Straight from the Heart to our senior colleagues: We seek your blessings and support

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To

All our Senior Colleagues – Past Presidents, Association Presidents, Medical Leaders, National Awardees, Teachers, Administrators and Mentors

We need your blessings and support in fighting for the cause of the medical profession

Dear Colleague

Our medical profession is facing very tough times. From time to time, doctors are being abused or beaten, manhandled, tried in the media, defamed in social media, criticized by the public or charge sheeted by the police. Don’t you think that we now need to speak out in ‘one voice’ and fight against this multipronged assault?

Two and a half years back, I practically took a sabbatical from my clinical practice and have devoted myself to work for the betterment of and in the interest of the medical profession in my various capacities in the Indian Medical Association (IMA).

Through these years, it has been my endeavor to provide a common platform for dialogue amongst the fraternity and also with the policymakers and other stakeholders.

And, I now seek you support to take this fight to its rightful conclusion.

If you feel, that IMA is right

1. That we have a right to live with dignity and honor.
2. That no media trial of doctors should be allowed.
3. That no media should disclose the name of the doctor till he/she has been convicted by any court of law.
4. That we have the autonomy to choose drugs, investigations and the line of treatment
5. That we have the autonomy to decide our consultation and procedure charges
6. That we have the right to practice in a violence-free environment
7. That we are not against accountability but no one has a right to take law in their hands
8. That how can compensation to a patient be awarded on the basis of the income of the patient?
9. That how can AYUSH doctors be allowed to practice modern medicine?
10. That how can our service doctors be on contract for decades on peanut salaries?
11. That how can our doctors work in rural areas with half the salary of those working in the urban area?
12. That how can we be criminally prosecuted for clerical errors?
13. That how can we be under the purview of the PC PNDT Act, when many of us do not see any obstetric cases?
14. That how are we expected to provide for the complete treatment of victims of acid attack, rape or child sexual abuse?
15. That how can we sustain ourselves when CGHS does not pay us for months?
16. That how can we survive with the types of payment as scheduled by Mediclaim and TPAs?
17. That we buy diagnostic machines in dollars, but charge our patients in rupees, then how why are we accused of being commercial?
18. That when all my scientific updates are given to me by the hospital or industry then how can I be blamed of being in a nexus with them?
19. That when I am supposed to implement all national Health programs, than why am I not given compensation in the form of subsidy?
20. That when government looks after only 20% of the population and the private sector is forced to fill in for the government by looking after 80% of their work, then why am I not being acknowledged for the same?

If you think that these concerns of IMA are genuine, then I ask you to join us and help build the movement “Enough is Enough: Dilli Chalo” on 6th June from Rajghat to Indira Gandhi Stadium, 8am to 2 pm.

Please sign the petition at ima-india.org/dillichalo.

A live webcast of the event would also be available at ima-india.org/dillichalo.

There are several ways by which you can contribute in making this movement a success.

1. You can accompany us on 6th June to meet a political dignitary with our demands
2. You can help sensitize the MPs and other political leaders.
3. You can help sensitize the retired judges and senior lawyers.
4. You can have doctors sign the petition.
5. You can join and bless the team at Indira Gandhi Stadium with encouraging words of wisdom.
6. You can send your words of wisdom to be spoken at the event.
7. You can speak to the media about the issues facing the medical profession.
8. You can sensitize the media for a TV debate.
9. You can have someone sponsor a few advts for that day.
10. You can post your video support on social media.
11. Collect donations for IMA for this movement.

Dr KK Aggarwal
National President IMA & HCFI

Straight from the heart

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Krishan Kumar in conversation with Dr KK Aggarwal

Dr KK Aggarwal
National President IMA & HCFI

Krishan Kumar: The earlier medical days of Dr KK Aggarwal.

Dr KK: Krishan, now a days, there is a lot of mistrust between patients and doctors. Was it there in your era also?

Krishan: No, during my PG and early post PG days we had very cordial relationship with our patients. We used to get full respect from the patients and we used to take decisions on their behalf. There was no question of any violence. But why are you asking this question?

Dr KK: Today when we cross the ICU corridors, relatives do not get up. And when we enter the room of the patient, the relatives talk to us sitting on the sofa. We do not get the same respect you are talking about.

Krishan: But during our times most of the hospitals in private were trust non- profit hospitals and not profit making corporate hospitals. That perception that the hospital is not-for-profit was sufficient for the public to trust the hospitals and their billing. Also, in 1995, full one week treatment in ICU for a heart failure patient was Rs 12000/- only.

Dr KK: But why are the patients are violent today? What was in your era that this violence was missing?

Krishan: In our time, there were no mobile smart phones and internet services right at our hands. The patient was dependant on information provided by us. Today your patients are well-informed and want to be a part of treatment unlike our times when we used to take their decisions.

Dr KK: In your time, were the patients a potential litigant?

Krishan: No, we never heard of that. Only occasionally we used to hear about cases going to consumer courts. We used to have a very efficient and good patient and relatives redressal mechanisms.

Dr KK: Who used to refer patients?

Krishan: Mostly family physicians referred the patients. The association was on merit. Once the patient was discharged, they (family physicians) followed up with the patients.

Dr KK: Was there an allegation that doctors used to get referral fee for referring patients?

Krishan: No, the first CT scan in Delhi was put by someone named Dr Gupta, he started the scheme “refer four and get one poor patient free”. There was no concept of referral fee without a service.

Dr KK: Did you ever see dengue patients in that era?

Krishan: Yes, in late nineties, for up to ten years, we used to see a mysterious viral illness with low platelet count. Most will recover by themselves. Later, this was named by AIIMS as dengue. Because we used to treat them as simple virus fever, there was no panic. We never repeated platelets counts. No platelet transfusions were given.

Dr KK: Are you happy, that you did your MBBS in 1975-79?

Krishan: Yes. I learnt how to treat patients without investigations. We used to treat heart patients with lifestyle management with very satisfactory results. My fee at medical college was only Rs 100/- per month. I do not think I could have afforded studying at a private medical college at that time.

Krishan: Are you not happy that I never started smoking or taking alcohol in my college days?

Dr KK: Yes, I am very thankful to you. I know today how difficult it is, even for doctors, to stop addiction.

Krishan: I have heard you always wear a stethoscope?

Dr KK: You are right. I love my profession. A stethoscope, all the time, reminds me of my medical dharma.

Krishan: You are known to be deep into Vedic Philosophy then why are you planning the campaign Dilli Chalo on 6th June?

Dr KK: I am a Vedic medicine student and believe in both Rama and Krishna. Both taught us to fight for our Dharma in the interest of the community.

We need to fight for the rights of the patients, community and our profession. How can we allow second grade treatment to our patients by quacks and government sponsored quackery through AYUSH? How can I allow criminalization of medical practice on my doctor colleagues? How can I allow my doctors to go to jail for clerical errors? How can I allow my medical students to go for one more exam once they have cleared their MBBS? How can I allow my MCI to be replaced by a nominated body?

I believe in my conscience and I will do what is good for the profession. I do not think so you would have done differently if the same situation was in your era.

Krishan: I agree with you. I think IMA is doing a humane job for the community.

—————-

About Krishan Kumar

Right from the age of four, Krishan wanted to become a heart specialist. Born in an average family of nine brothers and sisters he did his schooling at ASVJ higher secondary government school, Darya Ganj Delhi, pre-medical from Desh Bandhu College Delhi and in 1975 joined Mahatma Gandhi Institute of Medical Sciences Sevagram Wardha and did MBBS and MD Medicine from there getting a medal in every subject, topping all three MBBS and getting Nagpur University Gold Medal.

About Dr KK Aggarwal: At Moolchand Hospital, his boss was Dr K L Chopra (Krishan Lal Chopra), father of new age Guru Dr Deepak Chopra. To avoid confusion, Krishan Kumar now became Dr KK Aggarwal. At Moolchand, he joined as a consultant in Medicine and Cardiology, went to US for Fellowship in Non-Invasive Cardiology and Color Doppler Echocardiography, started Echo institute and Heart Care Foundation of India, received Padma Shri in 2010 and currently is the National President of IMA.

Air pollution and the heart

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· Air pollution, and specifically fine particulate matter, is associated with increased cardiovascular disease mortality.
· Air pollution has emerged as a potentially modifiable risk factor for the development of CVD.
· Whether air pollution is associated with episodes of AF was evaluated in a study of 176 patients with dual chamber implantable cardioverter-defibrillators that were capable of detecting episodes of AF. After follow-up of nearly two years, there were 328 episodes of AF lasting 30 seconds or more found in 49 patients.The potential impact of multiple parameters of air pollution, (measured hourly) on the development of AF was examined. The odds of AF increased significantly as the concentration of particulate matter increased in the two hours prior to the event. ( J Am Coll Cardiol 2013; 62:816. )
· Multiple observational studies have demonstrated an association between fine particulate air pollution (primarily from the use of fossil fuels in automobiles, power plants, and for heating purposes) and cardiovascular and cardiopulmonary mortality as well as an increased risk for the development of acute coronary syndromes
· The Women’s Health Initiative Observational study database of more than 65,000 postmenopausal women without prior CVD was used to evaluate the relation between a woman’s long term exposure to air pollutants and the risk for a first cardiovascular event.For each 10 mcg/m3 increase in pollution concentration, there were significant increases in the risk of any cardiovascular event (hazard ratio 1.24), death from CVD (hazard ratio 1.76), and of cerebrovascular events (hazard ratio 1.35). ( N Engl J Med 2007; 356:447. )
· Mortality data from nearly 450,000 patients in the American Cancer Society Cancer Prevention Study II data base were correlated to air pollution data, including average concentrations of ozone and fine particulate matter (≤2.5 micrometers in diameter [PM2.5]). In multivariate analysis PM2.5, but not ozone, concentration was significantly associated with the risk of death from cardiovascular causes (relative risk 1.2). (< N Engl J Med 2009; 360:1085. )
· Further support for the significance of air pollution comes from a study of death rates in Dublin, Ireland before and after a ban on coal sales that led to a 70 percent reduction in black smoke concentrations ( Lancet 2002; 360:1210. ). Adjusted cardiovascular deaths fell by 10.3 percent in the six years after the ban.
· Both the American Heart Association (2010) and the European Society of Cardiology (2015) have issued official statements discussing the association between long-term exposure to fine particulate air pollution and increased risk of developing cardiovascular disease ( Circulation 2010; 121:2331. Eur Heart J 2015; 36:83)
· In addition to long-term risk, short-term exposure to air pollutants (both ozone and fine particulate matter) has been associated with acute coronary ischemic events.’
· In a study of over 12,000 patients living in a defined geographic area, a short-term increase in fine ambient particulate matter positively correlated with an increase in acute ischemic coronary events ( Circulation 2006; 114:2443 )
· In a systematic review and meta-analysis of data from 34 studies, CO, NO2, SO2, and PM < 10 microns and less than 2.5 microns were all associated with an increased risk of myocardial infarction, with the overall population attributable risk ranging from 1 to 5 percent ( JAMA 2012; 307:713 )
· In a study of 772 patients with an acute MI, the risk of an MI was increased in the two hours after exposure to elevated levels of fine particles in the air (odds ratio 1.48 compared to low levels of fine particles); this effect lasted for up to 24 hours after exposure ( Circulation 2001; 103:2810. ).
· Possible mechanisms by which fine particulate air pollution may increase the risk of CVD include (Eur Heart J 2015; 36:83)
· An increase in mean resting arterial blood pressure through an increase in sympathetic tone and/or the modulation of basal systemic vascular tone ( Circulation 2002; 105:1534 )
· An increase in the likelihood of intravascular thrombosis through transient increases in plasma viscosity and impaired endothelial dysfunction ( Circulation 2002; 106:933 )
· The initiation and promotion of atherosclerosis (Circulation 2010; 121:2755)
· Multiple observational studies have demonstrated an association between fine particulate air pollution and distance from a major urban road or freeway and cardiovascular and cardiopulmonary mortality. However, there is conflicting evidence concerning whether air pollution is (J Thromb Haemost 2010; 8:669.), or is not ( J Thromb Haemost 2011; 9:672.), causally related to VTE development

(Source: uptodate)

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