Should we compare ourselves with CAs, Lawyers and Architects?

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Dr K K Aggarwal

Recipient of Padma Shri

Quiet often we argue that medical profession cannot be treated in isolation.

All other professions, be it law, CA, sportspersons, actors, hotels, musicians, social lecturers, astrologers may charge recklessly without doing as much, even one-tenth of doctors, with sincerity and seriousness.

But remember we are different.

We, and not they, are considered next to God. We, and not they, are social business houses.

We, and not they, are given permission to suffix Dr. before their names.

We, and not they, are bound by professional ethics.

MCI Code of Ethics Regulations 6.3 Running an open shop (Dispensing of Drugs and Appliances by Physicians):A physician should not run an open shop for sale of medicine for dispensing prescriptions prescribed by doctors other than himself or for sale of medical or surgical appliances. It is not unethical for a physician to prescribe or supply drugs, remedies or appliances as long as there is no exploitation of the patient. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.”

Supreme Court of India: Samira Kohli vs Dr. Prabha Manchanda & Anr on 16 January, 2008:28. But unfortunately not all doctors in government hospitals are paragons of service, nor fortunately, all private hospitals/doctors are commercial minded. There are many a doctor in government hospitals who do not care about patients and unscrupulously insist upon unofficial payment for free treatment or insist upon private consultations. On the other hand, many private hospitals and Doctors give the best of treatment without exploitation, at a reasonable cost, charging a fee, which is reasonable recompense for the service rendered.

Of course, some doctors, both in private practice or in government service, look at patients not as persons who should be relieved from pain and suffering by prompt and proper treatment at an affordable cost, but as potential income-providers/ customers who can be exploited by prolonged or radical diagnostic and treatment procedures. It is this minority who bring a bad name to the entire profession.”

The word exploitation in the first reference and reasonable in the second reference bind us different from other professions.

Opinions may differ but my personal opinion is that for medical professionals, earning is a byproduct and not the first objective.

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

MCI RECOGNISES 2-YR DIPLOMA COURSES OF College of Physicians and Surgeons. WILL IT RECOGNISE DIPLOMAS FROM OTHER UNIVERSITIES LIKE IGNOU?

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The Medical Council of India has allowed the MBBS students to practice as medical specialists in case they have done the two-year diploma courses from the Mumbai-based College of Physicians and Surgeons.

Health Ministry issued a notification in this regard.

The CPS offers two-year diploma courses in broad specialties like anaesthesia, paediatrics, obstetrics and gynaecology, orthopaedics, radiology and a few others. These were till recently were recognised only by Maharashtra and Gujarat Government.

Now MBBS doctors in Government hospitals are eligible to become specialists in two years.

All 200-bed multi-specialty hospitals and 100 bed single hospitals in Government and private sector having experienced faculties and adequate clinical load will be eligible to host the CPS training courses.

In keeping with the Supreme Court order on a single entrance for all post graduate courses, CPS too will be taking in only NEET-qualified candidates and through a centralised counselling.

India is producing 63,835 MBBS graduates every year but has less than 25,000 PG seats.

Diploma courses run by CPS would not be treated as a recognised medical qualification for the purpose of teaching. The courses will be reviewed every three years for their continuation.

The three-year fellowship programmes are not recognised by MCI but only 2-year diploma courses are recognised.

CPS diploma holders will be eligible for Post Diploma (Secondary) DNB course run by National Board of Examinations

MINISTRY OF HEALTH AND FAMILY WELFARE (Department of Health and Family Welfare) NOTIFICATION New Delhi, the 17th October, 2017 S.O. 3402(E).—

In exercise of the power conferred by sub-section (2) of Section 11 of the Indian Medical Council Act, 1956 (102 of 1956), the Central Government after consulting the Medical Council of India, hereby makes the following further amendments in the First Schedule of the Act, namely;

The following Broad Specialty Diploma Courses (two years courses at the Post MBBS level) granted by College of Physicians and Surgeons, Mumbai, shall be inserted, namely

“…List of 39 Diplomas………………………………”

Note : (i) All the admissions should be through NEET PG and centralized counselling and as per Government policy from time to time.

(ii) The CPS qualifications shall not be treated as a recognized medical qualification for the purpose of teaching.

(iii) Further, any postgraduate degree course to be run by the CPS shall be with the prior approval of this Ministry subject to fulfilment of stipulations prescribed on the lines of Minimum Standard Requirement Regulations of MCI.

[No. V.11025/14/2015-MEP] ARUN SINGHAL, Jt. Secy.

Dr KK Aggarwal

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

President Heart Care Foundation of India

Immediate Past National President IMA

Objections of K Sujatha Rao, Former Union Health Secretary to NMC

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  • Objections of K Sujatha Rao, Former Union Health Secretary,  to NMC are as follows:

o    Over centralization: The over centralization of the NMC and the near control over it by the central government, ranging from appointing all the 77 members for the various bodies; being the appellate for a variety of routine technical matters rejected by the autonomous bodies and the whole NMC such as, granting permission to set up colleges; granting exemptions to criteria; approving courses; setting aside any punishment against a doctor found negligent; allowing doctors trained abroad to do surgery and practice without having to go through any screening or taking the licentiate examination; recognizing degrees and qualifications; and finally having powers to issue directions to state governments and the NMC to comply with any orders it seeks to issue, not to speak of setting the Commission itself aside.

Such wide-ranging powers that will be exercised by the central ministry robs not just the federal nature of the law and reduce the NMC to an advisory role. In fact, the whole nine-year battle for revamping the MCI was mainly centered around the growing politicization of medical education with the powers introduced in the Act in 1992 that made it mandatory for MCI to take prior approval for starting a college, a course and student strength. This is one grouse that those opposing the Bill have.

o    Cross pathy: In view of the shortage of qualified doctors, the urgency to address the primary health needs of the communities and public health that are now largely being provided by unqualified quacks, the government has, since 2010, been requesting the MCI to institute new cadres of public health personnel along the lines of the LMP’s (Licentiate in Medical Practice) during the British days that worked very well.

Instead of mandating the board related to undergraduate education and the NMC to consider such options, keeping in view the current realities prevailing in the country, the Act has introduced a system under which the Commission and the heads of the councils of Ayush can, by a simple voice vote of those present, design bridge courses legalizing Ayush practitioners to prescribe allopathy medicines. At all levels – primary level to postgraduate. Such cross pathy then endangers the credibility of all the systems of medicine and has been severely opposed.

o    NEET: One bold reform pertains to the National Eligibility Entrance Test (NEET), about which much has already been said, and the National Licentiate Examination that all students have to take for getting the license to practice and also pursue postgraduate education. This is a laudable idea as it will enable standardizing the competence levels of the “Indian Doctor”. Currently, the variance between the training and competencies in different colleges and regions is astoundingly wide. So such a reform was sorely required. Yet, there is apprehension that in the absence of standardization of the quality of instruction in the country, it may widen disparities and become inequitable.

With a sizeable number of medical colleges with fake faculty or hopeless infrastructure, the quality of teaching is highly varied resulting in hurting students from backward states, poorer families and rural areas. But of greater importance is the fate of the students who study in accredited colleges, pass approved courses and examination systems and are found fit to practice by the university, but fail in the multiple choice question (MCQ) examination. What happens to them if they cannot afford private tuition to prepare for the licentiate examination?

o    Fees: Assuming that an investment of Rs 400 crores is required to set up a medical college and with a view to attract investment, the Bill permits 60% of seats to be open for managements with unfettered freedom to charge any quantum of fees in order to recoup the investment. This logic is highly debatable. It is apprehended that this will increase rent seeking, corruption and reserve medical education only for the rich and well off.

  • Glanders on the rise in animals: Glanders is a highly infectious and often fatal zoonotic disease primarily affecting horses, donkeys and mules. It is a notifiable disease of equines caused by Gram-negative bacterium, Burkholderia mallei. It is a rare disease in humans with cases having occurred in veterinarians, other people working closely with horses, and laboratory workers handling the organism. In addition to animals with clinical disease, asymptomatically infected animals also pose risk to humans. Humans are accidental hosts and human to human transmission is rare.

In 2014-15, disease was noted in three states – Himachal Pradesh, Uttar Pradesh and Jammu and Kashmir. In 2015-16, it was seen in five states – Jammu and Kashmir, Punjab, Uttar Pradesh, Uttarakhand and Gujarat but in 2016-17, it has been seen in nine states – Haryana, Himachal Pradesh, Jammu and Kashmir, Punjab, Uttar Pradesh, Uttarakhand, Gujarat, Rajasthan and Madhya Pradesh.

Glanders has traditionally been clinically categorized into nasal, pulmonary and cutaneous forms based on the most commonly affected organ systems in equines. Glanders can have nasal, pulmonary and cutaneous forms. B. mallei is transmitted to humans through contact with tissues or body fluids of infected animals. The bacteria enter the body through cuts or abrasions in the skin and through mucosal surfaces such as the conjunctiva and nose. The infection may occur by inhaling infected aerosol dust. Animal-to-human and human-to-human transmission of glanders is rare.Despite many reported cases of the disease in equines, no human case of glanders has been reported in India till date.

The clinical symptoms of glanders in humans are non- specific therefore accurate diagnosis and treatment is difficult. The symptoms in humans include low- grade fever and chills, malaise, fatigue, myalgias, backache, headache, rigors, chest pain and lymphadenopathy.

  • US Preventive Services Task Force (USPSTF) guidelines currently recommend that cigarette smokers aged 55 to 80 years have annual low-dose computed tomography screening for lung cancer. The guidelines also recommend annual screening for former smokers who have quit within the past 15 years but have a 30-pack-year smoking history (JAMA, December 8, 2017).
  • A Supreme Court bench headed by Justice AK Sikri on Friday quashed the FIR lodged by the Orissa police against CBI officials for wrongly reaching the house of a sitting high court judge for search, after CBI officials tendered “unqualified apology”.
  • In 2013–2014, approximately one third of adults in the United States were overweight (body mass index [BMI] 25.0–29.9 kg/m2) and approximately one-third had obesity (BMI ≥30 kg/m2).
  • Approximately half of US residents are unaware that adults who are overweight or have obesity are at increased risk for cancer.
  • The International Agency for Research on Cancer (IARC) states that there is sufficient evidence for an association with excess body fatness, including overweight, obesity, and weight gain, and at least 13 cancers. These cancers include adenocarcinoma of the esophagus; cancers of the breast (in postmenopausal women), colon and rectum, endometrium (corpus uterus), gallbladder, gastric cardia, kidney (renal cell), liver, ovary, pancreas, and thyroid; meningioma, and multiple myeloma.
  • The much-discussed Karnataka Private Medical Establishments (Amendments) Bill has finally got Governor Vajubhai R. Vala’s assent.
  • Indian Medical Associations (IMA) proposed biomedical waste treatment plant at Palode seems to have landed in a fresh legal complication as the latest assessment by revenue department found that a major portion of the land purchased by IMA for the purpose is a wetland. As per the report submitted by Nedumangad tehsildar to the district collector, of the 6.80 acres of the project land, five acres are wetland featuring mangroves and groundwater sources, which means that any construction activity in this area would violate Kerala Conservation of Paddy Land and Wetland Act. The report also cautioned on possible law and order problem in the area due to existing public protest against the plant.
  • A research published in the New England Journal of Medicine reported the work done by American researchers Li and colleagues.  The scientists have been successful in creating surgical glue that is stretchable, works on wet surfaces, and is nontoxic to humans. Surgical glue strongly adheres to the skin, cartilage and arteries. It also sealed holes in rat liver and pig heart.

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-chief IJCP PublicationsPresident Heart Care Foundation of IndiaImmediate Past National President IMA

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