Wednesday, December 21, 2011

5 S Process


Sorting: Clothes that were laying on the floor were sorted into their respective piles (shirts, tank tops, pants, etc.) Any of these that were not packed to come home with me were sorted into their respective drawer. 
Straightening: Random things that were laying around were picked up and either placed in a
Systematic Cleaning: I dusted, vacuumed the floor, and cleaned the mirror, the magazine rack, my desk, and my drawers.
Standardizing: T 
Sustaining: My room will be able to stay this clean for at least a month while I'm at home for break. Next semester I can hopefully work harder so it does not get to the state it was in previously.
Safety: The only safety issue that remains is my bed; on the edge there is a panel that sticks out and I always trip over it - makes for very good free entertainment for my roommate.
Security: The front door to my apartment is locked and my door is shut.
Satisfaction: I am very satisfied with the cleanliness of my room :-)

Sunday, December 18, 2011

Is ECT an Acceptable Form of Psychiatric Treatment?

My field of interest is in medicine, with a specific interest in the human brain and mind; the brain being a physical thing, and the mind being an intangible entity. Because the brain and mind cannot exist without one another, many problems arise in biological, chemical and psychological aspects when complications occur in one of these. Some of these complications may include depression, schizophrenia and other mental disorders. Nowadays, there is an abundance of pharmaceuticals that physicians prescribe to treat these. What happens when they don't work?     

Electroconvulsive/Electroshock Therapy (ECT)
ECT is a form of rehabilitation typically used to treat mental health patients suffering from long-lasting depression and/or schizophrenia. Currently, when ECT is given to patients, it is mainly utilized after exhausting all other psychotherapy and medication options. To begin, patients are first issued intravenous antesthethics. Electrodes are then placed over specific regions of the brain, and electrical waves are sent in order to produce seizure. These seizures generally last approximately thirty to ninety seconds. If a convulsion should last longer than three minutes termination is suggested. After twenty to forty minutes post-treatment, a patient is usually awake and stable. Throughout course of treatment patients are observed closely by a group of medical professionals.

  • Currently, when ECT is given to patients, it is generally utilized as a last resort form of therapy. The only time this form of therapy is truly ever considered as a frontline regimen for a patient is if they are suicidal, manic depressive, or have lived with chronic depression for many years.
  • ECT is safer. Despite the adverse affects that ECT may cause an individual, through research, it has been recognized that the most secure and conducive way to apply convulsions as a type of therapy is through electrical agitation. Research in the last ten years has also deduced that contrary to previous belief, unilateral (one-sided) ECT has proven to be just as proficient as bilateral (two-sided) ECT, but with a more limited effect to cognitive dysfunction. Electroconvulsive therapy has also found to be a method that is safe and effective during pregnancy unlike many of the drug therapies that are discouraged in those nine months.   
  • ECT is effective. There are possible causations for detrimental effects, but it is rare that a person who has undergone electroconvulsive therapy will be traumatized long-term with these repercussions. It is also important to understand that once a person has completed a course of ECT, most will either continue with the treatment, be put on some form of antidepressant or mood stabilizer, or will consider another form of maintenance treatment

  • Much contention towards ECT is due to negative images created by movies such as One Flew Over the Cuckoo's Nest. In reality, patients are not coerced into this treatment, nor are they awake and flailing arms all over the table. 
  • ECT is expensive. Each treatment of ECT may cost anywhere between $300 and $800 for services of a psychiatrist, anesthesiologist, nursing team, the actual treatment, and miscellaneous hospital charges. Most patients that are prescribed electroshock for therapy, experience it the treatment numerous times which can quickly add up. Although some health insurances may cover costs, many people today cannot even afford coverage for their health. 
  • ECT may cause slight cognition loss. Anywhere up to several months after persisting through treatment, a patient may experience retrograde amnesia, depletion in some cognitive functioning, or suicidal ideation and thoughts. More often than not, this memory deficit will only affect the patient’s recollection of the procedure or events encompassing the weeks nearby. Studies have shown that both loss of memory and cognitive functionality could be due to placement of electrodes, magnitude and wave classification of electricity, recurrences of regimen, and undetected medical circumstances. An electroencephalogram (EEG), which is an electrode cap used to measure and record brain electrical activity, will show that mental operations are in fact moving at a slower rate for up to three months. It has also been gathered that a patient with more than one personality disorder is less likely to have a pronounced recovery. 
  • ECT may be fatal. Although the death rate, due primarily to cardiac arrhythmia, has decreased from 0.1 percent in the year 1950 to less than 2 for 100,000 ECT treatments (Panksepp, 2004), this is still a risk that patients have to factor into their decision-making plans for recovery.

My opinion:
I believe that electroshock therapy is an acceptable form of treatment as it stands. As stated previously, it is rarely used as an initial procedure and is only really used as a last resort after an extensive amount of psychotherapy and such. As for the anti-shock activists, there is no such thing as cheap treatment for anything anymore. There is also never a total guarantee that a person will wake up after all procedures.   

  • Breggin, P. R. (2008). Electroconvulsive Therapy (ECT) for Depression. In P. R. Breggin, Brain-Disabling Treatments in Psychiatry (pp. 217-251). New York, NY: Springer Publishing Company, LLC.
  • Figiel, G. S., McDonald, W. M., McCall, W. V., & Zorumpski, C. (2001). Electroconvulsive Therapy. In A. F. Schatzberg, & C. B. Nemeroff, Essentials of Clinical Psychopharmacology (pp. 327-349). Washington, DC: American Psychiatric Publishing, Inc.
  • informed consent. (2010). Retrieved November 2010, from Encyclopaedia Britannica Online:
  • Janicak, P. G., Davis, J. M., Preskorn, S. H., & Ayd Jr., F. J. (2001). Treatment with Electroconvulsive Therapy and Other Somatic Therapies. In P. G. Janicak, J. M. Davis, S. H. Preskorn, & F. J. Ayd Jr., Principles and Practice of Psychopharmacotherapy - Third Edition (pp. 327-362). Philadelphia, PA: Lippincott Williams & Wilkins.
  • Kneeland, T. W., & Warren, C. A. (2002). Pushbutton Psychiatry: A History of Electroshock in America. Westport, CT: Praeger Publishers.
  • National Alliance on Mental Illness. (1996-2010). About Mental Illness. Retrieved November 2010, from National Alliance on Mental Illness:
  • Panksepp, J. (2004). Somatic Treatments in Psychiatry. In J. Panksepp, Textbook of Biological Psychiatry (pp. 522-525). Hoboken, N.J.: John Wiley & Sons, Inc.
  • Sackeim, H. A. (1989). The Efficacy of Electroconvulsive Therapy in the Treatment of Major Depressive Disorder. In S. Fisher, & R. P. Greenberg, The Limits of Biological Treatment for Psychological Distress (pp. 275-307). Hillsdale, N.J.: Lawrence Erlbaum Associates, Inc.
  • Shorter, E., & Healy, D. (2007). Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Piscataway, N.J.: Rutgers University Press.

Project Title, Issue and Action Plan


Issue: Creating a novel medical device or treatment for this disease.
Action Plan:
  • Meeting with Dr. Ruth within first of November to discuss ideas
  • Dividing research amongst group members
Me: Pathogenesis of COPD
Mitch: Reversibility or ways to slow the progression of COPD, When is O2 needed
Kallie: Primary causes of COPD, Impact on patients quality of life, Common patient complaints related to COPD
Whitney: What helps with the disease (treatments, drugs), What exacerbates the disease
Kevin K: Pathophysiology of COPD
Kevin O: What happens to the lungs and surrounding organs,What is happening to the Alveoli on an anationical and cellular level
Matt: What part of the lungs are affected and how does this differ in different patients
Jennifer: Incidence and Prevalence, What organ systems are involved
Danielle: What is happing to the bronchi on an anatomical and cellular level, What part of the disease makes the patients feel ill

Ethical Question

Is it ethical for a physician to accept Wild tickets from a pharmaceutical rep to take her family to the game?

No it is not ethical for a physician to accept Wild tickets from a pharmaceutical representative. If a doctor receives this benefit, it is likely that she will be expected to favor ordering drugs from this particular person or company. Even if this is not the case, a physician may be biased towards this specific company because they are expecting a returnable favor. If these circumstances occurred, the patients' needs and wants would no longer be the chief importance, focus and goal of the association. I assume that most health and medical organizations would agree that this is most always the central purpose.     

General Ethics

Post an ethical code/statement for your career field of interest that has been developed by a professional organization in your field.

American Psychiatric Association

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

Section 1 A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

Section 2 A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

Section 3 A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

Section 4 A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

Section 5 A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
Section 6 A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

Section 7 A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

Section 8 A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

Section 9 A physician shall support access to medical care for all people.

Heart of Healing Acupuncture & Chinese Medicine

As a Physician of Traditional Chinese Medicine:

  • I shall look upon those who are in grief, as if I myself have been struck and I shall sympathize with them deep in my heart.
  • I will not give way to wishes and desires but develop first a marked attitude of compassion.
  • I shall not ponder over my own fortune or misfortune and thus preserve life and have compassion for it.
  • Whoever suffers from disease and illness will be looked upon with contempt by people. I shall maintain an attitude of compassion, of sympathy and of care. In no way shall arise an attitude of rejection.
  • I shall treat all patients alike, whether powerful or humble, rich or poor, old or young, beautiful or ugly, resentful relatives or kind friends, Chinese nationals or foreigners, fools or wise men.
  • I shall not emphasize my own reputation and belittle the rest of physicians while praising my own virtue.
  • Neither dangerous mountain passes, nor time of day, neither weather conditions nor hunger, thirst nor fatigue shall keep me from helping wholeheartedly.

With this oath, I shall fulfill my responsibilities and my destiny as a physician to each and every patient who seeks help from me, until I am no longer capable of fulfilling my obligations, or until the end of this lifetime.

United Nations (Israel)

Principles of Medical Ethics relevant to the role of health personnel, particularly physicians, in the protection of prisoners and detainees against torture, and other cruel, inhuman or degrading treatment or punishment

Principle 1

Health personnel, particularly physicians, charged with the medical care of prisoners and detainees, have a duty to provide them with protection of their physical and mental health and treatment of disease of the same quality and standard as is afforded to those who are not imprisoned or detained.

Principle 2

It is a gross contravention of medical ethics, as well as an offence under applicable international instruments, for health personnel, particularly physicians, to engage, actively or passively, in acts which constitute participation in, complicity in, incitement to or attempts to commit torture or other cruel, inhuman or degrading treatment or punishment.

Principle 3

It is a contravention of medical ethics for health personnel, particularly physicians, to be involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve their physical and mental health.

Principle 4

It is a contravention of medical ethics for health personnel, particularly physicians:

To apply their knowledge and skills in order to assist in the interrogation of prisoners and detainees in a manner that may adversely affect the physical or mental health or condition of such prisoners or detainees and which is not in accordance with the relevant international instruments;

          "1.  For the purpose of this Declaration, torture means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted by or at the instigation of a public official on a person for such purposes as obtaining from him or a third person information or confession, punishing him for an act he has committed or is suspected of having committed, or intimidating him or other persons.  It does not include pain or suffering arising only from, inherent in or incidental to, lawful sanctions to the extent consistent with the Standard Minimum Rules for the Treatment of Prisoners.

          "2.  Torture constitutes an aggravated and deliberate form of cruel, inhuman or degrading treatment or punishment."

Article 7 of the Declaration states:

               "Each State shall ensure that all acts of torture as defined in
          article 1 are offences under its criminal law.  The same shall apply
          in regard to acts which constitute participation in, complicity in,
          incitement to or an attempt to commit torture."

          To certify, or to participate in the certification of, the fitness
          of prisoners or detainees for any form of treatment or punishment
          that may adversely affect their physical or mental health and which
          is not in accordance with the relevant international instruments, or
          to participate in any way in the infliction of any such treatment or
          punishment which is not in accordance with the relevant
          international instruments.

 Principle 5

It is a contravention of medical ethics for health personnel, particularly physicians, to participate in any procedure for restraining a prisoner or detainee unless such a procedure is determined in accordance with purely medical criteria as being necessary for the protection of the physical or mental health or the safety of the prisoner or detainee himself, of his fellow prisoners or detainees, or of his guardians, and it presents no hazard to his physical or mental health.

Principle 6

There may be no derogation from the foregoing principles on any ground whatsoever, including public emergency.
Eastern Mediterranean - WHO - Islam (Saudi Arabia)

There is no censorship in Islam on scientific research, be it academic to reveal the signs of God in His creation, or applied aiming at the solution of a particular problem.

Freedom of scientific research shall not entail the subjugation of Man, telling him, harming him or subjecting him to definite or probable harm, with holding his therapeutic needs, defrauding him or exploiting his material need.

Freedom of scientific research shall not entail cruelty to animals, or their torture. Suitable protocols should be laid upon for the uncruel handling of experimental animals during experimentation.

The methodology of scientific research and the applications resultant thereof , shall not entail the commission of sin prohibited by Islam such as fornication, confounding of genealogy, deformity or tampering with the essence of the human personality, its freedom and eligibility to bear responsibility.

The Medical Profession has the right- and owes the duty of effective participation in the formulation and issuing of religious verdict concerning the lawfulness or otherwise of the unprecedented outcomes of current and future advances in biological science. The verdict should be reached in togetherness between Muslim specialists in jurisprudence and Muslim specialists in biosciences. Single-sided opinions have always suffered from lack of comprehension of technical or legal aspects.

The guiding rule in unprecedented matters falling under no extant text or law, is the Islamic dictum :"Wherever welfare is found, there exists the statute of God".

The individual patient is the collective responsibility of society, that has to ensure his health needs by any means inflicting no harm on others. This comprises the donation of body fluids or organs such as blood transfusion to the bleeding or a kidney transplant to the patient with bilateral irreparable renal damage. This is another 'Fardh Kifaya', a duty that donors fulfil on behalf of society. Apart from the technical procedure, the onus of public education falls on the medical Profession, which should also draw the procedural, organizational and technical regulations and the policy of priorities.

Organ donation shall never be the outcome of compulsion, family embarrassment, social or other pressure, or exploitation of financial need.

Donation shall not entail the exposure of the donor to harm.

The Medical Profession bears the greatest portion of responsibility for laying down the laws, rules and regulations organizing organ donation during life or after death by a statement in the donor's

will or the consent of his family; as well as the establishment of tissue and organ banks for tissues amenable to storage. Cooperation with similar banks abroad is to be established on the basis of reciprocal aid.

** "Umar ibnul -Khat tab, second Caliph, decreed that if a man living in a locality died of hunger being unable of self-sustenance, then the community should pay his moneyransom (fidiah) as if they had killed him. The similitude topeople dying because of lack of blood transfusion or adonated kidney is very close.

** Two traditions of the Prophet seem to be quite relevant inthis respect. The one is: 'The faithful in their mutual love and compassion are like the body if one member complains of an ailment all other members will rally in response. The other tradition says, "The faithful to one another are like theblocks in a whole building they fortify one another". ** God described the Faithful in the Qoran saying: "Theygive priority over themselves even though they are needy". This is even a step further than donating a kidney, for the donor can dispense with one kidney and live normally with the other as routinely ascertained medically prior to donation
** If the living are able to donate, then the dead are even more so: and no harm will afflict the cadaver if heart, kidneys, eyes or arteries are taken to be put to good use in a living person. This is indeed a charity and directly fulfils God's words: ' And who-so-ever saves a human life it is as though he has saved all mankind'. A word of caution, however, is necessary, Donation should be voluntary by free will or the dictatorships will contiscate people's organs thus violating two basic Islamic rights: the right of freedom and the right of ownership.
** In the society of the Faithful donation should be in generous supply and should be the fruit of faith and love of God and His subjects. Other societies should not beat us to this noble goal".

Indian Medical Ethics
Indian Medical Council
(Professional Conduct, Etiquette and Ethics) Regulations, 2002
(Published in Part III, Section 4 of the Gazette of India, dated 6th April, 2002) MEDICAL COUNCIL OF INDIA NOTIFICATION New Delhi, dated 11th March, 2002 No. MCI-211(2)/2001/Registration. In exercise of the powers conferred under section 20A read with section 33(m) of the Indian Medical Council Act, 1956 (102 of 1956), the Medical Council of India, with the previous approval of the Central Government, hereby makes the following regulations relating to the Professional Conduct, Etiquette and Ethics for registered medical practitioners, namely:- Short Title and Commencement: (1) These Regulations may be called the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002. (2)They shall come into force on the date of their publication in the Official Gazette.
1. CODE OF MEDICAL ETHICS A. Declaration: Each applicant, at the time of making an application for registration under the provisions of the Act, shall be provided a copy of the declaration and shall submit a duly signed Declaration as provided in Appendix 1. The applicant shall also certify that he/she had read and agreed to abide by the same. B. Duties and responsibilities of the Physician in general: 1.1 Character of Physician (Doctors with qualification of MBBS or MBBS with post graduate degree/ diploma or with equivalent qualification in any medical discipline): 1.1.1 A physician shall uphold the dignity and honour of his profession. 1.1.2 The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. Who- so-ever chooses his profession, assumes the obligation to conduct himself in accordance with its ideals. A physician should be an upright man, instructed in the art of healings. He shall keep himself pure in character and be diligent in caring for the sick; he should be modest, sober, patient, prompt in discharging his duty without anxiety; conducting himself with propriety in his profession and in all the actions of his life. 1.1.3 No person other than a doctor having qualification recognised by Medical Council of India and registered with Medical Council of India/State Medical Council (s) is allowed to practice Modern system of Medicine or Surgery. A person obtaining qualification in any other system of Medicine is not allowed to practice Modern system of Medicine in any form. 1.2 Maintaining good medical practice: 1.2.1 The Principal objective of the medical profession is to render service to humanity with full respect for the dignity of profession and man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Physicians should try continuously to improve medical knowledge and skills and should make available to their patients and colleagues the benefits of their professional attainments. The physician should practice methods of healing founded on scientific basis and should not associate professionally with anyone who violates this principle. The honoured ideals of the medical profession imply that the responsibilities of the physician extend not only to individuals but also to society.
1.2.2 Membership in Medical Society: For the advancement of his profession, a physician should affiliate with associations and societies of allopathic medical professions and involve actively in the functioning of such bodies. 1.2.3 A Physician should participate in professional meetings as part of Continuing Medical Education programmes, for at least 30 hours every five years, organized by reputed professional academic bodies or any other authorized organisations. The compliance of this requirement shall be informed regularly to Medical Council of India or the State Medical Councils as the case may be. 1.3 Maintenance of medical records: 1.3.1 Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3. 1.3.2. If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours. 1.3.3 A Registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared as in Appendix 2. 1.3.4 Efforts shall be made to computerize medical records for quick retrieval. 1.4 Display of registration numbers: 1.4.1 Every physician shall display the registration number accorded to him by the State Medical Council / Medical Council of India in his clinic and in all his prescriptions, certificates, money receipts given to his patients. 1.4.2 Physicians shall display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements. 1.5 Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he / she shall ensure that there is a rational prescription and use of drugs. 1.6 Highest Quality Assurance in patient care: Every physician should aid in safeguarding the profession against admission to it of those who are deficient in moral character or education. Physician shall not employ in connection with his professional practice any attendant who is neither registered nor enlisted under the Medical Acts in force and shall not permit such persons to attend, treat or perform operations upon patients wherever professional discretion or skill is required. 1.7 Exposure of Unethical Conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession. 1.8 Payment of Professional Services: The physician, engaged in the practice of medicine shall give priority to the interests of patients. The personal financial interests of a physician should not conflict with the medical interests of patients. A physician should announce his fees before rendering service and not after the operation or treatment is under way. Remuneration received for such services should be in the form and amount specifically announced to the patient at the time the service is rendered. It is unethical to enter into a contract of "no cure no payment". Physician rendering service on behalf of the state shall refrain from anticipating or accepting any consideration.
1.9 Evasion of Legal Restrictions: The physician shall observe the laws of the country in regulating the practice of medicine and shall also not assist others to evade such laws. He should be cooperative in observance and enforcement of sanitary laws and regulations in the interest of public health. A physician should observe the provisions of the State Acts like Drugs and Cosmetics Act, 1940; Pharmacy Act, 1948; Narcotic Drugs and Psychotropic substances Act, 1985; Medical Termination of Pregnancy Act, 1971; Transplantation of Human Organ Act, 1994; Mental Health Act, 1987; Environmental Protection Act, 1986; Pre.natal Sex Determination Test Act, 1994; Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954; Persons with Disabilities (Equal Opportunities and Full Participation) Act, 1995 and Bio-Medical Waste (Management and Handling) Rules, 1998 and such other Acts, Rules, Regulations made by the Central/State Governments or local Administrative Bodies or any other relevant Act relating to the protection and promotion of public health.
2. DUTIES OF PHYSICIANS TO THEIR PATIENTS 2.1 Obligations to the Sick 2.1.1 Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician. 2.1.2 Medical practitioner having any incapacity detrimental to the patient or which can affect his performance vis-a-vis the patient is not permitted to practice his profession 2.2 Patience, Delicacy and Secrecy : Patience and delicacy should characterize the physician. Confidences concerning individual or domestic life entrusted by patients to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed unless their revelation is required by the laws of the State. Sometimes, however, a physician must determine whether his duty to society requires him to employ knowledge, obtained through confidence as a physician, to protect a healthy person against a communicable disease to which he is about to be exposed. In such instance, the physician should act as he would wish another to act toward one of his own family in like circumstances. 2.3 Prognosis: The physician should neither exaggerate nor minimize the gravity of a patient.s condition. He should ensure himself that the patient, his relatives or his responsible friends have such knowledge of the patient.s condition as will serve the best interests of the patient and the family. 2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care. 2.5 Engagement for an Obstetric case: When a physician who has been engaged to attend an obstetric case is absent and another is sent for and delivery accomplished, the acting physician is entitled to his professional fees, but should secure the patient.s consent to resign on the arrival of the physician engaged.
3. DUTIES OF PHYSICIAN IN CONSULTATION 3.1 Unnecessary consultations should be avoided: 3.1.1 However in case of serious illness and in doubtful or difficult conditions, the physician should request consultation, but under any circumstances such consultation should be justifiable and in the interest of the patient only and not for any other consideration. 3.1.2 Consulting pathologists /radiologists or asking for any other diagnostic Lab investigation should be done judiciously and not in a routine manner. 3.2 Consultation for Patient¡¯s Benefit: In every consultation, the benefit to the patient is of foremost importance. All physicians engaged in the case should be frank with the patient and his attendants. 3.3 Punctuality in Consultation: Utmost punctuality should be observed by a physician in making themselves available for consultations. 3.4 Statement to Patient after Consultation: 3.4.1 All statements to the patient or his representatives should take place in the presence of the consulting physicians, except as otherwise agreed. The disclosure of the opinion to the patient or his relatives or friends shall rest with the medical attendant. 3.4.2 Differences of opinion should not be divulged unnecessarily but when there is irreconcilable difference of opinion the circumstances should be frankly and impartially explained to the patient or his relatives or friends. It would be opened to them to seek further advice as they so desire. 3.5 Treatment after Consultation: No decision should restrain the attending physician from making such subsequent variations in the treatment if any unexpected change occurs, but at the next consultation, reasons for the variations should be discussed/ explained. The same privilege, with its obligations, belongs to the consultant when sent for in an emergency during the absence of attending physician. The attending physician may prescribe medicine at any time for the patient, whereas the consultant may prescribe only in case of emergency or as an expert when called for. 3.6 Patients Referred to Specialists: When a patient is referred to a specialist by the attending physician, a case summary of the patient should be given to the specialist, who should communicate his opinion in writing to the attending physician. 3.7 Fees and other charges: 3.7.1 A physician shall clearly display his fees and other charges on the board of his chamber and/or the hospitals he is visiting. Prescription should also make clear if the Physician himself dispensed any medicine. 3.7.2 A physician shall write his name and designation in full along with registration particulars in his prescription letter head. Note: In Government hospital where the patient.load is heavy, the name of the prescribing doctor must be written below his/her signature. CHAPTER 4 4. RESPONSIBILITIES OF PHYSICIANS TO EACH OTHER 4.1 Dependence of Physicians on each other : A physician should consider it as a pleasure and privilege to render gratuitous service to all physicians and their immediate family dependants.
4.2 Conduct in consultation : In consultations, no insincerity, rivalry or envy should be indulged in. All due respect should be observed towards the physician in-charge of the case and no statement or remark be made, which would impair the confidence reposed in him. For this purpose no discussion should be carried on in the presence of the patient or his representatives. 4.3 Consultant not to take charge of the case: When a physician has been called for consultation, the Consultant should normally not take charge of the case, especially on the solicitation of the patient or friends. The Consultant shall not criticize the referring physician. He / she shall discuss the diagnosis treatment plan with the referring physician. 4.4 Appointment of Substitute: Whenever a physician requests another physician to attend his patients during his temporary absence from his practice, professional courtesy requires the acceptance of such appointment only when he has the capacity to discharge the additional responsibility along with his / her other duties. The physician acting under such an appointment should give the utmost consideration to the interests and reputation of the absent physician and all such patients should be restored to the care of the latter upon his/her return. 4.5 Visiting another Physician¡¯s Case: When it becomes the duty of a physician occupying an official position to see and report upon an illness or injury, he should communicate to the physician in attendance so as to give him an option of being present. The medical officer / physician occupying an official position should avoid remarks upon the diagnosis or the treatment that has been adopted. CHAPTER 5 5 DUTIES OF PHYSICIAN TO THE PUBLIC AND TO THE PARAMEDICAL PROFESSION 5.1 Physicians as Citizens: Physicians, as good citizens, possessed of special training should disseminate advice on public health issues. They should play their part in enforcing the laws of the community and in sustaining the institutions that advance the interests of humanity. They should particularly co-operate with the authorities in the administration of sanitary/public health laws and regulations. 5.2 Public and Community Health: Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs a physician should not abandon his duty for fear of contracting the disease himself. 5.3 Pharmacists / Nurses: Physicians should recognize and promote the practice of different paramedical services such as, pharmacy and nursing as professions and should seek their cooperation wherever required.
6. UNETHICAL ACTS : A physician shall not aid or abet or commit any of the following acts which shall be construed as unethical - 6.1 Advertising:
6.1.1 Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organisations is unethical. A physician shall not make use of him / her (or his / her name) as subject of any form or manner of advertising or publicity through any mode either alone or in conjunction with others which is of such a character as to invite attention to him or to his professional position, skill, qualification, achievements, attainments, specialities, appointments, associations, affiliations or honours and/or of such character as would ordinarily result in his self aggrandizement. A physician shall not give to any person, whether for compensation or otherwise, any approval, recommendation, endorsement, certificate, report or
statement with respect of any drug, medicine, nostrum remedy, surgical, or therapeutic article, apparatus or appliance or any commercial product or article with respect of any property, quality or use thereof or any test, demonstration or trial thereof, for use in connection with his name, signature, or photograph in any form or manner of advertising through any mode nor shall he boast of cases, operations, cures or remedies or permit the publication of report thereof through any mode. A medical practitioner is however permitted to make a formal announcement in press regarding the following: (1) On starting practice. (2) On change of type of practice. (3) On changing address. (4) On temporary absence from duty. (5) On resumption of another practice. (6) On succeeding to another practice. (7) Public declaration of charges. 6.1.2 Printing of self photograph, or any such material of publicity in the letter head or on sign board of the consulting room or any such clinical establishment shall be regarded as acts of self advertisement and unethical conduct on the part of the physician. However, printing of sketches, diagrams, picture of human system shall not be treated as unethical. 6.2 Patent and Copy rights: A physician may patent surgical instruments, appliances and medicine or Copyright applications, methods and procedures. However, it shall be unethical if the benefits of such patents or copyrights are not made available in situations where the interest of large population is involved. 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. 6.4 Rebates and Commission: 6.4.1 A physician shall not give, solicit, or receive nor shall he offer to give solicit or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment. A physician shall not directly or indirectly, participate in or be a party to act of division, transference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment. 6.4.2 Provisions of para 6.4.1 shall apply with equal force to the referring, recommending or procuring by a physician or any person, specimen or material for diagnostic purposes or other study / work. Nothing in this section, however, shall prohibit payment of salaries by a qualified physician to other duly qualified person rendering medical care under his supervision. 6.5 Secret Remedies: The prescribing or dispensing by a physician of secret remedial agents of which he does not know the composition, or the manufacture or promotion of their use is unethical and as such prohibited. All the drugs prescribed by a physician should always carry a proprietary formula and clear name. 6.6 Human Rights: The physician shall not aid or abet torture nor shall he be a party to either infliction of mental or physical trauma or concealment of torture inflicted by some other person or agency in clear violation of human rights. 6.7 Euthanasia: Practicing euthanasia shall constitute unethical conduct. However on specific occasion, the question of withdrawing supporting devices to sustain cardio-pulmonary function even after brain death, shall be decided only by a team of doctors and not merely by the treating physician alone. A team of doctors shall declare withdrawal of support system. Such team shall consist of the doctor in charge of the patient, Chief Medical Officer / Medical Officer in charge of the hospital and a doctor nominated by the in-charge of the hospital from the hospital staff or in accordance with the provisions of the Transplantation of Human Organ Act, 1994.
The Clause No. 6.8, as under, is included in terms of Notification published on 14.12.2009 in Gazette of India & the same is also enclosed as Annexure - I. ¡°6.8 Code of conduct for doctors and professional association of doctors in their relationship with pharmaceutical and allied health sector industry. 6.8.1 In dealing with Pharmaceutical and allied health sector industry, a medical practitioner shall follow and adhere to the stipulations given below:- a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives. b) Travel facilities: A medical practitioner shall not accept any travel facility inside the country or outside, including rail, air, ship , cruise tickets, paid vacations etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc as a delegate. c) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext. d) Cash or monetary grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law / rules / guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed. e) Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries. A medical practitioner is obliged to know that the fulfillment of the following items (i) to (vii) will be an imperative for undertaking any research assignment / project funded by industry . for being proper and ethical. Thus, in accepting such a position a medical practitioner shall:- (i) Ensure that the particular research proposal(s) has the due permission from the competent concerned authorities. (ii) Ensure that such a research project(s) has the clearance of national/ state / institutional ethics committees / bodies. (iii) Ensure that it fulfils all the legal requirements prescribed for medical research. (iv) Ensure that the source and amount of funding is publicly disclosed at the beginning itself. (v) Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research project(s). (vi) Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way. (vii) Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other document / agreement for any such assignment. f) Maintaining Professional Autonomy: In dealing with pharmaceutical and allied healthcare industry a medical practitioner shall always ensure that there shall never be any compromise either with his / her own professional autonomy and / or with the autonomy and freedom of the medical institution.
g) Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers, as treating doctors or in any other professional capacity. In doing so, a medical practitioner shall always: (i) Ensure that his professional integrity and freedom are maintained. (ii) Ensure that patients interest are not compromised in any way. (iii) Ensure that such affiliations are within the law. (iv) Ensure that such affiliations / employments are fully transparent and disclosed. h) Endorsement: A medical practitioner shall not endorse any drug or product of the industry publically. Any study conducted on the efficacy or otherwise of such products shall be presented to and / or through appropriate scientific bodies or published in appropriate scientific journals in a proper way¡±.
7. MISCONDUCT : The following acts of commission or omission on the part of a physician shall constitute professional misconduct rendering him/her liable for disciplinary action 7.1 Violation of the Regulations: If he/she commits any violation of these Regulations. 7.2 If he/she does not maintain the medical records of his/her indoor patients for a period of three years as per regulation 1.3 and refuses to provide the same within 72 hours when the patient or his/her authorised representative makes a request for it as per the regulation 1.3.2. 7.3 If he/she does not display the registration number accorded to him/her by the State Medical Council or the Medical Council of India in his clinic, prescriptions and certificates etc. issued by him or violates the provisions of regulation 1.4.2. 7.4 Adultery or Improper Conduct: Abuse of professional position by committing adultery or improper conduct with a patient or by maintaining an improper association with a patient will render a Physician liable for disciplinary action as provided under the Indian Medical Council Act, 1956 or the concerned State Medical Council Act. 7.5 Conviction by Court of Law: Conviction by a Court of Law for offences involving moral turpitude / Criminal acts. 7.6 Sex Determination Tests: On no account sex determination test shall be undertaken with the intent to terminate the life of a female foetus developing in her mother.s womb, unless there are other absolute indications for termination of pregnancy as specified in the Medical Termination of Pregnancy Act, 1971. Any act of termination of pregnancy of normal female foetus amounting to female foeticide shall be regarded as professional misconduct on the part of the physician leading to penal erasure besides rendering him liable to criminal proceedings as per the provisions of this Act. 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. 7.8 A registered medical practitioner shall not contravene the provisions of the Drugs and Cosmetics Act and regulations made there under. Accordingly, a) Prescribing steroids/ psychotropic drugs when there is no absolute medical indication; b) Selling Schedule .H. & .L. drugs and poisons to the public except to his patient;
in contravention of the above provisions shall constitute gross professional misconduct on the part of the physician. 7.9 Performing or enabling unqualified person to perform an abortion or any illegal operation for which there is no medical, surgical or psychological indication. 7.10 A registered medical practitioner shall not issue certificates of efficiency in modern medicine to unqualified or non-medical person. (Note: The foregoing does not restrict the proper training and instruction of bonafide students, midwives, dispensers, surgical attendants, or skilled mechanical and technical assistants and therapy assistants under the personal supervision of physicians.) 7.11 A physician should not contribute to the lay press articles and give interviews regarding diseases and treatments which may have the effect of advertising himself or soliciting practices; but is open to write to the lay press under his own name on matters of public health, hygienic living or to deliver public lectures, give talks on the radio/TV/internet chat for the same purpose and send announcement of the same to lay press. 7.12 An institution run by a physician for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation centre or any type of training institution etc. may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees. 7.13 It is improper for a physician to use an unusually large sign board and write on it anything other than his name, qualifications obtained from a University or a statutory body, titles and name of his speciality, registration number including the name of the State Medical Council under which registered. The same should be the contents of his prescription papers. It is improper to affix a sign-board on a chemist.s shop or in places where he does not reside or work. 7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except . i) in a court of law under orders of the Presiding Judge; ii) in circumstances where there is a serious and identified risk to a specific person and / or community; and iii) notifiable diseases. In case of communicable / notifiable diseases, concerned public health authorities should be informed immediately. 7.15 The registered medical practitioner shall not refuse on religious grounds alone to give assistance in or conduct of sterility, birth control, circumcision and medical termination of Pregnancy when there is medical indication, unless the medical practitioner feels himself/herself incompetent to do so. 7.16 Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may result in sterility the consent of both husband and wife is needed. 7.17 A registered medical practitioner shall not publish photographs or case reports of his / her patients without their permission, in any medical or other journal in a manner by which their identity could be made out. If the identity is not to be disclosed, the consent is not needed. 7.18 In the case of running of a nursing home by a physician and employing assistants to help him / her, the ultimate responsibility rests on the physician. 7.19 A Physician shall not use touts or agents for procuring patients. 7.20 A Physician shall not claim to be specialist unless he has a special qualification in that branch.
7.21 No act of invitro fertilization or artificial insemination shall be undertaken without the informed consent of the female patient and her spouse as well as the donor. Such consent shall be obtained in writing only after the patient is provided, at her own level of comprehension, with sufficient information about the purpose, methods, risks, inconveniences, disappointments of the procedure and possible risks and hazards. 7.22 Research: Clinical drug trials or other research involving patients or volunteers as per the guidelines of ICMR can be undertaken, provided ethical considerations are borne in mind. Violation of existing ICMR guidelines in this regard shall constitute misconduct. Consent taken from the patient for trial of drug or therapy which is not as per the guidelines shall also be construed as misconduct.
The following Clause No. 7.23 & 7.24 are deleted in terms of Notification published on 22.02.2003 in Gazette of India & the same is also enclosed as Annexure - II. 7.23 If a physician posted in rural area is found absent on more than two occasions during inspection by the Head of the District Health Authority or the Chairman, Zila Parishad, the same shall be construed as a misconduct if it is recommended to the Medical Council of India/State Medical Council by the State Government for action under these Regulations. 7.24 If a physician posted in a medical college/institution both as teaching faculty or otherwise shall remain in hospital/college during the assigned duty hours. If they are found absent on more than two occasions during this period, the same shall be construed as a misconduct if it is certified by the Principal/Medical Superintendent and forwarded through the State Government to Medical Council of India/State Medical Council for action under these Regulations. CHAPTER 8 8. PUNISHMENT AND DISCIPLINARY ACTION 8.1 It must be clearly understood that the instances of offences and of Professional misconduct which are given above do not constitute and are not intended to constitute a complete list of the infamous acts which calls for disciplinary action, and that by issuing this notice the Medical Council of India and or State Medical Councils are in no way precluded from considering and dealing with any other form of professional misconduct on the part of a registered practitioner. Circumstances may and do arise from time to time in relation to which there may occur questions of professional misconduct which do not come within any of these categories. Every care should be taken that the code is not violated in letter or spirit. In such instances as in all others, the Medical Council of India and/or State Medical Councils have to consider and decide upon the facts brought before the Medical Council of India and/or State Medical Councils. 8.2 It is made clear that any complaint with regard to professional misconduct can be brought before the appropriate Medical Council for Disciplinary action. Upon receipt of any complaint of professional misconduct, the appropriate Medical Council would hold an enquiry and give opportunity to the registered medical practitioner to be heard in person or by pleader. If the medical practitioner is found to be guilty of committing professional misconduct, the appropriate Medical Council may award such punishment as deemed necessary or may direct the removal altogether or for a specified period, from the register of the name of the delinquent registered practitioner. Deletion from the Register shall be widely publicized in local press as well as in the publications of different Medical Associations/ Societies/Bodies. 8.3 In case the punishment of removal from the register is for a limited period, the appropriate Council may also direct that the name so removed shall be restored in the register after the expiry of the period for which the name was ordered to be removed. 8.4 Decision on complaint against delinquent physician shall be taken within a time limit of 6 months. 8.5 During the pendency of the complaint the appropriate Council may restrain the physician from performing the procedure or practice which is under scrutiny.
8.6 Professional incompetence shall be judged by peer group as per guidelines prescribed by Medical Council of India.
8.7 The following Clause No. 8.7 & 8.8 are included in terms of Notification published on 27.05.2004 in Gazette of India & the same is also enclosed as Annexure - III. ¡°8.7 Where either on a request or otherwise the Medical Council of India is informed that any complaint against a delinquent physician has not been decided by a State Medical Council within a period of six months from the date of receipt of complaint by it and further the MCI has reason to believe that there is no justified reason for not deciding the complaint within the said prescribed period, the Medical Council of India may- (i) Impress upon the concerned State Medical council to conclude and decide the complaint within a time bound schedule; (ii) May decide to withdraw the said complaint pending with the concerned State Medical Council straightaway or after the expiry of the period which had been stipulated by the MCI in accordance with para(i) above, to itself and refer the same to the Ethical Committee of the Council for its expeditious disposal in a period of not more than six months from the receipt of the complaint in the office of the Medical Council of India.¡± ¡°8.8 Any person aggrieved by the decision of the State Medical Council on any complaint against a delinquent physician, shall have the right to file an appeal to the MCI within a period of 60 days from the date of receipt of the order passed by the said Medical Council: Provided that the MCI may, if it is satisfied that the appellant was prevented by sufficient cause from presenting the appeal within the aforesaid period of 60 days, allow it to be presented within a further period of 60 days.