the standards of care should be the same.

88. Do not call your colleague as a trainee, student or a junior. The patient may not understand that language.

89. You have a right to refuse a patient provide it was not an emergency.

90. You have a right to choose your fees.

91. The business laws are: Profit, policy, happiness. Your policies should be such they not only ends in savings but also provides happiness to you, your patients and your employees.

92. Even to your relations give consults in your chamber. You will have a better respect.

93. Do not give walking consults in parties. Insist them to come to your chamber.

94. Always update your knowledge. The patient is well read today.

95. Never shy of saying, “ let me read about the subject”. Even judges do the same.

96. Always ask the patient about other doctors he or she is seeing. There are chances he or she may be taking drugs from dentist, ortho or gynae doctor already for different ailments.

97. Always ask for the old records. No one will excuse you of missing drug reactions mentioned in the old records.

98. Never hurt the religious sentiments of patients. Respect all aspects of their emotions.

99. Remember the Vedantic phrase:

Watch your thoughts, they become your words.Watch your words, they become your action.Watch your action, they become your habits. Watch your habits, they become your character.

100. Sow an action and reap a habit.

Sow a habit and reap a character.

Sow a character and reap a destiny.

.....Read More


sprritual blog Neti Neti (Not This Not This)

(The Main Principle of Knowing the Truth)

The main figure in the Upanishads is that of the sage Yajnavalkya. Most of the great teachings of later Hindu and Buddhist philosophy are derived from him. He taught the great doctrine of “neti-neti”, the view that truth can be found only through the negation of all thoughts. ...Read More

Dr K K Blogspot

cardiology news
pediatrics news
wellness blog

Diet is linked to the diabetes epidemic

A study published in the journal Diabetes Care, highlights the importance of the .. .... Read More


Situation: A child with suspected child abuse was found to have a lax anus.
Dr. Bad: This can be normal.
Dr. Good: This is suspicious of sexual abuse.
Lesson: Laxity of the anus may represent abuse. Read More

press release

Monitoring LFT on a Patient


Health risks from dead bodies are negligible (Dr K K Aggarwal)

The health risks of dead bodies are dangers related to the improper preparation and disposal of cadavers. ...Read More

Stress management programs for heart patients a must

Drugs such as beta-blockers and psychosocial interventions can reduce the physiologic response to some forms of stress.

In patients with known coronary disease, the cardioprotective effect of beta blockers with regard to heart attack and sudden cardiac death are partly due to a diminution of catecholamine and hemodynamic-induced endothelial damage and a rising of the threshold for ventricular fibrillation. ...Read More

News Around The Globe

Gene test gives clues to asthma persistence

Genetic risk assessment can provide useful information about whether childhood asthma will remit or persist, but a clinically meaningful test based on identified gene variants is likely many years away, researchers found. (Source: Medpage Today)

Same gene causes hypo- and hypercalcemia

Germline mutations in the GNA11 gene, which plays a critical role in calcium-receptor signaling, can lead to both hypercalcemia or hypocalcemia, researchers reported. (Source: Medpage Today)

CKD: Holistic care may improve low QOL in young patients

Adolescents and young adults with chronic kidney disease (CKD) have low quality of life (QOL) and are willing to trade life expectancy for perfect health, according to a cross-sectional study published online June 24 in the Journal of Pediatrics. (Source: Medscape)

ADA: Aerobic exercise burns fat all on its own

In obese teenage girls, both aerobic exercise and resistance training were effective at reducing total fat -- even if the girls didn't cut calories or lose weight, researchers found. (Source: Medpage Today)

Brisdelle okayed as first nonhormonal Rx for hot flashes

The first nonhormonal drug for hot flashes associated with menopause was approved by the US Food and Drug Administration (FDA) today despite an agency advisory committee having rejected it as too much risk for minimal benefit. (Source: Medscape)

Doctor Patient Relationship: Paradigm Shift ( Dr K K Aggarwal )

Then and Now

Doctor is GOD

Patient is GOD

Doctor is an asset

Patient is an asset

Patient will be your spokesman

You need to do your own ethical PR

Doctor chooses their patients

Patient choses their doctors

Doctor is always right

Patient is always right

Doctors do not come under consumer protection act

Doctors come under consumer protection act

Patients leave treatment to you

They want to know every thing

Doctors should charge less fee

You charge want you want we want service

Doctors can not advertise

Doctors are under CPA but still cannot advertise

Doctors should not be charged for consultation

If insurance is paying why should we leave doctors

I must have a family doctor

I need specialists for every illness

My patient has died of has bad karmas

There must be a negligence on the part of a doctor







today emedipics

In a Press Conference organized by Heart Care Foundation of India on 27th June 2013, Dr. KK Aggarwal President Heart care Foundation of India released the dates and the theme.

Valvular Heart Disease Update

Functional mitral insufficiency can be inferred when the valve is morphologically normal but the left ventricle is either globally or segmentally abnormal. The color flow jet is usually central, occurring at a coaptation point that is marked by decreased contact area and displacement toward the left ventricle apex, a direction that is the opposite of prolapse.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is pelvic adhesion?

Adhesions in and around the pelvic cavity may form if you have endometriosis, a pelvic infection, surgery on your pelvis, a cyst on an ovary, or have had surgery on your pelvis. Scar tissue causes organs that normally are separate from each other to become attached.

Rabies Update (Dr. A K Gupta)

What is “furious form” of rabies in animals?

The excitative phase follows the prodromal phase in some animals. The animal becomes irrational and may aggressively use its teeth, claws, horns, or hooves. The expression is one of anxiety with dilated pupils. Noise invites attack. The rabid animal roams extensively and attacks other animals, including humans and any moving object. Cats usually manifest furious type of rabies.

medicolegal update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Should a doctor perform CPR in already injured chest patient?

When a person needs CPR or cardiopulmonary resuscitation, this means that he/she is unconscious, not moving and not breathing normally. If this is the case, the person is presumably in cardiac arrest or in a state that justifies cardiopulmonary Read More

ijcp book of medical records
medicolegal update

What are punishments for professional misconduct?

Relevant laws

MCI 8: Punishment and disciplinary action

8.1 It must be clearly understood that the instances of offences and of professional misconduct which are given above do not constitute and are not intended to constitute a complete list of the infamous acts which calls for disciplinary Read More

dr good dr bad

Situation: What is the dose of T4 during pregnancy?
Dr. Bad: Same as non-pregnant stage.
Dr. Good: Higher than in non-pregnant stage.
Lesson: Approximately 75-85% of women with pre-existed hyperthyroidism need a higher dose of T4 during Read More

make sure

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.

quote of the day

We must use time wisely and forever realize that the time is always ripe to do right. Nelson Mandela

twitter of the day

Dr KK Aggarwal: AMA Declares Obesity http://bit.ly/14JxRjo #Health

Dr Deepak Chopra: Please take a look at the 7 Mind-Body Practices to
http://bit.ly/14JxRjo #Health

emedinews humor

Murphy's Laws for Humor

If at first you don't succeed, destroy all evidence that you ever tried.
Read More

reader response

Dear Sir, Reading emedinews is very informative and full of interest. I am a regular reader of emedinews and miss it just like a morning cup of tea.Regards: Dr SP Sharma

An Inspirational Story

Today's lesson

One day a farmer's donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the animal was old, and the well needed to be covered up anyway; it just wasn't worth it to retrieve the donkey. He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. ............Read More

eMedi Quiz

Read this…………………

The symptoms of toxic oil syndrome most closely resemble which dermatologic disease?

B. Panniculitis
C. Scleroderma
D. Dermatomyositis

Yesterday’s Mind Teaser: The inherited deficiency of which enzyme is responsible for the fish odour syndrome?

A. Trimethylamine oxidase
B. Trimethylamine reductase
C. Flavin monooxygenase
D. Choline esterase

Answer for yesterday’s Mind Teaser: C. Flavin monooxygenase

Correct answers received from: DR BRIJESH SONI, Tukaram Pagad, Dr. B.B. Gupta, DR AVTAR KRISHAN, Dr Jainendra Upadhyay

Answer for 29th June Mind Teaser: a. Citrus fruits

Correct answers received from: Muthumperumal Thirumalpillai, DR AYYAVOO ERODE

Send your answer to ijcp12@gmail.com

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Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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