Role of physician in society

role of physician

1. Role of Physician in Society Dr R K PAL, Professor Dr Mitasha Singh, Assistant Professor Department of Community Medicine ESIC Medical College, Faridabad 1

2. To provide students with a brief view of 1.What is expectation of National Medical Commission (earlier MCI) about preparing a Basic Doctor. 2.List the knowledge & Skill topics that a basic doctor should know about: Diagnosis & Treatment of common diseases & when to refer. How to find out -Reasons of common diseases/ health problems (by Community diagnosis) & how to prevent & control them. Skills necessary for Physician to deal with patients and community effectively (Communication & Health Education). Basic administration of a Health Centre. AIMS 2

3. 1. Park’s Text Book of PSM (24 th Edition), page 931-934. 2. IAPSM’s Text Book of Community Medicine, chapter 1, Dr. A. M. Kadri. 3. Vegetables in Delhi,Yamuna floodplain, The study was conducted in February 2019 by the NEERI, a research institute under the Council of Scientific and Industrial Research (CSIR). Updated: Jul 26, 2019 07:33 IST By Joydeep Thakur, Hindustan Times, New Delhi References & Acknowledgements 3

4. 4 FUNCTIONS OF A DOCTOR ?

5. 5 HEALING

6. Common Health Problems in India – Tuberculosis – Every Year 2.2 Million persons develop Tuberculosis. Out of these 2.2 Million – 0.62 Million are new sputum smear positive highly infectious cases. 0.24 Million people die each year due to Tuberculosis. New challenges – Emergence of HIV-TB co – infection & Multi Drug Resistant T.B. (MDR-T.B.) has increased. Diagnosis & Treatment of Common diseases / Health Conditions 6

7. Common health problems in India – Malaria – 1.13 Million cases in 2015 . (67% P.falciparum ) Cases have increased in North East, M.P., Chhatisgarh , Jharkhand, Orissa, A.P. & Maharashtra. 7

8. Major cause of disease (Mortality) & Death (Mortality) in children below 5 Years of age. 11.67 Million cases of Diarrhoea are reported each year. Acute Respiratory Infection (ARI) -During 2014, 34.81 Million episodes of ARI were reported with 2932 deaths. Diarrhoeal Diseases & ARI- In India 8

9. Leprosy – During Year 2013-14, 1.27 Lakh (0.127 Million) new cases were detected, out of which child cases were 9.49%. AIDS – By the end of year 2015, there were about 2.1 Million HIV positive cases in the country. Other common communicable diseases are – Filaria, Meningitis, Japanese Encephalitis, Viral hepatitis, Kala –azar, Dengue fever, Enteric Fever & Helminthic infestations. Leprosy, & AIDS – In India 9

10. There are approximately 25 Lakh (2.5 Million) cancer cases in the country. Every year 7 to 9 Lakh new cancer cases are added. Tobacco related cancers are 50 % of total cases in Men & 20 % in women. Blindness - More than 12 Million people are blind. Cataract is the main cause of blindness – 62.6 % followed by Refractive Error – 19.70 % Other Major NCDs are - C.V.Ds, Stroke & Chronic Lung Disease. Non Communicable Diseases (NCDs) in India –Cancer, Blindness 10

11. Protein- Energy Malnutrition (PEM) – Nutritional Anaemia- Low Birth Weight- Nutritional Blindness – Iodine Deficiency Disorder – Other important problems are – Lathyrism, Endemic fluorosis & Adulteration of food items. ( Reference for slide 4 to 10 – Ref.1) Nutritional Problems – In India 11

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13. Role of Physician As Health Educator 13

14. Community Diagnosis of common Diseases & Health Problems – Finding the Root Cause (Reference No.2) The Parable of The Clinician & The Epidemiologist The brown river usually flows lazily through the middle of town. But today it is torrent carrying human bodies, some still alive, are gasping for air & thrashing the water. Approaching the river, to enjoy lunch on its banks, two doctors, horrified by what they see, begin to haul people out of the water. 14

15. Community Diagnosis of common Diseases & Health Problems – Finding the Root Cause (Reference No.2) The Parable of The Clinician & The Epidemiologist The doctors can not keep up with the flow of bodies. They save a few & watch helpless as the others drift beyond them. Suddenly one of the Doctors starts to run. “What are you doing ?” yells the other doctor. “For God’s sake, help me to save these people !. Without stopping, she yells back - “ I am going upstream to find out – Why they are falling in !.” 15

16. The Real Life Example – (Reference No.3) Vegetables grown on the Yamuna floodplain have been found to contain high doses of lead, which, on prolonged consumption, could trigger a range of diseases, including cancer, and damage organs, according to a new study by the National Environmental Engineering Research Institute (NEERI), in Feb. 2019. These vegetables are supplied to large wholesale mandi s such as in Azadpur , Ghazipur and Okhla and distributed further to be sold at weekly markets as well as by local vendors. Highest concentration being in east Delhi Community Diagnosis of common Diseases & Health Problems – Finding the Root Cause 16

17. The Real Life Example – (Reference No.3) “ Samples of at least seven types of winter vegetables were collected from three different locations — Usmanpur , Mayur Vihar and Geeta Colony. They were tested for lead, mercury, nickel and cadmium . While the safe limit for lead in vegetables has been set at 2.5mg/kg by the Food Safety and Standards Authority of India (FSSAI), the level of the metal detected in vegetable samples collected from the floodplain ranges from 2.8mg/kg to 13.8mg/kg. Community Diagnosis of common Diseases & Health Problems – Finding the Root Cause 17

18. The Real Life Example – (Reference No.3) Except for cabbage, lead levels were found to be above the standard in all vegetables collected from vendors, with the highest level found in spinach & Coriander (14.1 mg/kg). “ Lead poisoning can lead to mental retardation in children. “ The source of lead could be industries dealing in automobile parts, batteries, paint and polythene.   Community Diagnosis of common Diseases & Health Problems – Finding the Root Cause 18

19. The Real Life Example – (Reference No.3) Even though only 2% of the Yamuna’s stretch passes through Delhi, it receives around 70% of the Capital’s polluted water. In 2015, the NGT ( Tribunal / Court based on National Green Tribunal Act 2010, related with Environment) had banned the cultivation of edible crops and fodder on the floodplain saying that such vegetables were highly contaminated. Despite this, the practice continues. Community Diagnosis of common Diseases & Health Problems – Finding the Root Cause 19

20. Inform the community & his patients – About risk from vegetables grown on bank of Yamuna River. Wash all vegetables thoroughly with water before cooking & eating. Avoid using if you find they are from bank of Yamuna river. Keep a watch & inform urgently if any one in family develops signs of disease after consuming. The doctor should Compile summary of all such cases coming to him / her (Signs of Disease, No. of cases, their location) & inform soon to – CMHO, District Municipality dealing with Prevention of Food Adulteration Act & N.G.T. So After Finding the Root Cause – What is the Role of Physician in the Community 20

21. Role of Physician As Leader of Health Team 21

22. It is the manner of communication which is important as compared to information Effective Patient-physician communication –equivalent to drugs The physician who can communicate bad news in a direct and compassionate way help the patient cope, strengthen the therapeutic relationship, endures and further extends the healing process Role of Physician as communicator 22

23. Physicians should become competent in five key communication skills: listening effectively; eliciting information using effective questioning skills; providing information using effective explanatory skills; counseling and educating patients; and making informed decisions based on patient information and preference Role of Physician as communicator 23

24. Role of physician as collaborator The work of the physician always takes place in partnership with other people at different levels patient, relatives, care team, other physicians other departments: lab, pharmacy, radiology, etc. Electricity, water, cssd, housekeeping, etc. 24

25. Medical science changes each week, and it will change in fundamental ways during our careers. We must continuously read and evaluate the literature, discuss it with colleagues, and formulate opinions that impact our practice. The physician-scientist thus has a contribution that is unique from scientists who do not receive medical training. Role of Physician as researcher/scientist 25

26. 26 Dr. Robert Koch Nobel Prize for Physiology or Medicine in 1905 Louis Pasteur Father of Microbiology James Lind Scottish doctor Scurvy Edward Jenner English doctor, the pioneer of smallpox vaccination and the father of immunology. John Snow Anesthetist Father of epidemiology Jonas Salk Physician and virologist First IPV Albert Sabin OPV vaccine

27. Hargobind Khurana : Nobel Prize for Physiology or Medicine, in 1968.  Yellapragada Subbarow : developed a cancer treatment called methotrexate , and diethylcarbamazine , the only known treatment for filariasis or elephant foot. Asima Chatterjee : contributed to the development of powerful anti-malarial and anti-epileptic drugs. Soumya Swaminathan : Pediatrician, DG-ICMR, notable work in TB Poonam Khetarpal Singh: Regional Director, SEARO, W.H.O. Indian medical scientists 27

28. 18-08-2019 28 LEADER

29. Role of physician as manager Physicians are now routinely involved in issues affecting the entire hospital - strategic planning, capital and operating budgets, information systems design and quality improvement . The manager is expected to be responsible for the selection of the other staff member, providing him or her with orientation to the role, assigning work, evaluating performance and providing training. 29

30. The physician’s medical expertise, experience at the bedside, and status in society can provide invaluable perspective and influence in informing the policy process. The doctor-patient relationship offers unique insight into the lives and needs of a vast cross-section of the public. Role of physician as policymaker 30

31. 31 Dr. Harsh Vardhan ENT surgeon, MP (Delhi) Minister of Health and Family Welfare Dr. Mahesh Sharma MBBS, MP (Greater Noida ) Dr. Anil Jain MBBS, UP Rajya Sabha member Dr. Vikas Mahatame Ophthalmologist, Maharashtra Rajya Sabha Member Dr. Kirodi Lal Meena MBBS, Rajasthan Rajya Sabha Member Dr. Ambumani Ramadoss MBBS, Chennai Rajya sabha member Dr. DP Vats Ophthalmologist Hisar, Haryana Rajya Sabha Member Dr. Subhash Bhamre Oncologist, Maharashtra Minister of state for Defence Dr. Shrikant Shinde Orthopedics MP, Maharashtra

32. Role of Physician As Leader of Health Team 32