Inform your patients before traveling

Health Care No Comments

The doctor-patient relationship is a sacred relationship. This relationship is initiated when the patient comes to the doctor, who in turn agrees to treat him. This ‘implied contract’ imposes on the doctor a legal duty to exercise due skill and care in providing medical treatment. Once a doctor takes on the care of the patient, he also has a duty to provide continuity of care when he is traveling or is unable to attend to the patient.

The ‘fiduciary’ nature of the relationship, one that is based on trust, which the patient reposes in his doctor also places an ethical obligation on the doctor to always put the interests of the patient first. Patients rely on doctors for help in their time of need. Regulation 1.2.1 of MCI Code of Ethics requires that “…Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion.”

So, before you undertake a case, if you are planning a visit out of town or a vacation, you still need to take care of your patients.

Communication is the key to developing and nurturing the trust in a doctor-patient relationship. So, if you are going to be away on a vacation or for a conference etc. also convey the same to your patient. Inform them about the duration of time you would be away and the dates of your departure and return. If you have arranged for another physician to take care of your patients in your absence, then share the names, along with his or her credentials and training, with your patients also. This enables the patient to make an informed decision, whether to continue with you as his doctor. Before doing a surgery, the patient must know that you would not be there for his postop care. Take an informed consent of the patient, otherwise avoid doing the surgery.

A physician is required to be “diligent in caring for the sick” (MCI Regulation 1.1.2). Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family (MCI Regulation 2.4).

Failing to do so might put you at risk for a medical malpractice claim.

Dr KK Aggarwal
National President IMA & HCFI

Dr K K Aggarwal
Recipient of Padma Shri, Vishwa Hindi Samman, National Science Communication Award, Dr B C Roy National Award & FICCI Health Care Personality of the Year Award
National President IMA
Vice President Confederation of Medical Associations of Asia and Oceania
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)

Family physicians are the need of the hour

Health Care No Comments

With a population of more than a billion (~1.32 billion), India is facing a shortage of doctors, establishment and beds. Presently, India has one doctor for every 1700 people against the WHO recommended norm of 1 doctor for every 1,000 people. There are not enough doctors to take care of the health needs of all.

This is the time to bring back the age-old concept of ‘Family physician’. Unlike a General Practitioner, a family physician looked after all the health needs of a family, even many generations of a family, regardless of his/her specialization. They not only treat, but also provide preventive health care to the family being aware of the family history and was the link between the patient and the specialist. Considered a part of the family, he was an integral part of all important family functions and events. All in all, he was a ‘friend, philosopher and guide’ of the family.

For good health outcomes, a physician has to be aware of the social determinants of health i.e. the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. It is important to know the socio-economic circumstances of a patient, because these influence outcomes. Family physicians address the social determinants of health.

Family physicians also offer several advantages; most important are familiarity, trust, and ease of communication due to a long-lasting relationship. As a result, patient is more likely to open up about his problems and adhere to the treatment prescribed. Family physicians provide a continuum of care at all levels of care, including emergency care.

Medicine has become highly specialized today leading to isolation among different specialties as well as from patients. Lack of communication has fostered distrust among patients becoming evident as rising litigations or often as violence against doctors.

Hence, instead of destroying the family physician system, re-introducing the ‘traditional concept’ of family physician is the need of the hour. They are the first link in health care delivery for the population and play a pivotal role in preventive health, early diagnosis and timely referral including maintaining health details of all family members. Their services can be used on a retainership basis.

One of our demands in the Dilli Chalo Movement on 6th of this month was that we need more than 25,000 additional PG seats in Family Medicine.

Dr KK Aggarwal
National President IMA & HCFI

Cellulose-based capsules to replace gelatin capsules

Health Care, Medicine No Comments

Capsules are a very widely used dosage form. They are easy to administer, mask the odor and taste of drugs, which may be unpleasant to some patients. Due to rapid disintegration, the drug is rapidly released in the stomach. Hence, they are a necessary form of drug. However, one aspect that is of concern is their storage. Capsules should be stored in airtight containers and in a cool and dry place to avoid degradation. They need to be protected from light and moisture.

Gelatin has been commonly used to manufacture capsules, which is derived from animal sources, including bones.

But now, the Govt has recommended a proposal to replace gelatin capsules with vegetable capsules. The sources of these vegetable capsules are plant in origin.

In March this year, an Expert Committee was constituted to address all technical issues pertaining to the replacement of gelatin (non-vegetable) capsules with cellulose-based capsules. According to notice from the Directorate General of Health Services (DGHS) office dated June 2, 2017, the proposal is open to suggestions/comments within 21 days.

The Bureau of Indian Standards (BIS) has formulated Draft Indian Standards for cellulose based vegetable capsule shells. Hydroxypropyl methyl cellulose (HPMC), most commonly known as hypromellose, is used in the manufacturing of the cellulose-based capsule shell.

India is a land of diverse religious and cultural beliefs and traditions. A vegetable alternative should be available. On account of religious and cultural sentiments, patients may prefer the cellulose-based capsules over gelatin capsules. Additionally, personal preferences may influence the choice of the vegetable capsules. We have to respect these choices. Patients should be conveyed that the capsule is non-vegetable.

In addition their safety and stability, the most important concern to be addressed is affordability to the patient. If the cost comes out to be the same as gelatin capsules, then the gelatin capsules can be replaced with cellulose-based capsules. But, if these capsules would cost more than the gelatin capsules, then both the options should be made available, leaving it to the patient to choose his preference.

Another issue that comes up is the manufacturing capacity. More than a billion capsules are manufactured in India every year. Do we have the production capacity to match and then meet the growing demands?

How do we differentiate the vegetable capsules from gelatin capsules? Will they be identified by the green and maroon circles in a square as used on food items? A maroon dot indicates the presence of non-vegetarian ingredients, while a green dot identifies vegetarian food. In May last year, the Drugs Technical Advisory Board (DTAB) had rejected the proposal to label the cellulose-based capsule with green dot to indicate its vegetarian origin to differentiate them from the normally available gelatin-based capsules stating that “unlike food, drugs are not taken by choice but are prescribed by the doctors to save lives and marking them vegetarian or non-vegetarian origin is not desirable”.

DCGI is the regulatory authority, which provides the standards and quality of manufacturing, selling, import and distribution of drugs in India. Any drug approved by the Drugs Controller General of India (DCGI) is safe and a quality drug. But, there are issues that need to be addressed. 

Dr KK Aggarwal
National President IMA & HCFI

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