Volume : 2 Issue : 18 August 2017

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HBI HBI HBI e-connectINDIAN MEDICAL ASSOCIATION

Dr. K.K. Aggarwal, National President, IMA

Dr Mangesh Pate , Treasurer, IMA HBI

Dr. R.N. Tandon, Hony Secretary General

Dr. K. M. Abul Hasan, Editor, IMA HBI

Dr. R.V. Asokan, Chairman, IMA HBI

Email: drkmabulhasan@yahoo.com

Dr Jayesh Lele, National Secretary, IMA HBI

Website: www.imahbi.in

BULLETIN OF HOSPITAL BOARD OF INDIA

Should doctors be role Models for their pa�ents?

Lack of networking leading to organ wastage

The Five S of Modern Medical Prac�ce

Health Ministry And State Opposes PPP Healthcare

Smartphone app can predict disease risk based on health inputs

Pharma, med devices should be under one ministry

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Should doctors be role Models for their pa�ents? The latest direc�ve of IMA forbidding Doctors from

drinking in Public has evoked mixed response from Medical

Community. Some have welcomed it, some found it

restric�ve, some did not agree with specifics of it. Yet the

intent of diktat raises a fundamental ques�on- Should

doctors be role Models for their pa�ents?

Whenever i think of this ques�on, I am reminded of an

incident which occurred almost 30 years back -I referred a

case of MI to Dr. S Padmawa�, a pioneer in Cardiology.

She advised Mr. Khanna, (I s�ll remember second name of

pa�ent vividly) the pa�ent, to reduce weight. Mr Khanna

politely retorted to her “Can I ask you a ques�on, why don't

you reduce your weight, Mam! (She was on a heavier side at

that �me).She by virtue of stature and quick wit could

effec�vely handle that ques�on which would make most of us perplexed and put us at our wit's ends. She replied –” Mr.

Khanna if I ever have a disease of your magnitude, I will certainly reduce my weight.”

This incident again brings us back to the important ques�on for contempla�on-Should doctors be role Models for their

pa�ents?

This is an established fact that a common man apes lifestyle of celebri�es which may include Film Actors, Sports persons,

business tycoons and some poli�cians. It is therefore logical that pa�ents also unknowingly follow lifestyle of their trea�ng

doctors. Physicians who prac�ce healthy habits play a key role by helping their pa�ents to adopt healthy lifestyles for

primary preven�on of chronic diseases. The health of general prac��oners (GPs) is important because they serve as health

role models and because they are more likely to counsel their pa�ents about health behavior change if they prac�ce

healthy habits themselves. One of the strongest predictors of health promo�on counseling by primary care physicians is

prac�cing a healthful behavior oneself – it is clear that many physicians report difficulty counseling pa�ents about

behaviors they themselves do not prac�ce.

The basic ques�ons asked in the scenario are whether physicians should always “prac�ce what they preach,” and whether a

physician's personal life should be accessible and relevant to pa�ents. Professional role models are important. For

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example, a person would be unlikely to seek advice from a financial advisor who has filed for bankruptcy.

Are physicians required to have perfect behavior before they can give advice to pa�ents? Can physicians offer therapies to

the best of their ability, irrespec�ve of whether they follow the same recommenda�ons? To what extent do pa�ents expect

us to be role models for them, and to what extent should we expect this of ourselves? An interes�ng ques�on is whether

certain physician behaviors or experiences are counterproduc�ve in providing effec�ve counseling about lifestyle

modifica�on. The research in this area is scant and provides li�le guidance.

The ethical basis of physician behavior probably has more to do with mo�ves than with the behavior itself. Physicians are as

imperfect as pa�ents; therefore, expec�ng a physician to always follow recommenda�ons he or she gives to pa�ents, while

intui�vely reasonable, is probably not appropriate. They are not obliged to be role models but at least they must adhere to

certain principles in public life since their profession requires more in terms professionalism than most other professions.

Always display pleasant manners in public.

Cut down intake of unhealthy foods.

Don't Smoke or drink in public in case you cannot give them up.

Do take out �me for exercise and walk not only to pass on a good message to your pa�ents but it is otherwise beneficial.

Avoid disclosing personal informa�on and beliefs to pa�ents on social Media.

Moderate what you disclose in your online profiles and pos�ngs, a good rule of thumb is to always consider the

analogue situa�on. Would you be confident speaking the content of your post in public lecture theatre?

Doctors should preferably remain mindful of their duty to act professionally in all public arenas and set a good example to

their pa�ents, but this is not a must. They are not obliged to be role models but should try to be.

Lack of networking leading to organ wastage “We now see smaller ci�es and districts registering for dona�ons even if they don't have centres to do transplants,“ said

director general of health services Jagdish Prasad.

CHENNAI: Thousands of people die of end-stage organ disease in the country every year. Yet, hundreds of organs such as

heart, lungs and liver donated by the deceased in India are being discarded even a�er families of the deceased volunteered

to donate them, Na�onal Organ and Tissue Transplant Organisa�on data show.

Un�l 2013, many ci�es including Mumbai had not done a heart transplant because they didn't have a programme to

retrieve organs from the brain-dead but with a system in place, the situa�on is improving, he said. In the last three years,

Mumbai has done nearly 50 transplants. “We now see smaller ci�es and districts registering for dona�ons even if they

don't have centres to do transplants,“ said director general of health services Jagdish Prasad.

Chennai has one of the oldest surviving heart transplant pa�ents in the country and the city leads in the number of heart

transplants. However, only 32% of hearts received were used by surgeons in the state since 2008, according to sta�s�cs

from Tamil Nadu Organ Transplant Authority.

“But that number has improved from 12% in 2013 to 58% this year. Similarly, lung transplant has improved from 15% in

2013 to 44% in 2017. With more centres doing such transplants, there is a be�er wai�ng list and we have been able to allot

organs in a more judicious manner,“ said member secretary of the state authority , Dr P Balaji.

Organ transplant, although expensive, is the only permanent cure for pa�ents with irreparable organ damage. During this

procedure, doctors replace the ailing organ with a healthy one from a brain-dead pa�ent.

Organisa�ons such as state-level (SOTTO) and re gional-level (ROTTO) organisa�ons will aim to distribute organs in a fair

and judicious manner.

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Officials in NOTTO say they are already beginning to see Tamil Nadu's success re plicated in many states. “An organ

retrieved in the state will be used within the state.Organs are allo�ed to pa�ents on the basis of medical merit and a wai�ng

list. If for some reason the organ can't be used by the state, it is allo�ed to the states that fall within the region. If the wai�ng

list in the region is exhausted then the na�onal organisa�on looks at a country-wide possibility. If no one in the country

needs it, NRI and foreigners are given preferences,“ said NOTTO director Dr Vimal Bhandari. The organisa�on has already

sought for an organ wai�ng list from across the country .

The western region's Regional Organ and Tissue Transplant Organisa�on (ROTTO), which will centralize the cadaver

dona�on ac�vi�es between Maharashtra, Daman and Diu, Goa, Gujarat and Madhya Pradesh, started shaping up in

February this year, nearly two years a�er the union health ministry decided to create a na�onal organ sharing network.

The first grant instalment of Rs 63.20 lakh received in January is being used to set up ROTTO's office for the western zone at

KEM Hospital, Parel.

KEM dean Dr Avinash Supe said, “Our priority is to have uniformity in policies across five states in terms of dona�on and

distribu�on.A�er several mee�ngs, we have also formed commi�ees for distribu�on of each organ besides a general

commi�ee to oversee all,“ he said. They have hired four medical social workers for JJ, KEM, Sion and Nagpur medical

colleges and are planning to start a cadaver and a �ssue bank.

But states like Rajasthan are yet to make a beginning.Rajasthan is yet to get a State Organ and Tissue Transplant

Organiza�on.

“Earlier, SOTTO was planned at AIIMS, Jodhpur.But as all cadaver organ dona�ons are reported in Jaipur, we have asked the

Centre to set up SOTTO in Jaipur.We have sent a le�er to the cabinet secretary ,“ said Dr Manish Sharma, nodal officer, state

organ transplant programme.

The Five S of Modern Medical Prac�ceAs medicine grows exponen�ally, with new developments

and paradigm shi�s, the prac��oner unfortunately is

cornered with growing social indictment of inep�tude and

inappropriate profit-making. Amidst this chaos, the

Government has added newer confusion and laws, which

merely in�midates the prac��oner further.

The Media is doing, what it does best- adding fuel to fire.

We need to implement the 5 s in our prac�ces: -

1. Safe: Let's choose our pa�ents correctly. We only go as

far as we our capable with our own knowledge and the

resources we have at hand.

2. Smart: Implement all the tac�cs of a sound and ethical business, inform our clients regularly, use technology usefully

and impress clients(pa�ents) with modern day business prac�ces (which also includes excellent documenta�on). Be

smart, be suave, a�er all aren't you the creamy layer of intelligentsia.

3. Scien�fic: Let us be reasonably updated to the current understanding in our fields, so that our treatment is

contemporary and up to date.

4. Sa�sfactory: Our prac�ce should be such that it allows us to be sa�sfied with it. Seeing too many pa�ents in too short a

�me is counter produc�ve in the long run. Let's not allow the horses of our wishes go uncontrolled.

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5. Sociable: Mingle with society more o�en. It's a common observa�on that most doctors do not socialise with the general

society. Many are content only interac�ng with "doctor associa�ons".Interac�ng with society in general always makes

you a part of the society, it helps people understand your problems, your limita�ons and the hardships you face.

In the words of Patch Adams "treat a disease, you win or lose, treat a person you will always win no ma�er what the

outcome ".

Health Ministry And State Opposes PPP HealthcareThe Ministry of Health and Family Welfare has said that it will respond to the Ni� Aayog's dra� agreement proposing

terms by which district hospitals across the country could be opened to private par�cipa�on in the treatment of non-

communicable diseases.

The government policy thinks tank sent a le�er to states in June proposing a model by which private companies could

poten�ally bid for 30-year leases over parts of district hospital

buildings and land to set up 50-bed or 100-bed hospitals in district

headquarters.

In its le�er asking states for their views on the ma�er, Ni� Aayog said

the model contract had been prepared jointly by the Union health

ministry and with the World Bank as a technical advisor.

But an official in the health ministry said that the department was

involved only in early discussions before the final dra� was prepared.

“The final dra� that was shared by Ni� Aayog was not ve�ed up front

by the ministry,” this person said. “We shall also be sending our

comments on the dra�.”

Ni� Aayog was asked for comment about this conflic�ng version but

senior officials did not respond to media.

The health ministry official accepted that the department had, in principle, agreed that the private sector should play a role

in trea�ng non-communicable diseases but claimed it was not involved in detailing the condi�ons laid down in the model

contract agreement.

The official added that the health ministry is not averse to involving the private sector in public healthcare. “We had only

agreed to it [the idea of involving private sector] at a more generic level,” he said. “In principle, one may not have an issue.

But the terms and condi�ons of this nature will have to be neatly designed.”

It is also evident from the Na�onal Health Policy 2017 that various arms of the Bhara�ya Janata Party-led government are

on the same page, in principle, on providing a greater impetus to the private sector health industry.

The policy states: “The health policy recognises that there are many cri�cal gaps in public health services which would be

filled by 'strategic purchasing'. Such strategic purchasing would play a stewardship role in direc�ng private investment

towards those areas and those services for which currently there are no providers or few providers.” The policy advocates

“building synergies” with not for profit organisa�ons and the private sector.

Before the Na�onal Health Policy could be finalised, Ni� Aayog and the health ministry had disagreed on how much space

the government should cede to the private sector in the cri�cal public health sector.

The model contract agreement now shared by Ni� Aayog in June with states is built on a generic contract for “brownfield

hospitals” available on a website run by the department of economic affairs. The contract is �tled “Greenbook for

Brownfield Hospital – 25 02 2014”. The World Bank, on its microsite for public-private projects, also provides a link to this

document.

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States resist: Meanwhile, the Tamil Nadu government has opposed the contract's proposal to hand over government land

and resources to private providers for 30 years.

“The Tamil Nadu government strategy is a health insurance model and a health systems strengthening model,” said

Secretary for health and family welfare in Tamil Nadu.

Another health official from the state explained the problems with a 30-year agreement. “I want to improve my

government hospitals,” he said. “If I hand it over, how will I improve them? Even if I do not have money now, I may have

money later to improve them.”

He said, “The state believes in the con�nuum of care, where primary, secondary and ter�ary level of healthcare is

intricately linked.”

The Ni� Aayog model, he added, would create a compartmentaliza�on of these services in Tamil Nadu, which is not

desirable. He also pointed that the state government itself was planning to expand services in the areas into which the Ni�

Aayog wants the private sector to step. Tamil Nadu has approved the opening of 13 state-funded district chemotherapy

centres or cancer treatment and 11 cath labs where heart ailments are diagnosed.

The health insurance model, where some services that the state does not have resources to provide are strategically

purchased by the private provider, has checks and balances, he said.

“We want to create a strong government healthcare system and a private healthcare system complemen�ng it,” he

explained.

The health ministry official said that the model contact would be more useful for states in North India, Central India and

West India. “States such as Tamil Nadu already have robust care for people with noncommunicable diseases in their district

hospitals,” he said.

Several other states contacted said they had not yet formulated a formal response to the document. Senior health officials

from Tripura and Karnataka claimed they have not yet received the document.

With health being a state subject under the Cons�tu�on, the response of states are expected to vary. For instance, secretary for

health care, human and family welfare in Sikkim, said that his state's districts are too small for projects on a public-private

partnership mode. “Our popula�on is just over six lakhs,” he said. “It will not be profitable for the private sector.”

Smartphone app can predict disease risk based on health inputsThe app, called Healthians, allows users to log their basic body vitals like

blood pressure, weight and sugar levels as well as maintain a depository of

all their test reports for future reference.

NEW DELHI: A new smartphone app, developed by a Gurgaon-based start-

up, can provide 'smart reports' that may predict the user's risk of diseases

and expose hidden disorders based on their symptoms and lifestyle inputs.

The app, called Healthians, allows users to log their basic body vitals like

blood pressure, weight and sugar levels as well as maintain a depository of

all their test reports for future reference.

The app then analyses the data for abnormal parameters, and recommends

the future course of required ac�on, including suitable medical specialist to

consult and addi�onal tests, if needed.

"With pathology checkups, understanding a medical report and its

implica�ons on one's health has always been a challenge," said Deepak Sahni, CEO and Founder of Healthians.

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"With the Healthians app, this difficulty is addressed and people can now at a click of a bu�on get deep insights into their

health," said Sahni. The smart report feature helps uncover latent diseases and predict risk of future ones and to expose any

latent ones.

It recommends lifestyle and dietary changes based on the user's inves�ga�ons, symptoms and lifestyle inputs. Pa�ents will

be able to review their medical condi�ons and reach their treatment goals much faster, drama�cally lowering the risks of

serious health complica�ons.

"The smart report is meant to empower users with a fore- knowledge of possible health risks and to effec�vely manage

chronic diseases," said Sahni.

"Any decision regarding our health is best taken in an informed manner. Healthians app is exactly that channel of reliable

informa�on," he added.

Diseases are predicted based on the pa�ents' health check-up report values of different parameters along with their age,

lifestyle habits, symptoms and family medical history, Sahni said. Along with symptoms we take lifestyle habits, age, gender

and pa�ents medical history into account to eliminate the chances of making a wrong diagnosis, he said.

To ensure any such misinterpreta�ons, free doctor and die�cian consulta�on is provided. We give a clear disclaimer to the

user that these are system generated recommenda�ons only. For an accurate diagnosis, user is encouraged to visit a

par�cular specialist.

Pharma, med devices should be under one ministryThe new ministry could be named Ministry of Pharmaceu�cals and Medical Devices, Minister of State for Chemicals and

Fer�lisers Mansukh L Mandaviya said in a wri�en reply in the Lok Sabha.

New Delhi: The Department of Pharmaceu�cals (DoP) feels that

subjects and regulatory bodies related to pharmaceu�cals and

medical devices should preferably be under a new ministry,

Parliament was informed on Tuesday.

The new ministry could be named Ministry of Pharmaceu�cals and

Medical Devices, Minister of State for Chemicals and Fer�lisers

Mansukh L Mandaviya said in a wri�en reply in the Lok Sabha.

The DoP is of the view that the subjects and regulatory bodies related

to pharmaceu�cals and medical devices and ma�ers rela�ng their

export along with the work currently handled by the department

should be done so at one place preferably by a new ministry, he said.

The regulatory bodies include the Central Drugs Standard Control

Organisa�on, the Pharmacopeia Commission and Pharmacy

Educa�on, Mandaviya said.

The minister also said there is no demand to merge the DoP and the

health ministry.

Mandaviya said there is, however, a recommenda�on of the group of

secretaries on health, sanita�on and urban development proposing

to bring DoP and the Ministry of AYUSH under the Ministry of Health

and Family Welfare.

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