October 7   2015, Wednesday
Dr KK AggarwalDr KK Aggarwal
Charity begins at home

“Practice what we preach” is a well-known saying. And, nowhere does it fit so aptly than for us doctors.

The general public does not expect us, doctors, to suffer from lifestyle disorders. Instead, they expect us to be perfectly fit. They also expect that doctors should avoid alcohol, smoking and have perfect and healthy blood parameters.

But most surveys done on doctors have shown that we do suffer from lifestyle disorders.

Doctors too should get their annual health checkup and practice the Dos and Don’ts of a healthy lifestyle; take regular walks and practice parasympathetic breathing and parasympathetic posture.

IMA is organizing a 2-day Detox Meeting for IMA leaders at Om Shanti Retreat Centre, Pataudi Road, Near Manesar, Gurgaon on 10th and 11th October, 2015.

In addition to discussing IMA-related issues, all doctors will also practice and re-learn the techniques of parasympathetic lifestyle.

The program is open to all IMA members. In-House hospitality at Om Shanti Retreat Centre, Pataudi Road, Near Manesar, Gurgaon is being taken care of. Any member of IMA, who wants to participate in this Detox Meeting, can write to us at np@ima-india.org.
Breaking news
Nobel Prize in Physiology or Medicine 2015 announced

Nobel Prize in physiology or medicine for the year 2015 has been awarded jointly to William C. Campbell and Satoshi Omura for their discoveries concerning a novel therapy against infections caused by roundworm parasites and to Youyou Tu for her discoveries concerning a novel therapy against Malaria.

William C Campbell and Satoshi Omura discovered a new drug, Avermectin, the derivatives of which have radically lowered the incidence of River Blindness and Lymphatic Filariasis, as well as showing efficacy against an expanding number of other parasitic diseases. Youyou Tu discovered Artemisinin, a drug that has significantly reduced the mortality rates for patients suffering from Malaria.

FDA approves first bioabsorbable stent in US

Boston Scientific, Synergy bioabsorbable polymer drug-eluting stent is the first such device to receive marketing approval from the FDA. FDA approval was based on results from the EVOLVE II trial, which were reported in November 2014 at the American Heart Association meeting.
Dr Good Dr Bad
Situation: A patient with chest pain could pinpoint his pain.

Dr. Bad: It is a classical heart attack.

Dr. Good: This is non-cardiac chest pain.

Lesson: A cardiac chest pain can never be pinpointed by a finger.

(Copyright IJCP)
Specialty Updates
  • In the first year after a postmenopausal woman discontinues hormone therapy, her risk for cardiovascular mortality is higher than if she had continued the therapy, suggested an observational study published in the Journal of Clinical Endocrinology and Metabolism.
  • Microvascular decompression is more effective than gamma knife surgery for the treatment of pain associated with trigeminal neuralgia, reported a new systematic review and meta-analysis presented at the Congress of Neurological Surgeons (CNS) 2015 Annual Meeting.
  • Psoriasis and psoriatic arthritis are associated with an increased risk of migraine, suggests new research published online in the Journal of the American Academy of Dermatology.
  • A new study finds that children with congenital heart disease and ADHD can take stimulant medications without fear of significant cardiovascular side effects. The study was presented at the annual meeting of the Society for Developmental and Behavioral Pediatrics.
  • The Royal College of Obstetricians and Gynaecologists (RCOG) has released an updated guideline on vaginal birth after previous cesarean (VBAC) delivery. The guidelines state that planned VBAC is appropriate for majority of women with a singleton pregnancy of cephalic presentation at 37+0 weeks or beyond who have had a single previous lower segment caesarean delivery, with or without a history of previous vaginal birth.
  • Results from a phase 2 clinical trial in patients trying to quit smoking suggest that smokers administered a novel respiratory drug INV102 (nadolol) were more likely to stop smoking completely, or dramatically reduce the number of cigarettes smoked.
  • Screening for colorectal cancer should begin at age 50 and continue through age 75, using fecal occult blood tests (FOBT), colonoscopy, or a combination of FOBT and endoscopy, suggest updated draft recommendations from the U.S. Preventive Services Task Force (USPSTF).
  • A new study suggests that dishwashing can boost mental well-being. The results, published in the journal Mindfulness, stress that engaging in mindful dishwashing - focusing on the smell of the soap, the feel of the dishes and the warmth of the water - can trigger a positive state of mind.
  • A new study suggests that getting a flu vaccine each flu season reduces the risk of flu-associated pneumonia. The findings are published in the online issue of JAMA.
  • Communication and teamwork are some of the biggest keys to reduce diagnostic error. Communication is a great thing to focus on because "it plays out so many ways in the diagnostic process," said Graber, who is president of the Society to Improve Diagnosis in Medicine and also served on the Institute of Medicine (IOM) committee that wrote the recently released report on reducing diagnostic errors.
Kindly Watch Dr KK Aggarwal, today on DD National "Aaj Savere", 7.30 Am - 8.30 Am
Why do we apply holy ash?
Bhasma is the holy ash produced from the Homa, the sacrificial fire, wherein special wood along with ghee and other herbs are offered as a part of pooja. By the time a Bhasma is formed, no trace of original matter remains in the ash. Ash obtained from any burnt object is not bhasma.

The ritual involves worshipping the deity by pouring ash as abhishek and then distributing it as Bhasma, which is then applied on the forehead (usually), upper arms, chest, or rubbed all over the body. Some consume a pinch of Bhasma when they receive it.

The word Bhasma is derived from “bha” or "bhartsanam" ("to destroy") and "sma" or "smaranam" ("to remember"). It denotes "that by which our sins are destroyed and the Lord is remembered". Bhasma is also called vibhuti, which means glory. Bhasma is associated with Lord Shiva who applies it all over His body.

Spiritually, the Homa is the offering of oblations into the fire with sacred chants and signifies offering or surrender of the ego and egocentric desires into the fire of knowledge. The resultant ash signifies the purity of the mind. The fire of knowledge burns the oblation and wood signifying ignorance and inertia respectively. The application of ash implies that one should burn false identification with the body.

Bhasma has medicinal values in Ayurveda. It is supposed to be the strongest of all Ayurveda preparations. According to Ayurveda, a Bhasma is formed when the matter is converted into non matter by the process of homa. The non matter is the spirit or the energy of the matter being processed with strong healing powers. It has the same significance as any ‘potentised’ medicine in homoeopathy.

It absorbs excess moisture from the body and prevents colds and headaches.

When applied with a red spot at the centre, the mark symbolizes Shiva–Shakti (the unity of energy and matter that creates the entire seen and unseen universe).

The Upanishads say that the famous Mrityunjaya Mantra should be chanted whilst applying ash on the forehead.
Legal Quote
Martin F. D’Souza vs. Mohd. Ishfaq, AIR 2009 SC 2049
“When a patient dies or suffers some mishap, there is a tendency to blame the doctor for this. Things have gone wrong and, therefore, somebody must be punished for it. However, it is well known that even the best professionals, what to say of the average professional, sometimes have failures. A lawyer cannot win every case in his professional career but surely he cannot be penalized for losing a case provided he appeared in it and made his submissions.”
TB Fact
Microscopy to detect acid-fast bacillus (using Ziehl-Neelsen or Kinyoun stain) is a commonly used procedure for the rapid diagnosis of tuberculosis (TB); a specimen must contain at least 104 colony forming units (CFU)/mL to yield a positive smear. Microscopy of specimens stained with a fluorochrome dye (such as auramine O provides) is a more sensitive and efficient technique. Microscopic detection of mycobacteria does not distinguish M. tuberculosis from nontuberculous mycobacteria.
Controlling your Cash Flow
Save regularly and systematically

It is important to assign a portion of each paycheck for the savings and investment program. Consider it an obligation just as important as any other monthly obligation. In addition to saving a portion of monthly income, it is equally important that any money saved by tax planning each year be invested the following year. This will give one an additional source of investment funds as well as a means of reducing income tax liability on a regular basis.

(Source: IJCP)
Industry News
  • Startups, big business groups use psychometric tests to peek into potential recruits’ minds: Mumbai: Good interview and group discussion skills, a nice curriculum vitae backed by a spruced up social media profile, might not be enough for landing the right job anymore. Increasingly, companies are taking a deeper dive into a candidate's mind, using psychometrics to look for a cultural fit and reject bad apples before hiring. India is seeing a rapid growth in ecommerce startups and some estimates suggest there are 1.5 lakh jobs up for grabs by the end of 2016. (The Economic Times- Suman Layak)
  • Five best performing startup sectors in 2015: The beginning of this year saw a great rush of venture money and a significant uptick in valuations. As a seed round of a million dollars became the new norm, startups started mushrooming throughout the country. Sectors that saw significant interest include: IoT and Wearables. Food Tech, local market, Logistics Management, local services marketplace. (The Economic Times- Guest Column)
  • Federal Bank sets up Rs 25 crore startup fund: The Federal Bank has created a startup fund with an initial corpus of Rs 25 crore, which the bank mentions is scalable. The bank intends to invest in startups in sectors like digital financial services, biotech, hi-tech farming, healthcare, logistics, ecommerce etc. According to the Federal Bank, it will focus on projects in Kerala and Gujarat initially, before funding startups in other states. (Medianama.com- Vivek Pai)
  • Chhattisgarh to formulate policy to encourage startups: Raipur: In tune with the Prime Minister, Narendra Modi's call of "Start up India, Stand up India", Chhattisgarh government is all set to formulate a new policy, "Innovation & Entrepreneurship Development 2015", to encourage start-ups in the state. The draft policy, which aims at achieving sustainable economic growth and creating job opportunities to the educated youths, is likely to be approved in the next cabinet meeting scheduled on October 13. The policy is more or less based on the lines of Kerala's "Startup Village" concept at Kochi, which aims to launch 1,000 technology startups over the next ten years and start the search for the next billion-dollar Indian company. (The Times of India- Anuja Jaiswal)
Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
Inspirational Story

I ran into a stranger as he passed by, "Oh excuse me please," was my reply. He said, "Please excuse me too; I wasn’t watching for you." We were very polite, this stranger and I. We went on our way saying goodbye.

But at home a difference is told, how we treat our loved ones, young and old. Later that day, cooking the evening meal, my son stood beside me very still. As I turned, I nearly knocked him down. "Move out of the way," I said with a frown. He walked away, his little heartbroken. I didn't realize how harshly I’d spoken. While I lay awake in bed, God’s still small voice came to me and said, "While dealing with a stranger, common courtesy you use, but the children you love, you seem to abuse. Go and look on the kitchen floor, you’ll find some flowers there by the door. Those are the flowers he brought for you. He picked them himself: pink, yellow and blue. He stood very quietly not to spoil the surprise, and you never saw the tears that filled his little eyes."

By this time, I felt very small, and now my tears began to fall. I quietly went and knelt by his bed, "Wake up, little one, wake up," I said. "Are these the flowers you picked for me?" He smiled, "I found ‘them, out by the tree. I picked ‘them because they’re pretty like you. I knew you’d like ‘them, especially the blue."

I said, "Son, I’m very sorry for the way I acted today; I shouldn’t have yelled at you that way." He said, "Oh, Mom, that’s okay. I love you anyway." I said, "Son, I love you too, and I do like the flowers, especially the blue."

Are you aware that if we died tomorrow, the company that we are working for could easily replace us in a matter of days. But the family we leave behind will feel the loss for the rest of their lives. And come to think of it, we pour ourselves more into work than to our own family – an unwise investment indeed, don't you think?

So what is behind the story? Do you know what the word FAMILY means?

FAMILY = (F)ather (A)nd (M)other, (I) (L)ove (Y)ou!
Amiodarone linked to Cancer Risk in Men

The risk of cancer is increased in men taking amiodarone particularly in those with extensive exposure to the drug as per a retrospective study. Among men taking amiodarone, the risk for any cancer rose by almost 20% compared with the general population, according to Chia–Jen Liu, MD, of National Yang–Ming University Hospital in Yilan, Taiwan, and colleagues. And for men whose cumulative defined daily doses in a year exceeded 180, the risk was 46% higher the researchers reported online in the journal Cancer.
Anniversary Gift

After she woke up, a woman told her husband, "I just dreamed that you gave me a pearl necklace for our anniversary. What do you think it means?" "You’ll know tonight," he said. That evening, the man came home with a small package and gave it to his wife. Delighted, she opened it – to find a book entitled "The Meaning of Dreams."
Referred pain from ureteric colic is felt in the groin due to involvement of the following nerve:

1. Subcostal.
2. Iliohypogastric.
3. Ilioinguinal.
4. Genitofemoral

Yesterday’s Mind Teaser: All of the following muscles are grouped together as muscles of mastication except:

1. Buccinator.
2. Masseter.
3. Temporalis.
4. Pterygoids.

Answer for Yesterday’s Mind Teaser: 1. Buccinator.

Answers received from: Kusum Gandhi, Dr Pravar Passi, Dr Poonam Chablani, Dr B R Bhatnagar, Dr K V Sarma, Dr K Raju, Dr Avtar Krishan, Daivadheenam Jella.

Answer for 5th October Mind Teaser: 2. Iliohypogastric

Correct Answers received from: Dr K R Gandhi,
Dr Pravin H Patel, Dr Rajesh S Joshi, Dr Avtar Krishan, Dr Poonam Chablani.
Press Release
Arthritis weakens the foundational base of the human body by depleting the power of joints

Your body becomes what you wish to make it, but sometimes, even after taking necessary precautions you can’t protect it from something as important as joint inflammation and pain. As we know, a joint is where two bones meet and our body is held together by a variety of those joints. They make our body flexible by lubricating our bones to cause them to move without friction. But we still tend to forget how these joint help us during our daily lives by simplifying all our day-to-day activities. As a result, this frequent usage makes our joints a little more prone to the overuse and ligament tear casualties. Apart from all this, our joints become vulnerable to a severe disease known as Arthritis. As we age, we often report symptoms of pain, inflammation, stiffness and swelling in our joints, which happen very much due to arthritis.

Osteoarthritis ( green flag) and inflammatory (red flag) arthritis are the two most common types of arthritis. The former happens due to wear and tear of muscles, and the latter happens due to continuous attacks on an individual’s immunity system. The onset of arthritis is described by dull aching pain in the knees. The pain worsens when an individual does a physical activity or makes other movements.

Speaking on the issue, Padma Shri Awardee, Dr. K K Aggarwal – Honorary Secretary General IMA and President HCFI, “It’s all a myth if you think arthritis affects only those above 60 or men specifically. An increased number of rheumatoid arthritis cases in women and juvenile arthritis in youngsters and children are being reported. However, the exact cause of the soaring numbers is not known.

Rheumatoid arthritis in women who are between the ages of 20-40 causes inflammation in multiple joints while older women complain about knee osteoarthritis, which happens due to the wear and tear of the knee joints. Osteo-arthritis is preventable and manageable; all you need is a lifestyle change. One must follow a healthy diet, which includes Vitamin C and calcium, and a regular exercise routine. Try to indulge in a variety of leg strengthening and balancing exercises, these will enhance the elasticity of your bones and will not cause them to become stiff. The most integral part is to keep your body weight in check. The problem becomes severe in patients who are obese and overweight.”

Osteoarthritis can be compared to rusting of a door joint and rheumatoid arthritis to Termites affecting the joints. In osteoarthritis one will get pain on walking and in rheumatoid arthritis the pain will become less on exercise.

Follow these to beat arthritis:
  • Exercise routinely to maintain the flexibility of the bones
  • Don’t smoke as it can lead you to develop rheumatic arthritis
  • Consume a low-fat diet; increase the consumption of whole grains, fruits and vegetables. People who eat such foods are on a low risk of developing arthritis
  • Consume more of vitamin C if you are an arthritis, patient. The best sources of vitamin C are strawberries, kiwi, pineapple, kidney beans, cabbage and cauliflower
  • People who consume Omega 3 have fewer chances of developing swelling and stiffness in the joints. The best sources for the daily dose of Omega 3 are salmon, trout, sardines, mackerel and anchovies. And if you are a vegetarian, then walnuts, fish oil supplements and flaxseed are some of the options
Breaking news
The Assisted Reproductive Technology (Regulation) Bill, 2014

(11) (a) Surrogacy for foreigners in India shall not be allowed but surrogacy shall be permissible to Overseas Citizen of India (OCIs), People of Indian Origin (PIOs), Non Resident Indians (NRIs) and foreigner married to an Indian citizen.

(b) The commissioning couple including Overseas Citizen of India, People of Indian Origin, Non Resident Indians and foreigner married to an Indian citizen who have availed of the services of a surrogate shall be legally bound to accept the custody of the child or children irrespective of any abnormality that the child or children may have.

(c) If abnormalities are detected in the child/children during the gestation period, then the commissioning parent shall ensure that the defected/disabled child/children are appropriately insured and compensation to be used for the development and growth of the child/children by the next in the family, in case of accidental death of the commissioning parents during delivery or in the process of delivery of the surrogate child.

(12) A foreigner married to an Indian citizen shall have to come on a 'Medical Visa for surrogacy (MED-S) when they come to India for commissioning surrogacy;

(13) An Overseas Citizen of India (OCIs), People of Indian Origin (PIOs) and foreigner married to an Indian citizen shall produce a duly notarized agreement between the applicant couple and the prospective Indian surrogate mother;

(14) An Overseas Citizen of India (OCIs), People of Indian Origin (PIOs) and foreigner married to an Indian citizen shall produce an undertaking that they would take care of the child/children born through surrogacy;

(15) An Overseas Citizen of India (OCIs), People of Indian Origin (PIOs) and foreigner married to an Indian citizen shall require an 'exit' permission from the FRRO/FRO concerned for the child or children born through surrogacy before leaving India;
Situation: A 60–year–old male developed acute heart attack after consuming Viagra.
Reaction: Oh my God! Why was cardiac clearance not taken before?
Lesson: Make sure that all older patients get a cardiac clearance before they are given Viagra group of drugs.
IMA Digital TV
Government to go digital in 2nd phase of immunization programme

TNN | Oct 6, 2015, 07.42 AM IST

New Delhi: The government plans to go digital while ramping up its ambitious national immunization programme. Encouraged with the coverage achieved during the first phase of 'Mission Indradhanush', the Centre is now set to commence the second phase of the immunization drive, which will cover 352 districts starting October 7.

The health ministry is planning to adopt technology, including tablets and apps, to assist healthcare workers for regular updates on coverage during this phase. Launching the second phase of 'Mission Indradhanush', Union Health Minister J P Nadda interacted with state health ministers and department secretaries through video-conferencing to enquire about their preparedness, and said his ministry aims to achieve full immunisation of more than 90% children by 2020. The idea is to fully immunize more than 89 lakh children who are either unvaccinated or partially vaccinated. The mission aims to immunise them against seven life-threatening but vaccine-preventable diseases -- diphtheria, whooping cough, tetanus, tuberculosis, polio, measles and hepatitis-B.
Medical Council of India (MCI) has derecognized additional 20 MBBS seats in Dayanand Medical College (DMC) in Ludhiana.
As per the MCI rules, 20 deliveries have to be conducted by each final year MBBS student in the last year of the degree.

Health Minister's Cancer Patients Funds (HMCPF) has been set up under Rashtriya Arogya Nidhi (RAN) with a Corpus Fund of Rs. 100 crore for providing financial assistance for treatment of cancer patients living below poverty line, presently through 27 Regional Cancer Centres recognized by Government of India. Interest accrued on the Corpus is utilized for treatment of the patients in Government Hospitals and Institutions. We earnestly appeal to individuals, trusts, corporate and funding agencies to donate generously to help the poor and needy cancer patients. Donations made under RAN are tax exempt under Section 80-G of Income Tax Act, 1961.
The Ministry of Health & Family Welfare website at mohfw.gov.in may be accessed for further information on RAN.

Your generosity will make a difference in the lives of many people. You may deposit the donation in Account No. 26030100005232, IFSC Code: BARB0NIRDEL, Bank of Baroda, Nirman Bhawan, New Delhi. You may also send your Cheque/DD in favour of "Rashtriya Arogya Nidhi" at the following address:

Director (Grants)
Ministry of Health & Family Welfare
Room No. 414-A, D-Wing, Nirman Bhawan,
New Delhi-110011
Tel: 011-23063481
California Governor Signs Landmark Right-To-Die Law

California Gov. Jerry Brown signed landmark legislation Monday, allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose. One of the key co-authors of the legislation, state Sen. Bill Monning, a Democrat from Carmel, Calif., said the signing "marks a historic day in California" and called the governor's thoughts "a powerful statement."

Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was "disappointed" and "worried. “Marilyn Golden, a policy analyst with the Disability Rights Education and Defense Fund, also strongly opposes the new law. It lacks safeguards, she said, adding that she fears abusive heirs or caregivers could "steer" patients toward assisted suicide.

U.S. Sen. Dianne Feinstein, a Democrat from California, said Brown made the "absolutely correct" decision. "I've seen firsthand the agony that accompanies prolonged illness, for both patients and loved ones, and this bill provides a compassionate, kind option," Feinstein said in a prepared statement, which emphasized the law's safeguards. Dr. Robert Liner, a retired obstetrician who is in remission from lymphoma, said he was thrilled with the governor's action, having fought for this change for many years.
  • The new law requires two doctors to determine that a patient has six months or less to live before the lethal drugs can be prescribed.
  • Patients also must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.
  • One of the meetings must be private, with only the patient and the physician present. That requirement is aimed at ensuring the patient is acting independently
  • Patients must also reaffirm in writing that they intend to take the medication within 48 hours.
The law will take effect sometime in 2016 — 91 days after the special legislative session, which is still ongoing — concludes.

At that time, California will become the fifth state to allow physician-assisted suicide. Oregon, Washington, Montana and Vermont permit the practice. It was permitted in New Mexico until August, when an appeals court in the state reversed a lower court ruling that had established physician-assisted suicide as a right. The New Mexico Supreme Court is now hearing that case.

(Source: KQED's blog, Anna Gorman, a senior correspondent with the NPR partner Kaiser Health News)
CDC names six new medical research centers to accelerate health care innovations

New funding from the Centers for Disease Control and Prevention (CDC) today more than doubled the number of CDC Prevention Epicenters. Six new American academic institutions join the five existing Epicenters working to discover new ways to protect patients from dangerous germs. The CDC awarded a total of $11 million to the six academic institutions to identify possible new and improved ways to prevent the spread of infectious diseases like Ebola in health care facilities. The goal is to help doctors and nurses better protect the health and safety of their patients, and each other, from high-risk disease threats. (Source: CDC)
GP Tip: The formula of 3-2, 4-2

For uncomplicated TB sputum negative TB or extra pulmonary variety of TB remember the formula of 3-2, 4-2 which means 3 drugs for 2 months and 4 months with 2 drugs.
WMA News
Declaration of Geneva workgroup meeting next Tuesday in Moscow: WMA Declaration of Geneva

Adopted by the 2nd General Assembly of the WMA, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and editorially revised by the 170th WMA Council Session, Divonne-lesBains, France, May 2005 and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006


I SOLEMNLY PLEDGE to consecrate my life to the service of humanity;

I WILL GIVE to my teachers the respect and gratitude that is their due;

I WILL PRACTISE my profession with conscience and dignity;

THE HEALTH OF MY PATIENT will be my first consideration;

I WILL RESPECT the secrets that are confided in me, even after the patient has died;

I WILL MAINTAIN by all the means in my power, the honour and the noble traditions of the medical profession;

MY COLLEAGUES will be my sisters and brothers;

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

I WILL MAINTAIN the utmost respect for human life;

I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

I MAKE THESE PROMISES solemnly, freely and upon my honour
Readers column
  • The Dr Good, Dr Bad column is a really good practical tip provider. Amit Mishra
  • Sir, I am a regular reader of your eMedinewS. I am a very busy practitioner and the little time I get, I read your articles. They are extremely good and give all-round information. Well done and please continue the good work. Dr. Lokare
Achieving Privacy and confidentiality in day to day practice- an ethical dilemma

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

Doctors in busy settings face an ethical dilemma. Maintenance of confidentiality and privacy becomes problematic due to the use of shared rooms. At times, the patient hesitates to share medical information due to this fact. More funds and better infrastructure may not always be possible. What is your preferred solution in such circumstances?

a) Ignore the issue as sharing information is culturally acceptable in India

b) Acknowledge overcrowding, try to make the patient comfortable within the shared setting

c) Extend work hours, push back appointments to ensure one patient per room at a time

d) Whisper/ talk in low voices

Do write in with your views and solutions.

Here are the responses received
  • I will go for a) Ignore the issue, as sharing information is culturally acceptable in India unless someone specifically asks for not sharing a small part of information. Saranya Devanathan, Psychiatrist
  • I think we cannot see 2 or 3 patients in one room. The patient’s right of privacy cannot be compromised for any reason. Each patient should be interviewed in a single room, and the patient and the family members should also be seen separately at least once and as and when needed. Infrastructural issues cannot be the excuse for inefficient treatment. Prof. Anil Agarwal, Psychiatrist
  • Lack of infrastructure is not an excuse for not observing privacy and confidentiality Patients should be seen alone as well as with family members. Prof. Satish Malik
  • Explain that the other person too is a doctor like me and assure that she would maintain confidentiality. Sudhakar Bhat, Psychiatrist
  • It is very difficult to provide a separate place and extending work hours may not be possible for doctors. They can talk in low voices and make the patient as comfortable as possible. If the issue really demands confidentiality like HIV or any other which patient is not at all confident to discuss in overcrowded situations, then extra time can be given after the crowding hours. Respecting the privacy of the patient is very important. Triptish Bhatia, Principal Investigator, GRIP-NIH, USA Project, Dept. of Psychiatry, Dr Ram Manohar Lohia Hospital, New Delhi
  • Firstly, we can have cabins or space with glass partitions, which prevent the sound from reaching other places. Secondly, if we are to be economical then probably the patients, of course depending upon their problem and certainly alongside giving him assurance and confidence about confidentiality, can be asked to record their voices in their phones and then ear phones can be used as a medium to listen to the voice recorded by the patient. These ear phones shall be inserted/worn by both - the patient as well as the client so that they are on the same track of conversation. But, this can be done only at the time of case history taking. If the client is educated, he can write and the doctor can ask and clarify. Enquiry questionnaires could be used. Structuring the room accordingly can help. I don't know how much do we support online counselling and case history taking. However, people (doctors and patients) who are ready for the online case history-taking, shall be taken separately by doctors at say a particular day and they must be given facility and services of the same with helpers available around in a particular room Or can be done in a booth placed to be able to communicate with the doctors in any given area within the compound. Parul
  • Lack of rooms is a fact in mental health care. But mental health service cannot and should not be stopped due to this fact only. Privacy is definitely an important issue but when infrastructure is not adequate then also treatment means a lot. When any country does not have adequate infrastructure then decision should be taken according to what is available in nearby surrounding. So treatment comes first as per hierarchy of decision criteria. So the clinician should explore the possibility of privacy if possible. S/he may evaluate himself/herself, the nature of information forthcoming during the interview and take decision accordingly whether to ensure privacy or not. However privacy of any nature should be given due respect. But this suggestion is for setting where rooms are not available in adequate number. So the clinician may also ask the patient and family about their comfort level. However it has been observed that people do not care that much in a hospital outpatient department as they have their mind made up for such crowded places. And again people feel a kind of security being stranger in the crowd. If there are not too many patients then privacy must be secured for the patient. But during a rush this issue should be dealt by considering the nature of the problem and the sensitivity of the patient and the family. Ranjita Thakur
  • Having interned at Sion Hospital in Dept of psychiatry department, this dilemma was an everyday problem. However, practitioner skills made huge difference. Doctors who were able to successfully get history and provide details at the same time respecting confidentiality showed the following:
    • Apologize to the patient for the overcrowding but saying at the same time that all these people require a doctor so we have to work with this.
    • Telling that other professionals in this room are competent and caring doctors and will not make fun of (most men who were hesitant came with premature ejaculation issues); instead can actually assist in solving the problem.
    • Allowing them to speak softly if it is a sensitive detail.

      Therefore if we really want to keep patient’s interest at the fore, a way can always be found to do so. Sadaf Vidha
  • Acknowledge overcrowding, try to make the patient comfortable within the shared setting and talk in an audible voice/tone. At the same time, if the number of patients is very high, capital expenditure in infrastructure is required. Dr S Rastogi, Director
  • It is quite natural that the patient will not like to express his symptoms before anybody and the doctors may not find a place to listen to him exclusively. In this situation, if the patient is hesitating to tell his problem, the doctors should ask him to write it on a paper and the doctor should read it and give it back to him after reading. Dr BR Bhatnagar
Digital IMA