Wednesday, July 1, 2020

Reemerging and reaffirming importance of Primary Practice


Silver line in Dark Cloud of Corona Pandemic:
Reemerging and reaffirming importance of Primary Practice.

On the eve of doctor’s day a thought came to my mind about how the basis of delivery healthcare delivery has changed over a period of time.
Before the current pandemic, the society and unfortunately major stake holders and policy makers have just forgotten or overlook the importance of primary care in the country.
We family physicians firmly believe that primary care or family physicians are backbone and most important pillar of any healthcare system, anywhere in the world, but all miserably failed to accept it and have move forward and this fast life and unfortunately paying price for it.
Robust primary care in needed at all times, may it be current pandemic or ever emerging threat of lifestyle diseases.
Let’s have a look what primary care has done in these unprecedented times for across the world.
The main weapons or strategy  to counter current pandemic and manage it are:


1.    Change in behavior of public: most important, the specialty which connected to grass root can do it the best.
2.    Mass public education: via clinics and social media and people still believe what there doctors say….
3.    Early diagnosis: first contact point
4.    Community tracing: good knowledge of social background of patients and community
5.    Early referral in cases where it is needed: identifying danger sings early
6.    Effective follow up of confirmed cases after acute phase is over: post discharge care: answering never ending questions
7.    Home quarantined patients care: customized guidance depending upon patient profile,follow up of vital signs
8.    Psychological counselling: dispel the myths and remove anxiety,panic

And much more, which could do it effectively or better to say already, done it? Of course the answer is loud and clear.

You will be surprised to know that many patients were diagnosed (because family physicians could identify high risk patients as they have strong index of suspicion and community connect and of course they are updated) in just first visit and that too in just 100Rs (most of the family physicians are under paid for the class of service that they provide-but that is not the topic today, some other time): single consultation.
Can you imagine such an affordable care that country like India needed the most?
There are some very milder cases that can be easily managed on out patient basis and treating at home and yet too economical.

This pandemic has 2 main challenges

1. Economic burden on society: because most of the businesses are affected badly, so need affordable care and this will be needed for may be long time.
2. We do not want people to roam around: so need easily accessible healthcare in their nearby.

Both this challenges can be easily met with robust and efficient primary care.

The intent of this article is to show torchlight to the society and planners to re look at the way they deal with primary care.Need is to plan and promote it properly and secondly I wanted to thank you to my family physician colleagues, any where in the system, government or private to keep up the good work that they are doing now and always.


Let’s take a pledge and make a society, where everyone has a family doctor, making healthcare the way it should be: Good quality, easy to access and yet affordable.
Thanks you.

Dr.Pragnesh Vachharajani
Family physician, Ahmedabad
Joint Secretary, federation of family physicians of India
Secretary, Gujarat state family physicians` forum
Past president, IMA, Ahmedabad.

(Views expressed here are personal)

Thursday, January 23, 2020

What to do when someone is suddenly seriously ill in your family?




*How to handle emergency @home or office?*

People are always confused and frightened when some mishap happens at home and often precious time is wasted due to ignorance.

What to do when you feel this is a medical emergency like(this are some of the common examples):

1. Someone become unconsciousness or seems like that
2. Sudden chest pain with lots of perspiration, feeling uncomfortable
3. Having difficulty in breathing
4. seems not responding well 
Or other unusual symptoms


What to do? First thing first.

1.    Call for medical help, Call ambulance-108
2.    Call for medical help, Call ambulance-108
3.    Call for medical help, Call ambulance-108-(This is not a repetition by mistake but intentionally written thrice to understand its importance)

4.    Then talk to your family physician or first contact point doctor and seek guidance on what to do.

5.    Go to a fully equipped nearby hospital- Do not opt for best, save time at least for primary assessment choose the nearest first.(preferably you can map healthcare facilities in your area is you are already having some patient at home who may need emergency care)

6.    Do not insist or wait for your doctor to visit your home in such circumstances. Time is important, waiting for doctor may lead loss of precious time in emergency.
7.    Do not try to give anything by mouth if patient dose not seems to be fully conscious
8.    Check blood sugar if patient is having diabetes
9.    Check blood pressure if you have facility at home
10. Keep treatment papers ready in mean time.


Wishing you good health

Thursday, April 5, 2018

Happy and Healthy Vacation

This post may sound  bit early I know but some of the schools are already having vacation some will have soon.

I still remember and cherish memories of vacation that we used to have.

No restrictions, No vacation classes, No study in vacation, No hobby classes, And free roaming around with cousins without wires.

Today vacation has become headache for parents and kids. Lets try to look at the solutions and make this vacation enjoyable for all.

Activities:

Activities are good and it will keep them occupied and help them  learn something creative and innovative but..............

  • Every parent wants their kids to fulfill their dreams of activities that they could not do. May it be swimming, playing cricket etc. 


  • Dear Please remember your kids are not your miniature. They  can have different inclination and totally different hobbies and interest.


  • Please do not force them or tie them in routine schedule of "another school" that is activity class.
  • Promote them to engage in group activities, which  makes their sharing and caring skill sharp. In this era of selfishness they must learn joy of giving ,caring and sharing. 
  • Encourage outdoor activities in early morning and evening.
  • Screen-TV,Mobile etc is unavoidable. What ever you do they will hang on it. Just keep an eye on what they are watching or doing and do educate them about using this gadgets and sharing personal information on various websites and social networking sites. Still try to restrict such usage about 1-2 hours a day.
  • Play with them some old games,this will give connect and engage them 


Food:

A big headache in vacation and at times night mare for mothers.

Because when they are free,they will frequently ask for food and that too tasty.

It has been seen and obvious that everyone prefer to have food that is tasty, looking attractive and having good smell.

What to do ?

Try to do some home work, discuss with friends, family and social circle and try to learn something new.

Make sure the things that you make looks and smells good. Plenty of options to find out good recipes now internet and other resources.

Restrict junk food, if they are old enough engage  then in cooking.

Let them understand value of food, its importance. 

Take them with you for shopping of vegetables,fruits and other things.

Summer is here, so you can offer them variety coolers, juices, butter milk etc and of course plenty of liquids.

Avoid packets,they are attractive, easily available but not good for health. Try to educate them.

Travel:
Vacation is always good time to visit places. May be relatives or just explore new places.

Make them responsible, take their help in packing,planning and arranging travel.

Let them me do some preliminary survey about places to be visited and learn historic aspects of that place. Young minds are curious , let them be.

During vacation restrict use of mobiles etc. You might also need to avoid temptation of using mobile while enjoying with family. There is no logic of everyone occupied with mobile on vacation. 

Vaccination:

Vacation is good time finish pending vaccines. When kids grow older  there are certain important vaccines are required. Please visit your family doctor, discuss and get them vaccinated .


I hope with this suggestions you have will happy and healthy vacation.

Enjoy.





Friday, August 18, 2017

Swineflu-Exercise Caution,Do not Panic

સ્વાઈન  ફ્લુ અને સામાજીક જવાબદારી :
સાવચેતી એ જ સલામતી ,બીવું નહિ,સજાગ રહેવું.
1.જાે તમને તાવ, ખાંસી, ગળામાં દુઃખાવો હોય તો  qualified ડોક્ટરની સલાહ તાત્કાલિક લો.
2.ઘરગથ્થુ ઉપચાર,ઊટવૈદેા પાસેથી કે દવાની દુકાન પર થી જાતે દવા ના લો.
3.બિમાર વ્યક્તિ એ ભીડમાં જવું ટાળવું .બિમાર બાળક ને શાળામાં ના મોકલવું. 2-4 દિવસ રજા રાખવાથી કઈ ખાટું,માેળું નહિ થાય.
4.ખાંસી કે છીંક ખાતી વખતે મોં ઉપર રૂમાલ રાખવો
5.વારંવાર ચોખ્ખા પાણી થી/સાબુ થી હાથ ધૂઓ. 6.In public places Clean frequently door handles,floor, table top of counters etc. Where there is frequent touching.
7.Please take special care of following person in your surrondings:
A.પાંચ વર્ષ કરતાં નાની ઉંમરના બાળકો
B.65 વર્ષ કરતાં મોટી ઉંમરના લોકો,
C.Heart disease or diabetes.                                       8.The person who is sick should inform people around him.                                        9.Discourage visitors,just came to say "કેવી તબીયત છે઼ ?  At home and in hospital.Ask well-being on phone.                        10. સાચી સમાજ સેવા કરવી હેાય તેા  બિમાર સમાજ થી દુર રહે એમા છે.
ગભરાવું નહીં - ચેતવું જરૂર.સમયસર સારવાર જરુરી છે઼. આપણા બધા ના હિત માટે જારી,Dr.Pragnesh Vachharajani. Honorary Secretary,Gujarat State Family Physicians Forum.

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.