President Trumps Health

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President Donald J. Trump underwent his first official health check-up since he entered the White House in January 2017.

Age 71 Examined on: January 12, 2018 Examined at: Walter Reed National Military Medical Center in Bethesda, Maryland Physician: White House physician, Navy Rear Adm. Ronny L. Jackson, MD Report made public by: Dr Jackson and Sarah Sanders, the White House press secretary

Report: Healthy

His last health information: September 2016 by Harold Bornstein, MD.

  • Height: 6 feet 3 inches     ·         Weight: 236 pounds     ·         BP: 116/70     ·         Fasting sugar: 99     ·         HDL: 63     ·         LDL: 94     ·         TG: 61     ·         Coronary artery calcium score (in 2013): 98     ·         Chest X ray and ECG: Normal     ·         PSA: 0.15     ·         Colonoscopy (in 2013) found no polyps     ·         Testosterone: 441.6     ·         LFT and TFT: Normal     ·         TTE: Normal

Medications: Rosuvastatin, low-dose aspirin, finasteride (baldness) and antibiotics for rosacea.

This 2016 as well as 2018 information does not mention cognitive health.

The mental health of the President has come into question several times in the first year of his Presidency in his speeches, his Tweets and TV appearances.

The day before the physical, a group of 75 physicians had urged the President’s physician to evaluate Trumps neurological health, including cognitive and mental health functions, as is called for in Medicare guidelines.

In a letter, they expressed what they called “increasing concern” over what they said was Trumps “declining faculties for complex thought, rambling speech, difficulty completing a thought; episodes of slurred speech; failure to recognize old friends; frequent repetition of the same concepts; decreased fine motor coordination; difficulties reading, listening and comprehending; suspect judgment, planning, problem solving, and impulse control; and, markedly declining vocabulary in recent years, with over reliance on superlatives.”

Trumps father died at 93, after having developed Alzheimers disease in his 80s. Suspecting that President Trump may have early Alzheimer’s disease, they recommended that the exam include a basic dementia screen.

However, it is not clear whether cognitive health was also evaluated in the annual exam. The President has been declared in excellent health, although no details have been released. The results of his physical exam are likely to be made public by next week with the consent of the President.

The question here arises whether it is right to comment on the mental health of a person without actually examining the person. Can the mental health of a person be judged simply on the basis of a person’s behavior?

The American Psychiatric Association (APA) does not think so and has called clinicians out for making “armchair” diagnoses, and recommended they heed the APAs Goldwater Rule, which proclaims it unethical to diagnose without examination.

APA guidelines

  • “A proper psychiatric evaluation requires more than a review of television appearances, tweets, and public comments,”
  • Diagnosis requires a review of medical and psychiatric history and records, and a complete examination of mental status.
  • “The Goldwater Rule embodies these concepts and makes it unethical for a psychiatrist to render a professional opinion to the media about a public figure unless the psychiatrist has examined the person and has proper authorization to provide the statement

Section 7 of the APA’s Principles of Medical Ethics is widely referred to as the Goldwater rule and it says as follows: “On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement (3)”.

New guidelines adopted by the American Medical Associations Council on Ethical and Judicial Affairs for Ethical Physician Conduct in the Media in November 2017 also state that physicians should “ Refrain from making clinical diagnoses about individuals (e.g., public officials, celebrities, persons in the news) they have not had the opportunity to personally examine”.

To an extent, things are open in the public in the US. The reports of the annual physical exam of the Presidents are released by the White House, of course, with their consent.

Individuals such as Presidents are important public figures. Their decisions and statements, while in office, affect not only their country, but also have an impact on world affairs. Hence, they should be in the best of health, physical as well as mental, as they are at the helm of affairs.

But this is not the case in India.

Should public figures, politicians in particular disclose their health issues or release results of their annual physical exam to the general public?

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

“Koi Dekh to Nahi Raha”: Doctors are brand ambassadors of health

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Doctors in India have been equated to God since ancient times. This has continued even today even after modern medicine has taken over. No other profession perhaps enjoys the same exalted status as that of the medical doctors.

A common man usually perceives God as a force for whom nothing is impossible, as the one who is the final decision maker, whose decisions cannot be challenged, who can provide instant relief and who overcomes miseries. He can also answer the unknown as He is omniscient i.e. all-knowing.

A doctor is a healer and helps the patient overcomes his problems, and at times, saves the life of a patient. Most of us have faith in God and trust that He will do right by us. Similarly, during illness or during any acute emergency, patients and/or their families repose the same faith and trust in their doctor.

Doctors are different, they are role models and icons. They are expected to act in a manner befitting their position in the society. Regulation 1.1.1 of the MCI Code of Ethics also requires a physician to “uphold the dignity and honour of his profession”.

Doctors look after the health of not only their patients, but also that of the community and are therefore regarded as “Brand Ambassadors of Health”.

This public role puts a responsibility on all of us to practice what we teach our patients about healthy habits and lifestyle.

And also maintain our dignity and integrity before the patients. For example, if they see you drinking even if it is social or indulging in any other ‘questionable’ personal action, this would make them suspicious of your integrity or regard it as hypocrisy. This moral code of ethics therefore must be respected at all times.

Despite a public role, doctors deserve a personal time, which should be off-limits for patients. The two should not mix.

Therefore whenever you are in your private life see “ Koi dekh to nahi rha”

IMA seeks increase in budgetary allocation for health

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It is the obligation of the state to provide free and universal access to quality health-care services to its citizens. India continues to be among those countries of the world that have a high burden of diseases. The various health program and policies in the past have not been able to achieve the desired goals and objectives.

High-level expert group (HLEG) on Universal Health Coverage (UHC) constituted by Planning Commission of India submitted its report in Nov 2011 for India by 2022. The recommendations for the provision of UHC pertain to the critical areas such as health financing, health infrastructure, health services norms, skilled human resources, access to medicines and vaccines, management and institutional reforms, and community participation. Planning commission has estimated that 3.30 lakh crores has to be spent in 12th FY period (2012-2017) to achieve the goal of UHC by 2022. We are already into the third year of the 12th FYP and yet only a meager proportion of this amount has been budgeted so far on an annual basis

It is believed that an important factor contributing to India‘s poor health status is its low level of public spending on health, which is one of the lowest in the world. In 2007, according to WHO’s World Health Statistics, in per capita terms, India ranked 164 in the sample of 191 countries. This level of per capita public expenditure on health was less than 30 percent of China’s (WHO, 2010). Also, public spending on health as a percent of Gross Domestic Product (GDP) in India has stagnated in the past two decades, from 1990–91 to 2009–10, varying from 0.9 to 1.2% of GDP

Government should increase the public expenditure on health from the current level of 1.1% GDP to at least 2.5% by the end of the 12th plan and to at least 3% of GDP by 2022. Government should ensure that a minimum of 55% of health budget is spend on primary, 35% on secondary and a maximum of 10% on tertiary care services (as proposed by National Health Policy 200), as against the current levels of 49%, 22% and 28% respectively.

The Twelfth Finance Commission provided grants to selected states for improving health indicators, but in effect, they recommended that the grants cover only 30% of the gap between the state‘s per capita health expenditure and the expenditure requirements assessed by them for each of the state. This should go up to at least fifty percent of the gap. Additional transfers from the central government to selected states have to be directed toward primary care and the first level of secondary care by strengthening the related health infrastructure and personnel. This is important not only to facilitate basic primary and secondary care but also to reduce the burden and expenditure share at the tertiary level.

The estimated additional expenditure requirement just to provide subcenters, health centers, and community health centers according to the norms is estimated at 0.6% of GDP. There are additional administrative expenditures and requirements for providing health facilities in urban areas, and these could add up to another 0.4%. Thus, a minimum of one percent of GDP will be required in the medium term (next 1 to 2 years) to ensure minimum levels of health care as per the norms.

There should be an increase in spending for public procurement of medicines from 0.1% to 0.5% of GDP. Government should bring in legislation to discourage pharmaceutical firms from using trade names in marketing. Drugs should be available only in chemical name; which will help to bring in uniformity. At the same time there should be strict mechanism to monitor and ensure that drugs available in the market are of good quality. Government should invest in establishing drug-testing laboratories in each state. In addition, government should support and rejuvenate the existing public sector drugs and vaccines manufacturing units

General taxation plus deductions for health-care from salaried individuals and taxpayers as the principal source of health-care financing should be used, and no fees of any kind be levied for the provision of health-care services under UHC. Insurance is not a panacea and government should refrain from promoting health insurance as the best solution for health care problems in the country.

Government should introduce a health cess (0.5%) as a component of the existing VAT system and the new Goods and Services Tax (GST) that is proposed. There should be additional health cess for sweetened beverages, tobacco, alcohol and cars. This will raise revenue for the government and at the same time will also act as a measure to discourage the use of these products

Water, hygiene and sanitation are the cornerstones for effective public health protection. Government should not only increase allocation to these areas, but also ensure that the money is spend properly and time-bound Government should move to a system of ‘purchasing’ secondary care services from private sector until it can provide these services by itself. This will help to prevent out-of-pocket expenses for a large section of population and also can reduce the burden on tertiary care.

The reimbursement scheme for health care should be extended to all people working in organized sector and not just to central government employees. This will help to relieve some pressure on the public health systems on one side, and will help to give more options for people in the organized sector.

The present schemes such as JSBY, RSBY, JSY etc. are run by different ministries and departments. The Budget should facilitate convergence among the various stakeholder ministries/departments so that we can evolve a comprehensive social security package

Public and private sectors should not move as parallel systems, but should complement each other. Public private partnership in health should be promoted. At present, the facilities in private sector are underutilized at one end, whereas public sector lack in facilities to cater to the needs. Government should design special programs in discussion with professional associations like IMA to optimally utilize the resources- both in the public and private sector. This will include sharing of the resources in private sector like CT, MRI scans etc. for patient care in public sector.

Services of family doctor/single man private clinics should be optimally used on a retainership basis, at least in places where government doctors are not available at PHCs, until government is able to recruit and sustain regular doctors.

Government should increase the allocation for health awareness programs. A repository on health information should be created and disseminated using the social media. Non-communicable diseases and health needs of the elderly need urgent attention. Government should increase the allocation to these areas significantly. National programs for NCD and care of elderly should be introduced in all the districts within the next two years. Telemedicine should be given importance, with simultaneous investment in increasing the availability of trained and qualified human resources.

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