Morning MEDtalks with Dr KK Aggarwal 4th September 2018

The Health Ministry released the draft of a “charter of patient rights” prepared by National Human Rights Commission (NHRC). The draft is in public domain for comments and suggestions for a period of 30 days. The ministry plans to implement the charter through state governments for provision of proper health care to patients by clinical establishments. The charter includes 17 rights of patients (as follows) along with the description of the rights and duty bearers.

1. Right to information

2. Right to records and reports

3. Right to emergency medical care

4. Right to informed consent

5. Right to confidentiality, human dignity and privacy

6. Right to second opinion

7. Right to transparency in rates, and care according to prescribed rates wherever relevant

8. Right to nondiscrimination

9. Right to safety and quality care according to standards

10. Right to choose alternative treatment options, if available

11. Right to choose source for obtaining medicines or tests

12. Right to proper referral and transfer, which is free from perverse commercial influences

13. Right to protection for patients involved in clinical trials

14. Right to protection of participants involved in biomedical and health research

15. Right to take discharge of patient, or receive body of deceased from hospital

16. Right to patient education

17. Right to be heard and seek redressal

Along with promoting their rights, the charter also states that “patients and caretakers should follow their responsibilities so that hospitals and doctors can perform their work satisfactorily”.

1. "Patients should provide all required health related information to their doctor, in response to the doctor’s queries without concealing any relevant information, so that diagnosis and treatment can be facilitated.

2. Patients should cooperate with the doctor during examination, diagnostic tests and treatment, and should follow doctor’s advice, while keeping in view their right to participate in decision making related to treatment.

3. Patients should follow all instructions regarding appointment time, cooperate with hospital staff and fellow patients, avoid creating disturbance to other patients, and maintain cleanliness in the hospital.

4. Patients should respect the dignity of the doctor and other hospital staff as human beings and as professionals. Whatever the grievance may be, patient / caregivers should not resort to violence in any form and damage or destroy any property of the hospital or the service provider.

5. The patients should take responsibility for their actions based on choices made regarding treatment options, and in case they refuse treatment (not clear???)."

Additionally, the charter also proposes a recommended mechanism for implementation of Charter of Patient’s Rights and grievance redressal mechanism.

A private hospital in Delhi was fined Rs 10 lakh for being deficient in its services. In 2001, Surendra Tyagi, 43, complained of numbness, which gradually spread all over his body. In 2002, he was diagnosed with Motor Neuron Disease, a neurological disorder. Around September the same year, at Apollo Hospital he was diagnosed with Guillain-Barre syndrome. They alleged that Tyagi was discharged from the hospital even though he had not recovered. Tyagi was discharged on April 21, 2004 at 3:45 pm. “Tyagi was taken to his residence in Hapur in a ventilator-equipped ambulance which reached about 6:45 pm. Upon withdrawal of ventilator, he died within 15 minutes,” Tyagis counsel told the court.

"The patient had an untreatable motor neuron disease. He was initially treated for GBS which is a treatable disease. No harm was done to him," the court was told. A medical board held that there was no medical negligence on the part of the doctor and the hospital because at times, certain features in case of MND can also be seen in GBS. "In other words electrophysiological features could be the same in case of MND and Axonal variety of GBS. The doctor was misled by the commonality of said features in MND and GBS," said the report of medical experts.

However, the Delhi State Consumer Disputes Rederessal Commission upheld the report of the medical board that ruled out medical negligence but held them accountable for deficiency in service.

The commission observed, “In view of the foregoing reasons, the Commission is of the considered opinion that the hospital and the doctor are not guilty of medical negligence. However, the patient was not made clear of the prognosis. Nothing was explained to the relatives in relation to the commonality of the features of Motor Neurone Diseases and GBS. Relatives of the patient remained in dark in that they remained under an impression that the disease was fully curable and the treatment was as per standard protocol.”

In view of the present case, the hospital and the doctor were deficient in service as the relatives of the patient were never explained the prognosis, the Commission said.

Lesson: Explain everything in detail to the patient, and ensure that the thumb impression of the patient has been taken.

US FDA has advised people against eating, drinking or handling food products that have liquid nitrogen added immediately prior to consumption.The FDA says that, although liquid nitrogen is nontoxic, it can seriously damage skin or organs "if mishandled or accidentally ingested due to the extremely low temperatures it can maintain." If someone were to inhale the vapor produced by liquid nitrogen, it could also be harmful to breathing, especially in people with asthma. Liquid nitrogen is used in food products and drinks immediately before being served to create a smoke-like vapor. These products "are often marketed under the names Dragon’s Breath, Heaven’s Breath, nitro puff and other similar names."

An elderly man died after suffering a suspected heart attack while swimming in the sea at a beach in Southbroom on the KwaZulu-Natal South Coast, South Africa on Sunday morning, the National Sea Rescue Institute (NSRI) said.

Online pharmacies will need to register with the Govt. of India to sell medicines through the internet. The new draft rules require online pharmacies to be registered with the Central Drugs Standard Control Organization (CDSCO) and obtain a trade licence — applicable across India — from any state government. The drugs sold online would need prescription and the pharmacy will have to maintain a detailed record. However, there should be strict confidentiality and no patient information should be leaked domestically or internationally. There should also be facility for customer support and grievance redressal. The draft rules also ban sale of narcotics, psychotropic drugs and tranquillizers.

Joint Commission 10 primary standards for restraint and seclusion of patients (Medpage Today)

1. “Restraint and seclusion should be used only when clinically justified or when patient behavior poses a physical danger to the patient or others

2. Patient restraint or seclusion should be implemented safely based on hospital policy as well as laws and regulations

3. Restraint or seclusion should be based on an individual order for specific patients, not standing orders; if the attending physician did not make the restraint or seclusion order, he or she should be consulted as soon as possible

4. Medical staff should monitor restrained or secluded patients

5. Hospitals should have written guidelines for restraint and seclusion

6. Patients who are restrained or secluded should be evaluated repeatedly

7. Patients who are both restrained and secluded should be monitored continually

8. Use of restraint or seclusion should be documented

9. Staff should be trained in the safe use of restraint and seclusion

10. Deaths linked to restraint or seclusion should be reported to the Centers for Medicare & Medicaid Services”

More than anything else, leadership and organizational culture drive employee engagement, says a recent study on the state of employee engagement published by HR.com, which surveyed more than 700 HR professionals. One of the key survey questions asked was, "Which of the following factors are most highly linked to employee engagement in your organization?" 77% of survey respondents cited “Trust in leaders” as the most important factor.

In patients with transthyretin amyloid cardiomyopathy, tafamidis was associated with reductions in all-cause mortality and cardiovascular-related hospitalizations and reduced the decline in functional capacity and quality of life as compared with placebo. Transthyretin amyloid cardiomyopathy is caused by the deposition of transthyretin amyloid fibrils in the myocardium (ATTR-ACT Study, August 27, 2018, NEJM).

A study from Germany reported nil prevalence of occult hepatitis B virus infection in chronic hemodialysis patients and a very low prevalence (<1%) in kidney transplant recipients suggesting that routine screening for HBV-DNA is not required in CHD population in our region. However, in kidney transplant recipients, pretransplant screening with HBV-DNA should be considered. Testing for HBV-DNA in PBMCs does not seem to be of additional value.

Rheumatoid arthritis vs psoriatic arthritis: Bone erosions, without new bone growth, and cervical spine involvement are distinctive of rheumatoid arthritis (RA), while axial spine involvement, psoriasis and nail dystrophy are distinctive of psoriatic arthritis (PsA). Patients with PsA typically have seronegative test findings for rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies, while approximately 80% of patients with RA have positive findings for rheumatoid factor (RF) and CCP antibodies (RMD Open, August 13, 2018).

Bhagavad Gita Shloka 7.3

“Manuṣyāṇāḿ sahasreṣu

kaścid yatati siddhaye

yatatām api siddhānāḿ

kaścin māḿ vetti tattvataḥ”

Translation: “Out of many thousands among men, one may endeavor for perfection, and of those who have achieved perfection, hardly one knows Me in truth.”

Video to watch: TEDx Talks

Dr KK Aggarwal: Modern day doctor-patient relationship

https://www.youtube.com/watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI