Supreme Court to decide about apology: Will the Apex Court’s decision on apology have implications on medical mistakes?

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Yesterday, the Congress president Rahul Gandhi expressed regrets in the Supreme Court over his remarks related to Rafaele.

If the Apex Court decides to accept the apology of Rahul Gandhi, this will provide another tool for councils to decide about medical apology.

The council has powers to accept the mistake. As per Regulation 8.2 of MCI Code of Ethics, “…If the medical practitioner is found to be guilty of committing professional misconduct, the appropriate Medical Council may award such punishment as deemed necessary or may direct the removal altogether or for a specified period, from the register of the name of the delinquent registered practitioner…”.

Apologies are gaining in importance, both nationally and internationally. These started with the example set by Pope John Paul II in his numerous apologies on behalf of the “children of the church” in anticipation of the Jubilee Year, as well as redress through national apologies to various groups-including Japanese Americans interned during World War II; Native Americans, whose land was confiscated and were otherwise mistreated; African Americans, whose ancestors were victims of slavery; and particular African Americans, who were victims of medical tests such as the “Tuskegee Experiment.”

The importance of the apologies of healthcare professionals-particularly physicians and hospital leaders through their risk management personnel-to their patients for medical errors became an important matter in medical education and practice around 2000.

There have been at least five converging forces leading to the current interest in medical error apology.

The physician-patient relationship is more egalitarian than ever before. Patients are now apt to be informed consumers-due in part to the Internet and popular advertising-who feel that they have the right to negotiate their treatment and know when mistakes have been made.
The American medical communitys knowledge about the frequency and seriousness of medical errors has been growing, and many believe that such knowledge and disclosure to patients will ultimately improve medical practice. Such disclosure is now required by the Joint Commission on Accreditation of Healthcare Organizations.
Once doctors disclose a serious medical error to a patient, it is only common wisdom for medical professionals to apologize for psychological and humanitarian reasons. Patients would inevitably perceive withholding an apology in such circumstances as offensive, insensitive, and unprofessional.
Physicians and other medical staff in several medical centers have successfully diminished the costs of malpractice suits by apologizing to patients for medical errors and, when appropriate, making out-of-court settlements.
Several states in USA have passed or are considering legislation that would allow supportive, benevolent comments, as well as apologies, to be inadmissible in malpractice cases, thereby encouraging physicians to offer such comments and apologies.
Lawyers have always advised physicians and other healthcare professionals to refrain from apologizing to patients, because they believed that offering an apology is an admission of guilt, which would increase the frequency and amount of malpractice claims.

This assumption is changing and today many believe that such apologies are not only ethically correct but may even decrease such claims.

“Hushing up’ of errors increases results in an angry patient and creates distrust between the doctor and the patient.

Apologize to the patient in such situations…While it does not undo the damage caused, an apology may soothe the emotions of the patient and/or the family and lessen the anger and distrust.

Let us see what the apex court decides…

(Source: De Paul University)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Stress and unhealthy eating can weaken the immune system

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Anti-inflammatory diet can work wonders for gut health and avert autoimmune disorders

New Delhi, 22 April 2019: A recent research conducted on mice discovered that having too much molecular switch called VGLL3, which regulates immune response genes in skin cells, lead to autoimmune diseases. The study published in ‘JCI Insight’ pointed a key role for VGLL3. Three years ago, a team of University of Michigan researchers showed that women have more VGLL3 in their skin cells than men.

One of the basic foundations of the human body, the immune systems, protects us from many diseases. However, even this system can sometimes turn against the body and cause tissue destruction and degenerative diseases by attacking the healthy cells. This condition leads to what are known as autoimmune disorders (AID).

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “AID often mimic several other health conditions and therefore, an accurate diagnosis is often difficult. They can affect different parts of the body. However, it is imperative to watch out for some symptoms and get tested if they prolong. Some of these include new allergies; heightened sensitivity to chemicals, foods, or smells; lack of energy; absence of any sickness since the immune system is busy attacking itself; brain fog; and even anxiety and depression. People with certain risk factors are more prone to AID than others. Genetic predisposition to the condition is an important aspect. Apart from this, their prevalence is more in women due to hormonal changes. In some, AID can set in during the childbearing years. Some other factors include age, ethnicity, certain bacterial or viral infections, and diet and exposure to chemicals and environmental toxins.”

Some examples of AID include multiple sclerosis, Type 1 diabetes, rheumatoid arthritis, and chronic thyroiditis, among others. Over 80 million types of AID affect approximately 100 million people worldwide. 1 In India, at least 10% of the population suffers from various such conditions making them an important reason for morbidity and mortality.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “AID can be diagnosed with a complete blood count test. A deviation from the normal level of white and red blood cells can indicate some underlying issue. A few other tests that can detect an inflammation characteristic to AID are the C-reactive protein and erythrocyte sedimentation rate test. As each AID has markedly different symptoms, the treatment can also vary accordingly. For instance, celiac disease needs to be managed with a gluten-free diet. Other conditions may require therapy or medication.”

Some tips from HCFI

  • Our eating patterns have a major role in the prevention of AID. It is imperative to avoid eating an unhealthy diet as processed foods can not only lead to inflammation but also set off an immune response.
  • A healthy and balanced diet can do wonders for gut health and further, a strong immune system. A diet rich in essential nutrients such as vitamins A and D, selenium, zinc, omega-3 fatty acids, pro-biotics, glutamine, and flavanols can avert the onset of autoimmune diseases.
  • It is also a must to engage in at least 30 minutes of physical activity a day as it helps in boosting the body’s natural anti-inflammatory mechanism.
  • Stress is a major factor triggering inflammation, and therefore, it is a good idea to practice relaxation techniques such as yoga and meditation.

Time to fight for the rights of mentally challenged people

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The Indian Medical Association (IMA) and Indian Psychiatric Society have condemned the title and poster of a soon to be released film “Mental Hai Kya”. They have also asked the producer of the film to withdraw the trailer and also change the title and content, if it has any such provocative sequence, dialogues or songs. The film is a dark comedy centered on the lives of its two protagonists, both of whom show suicidal tendencies.

The title of a recent film “PK” may be an oblique reference to “somebody who is drunk”. Films like “Munna Bhai MBBS”, “Gabbar is Back” had also projected the medical profession in a bad taste.

Under Section 92 (a, f) of the Rights of Persons with Disabilities Act “whoever intentionally insults or intimidates with intent to humiliate a person with disability in any place within public view shall be punishable with a jail term of not less than six months, which may extend to five years, with fine.”

Films are usually a reflection of our society and portray the changing times. They do create awareness about relevant prevailing issues and often bring about much-needed change. “Rang de Basanti” was one such film.

While artistes have the right to freedom of expression, no profession or illness or disease should be shown in poor light.

To remove the stigma, the medical profession has changed the terminologies from prostitute to commercial sex worker; physically handicapped to differently abled; penis to the male organ; vagina to the female organ; retarded to mentally challenged; addicted to dependent; hinjra to transgender etc.

Mental illnesses still have a stigma attached to them. For this reason, people still hesitate to share that they have a mental illness and are reluctant to seek professional help.

The phrase “pagal hai kya” is used every now and then in daily conversation. This is because the public is generally ignorant about mental health issues. If the film is successful, “Mental Hai Kya” may well become a part of common parlance or everyday speech.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

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