A shift towards person-centric medicine

Health Care, Medicine Comments Off

Every person has a distinct unique set of characteristics that distinguishes them from the other.

“Individualization” is inherent in the science of homeopathy, which recognizes every patient to be different from the other, even if they have the same disease and individualizes treatment for every person.

The modern system of medicine is also now shifting towards person-centric medicine. Every patient has to be managed differently for the best possible outcome. What is acceptable to one patient, may not be acceptable to the other. Treatment must be tailored to each individual patient taking into consideration their individual characteristics, culture, personal preferences, expectations etc.

The Institute of Medicine (IOM) has defined patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”

A few days back, I spoke about the social determinants of health; the social situation of the patient, environmental factors, which influence health of a person. These may differ from patient to patient. Their personal and family history including medical history are different. Individual response to drugs may vary, the side effects may vary. All these variables need to be taken into account when formulating a treatment plan.

For this reason, the standard treatment guidelines need to be challenged. Guidelines are evidence-based recommendations for groups of patients, but not the individual patient. While they give a direction, they cannot be applied to all patients alike. Doctors must exercise clinical judgement in selecting the best treatment option for a particular patient.

Individualized treatment plans are based on the unique demands of that particular patient and address the needs of that patient and what the patient wants. They also involve the patient and encourage shared decision making with the patient and the family.

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 Medalist 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)

Personal care medicine: Social health

Health Care, Medicine Comments Off

“Health is not just the absence of disease, but a state of complete physical, mental and social well-being”. This is a well-recognized definition of health as given by the World Health Organization (WHO).

As this definition clearly states, the social contexts of health and disease or “social health” also form important aspects of health. These are the conditions in which we live, learn, work and age i.e. the conditions of day-to-day life, which in turn are influenced by the political, social and economic systems of the country. How a person gets along with other people and how do people talk about a person behind his back is also social health.

These social determinants of health are equally important or perhaps even more important in influencing the health and well-being of an individual. For this reason, they have also been called “the causes of the causes”.

The WHO has identified 10 social determinants of health:

1. Social gradient
2. Stress
3. Early life
4. Social exclusion
5. Work
6. Unemployment
7. Social support
8. Addiction
9. Food
10. Transport

Social gradient is measured by variables such as income, education, housing or occupation.

Education inculcates healthy behaviors. Housing determines better access to healthy foods and health services. Conflicts, gender inequality are also important social determinant of health as they may also influence availability and access to health services.

Food- and water-borne diseases are due to lack of access to safe food and clean drinking water and poor sanitation. These are more often than not the consequence of poverty or low income, which is associated with poor housing, overcrowding and poor sanitation. So, you may treat that one episode of diarrhea but, the patient who lives in areas of poor housing and sanitation may come back to you with recurrent episodes of diarrheal diseases.

Air pollution is a major environmental risk to health. NCDs, such as cardiovascular diseases including stroke, chronic respiratory diseases and cancers have been linked to outdoor air pollution. Exposure to biomass smoke, or indoor air pollution, is a major risk factor for COPD.

A patient who is struggling to meet his daily needs may not be amenable to advice about lifestyle modifications – quitting smoking, physical activity/exercise, healthy food. These will not be a priority for him.

Social isolation and loneliness will only further aggravate the condition in a patient of depression.

Persons whom we come in contact with daily, be it family or friends, also influence healthy behaviors. If your family and friends exercise regularly, it is more than likely that you will also pick up this healthy habit. But remember, bad habits are also catching, for example, alcoholism, substance abuse, smoking, etc.

A research published in the May 22, 2008 issue of the New England Journal of Medicine had shown that when one person quits smoking, than others are likely to follow. One person quitting can cause a ripple effect, making others more likely to kick the habit.

• If your spouse stops smoking, you’re 67% less likely to continue smoking.
• If your friend kicks the habit, it’s about 36% less likely that you’ll be smoking.
• When a sibling gives up cigarettes, your risk of smoking decreases by 25%.
• Risk of smoking drops by 34% if a coworker in a small office quits smoking.
So, have positive influences around you. Keep the company or “sangat” of good people to spend time with. Adi Shankaracharya has described Sangat as the main force for living a spiritual life.

India is facing the double burden of infectious diseases and non communicable diseases, undernutrition and overnutrition (overweight and obesity). This is a reflection of the health inequities in the country.

Therefore, achieving the desired health outcomes is not just dependent on treating the disease alone. Addressing the social determinants of health is equally important, first to achieve the desired results and then to sustain them. A healthy person is more productive and contributes to the growth and development of society.

The concept of “One Health” recognizes that the health of people, animals and the environment are connected. Many diseases in humans or zoonoses are spread from animals.

Treat the person in totality and not just the disease.

As Sir William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.”

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 Medalist 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

Health Care, Medicine Comments Off

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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