Move Move and Move: IMA Campaign to control NCDs

Health Care Comments Off

Noncommunicable diseases (NCDs) are a major cause of premature and preventable deaths worldwide. According to a WHO Global Survey Report “Assessing National Capacity for the Prevention and Control of Noncommunicable Diseases Global Survey 2015”, NCDs currently account for almost 70% of global deaths; majority of which occur in low- and middle-income countries. India too is not untouched by this. Due to rapid urbanization, India is experiencing an epidemiological transition moving away from a predominantly communicable or infectious to a predominantly non communicable disease pattern.

Along with tobacco, harmful use of alcohol and unhealthy diet, physical inactivity has been implicated in NCDs as a major risk factor. All these are behavioral risk factors and are modifiable through lifestyle changes. Modern and advanced technology has certainly made life easy and convenient for us – online shopping, online payments, accessing information, etc., all of which can be done from the comfort of our homes. But, has technology really made our life better? What it has also done is change our lifestyle pattern at the cost of health; we are less physically active now – sitting at a desk for a long time working on the computer, using social media on smartphones, watching TV or sitting in a meeting, all these activities promote sedentary behavior.

The benefits of exercise on physical health as well as mental health are well-established and know to us all. But, the level of physical activity among all age groups has decreased, either due to lack of initiative or lack of safe open spaces. A heavy work schedule is often a deterrent to physical activity for many of us.
Walking is the best form of exercise, which requires no investment, no special training. Walking in natural environments such as parks also reduces mental stress and fatigue and improve mood via the release of the ‘feel good’ endorphins. This proximity to nature also helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode manifested by lowering of blood pressure and pulse rate. This is also why most of our temples are located in distant places. The silence of the spiritual atmosphere reduces the internal noise and helps us onward in our inner journey.

It is important to remember here that ‘exercise’ is not synonymous with ‘physical activity’. Exercise is a planned, structured and repetitive activity while any other physical activity that is done during leisure time, for transport to get to and from places, or as part of a person’s work, also has a health benefit (WHO Fact Sheet, February 2017).
To control non-communicable diseases and promote physical activity, IMA has proposed a campaign “Move Move and Move”. People should move around more often all through the day in addition to regular exercise. Here are a few simple ways to increase physical activity both at home and your workplace.

• Take the stairs as often as possible.
• Get off the bus one stop early and walk the rest of the way.
• Have “walk-meetings” instead of “sit-in” meetings.
• Walk to the nearby shops instead of driving.
• Stand up and walk while talking on the phone.
• Walk down to speak to your colleague instead of using the intercom/phone.
• Walk around your building for a break during the work day or during lunch.
• Buy a pedometer.

Walk 80 minutes each day; brisk walk 80 minutes a week with a speed of 80 steps per minute. This is a ‘Formula of 80’ that I have devised and which I recommend to all my patients.

BE FAST: A modified assessment tool to identify stroke

Health Care Comments Off

‘Time is brain’. A patient with suspected stroke or ‘brain attack’ should therefore be shifted to hospital at the earliest and given a clot dissolving therapy. Jeffrey L. Saver reported in the journal Stroke that “every minute in which a large vessel ischemic stroke is untreated, the average patient loses 1.9 million neurons, 13.8 billion synapses, and 12 km (7 miles) of axonal fibers. And, each hour in which treatment fails to occur, the brain loses as many neurons as it does in almost 3.6 years of normal aging” (Stroke. 2006;36:263-6).

The American Stroke Association recommends the mnemonic FAST to recall the signs of stroke and quickly identify victims of stroke; “F” stands for Face drooping; “A” stands for arm weakness i.e. inability to raise arms high, “S” stands for Speech difficulty – slurring of speech and “T” stands for Time – time to call for emergency medical help.

A new research has devised a modified version of this simple prehospital stroke assessment tool, ‘BE FAST’ for early identification of patients with occlusion of large vessel, which was presented at the American Stroke Association’s International Stroke Conference 2017, which concludes in Houston, USA today (AHA News, February 22, 2017).

The acronym ‘BE FAST’ evaluates:

• Balance/coordination
• Eye deviation
• Facial weakness
• Arm/leg weakness
• Slurred speech/sensory deficits
• Time of onset

Researchers examined 455 ischemic stroke patient charts from July 2014 to June 2015, using information about patients’ symptoms and physical findings. The sensitivity i.e. positively recognizes a large vessel occlusion, for the ‘BE FAST’ score was found to be 83%.

Stroke is an emergency and getting timely help and treatment is extremely important. Hence, it is very important to act fast to identify these patients. Early treatment improves the chances of recovery.

“Sorry I cannot oblige you for…”: IMA Campaign against issuance of false medical certificates

Health Care Comments Off

Dr KK Aggarwal
National President IMA & HCFI

Doctors are required to issue medical certificates and/or certificate for fitness to work or resume duty.
The Medical Council of India (MCI) has provided a list of certificates, reports, notifications etc. issued by doctors for the purposes of various acts / administrative requirements in Appendix 4 of its Code of Ethics Regulations, 2002:

• Under the acts relating to birth, death or disposal of the dead.
• Under the Acts relating to Lunacy and Mental Deficiency and under the Mental illness Act and the rules made thereunder.
• Under the Vaccination Acts and the regulations made thereunder.
• Under the Factory Acts and the regulations made thereunder.
• Under the Education Acts.
• Under the Public Health Acts and the orders made thereunder.
• Under the Workmen’s Compensation Act and Persons with Disability Act.
• Under the Acts and orders relating to the notification of infectious diseases.
• Under the Employee’s State Insurance Act.
• In connection with sick benefit insurance and friendly societies.
• Under the Merchant Shipping Act.
• For procuring / issuing of passports.
• For excusing attendance in courts of Justice, in public services, in public offices or in ordinary employment.
• In connection with Civil and Military matters.
• In connection with matters under the control of Department of Pensions.
• In connection with quarantine rules.
• For procuring driving license.

At times, they may be urged by friends, or other individuals to provide certificates with falsified information to take medical leave, claim financial benefits, compensations, etc. And, they may find it difficult to say no.

The Indian Medical Association (IMA) is against issuing or obliging for false certificates. The IMA campaign in this regard “Sorry I cannot oblige you for…” is directed at learning to say no to issuing false certificates.

Medical certificates are legal documents. Doctors therefore must be aware of the implications of signing a medical certificate, to themselves, the patient and the organization to which the certificate would be submitted and act according to the regulations defined by the MCI relating to the Professional Conduct, Etiquette and Ethics.

Any certificate issued by a doctor not as per the requirements defined in the Regulation 1.3.3 of the MCI Code of Ethics Regulations, 2002 (as follows) is not a valid certificate: “A Registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report.”

In Ram Narain Gupta vs Smt. Rameshwari Gupta on 12 September, 1988 AIR 2260, 1988 SCR Supl. (2) 913, the Supreme Court of India observed: “… Neither in the first certificate (Ext. 4) nor in the second certificate (Ext. 3) … stated that the schizophrenia, the defendant is suffering from, was of the third variety, namely, Catatonia, when the patient becomes wild, destructive and violent. In this statement also … does not state that the schizophrenia was of Catatonia variety. He does not say even a word about the danger, arising from the mental disorder of the defendant. The certificate Ext. 3 does not bear the thumb impression or signature of the defendant and, therefore, it cannot be said with certainty that the said certificate was issued by … after having examined the defendant.”

If you issue a false certificate, you can lose your license (permanently) to practice as per Regulation 7.7, which says “Any registered practitioner who is shown to have signed or given under his name and authority any such certificate, notification, report or document of a similar character which is untrue, misleading or improper, is liable to have his name deleted from the Register.”

Issuing a false document is forgery, which is an offence liable to imprisonment under Section 468 of the Indian Penal Code and has been defined under Section 463 of the IPC.

“468. Forgery for purpose of cheating: Whoever commits forgery, intending that the 1[document or electronic record forged] shall be used for the purpose of cheating, shall be punished with imprisonment of either de¬scription for a term which may extend to seven years, and shall also be liable to fine.”

“463. Forgery. Whoever makes any false documents or false electronic record or part of a document or electronic record, with intent to cause damage or injury], to the public or to any person, or to support any claim or title, or to cause any person to part with property, or to enter into any express or implied contract, or with intent to commit fraud or that fraud may be committed, commits forgery.”

The Delhi Medical Council has framed guidelines for issuance of medical certificate in its order DMC/DC/F.14/Comp.1107/2/2014/ dated 17th October, 2014

a. “Medical certificates are legal documents. Medical practitioners who deliberately issue a false, misleading or inaccurate certificate could face disciplinary action under the Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations, 2002.

Medical practitioners may also expose themselves to civil or criminal legal action. Medical practitioners can assist their patients by displaying a notice to this effect in their waiting rooms. It is, therefore, a misnomer to state that medical certificate is “not valid for legal or Court purposes”, and should be avoided. Registered medical practitioners are legally responsible for their statements and signing a false certificate may result in a registered medical practitioner facing a charge of negligence or fraud.

b. The certificate should be legible, written on the doctor’s letterhead and should not contain abbreviations or medical jargon. The certificate should be based on facts known to the doctor. The certificate may include information provided by the patient but any medical statements must be based upon the doctor’s own observations or must indicate the factual basis of those statements. The Certificate should only be issued in respect of an illness or injury observed by the doctor or reported by the patient and deemed to be true by the doctor.

The certificate should:

i. indicate the date on which the examination took place
ii. indicate the degree of incapacity of the patient as appropriate
iii. indicate the date on which the doctor considers the patient is likely to be able to return to work
iv. be addressed to the party requiring the certificate as evidence of illness e.g. employer, insurer, magistrate
v. indicate the date the Certificate was written and signed.
vi. Name, signature, qualifications and registered number of the consulting Registered Medical Practitioner.
vii. The nature and probable duration of the illness should also be specified. This certificate must be accompanied by a brief resume of the case giving the nature of the illness, its symptoms, causes and duration. When issuing a sickness certificate, doctors should consider whether or not an injured or partially incapacitated patient could return to work with altered duties.

c. The medical certificate under normal circumstances, as a rule, should be prospective in nature i.e. it may specify the anticipated period of absence from duty necessitated because of the ailment of the patient. However, there may be medical conditions which enable the medical practitioner to certify that a period of illness occurred prior to the date of examination. Medical practitioners need to give careful consideration to the circumstances before issuing a certificate certifying a period of illness prior to the date of examination, particularly in relation to patients with a minor short illness which is not demonstrable on the day of examination and should add supplementary remarks, where appropriate, to explain the circumstances which warranted the issuances of certificate retrospective in nature.

d. It is further observed that under no circumstances, a medical certificate should certify period of absence from duty, for a duration of more than 15 days. In case the medical condition of the patient is of such a nature that it may require further absence from duty, then in such case a fresh medical certificate may be issued.

e. Record of issuing medical certificate -Documentation should include :

• Patient to put signature / thumb impression on the medical certificate
• Identification marks to be mentioned on medical certificate
• that a medical certificate has been issued
• the date / time range covered by the medical certificate
• the level of incapacity (i.e. unfit for work, light duties, etc. within scope of practice)

An official serially numbered certificate should be utilized. The original medical certificate is given to the patient to provide the documentary evidence for the employer. The duplicate copy will remain in the Medical Certificate book for records. The records of medical certificate are to be retained with the doctor for a period of 3 years from the date of issue.”

« Previous Entries Next Entries »