Patient-centric harm reduction healthcare approach is the need of the hour to improve health outcomes

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Healthcare practitioners should consider variability in every individual to tailor treatment plans accordingly

New Delhi, 7 December 2018: Research indicates that in India, out-of-pocket expenses make up for most of the health financing mix, in turn driving catastrophic expenditure for individuals. This results in a significant economic burden on marginal sections of the population further creating barriers to appropriate health seeking behavior. Harm reduction is gaining popularity as a public health strategy to reduce the potential risks associated with health behaviors.

The need of the hour is to adopt a patient-centered and harm reduction approach to treatment in India. The concept of “Individualization” — inherent in the science of homeopathy — recognizes every patient to be different from the other, even if they have the same disease and individualizes treatment for every person.

Speaking about this at the 4th Edition of The Healthcare Summit organized by Mail Today at The Lalit, New Delhi, Padma Shri Awardee, Dr KK Aggarwal, President, Heart Care Foundation of Infdia said, “The modern system of medicine is also now shifting towards person-centric medicine. Every patient must 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 social determinants of health including the patient’s social situation, environmental factors that influence the health of a person, etc. are also different. Their personal and family history including medical history are different. Individual response to drugs may vary, the side effects may vary. Patients not willing for quiting high risk behaviors may like to shift to less harmful ones. All these variables need to be taken into account when formulating a treatment plan.”

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.” Other eminent specialists including Dr Mahesh Verma, Dr Nand Kumar,; Dr V C Khilnani, and Dr Deepali Bhardwaj also presented their views at the summit.

Adding further, Dr Aggarwal, said, “Given the heterogeneity of individuals, the standard treatment guidelines also 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 a patient and address his/her needs. They also involve the patient and encourage shared decision making with the patient and the family.”

The core principles of Universal Health Coverage.

• Accessibility: All patients have the right to access the healthcare they need and when they need it.

• Patient-centeredness and equity: All people, regardless of disease or condition; age, gender, race or ethnic background; sexual orientation; geographic location; socio-cultural background, economic or legal status, must have fair and impartial access to quality healthcare.

• Choice and empowerment: All patients have the right to know about the healthcare services that are available. Patients must be able to be meaningfully involved in healthcare decision-making in a variety of ways at the local, national, regional and global level.

• Quality: It is not enough for all patients to have access to healthcare. Provision needs to be safe, of the highest attainable standard and include a commitment to learning and improvement. Patients need to define what constitutes quality in healthcare.

• Partnership and collaboration: Patients have a moral and ethical right to play a meaningful role at all levels; in health and in other areas that can have an impact on health and wellbeing.

• Sustainability and the value of healthcare: All stakeholders need to recognize the value of healthcare when considering investing in universal health coverage.

• Accountability and transparency: Accountability and transparency are vital to delivering safe, effective and affordable healthcare. All stakeholders need to be held accountable on commitments they have made to implement universal health coverage and be accountable to the patients that they serve.

A heartfelt tribute to my friend and colleague

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Dr KK Aggarwal

Recipient of Padma Shri

Yesterday, Dr Rajiv Dhir, my friend and colleague of many years, suddenly decided to hide himself from us forever and hereafter to stay on with us, in our memory and soul.

He was always an active member of IMA and DMA and was working with me for the last several years.

A General Practitioner, Writer, Editor and Leader, he always had a smile and a cheerful word for everybody. It remains upon us to keep his memory alive.

This brings to my mind the question of life after death. Life is nothing but a connection between wave and particle. Death occurs when they disconnect with each other. The particle then merges with the five elements and the wave part stays alive merging with the virtual part of the waves.

As per Bhagawad Gita, whatever you think becomes your habit; whatever your habits, will be your thoughts and whatever your thoughts are at the time of death, will decide the next journey for those who believe in it.

The purpose of our life is to think positive, do positive at every step in life.

Live everyday of your life to the fullest…the most predictable thing about life is its unpredictability.

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Join the Mahapanchayat on 25th March to make the Indian medical profession strongest in the world

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Dr KK Aggarwal Immediate Past National President IMA The IMA has been opposing the proposed NMC Bill in its present format on several grounds. Following a country-wide 12-hour strike on 2nd January this year, the proposed NMC Bill was referred to a Parliamentary Standing Committee. The Rajya Sabha Committee considered each clause of the proposed NMC Bill and has given its recommendations on each in Chapter 4 of its report “109th Report on the National Medical Commission Bill, 2017 (Presented to the Rajya Sabha on 20th March, 2018) (Laid on the Table of Lok Sabha on 20th March, 2018)”. The report is in the public domain. To deliberate on the report, the IMA is organizing a Mahapanchayat on 25th March at Indira Gandhi Stadium, New Delhi, 10 am to 2pm. Over 10,000 doctors from all across the country will deliberate on the issue. As per a note from our National President Dr Ravi Wankhedkar, “after the 1st victory due to the Surgical Strike of 2nd Jan, IMA’s massive pressure has achieved the 2nd victory. Some of IMA demands have been accepted in the Parliamentary Standing Committee report. But the committee report is just a recommendation. Government has to accept and implement these recommendations along with remaining demands.” 25th March is an opportunity to show our strength to the whole world. Collectively, we see and influence over two crore patients every month. Collectively, on the 25th we should also show that we can also influence government policies and turn them into community-friendly policies. Most government policies today have penal provisions for doctors likening us to criminals. There are no policies to protect us. The govt. has failed to formulate and implement even a simple demand for a stringent central act for violence against doctors. Doctors are not supposed to be on the roads protesting. True. Therefore, we are continuing our efforts towards our legitimate demands, the Gandhian way. The Mahapanchayat is a corollary of the Dilli Chalo movement on the 6th June last year followed by a dawn-to-dusk fast observed throughout the country on 2nd October, the birth anniversary of Mahatma Gandhi. Each movement must be bigger than the previous. The critical mass of one percent must be achieved for any movement to spontaneously spread across the entire nation. All those who joined physically the Dilli Chalo movement on 6th June last year must repeat their presence, but this time with one more additional friend. You can bring a Non- IMA member or even a non-medical friend to participate. Delhi Medical Association is hosting the Mahapanchayat. Hence, all doctors from Delhi, in particular, should achieve this critical mass. It’s time… we should seize this opportunity. We must persist in our efforts till our goals are achieved. Cancel all your appointments on 25th March. Just join the mass movement.

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