Thursday, June 8, 2017

Unfit system of issuing Fitness Certificate


One of the most common things that doctor’s specially family physicians and physicians come across is issuing fitness certificate.
Honestly one of the most difficult things to do.
The patients who seeks it does not value it much, “just a formality” . At times they come in group, and say we all want “just” simple certificate without bothering to know whether they are your regular patients or not.
The authorities who asks for it, most of time considered it part of check list.
The types of fitness certificate commonly issued includes
·         For job
·         For school or college
·         For sports activity
·         For outdoor activities like  trekking camps, expedition
·         Appearing for certain special exams like police recruitment etc
·         For Air Travel
·         For Special tours which involves high altitudes etc.
·         For Driving license
The problem is there are no prescribed guidelines for judging fitness of the person or set of predefined tests before issuing such fitness certificates. 
No fixed laid town standards.
Everybody has got its own set of format which they want doctors to sign.
There are no guidelines –which are must to assessment physical and at least cardiac status of individual.
How you can expect us to certify an individual who is going on high altitude doing trekking or going to run for kms in a physical exam with only clinical examination? Everyone feels that they are fit and does not need any investigations for obtaining certificate. 
There are chances that on clinical examination patients may look apparently healthy and only clinical examination may not suffice in many of cases.
Call centers want ENT assessment, someone wants Eye assessment, some want cardiac fitness etc.
Ideally
1.    There should be fixed criteria for assessment and patients must be subject to certain investigations based on the fitness certificate required.
2.    The companies/institutes should consult or take opinion of doctors before designing format for medical fitness certificates.
3.    Patients should understand that this just not a formality, it is a legal document and doctor can in trouble if something goes wrong.
4.    As per requirement, for Government programs or pilgrimages, the government hospitals should be made to issue certificate after proper work up.
5.    There should some schedule or reference table which guides on issuing fitness certificate.
Your suggestions, feedbacks are welcome.

Dr.Pragnesh Vachharajani

Family physician.

Monday, May 29, 2017

ZIKA-Be vigilant,do not panic.

ZIKA IMA Stand Update 

Dr K K Aggarwal • Zika, a viral infection causes fever, rash, joint pain, red eyes. It spreads mainly through the bite of Aedes mosquito. But the infection can also spread from a pregnant mother to her unborn baby, and through anal, oral or vaginal sex. • If acquired during pregnancy it can cause microcephaly in fetus. If one is not pregnant or not planning to get pregnant, it is likely to be harmless. • Zika has been reported from Central and South America, Mexico, Pacific Islands, Caribbean, Puerto Rico, US Virgin Islands, Africa, Southeast Asia. No cases have been reported in India yet. • Most (80%) people infected with Zika have no or only mild symptoms. If there are symptoms, they usually occur 2 to 12 days after being bitten by a mosquito that has the virus. • It can also cause Guillain-BarrĂ© syndrome. • If you are pregnant or trying to get pregnant, avoid traveling to countries with ongoing Zika virus transmission. • There is no specific treatment. Treatment involves rest, drink plenty of fluids and paracetamol. Do not take aspirin. In children, aspirin can cause a serious problem called Reye syndrome. • There is no vaccine for Zika virus infection. • To prevent Zika infection, stay inside when the aedes are most active. They bite during the daytime, in the very early morning, and in the few hours before sunset. Buildings with screens and air conditioning are safest. Wear shoes, long-sleeved shirts, and long pants when you go outside. Wear bug spray or cream that contains DEET or a chemical called picaridin. Do not use DEET on babies younger than 2 months. Use bug repellants that have a chemical permethrin on your clothes and gear. Drain any standing water. Avoid mosquito bites if you have already gotten Zika to stop further spread. • If you have been to a country where there is Zika virus, you should not donate blood for at least 4 weeks afterwards. • Travellers returning from areas with Zika virus transmission should abstain from or have only protected sex for at least 8 weeks. Couples planning to conceive should also wait 8 weeks—or 6 months if the male partner has symptoms of the virus. Previously, IMA recommended abstinence or protected sex for 4 weeks following a person’s return from an area where Zika is circulating. All Indian athletes and visitors attending this summer’s Olympic and Paralympic Games Rio 2016 should use condoms while in Rio and for 8 weeks after returning home. • WHO had already ruled out any change in timing or the location of the upcoming Olympic Games in Rio de Janeiro. However, WHO is reportedly reconsidering the rescheduling of the Olympic Games. It has asked a panel of experts to consider whether the Rio Summer Olympics should be held as scheduled due to concerns it could spread the Zika virus. Unnecessary risk is posed when 500,000 foreign tourists from all countries attend the Games, potentially acquire that strain and return home to places where it can become endemic. In the Commonwealth Games held in Delhi, there was a threat of deadly dengue virus • IMA has warned all those travelling to Brazil to take precautions against mosquito bites, and have said pregnant women should avoid areas where Zika is circulating, including Rio de Janeiro.

Courtasy IMA Blog

Friday, May 19, 2017

On this world family Doctors day…..for the desk of a family doctor(family physician)



Wishing all my colleagues and patients a happy family doctors day.

You will not find super sale offers on this day unlike other day which are commercialized. So there are chances that unlike our contribution to society this day you could not have remember easily or might not be even aware of.

As we all know and it is well established fact that family physicians are important pillars of any healthcare system of the world. We are essential to maintain balance in terms of quality of care, affordable healthcare and  most needed health care all near them; family physician is essential and forms the most important part of healthcare delivery system. 

The next decade is of lifestyle disease and family physicians role will gain more importance for effectively managing this and most importantly preventing it. Preventive medicine is most the neglected part and we family physicians are the most important workforce to fight this looming threat of lifestyle disease affecting approximately 1/5 of the populations worldwide.

What a family physician does for society….
  • ·         He or she understands your social as well medical conditions better than any other specialty.
  • ·         Lots of conditions especially lifestyle diseases require multi pronged approach, a blend of social, medical and psychological aspects, which only family physician can do.
  • ·         Economical yet effective treatment delivery is essential world vide as the cost of treatment are going up due to various uncontrollable factors. That`s the key of effective primary care.
  • ·         Mental health is a really concern in today`s era, stress, anxiety and other mental disorders affect ones productivity and other aspects. A 360 degrees approach is required to manage this and family physician is the person who can do it very effectively.
  • ·         Timely diagnosis and effective referral for life threatening condition is life saving and important to limit the morbitidity (effect on quality of life) and prevent death as far as possible. With limited resources we are doing this.
  • ·         Effective rehabilitation (a totally neglected segment as far as India is concerned) after major illness like cardiac etc. Regular follow up with vigilant eye on medical condition, constant motivation and keeping in loop all the healthcare providers is key for this.
  • ·         Guiding to select the right treatment, helping in taking decisions at a time when patients needs help and confused due to variety of treatment options and fear of unknown and obvious lack of knowledge.
  • ·         Day to day management of minor or seasonal aliments is also important. This is gaining importance as there is indiscriminate use of antibiotics in minor ailments due to ease of availability (lack of knowledge, dispensing without prescription and re use of prescription are main cause) this is led to emergence of antibiotic resistance which is quite dangerous.
  • ·         Most importantly apart from treatment, family physicians gives you time, he listens to you, answer most of your questions patiently which is important for satisfaction on part of patient and relatives.
  • ·         It is seen worldwide that bypassing primary care always results in high treatment expense and many a times low level of satisfaction.
  • ·         Home Care: as the life expectancy has increased and treatment options are effective the management of chronic disease and ageing issues require domiciliary treatment. Effective home care is now becoming very important.

We feel happy and thank god for giving us this noble profession when:
  • ·         When our patients does well after recovering from a serious illness, comes back to us and say few words of gratitude, this makes our day even without monetary gain.
  • ·         When we counsel someone for a social condition like teenage issues or some family disputes etc and they accept our suggestions and family lived happily.(recent example of girl who do not wish to marry due to some misconception in her mind and after engagement family comes with box of sweets)
  • ·         When we treat someone for something trivial or routine aliments at his or her important time of life like important exams, marriage or special occasion or something like that, and do they could do well in that and acknowledge that.
  • ·         When some senior citizens(staying alone or in family & who are always looking for social warmth) come to us and bless us with few words after being treated and feeling better.
  • ·         Being invited at good occasions and our need felt bad times of our family patients.

We feel bad when……
  • ·         When patients become impatient and visit a specialist directly for a minor aliment on first day or visit a specialist on advise of family member or friend based  on their “experience”
  • ·         Parents of a child feel that family physicians are not capable of treating pediatric patients and do routine work like vaccination. (At times they bluntly told us that please manage my child for a day, as my pediatrician in not available today). Family physicians are good for all ages and children are not an exception.
  • ·         After diagnosing a life threatening condition like Heart attack immediately and suggesting a timely referral, the patient and relative do not turn to say just “thank you doctor” after being treated in a corporate hospital.  Even God needs appreciation, and then family physicians are humans only. This is not with all but with many.
  • ·         “Just asking “for certificate even without taking treatment.
  • ·         After showing piles of reports and files of 3-4 hospitals (on which they have spend thousands of rupees) for seeking professional opinion on what to do as they are confused , When they are leaving the consulting room, they will ask “Sir, are we supposed to pay anything ? “ Because you are our family doctor.
  • ·         The person who knows everything  in the city(like where to eat famous food items etc), very particular in choosing things used in day to day life,  takes treatment from a quack or crosspatch even without bothering to know his degree. When you can choose everything perfectly why not a doctor?
  • ·         When the other stake holders of healthcare system like Government do not bother consult us or just meeting our recognized body even once year to discuss about our core area of expertise
  • ·         When the corporate hospitals tries to get patients directly bypassing primary care at all, by various check up schemes etc and not sending patients back for day to day management once admitted there.
  • ·         Not being paid enough. Because of cut throat competition from quacks, cross paths doctors and undercharging specialists and mindset of society of asking some causal consultations for free or taking things for granted.  Everyone has right to leave good life, everyone has right to dream and to have basic comforts of life. Why expecting charity from us only?

The bright future:
  • ·         Family practice in phase of complete transformation. Newer generation family practice will completely changed with effective primary care, more treatment options for patients in their vicinity and more range of service at family physicians clinic.
  • ·         Technology like virtual visits, online consultation will increase so patients can consult or contact doctor at their comfort.
  • ·         One stop shop for all primary care needs like pharmacy, blood investigations, home care, medical equipments etc.
  • ·         Completely coordinated care with super specialist for chronic disease like Heart disease, diabetes, cancer etc.

 As we always look upon for new things from western world all the time, let’s see that they are putting so much of efforts and money behind strengthening the primary care.

We wish that tomorrow every family has a family doctor to rely upon and will try to deliver as per expectation.

Have a great time.

Dr.Pragnesh M.Vachharajani

Family physician.

Wednesday, February 15, 2017

Visiting Super specialist Directly

The Late U Turn

It is known fact that patient is today’s era patients have become impatient.
It is commonly seen that even for minor aliment they rush to specialist and even to super specialist.
Normally what is followed world vide and ideal as we already know and must for country like India, first contact point should be primary care physician and then as per need patient can be referred.  This has to be followed except certain emergency conditions where direct approach is justified.
The problem on the part of patients is, expecting a miracle overnight cure and basic human mentality of getting superior services and treatment by spending more, unlike other sectors of life. Time is money as they perceive, wanted to get cured fast, no break from work, no sick days are accepted.
The result: More money spent, more investigations and less satisfaction, bad mouth to hospitals because nobody in this world can promise a miracle cure, specialist are not an exception. Even after giving their best, patients are not satisfied as expectations are sky high.
So the clock has starting ticking in reverse direction. They are vising family physician after visiting specialist! You will find patients waiting in clinic with 2 or 3 files from various hospitals. Now they wanted to know what is happening and in spite of spending good amount of money and why they are still not getting a solution. And pity is after taking almost thrice the time of routine consultation, they are not willing to pay even regular consultation charges.
I think our system needs to change. Patients’ needs to be explained time and again the importance of “patience” and avoid direct visits unless emergency. Insurance companies should ask for referral letter before routine hospital admission or consultations.
Corporate hospitals should have family physician department, superspeciality groups should have primary care physician or should have close liaison with family physicians and if possible patients should be told first consult their family physician before visiting them for minor or not so important aliment again. This makes the concentrate on needy patients, who genuinely needs specialist care.

Thanks, your suggestions are welcome.

Tuesday, January 31, 2017

Do not ask for false medical certificates

IMA is against issuing or obliging for fake certificates for medical leave, Mediclaim forms etc.

IMA campaign is directed at learning to say no “Sorry I cannot oblige you for...”

1.    You can loose your licence to practice permanently: MCI 7.7 Signing Professional Certificates, Reports and other Documents: Registered medical practitioners are in certain cases bound by law to give, or may from time to time be called upon or requested to give certificates, notification, reports and other documents of similar character signed by them in their professional capacity for subsequent use in the courts or for administrative purposes etc. Such documents, among others, include the ones given at Appendix –4. Any registered practitioner who is shown to have signed or given under his name and authority any such certificate, notification, report or document of a similar character which is untrue, misleading or improper, is liable to have his name deleted from the Register.



2. It can end up in Jail [IPC 468. Forgery for purpose of cheating.—Whoever commits forgery, intending that the 1[document or electronic record forged] shall be used for the purpose of cheating, shall be punished with imprisonment of either de­scription for a term which may extend to seven years, and shall also be liable to fine.]