The principles of creative thinking

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Creativity is a mindset that encourages imaginative thinking, unencumbered by rules and regulations. A creative person is willing to break free from his comfort zone to be innovative and create new ideas and concepts.

The creative process at first seems serendipitous or by chance, but in fact, is an outcome of various processes that occur in a logical sequence.

• Have an intention to create something “intended information”. This can be illustrated by the first three avatars of Vishnu.
o Be like the fish, Vishnu’s first incarnation (Matsya avatar); a fish can swim against the tide, which indicates that one should acquire the quality of taking independent decisions and not just follow what others say. Do not believe in mass imitation or “bhed chaal” or herd mentality. Instead learn to be different from others.
o The second Tortoise (Kurma Avatar) advocates learning the quality of “when to say no” or “when to withdraw completely” from a situation.
o The third Varaha Avatar or the Boar depicts the quality of not accepting defeat, even at the cost of his life. The boar symbolizes persistence.
o Collectively, these three avatars teach us that once one has learned the qualities of taking independent decisions and when to withdraw, the next thing to learn is that the withdrawal should not be permanent. Instead wait for the right opportunity and stay committed till the goal is achieved.
o The next quality to be acquired is that of lion or the Narsingha Avatar, who showed that nothing is impossible on earth. This means while you are persistent in your efforts, you should also have the conviction that everything is possible on this earth.
• Decide to do it i.e. “information gathering”. Listen to all to collect information. The big ears of Ganesha denote the importance of listening ‘without bias’.
• Next comes ‘information reshuffling’. Be like the Swan. To acquire knowledge from all the information gathered, learn the power of discrimination or wisdom or vivek. Exercise good judgement to keep what is good.
• The ‘incubation period’ then follows. Do something to relax your mind. To be creative, the mind has to be relaxed. Remove all your distractions to be creative. Do mind-body relaxation exercises. Shift your state of mind from the sympathetic to the parasympathetic state. In the sympathetic state, heart rate and blood pressure increase and a person cannot take correct and decisive decision. The relaxed mind state of the body is the parasympathetic mode, which is healing and is evident by reduction in heart rate, blood pressure. Flow of thought increases in a relaxed mind.
• After that you have flow of ideas or “insight” into what your consciousness tells you may be the right path or direction for you leading to creative “inspiration”.
• Inspiration motivates action and then you start “implementing” and your creative ideas come to fruition.

According to Ayurveda, 2–6 pm in the evening and 2–6 am in the morning are the periods of Vata or creativity. Most poets and writers do their creative work during these times of the day, especially 2–6 am in the morning. Vata period is more creative and you are less likely to make mistakes. Four p.m. in the evening is considered the best time to make a deal, sign a document or to send a confession note.

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medallist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

Let go of the ‘Chalta Hai’ attitude

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The literal meaning of Chalta Hai’, the very commonly used colloquial term is “it goes”, which has become a part of life for us.

What it denotes is a happy-go-lucky attitude that everything is okay.

There is a common perception that you can do anything and nothing will happen, so even if something happens, one tries to pass them off as “things do happen” and accept them even if they are not correct.
But this attitude affects our work quality, makes us laid-back and non-assertive for what is right.
A major surgery may be uneventful, but sometimes unanticipated accidents can happen, however careful you are, even in a minor surgery.

Sometimes, mistakes are made, but it is believed that nothing will happen either to the patient or the doctor. Sometimes, hemostats, lap pads, gauze pieces may be mistakenly left in the patient’s body without the surgeon taking any routine double count, about which he may not even be aware of. These things may be detected late or when the patient develops pain or discharge from the wound. And, the patient may seek a legal re-dressal in the Consumer Courts, MCI etc.

Protocols are important in the practice of medicine. Protocols help to complete an important procedure in an orderly manner for the benefit of patients. They are predefined guidelines for standard of care. And, they are meant to be followed.

“Chalta hai attitude” tries to justify our inaction or lack of attention to detailing and acceptance of mediocrity in place of excellence.

As doctors, patients are our first and foremost concern and their health is our responsibility. This attitude cannot be our routine.

Now an era has come where the patient wants to be a 100% partner in decision making and wants to know everything about a mishap.

In earlier time, as doctors we used to take decisions on the part of the patients but that time is now gone.
For rare complications, we never used to discuss with the patients but if that rare complication does occur, today, that patient will not spare us.

If nothing goes wrong then “chalta hai” but if something goes wrong then the same chalta hai is “chalta nahi hai”.

So change your attitude form “Kya pharak padta hai” to “bahut pharak padta hai”.

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award,Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medallist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)
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Negligence vs wilful negligence

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Medical negligence is lack of reasonable degree of care & skill or wilful negligence on the part of a medical practitioner while treating a patient resulting in bodily injury, ill-health or death (damage) such as failure to remove swabs/instruments during surgery; failure to give ATS in case of injury causing tetanus; breaking the needle during injections; mismatched blood transfusion; amputation of wrong finger; operation on wrong limb or removal of wrong organ; loss of use of hand by prolonged splinting; prescribing an overdose or poisonous medicine producing ill-effect.

A simple medical negligence is failure to exercise reasonable degree of care and skill that an ordinary competent person would normally be expected to exercise under the circumstances.

“The three essential components of negligence are: Duty, breach and resulting damage.

• The existence of a duty to take care, which is owed by the defendant to the complainant;
• The failure to attain that standard of care, prescribed by the law, thereby committing a breach of such duty; and
• Damage, which is both causally connected with such breach and recognised by the law, has been suffered by the complainant.”

‘Gross negligence’ does not mean the absence of ordinary care; gross negligence is negligence of very high degree or reckless disregard for the safety of the patient. There is another term ‘wilful negligence’, which means that the act that was deliberately done with the knowledge that the action would cause harm to the patient. Mere recklessness, even when extreme, is usually gross negligence rather than wilful misconduct.

In any situation of negligence, a doctor can be sued in civil/criminal courts and consumer forum.

A simple negligence may result only in civil liability, but gross negligence or recklessness may result in criminal liability as well. A Consumer Court usually decides on deficiency of service and liability for compensation, while the Criminal courts decide on any violation of the Indian Penal Code (IPC).

A civil liability arises only when there is damage. A patient cannot sue the doctor if no damage has occurred, however the doctor might be negligent. But, in criminal negligence, mens rea or criminal intent must be shown. The degree of negligence is also much higher; it is gross or negligence of a very high degree.

Under section 304 of the Indian Penal Code (IPC), it is first important to establish criminal intent (mens rea) or that the doctor had the ‘knowledge’ that the treatment could harm but did not take the necessary informed consent.

304. Punishment for culpable homicide not amounting to murder.—Whoever commits culpable homicide not amounting to murder shall be punished with 1[imprisonment for life], or imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine, if the act by which the death is caused is done with the intention of causing death, or of causing such bodily injury as is likely to cause death, or with imprisonment of either description for a term which may extend to ten years, or with fine, or with both, if the act is done with the knowledge that it is likely to cause death, but without any intention to cause death, or to cause such bodily injury as is likely to cause death.”

“The word ‘gross’ has not been used in Section 304A of IPC, yet it is settled that in criminal law negligence or recklessness, to be so held, must be of such a high degree as to be ‘gross’. The expression ‘rash or negligent act’ as occurring in Section 304A of the IPC has to be read as qualified by the word ‘grossly’.”(Jacob Mathew vs State of Punjab & Anr)

“To err is human” Simple medical negligence is considered a professional hazard and is covered under indemnity insurance, but coverage does not include gross or reckless negligence.

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medallist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

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