ENHANCEMENT OF STUDY LEAVE OF CHS OFFICERS FROM 24 MONTHS TO 36 MONTHS APPROVED WITH STIPULATION THAT BOND FOR SERVING FOR FIVE YEARS WILL BE REQUIRED AFTER P.G..
Above message was taken from www.mohfw.nic.in
Dr Marwah
Saturday, June 2, 2007
Wednesday, May 30, 2007
Vaccination schedule for children not immunized in time
- Vaccination schedule for children not immunized in time
Following table depicts the schedule which should be followed in case of unimmunized child.
- No other vaccine should be administered within 4 weeks interval after the administration of Measles/ MMR vaccine.
- A lapse in the immunization schedule does not require reinstitution of the entire series. Immunizations should be given at the next visit as if the usual interval had elapsed and the immunization schedule should be completed at the next available opportunity. In case of unknown or uncertain immunization status, it is appropriate to start the schedule of unimmunized child. There is at present no evidence to indicate that administration of vaccines to already immune recipients is harmful.
- Vaccines can be administered simultaneously both killed and or live vaccines together without decreasing the efficacy of the vaccine. However, the vaccines should be administered at different sites unless it is a combination vaccine.
Dr Marwah
Tuesday, May 29, 2007
Vaccine Preventable Diseases Surveillance
VPD Surveillance
Surveillance is a French word which means ‘watching with attention, suspicion and authority’. Any satisfactory immunization programme should result in gradual decline of the vaccine preventable diseases concerned. The WHO had declared 3 distinct objectives for the year 2000 A.D.However, none of the targets have been achieved so far.
- Polio Eradication
- NNT elimination
- Measles Reduction
It is possible to eradicate poliovirus from the Globe, but it is not possible to eradicate the source of tetanus bacilli which is animal excreta and spores in the soil. However, by immunizing large number of all mothers with TT it is possible to eliminate neonatal tetanus. Although Measles can be eradicated in the future, at the present time the single dose Measles immunization can only prevent Measles mortality by preventing Measles in the vast majority of immunized children.
Dr Marwah
Immunization for travelers
- Immunization for travelers
The risk of travelers contacting infectious disease depends on destination, duration of trip and nature and conditions of travel. Uniform recommendations are not possible because the epidemiology of diseases differs in various geographical areas. Therefore it is not possible to provide an exhaustive list of vaccines that should be advised to travelers to a particular destination. The two steps in immunizing travelers are to update routine immunization and to provide travel specific immunizations. For the second part, detailed information about the person’s itinerary, living conditions during the journey, mode of travel and purpose of travel are to be noted.
Vaccines commonly recommended for Indians traveling abroad include yellow fever vaccine for those traveling to destinations in
Vaccines to be recommended for children traveling from Western countries to
Immunization of Adolescents
- Immunization of Adolescents
- Adolescence presents special challenges for immunization in relation to life-style and other social issues, whilst also offering special opportunities, such as vaccine delivery in the setting of educational institutions.
Reasons for adolescent immunization fall into the following three broad categories:
- To boost the waning immunity by giving booster doses.
- To accelerate control or elimination efforts of various diseases like Measles.
- To counter a specific risk e.g. due to travel, their life style etc.
Vaccination Schedule in Adolescents
| Vaccine | Age |
| Tetanus Toxoid | Booster at 10 and 16 years |
| Rubella vaccine | As part of MMR vaccine or (Monovalent) 1 dose to girls at 12-13 years of age, if not given earlier |
| MMR Vaccine | 1 dose at 12-13 years of age. (if not given earlier) |
| Hepatitis B. Vaccine | 3 Doses (0, 1 and 6 m) if not given earlier |
| Typhoid Vaccine | TA, Vi or Oral typhoid vaccine every 3 years |
| Varicella Vaccine* | 1 dose up to 12-13 years, and 2 doses after 13 years of age. (if not given earlier) |
| Hepatitis A Vaccine* | 2 doses (0 and 6 months) if not given earlier |
Varicella* and Hepatitis A* vaccine are additional vaccines. These vaccines are recommended depending upon the epidemiology of these diseases especially in the adolescent age group where fatal complications are likely to occur. If a child has already suffered from Chickenpox/Hepatitis A the vaccine need not be given.
Dr MarwahIAP Immunization Time Table
IAP Immunization Time Table
The basic objective of immunization program of any country is the reduction of mortality, prolonged sequelae, disability and morbidity in order of priority against diseases that can be prevented by vaccines. Therefore, the vaccination schedule of a country should be mainly based on epidemiological profile of the diseases that leads to significant mortality, disability and morbidity. Additional important factors that need consideration are the logistics and operational feasibility, availability and the cost effectiveness of the vaccine. At this time, sufficient data are available to justify the inclusion of six diseases currently being covered under National Immunization Schedule. However in view of enough new data on various diseases and availability of several vaccines,
The IAP after detailed deliberations in the meeting of the Committee on Immunization formulated a policy on different vaccines to be administered to the children under their care. There is now sufficient epidemiological data to suggest that Hepatitis B vaccine to be given to the children starting at birth for prevention of perinatal transmission followed by two more doses at 6 and 14 weeks. If the birth dose is missed, the vaccine can be given at 6, 10 & 14 weeks. Sufficient available data suggests that 3 doses given at 1 month interval produce long lasting immunity. IAP also recommends inclusion of MMR, Typhoid and Haemophilus Influenzae b in the time table. However, in view of the mild nature of chickenpox and hepatitis A, these two are recommended as additional vaccines. If adolescents do not suffer from chickenpox by 12 years of age, varicella vaccine should be administered.
IAP Immunization Time Table
| Vaccine | Age Recommended |
| BCG | Birth - 2 weeks |
| OPV | Birth, 6, 10, 14 weeks |
| DPT | 6 weeks, 10 weeks, 14 weeks |
| Hepatitis B | Birth, 6 weeks, 14 weeks / 6 weeks, 10 weeks, 14 weeks |
| Hib Conjugate | 6 weeks, 10 weeks, 14 weeks |
| Measles | 9 months plus |
| MMR | 15 months |
| Typhoid | Above 2 years |
| 2 doses of TT | Pregnant Women |
Additional Vaccines
Varicella* 1 year onwards
Hepatitis A** 2 years onwards
Note
- To prevent perinatal transmission, birth dose of Hepatitis B vaccine within 12 hours is essential. BCG, OPV and Hepatitis B vaccines, when missed at birth can be started at the completion of 6 weeks.
- Combined DPTwc / Hepatitis B / Hib vaccines can be given at 6, 10, 14 weeks.
- In addition to ‘Routine OPV doses’, the recommended ‘Pulse OPV doses’ are also mandatory during PPI campaigns.
- For Typhoid* immunization, earliest age recommended : whole cell vaccine at 6 months, Vi antigen at 2 years and Oral Ty21a vaccine at 6 years. Revaccination every 3 years.
- Apart from the earliest age indicated, MMR, Typhoid, Varicella and Hepatitis A can be given at any age, relevant to local epidemiology.
- Td (Tetanus / diphtheria toxoid) should be preferred to TT (Tetanus toxoid) where available.
- Varicella** and Hepatitis A** are additional vaccines as recommended by
Td Vaccine (Tetanus, Diphtheria Toxoid)
Td Vaccine (Tetanus, Diphtheria Toxoid)
Td which contains usual dose of tetanus toxoid and only 2 units of diphtheria toxoid if available, is more appropriate which would prevent diphtheria, in addition to tetanus and is given at 10 years and 16 years and then every 10 years thereafter.
Dr Marwah
Why Pulse Polio?
Oral Polio Vaccine
The oral polio vaccine is a suspension of over 1 million particles of polioviruses type 1, 2 and 3 together. It is supplied with a stabilizing agent, namely magnesium chloride. Therefore the potency is quite stable under refrigeration or freezing. Several cycles of freezing and thawing do not reduce the potency. When OPV is given by mouth, the vaccine viruses go through the stomach and reach the intestines where they must establish infection ( = vaccine virus take) before an immune response may occur. The viruses survive the acidity of the stomach. However, for reasons not clearly understood, the ‘take’ rate is relatively low in our children.
For the above reason, multiple doses of OPV are necessary before 90 – 95% of children develop immune responses to all 3 poliovirus types. It is for this reason that the IAP recommends at least 4 routine doses of OPV, during infancy and 2 more repeat doses at 15 – 18 months and 5 years. In addition to the “Routine OPV doses”, “Pulse OPV doses every year on National Immunization days (NID’s) till the age of 5 years are also mandatory.
In order to ensure that vaccinated children do not participate in the chain of transmission of wild (pathogenic) polioviruses, a high level of gut immunity should be induced in them. For this reason also multiple doses of OPV are necessary.
Eradication is defined as no case of paralytic poliomyelitis by wild polio virus in last 3 calendar years along with absence of wild polio virus in the community, where excellent clinical and virological surveillance exists and the coverage of routine OPV is more than 80%.
Polio elimination is defined as Zero cases of paralytic poliomyelitis by the wild polio virus in one calendar year with other criteria same as in eradication.
- Adequate immunization is the method of eradication
- Clinical surveillance is the method to identify AFP status
- Virological investigations are necessary to document confirmation of polio virus.
In developing countries with high (pre-immunization era) incidence of polio, such as in India, 3 or 4 doses of OPV given to even 90% or more infants, did not result in polio eradication. In such countries with routine immunization of 4-6 doses of OPV and a near 100% coverage during annual pulse immunization - Pulse Polio Immunization, (PPI) will be necessary to achieve eradication. Surveillance must detect all cases of Acute Flaccid Paralysis (AFP), report them and investigate for poliovirus etiology. When any poliovirus is detected it should be examined by genomic analysis to identify it as wild poliovirus and to distinguish from vaccine strain of poliovirus, to facilitate recording the incidence of Vaccine Associated Paralytic Poliomyelitis (VAPP).
Why Pulse Polio?
On National Immunization Days (NID’s), pulse doses of oral polio vaccine has to be administered, as simultaneous feeding of the vaccine to all susceptible infants and children, would produce immunity to all and prevent wild poliovirus to multiply in the gut. Thus, wild polio virus cannot grow in susceptive host. Therefore, it is mandatory to administer all recommended doses in NID’s so that no wild poliovirus remains in the circulation.
Inject able Killed Polio Vaccine (IPV)
IPV is formaldehyde killed poliovirus grown in monkey kidney cell/human diploid cells containing 20, 8 & 32 D antigen against type 1, 2 and 3 poliovirus respectively. It is highly immunogenic. Seroconversion is 90-95%, after 2 doses and 99% after 3 doses. It produces excellent humoral immunity as well as local pharyngeal and possible intestinal immunity. The vaccine is very safe. However, it is not available at present in the Indian market for routine use and is licensed only for use in immunocompromised children.
Summary: Oral Polio Vaccine
- Live attenuated Poliovirus types 1, 2 and 3 developed by SABIN, 1961
- Temperature sensitive, store frozen or refrigerated
- Can be given simultaneously with any other vaccine
- Vaccine virus take = infection of GI tract
- Multiple doses necessary to ensure vaccine virus take and antibody response to all 3 types of polioviruses
- First dose is recommended in the newborn period or as early as possible
- IAP recommends additional doses of OPV as a part of Pulse Polio programme every year till the age of 5 years
Summary: Injectable (Killed) Oral Polio Vaccine
- Formaldehyde Killed Polio Virus grown in monkey kidney / human Diploid cell
- Contains 20, 8 and 32 D antigen units against type 1, 2 and 3 Polio Viruses respectively
- Seroconversion 90-95% after 2 doses and 99% after 3 doses
- Thermo stable and is indicated in Immunocompromised individuals, HIV infection and disease.
Motivation
Motivation
Motivation is a very broad topic, and one that reaches well beyond just pushing yourself to achieve more. High motivation is vitally important if you and your team are to achieve peak performance.
What Really Motivates People?
Dispelling the myths about motivation
Why do organizations, managers and team leaders want highly motivated employees? The answer is simple: To improve performance.
Better motivation leads to all sorts of positive behaviors: Motivated employees tend to work harder; be less stressed; take more care in their work; be less likely to leave their jobs; look for opportunities to improve the processes with which they work; and much more. But in the end, all of this adds up to one thing: Improved performance.
So, if you're a manager or you're in upper level administration, motivating your team is a must. And it can be one of the quickest ways to improve your "bottom line" too, whether your "bottom line" is financial or measured in another way such as customer satisfaction, production quality or reducing an inherited backlog.
So, just how can you increase motivation, improve employee performance and watch your "bottom line" grow, however it is measured?
Perhaps we should start with the old saying: "You can lead a horse to water, but you can't make it drink". The same is true for people. To get the best from people, you have to inspire and motivate them to give their best.
While it seems that some people are born with higher levels of motivation than others, this is not always the case. In fact, it has been proven that motivating people is a skill, one that must be mastered to achieve success.
Motivation - A Key Contributor to Performance
You can think of performance as a simple equation:
Job performance = ability x motivation
Ability depends, to some degree, on education, experience and training. This makes improvement a continual, lengthy process. By contrast, motivation can be quickly improved.
There are a handful of very basic, broad strategies that you can use to improve it. These include:
• Positive reinforcement
• Effective discipline
• Treating people fairly
• Satisfying employee needs
• Setting attainable work-related goals
• Restructuring jobs when necessary
• Giving rewards that are based on performance
While motivation practices will vary widely from workplace to workplace, these are the areas you should focus on when you want to motivate people.
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Frederick Herzberg's Findings
Now, it's worth going into a bit of theory here. To get a deeper understanding of motivation and job satisfaction, we can look to Frederick Herzberg, a well-respected researcher who closely studied the sources of employee motivation in the 1950s and 1960s. While Herzberg's studies were conducted some time ago, they are strongly respected and underpin much of our current view of motivation.
He found that the things that make people satisfied and motivated on the job are different in kind from the things that make them dissatisfied (or act as de-motivators.) This points to an approach which is exactly opposite of the motivators commonly put in place in the modern workplace, i.e. use of compensation and incentive packages.
For, as discussed in his classic article in the Harvard Business Review ('One More Time: How Do You Motivate Employees?" January - February 1968), Herzberg argued that spiraling wages may very well serve to motivate employees; however, the action they motivate is the seeking the next wage increase - and little more than that.
In fact, Herzberg's motivation-hygiene theory suggests that the factors that determine job satisfaction and serve to motivate are "separate and distinct from the factors that lead to job dissatisfaction." Hence, the opposite of job satisfaction is not job dissatisfaction, but rather no job satisfaction. Conversely, the opposite of job dissatisfaction is not job satisfaction, but no job dissatisfaction.
According to Herzberg, the factors to consider when working to enhance job satisfaction and motivation include:
• Achievement
• Recognition for Achievement
• Work Itself
• Responsibility
• Growth
• Advancement
And the factors which cause most dissatisfaction include:
• Company Policy
• Administration
• Poor Supervision
• Interpersonal Relationships
• Working Conditions
• Salary
• Status
• Security
So managers should seek to motivate people by giving opportunities for achievement and celebrating this, and helping individuals enjoy and grow in their jobs. And they should actively minimize the bureaucracy and petty irritations that organizations often unthinkingly inflict on employees.
Herzberg concluded that motivators are the primary cause of satisfaction and hygiene factors are the primary cause of unhappiness in the workplace. Taking an example:
People are often only temporarily motivated by an increase in salary, however they can become very demotivated if they think salaries are too low or if they're earning less than their peers.
Now, it's easy to pass over this information without absorbing its significance.
Instead, pause for a moment and put aside your current assumptions about other people's motivations. Reflect on how you feel yourself. Isn't this true for you? Don't you get your greatest satisfaction from doing a good job, being recognized for it, and from growing your capabilities? And aren't you most demotivated by the frustrations of bureaucracy, organizational stupidity, politics and being "taken advantage of"?
As it is for you, so it is for most other people.
Summary
If you're a manager, you already know that motivating your team is an important part of your job. In so many cases, the level of motivation of your team is a huge factor in its performance.
The role of motivation or "job enrichment", as Herzberg called it, is more than a single project, instead calling on continuous efforts from management. In working to do this, managers should:
• Where possible, enrich jobs so that they offer a level of challenge equal to the skills of the person that occupies them;
• Work to ensure those with ability are able to demonstrate it, and can win promotion to higher-level jobs; and
• Understand that the very nature of motivators (as opposed to hygiene factors) is that they have a long-term effect on employees' attitudes.
Obviously, not all jobs can be enriched, nor do all jobs need to be enriched. But as Herzberg concluded, if a small percentage of the time and money that is dedicated to "hygiene" was instead allocated to his motivating factors, the return in employee satisfaction and motivation, as well as economic gain, would be one of "the largest dividends that industry and society have ever reaped."
It's now time to put this into practice! How are you going to motivate your team? How will you make good motivation a routine part of your approach to management?
Keep reading to learn more about motivation theories as well as tips and suggestions for making them work in reality.
—
Herzberg's Motivation-Hygiene Theory
Frederick Herzberg, a well-respected researcher who closely studied the sources of employee motivation in the 1950s and 1960s, produced great work on job satisfaction and employee satisfaction. This work forms a large part of the foundation on which most successful motivation approaches are now built.
As Herzberg determined, the factors that contribute to job satisfaction and motivation are different from those that contribute to dissatisfaction.
You may remember Herzberg's argument that increasing wages does little more than motivate employees to seek the next wage increase. His works showed that the factors that determine job satisfaction (and serve to motivate) are "separate and distinct from the factors that lead to job dissatisfaction." Hence, the opposite of job satisfaction is not job dissatisfaction, but rather no job satisfaction. Conversely, the opposite of job dissatisfaction is not job satisfaction, but no job dissatisfaction. This is a bit of a mouthful!
Herzberg's "Hygiene Factors" (the things that make us unhappy and de-motivated) are obstructive company policy, unhelpful administration, intrusive supervision, bad working relationships, poor conditions, uncompetitive salaries, low status and job insecurity. By fixing these problems you can get rid of much de-motivation and unhappiness, but you will not build high motivation.
To start motivating people, these de-motivating factors need first to be controlled. But to build real motivation, you need to give opportunities for and recognize achievement; provide intrinsically rewarding work; and give opportunities for responsibility, growth and advancement.
The Simple Answer for Motivational Success
So how can you better motivate your team members to achieve the success you desire?
As simple as it may seem, the answer may lie in talking with them.
The importance of this cannot be overstated: If you don't make a point of listening to your team, you can miss huge opportunities both for removing de-motivators and for motivation. Team members may be upset by tiny points of bureaucracy of which you're not even aware. Or there may be simple actions that you could take that would have a huge impact on people's morale.
But what questions should you ask?
Ask questions that will help you learn more about their individual goals and their views in terms of their job. (For large groups, gather everyone and distribute a questionnaire that asks these questions in the simplest, most direct way possible).
Keep in mind that achievement, recognition, growth, meaningful work, equity and camaraderie and likely to be high on most people's list. This, of course, is aside from the obvious, which is that employees must have a safe working environment, a practical workload, comfortable working conditions, a reasonable degree of job security, satisfactory compensation and benefits, respectful treatment, credible and consistent management, and the opportunity to voice their concerns, if you're to achieve even minimal motivation. After all, these are the basics and should be considered not so much as motivational factors, but as basic necessities.
You should also ask team members if they feel challenged at work and if they feel they are able to use their skills and apply their knowledge. Is there adequate room for growth for your employees? Do they have the opportunity to expand their knowledge and learn new skills?
Do they perceive their job to be important? Do they receive recognition for their performance? And, are they proud to work for the company and proud of their individual contribution?
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Also, strive to learn more about their relationships within the workplace. Do your best to ensure your employees have consistently positive interactions with you, as well as with other members of the team? By having regular one-to-one chats with team members, you can quickly pick up and resolve issues before they become significant, as well as taking the opportunity to praise achievement.
From Theory to Successful Practice...
Remember, your goal here is to learn what will build higher morale, generate enthusiasm, and increase productivity. And just look at companies when they're performing at their best: What you'll most often find as a common denominator is the high morale of the workers.
Simply put, to motivate team members, help them be productive and be the best they can be, let them know how they are doing, make an investment in them and help them grow.
Considering that employee enthusiasm is directly related to employee performance, this becomes a never-ending cycle, one that when spun the right way, will yield unmatched results for you, your employees and the organization.
The bottom line is this: When it comes to motivating your team, perhaps you should start by considering what would motivate you. Then talk to your team members to find out what they want and need. And then work diligently to provide them with it.
Dr Marwah
Monday, May 28, 2007
Patients and Doctors Sound Off
SOURCE:Consumer Reports | GRAPHIC: The
Patient Satisfaction and Compliance
Patient Satisfaction and Compliance
In a conference on diabetes, the presenter stressed the importance of getting patients to check their blood sugars three times per day, in keeping with the latest clinical guidelines. Almost immediately the speaker received a strong objection from one physician in the audience. "We can't get our patients to check their blood sugars that often," he protested. "We're lucky to get them to check once a day!"
In her response, the presenter said that to get patients to change their behavior, whether in the context of smoking cessation or diabetes management, there is an element of "selling" that's required of the physician. In other words, the physician has to recognize the opportunity for intervention, reframe it in a way that makes it meaningful to the patient and generate a sufficient sense of urgency to compel the patient to take action. At the same time, the physician has to maintain a partnership with the patient, based on trust and understanding.
In many ways, this is the same approach taken by great salespeople. Although that comparison may make some physicians uncomfortable, we can find value in examining how other fields have approached similar challenges. What follows are five key lessons from the sales profession that have the potential to strengthen physician-patient relationships, improve patient satisfaction and enhance patient compliance.
1. Establish a sense of trust
This is a crucial first step in any patient encounter. In their book Primal Leadership: Realizing the Power of Emotional Intelligence, Daniel Goleman and his colleagues outline the importance of trust in conveying a message successfully.1 He explains that as an event takes place, such as hearing a recommendation or a sales pitch, the amygdala (which produces our "fight-or-flight" response) filters the perceived event and attaches an emotional context to it. If the amygdala perceives the event to be unsafe, either physically or psychologically, then it initiates an appropriate response. This response ultimately interrupts the path of the incoming information so that it does not reach the prefrontal cortex effectively.
Imagine a pharmaceutical representative presenting information to you in a fashion that makes you feel manipulated. Psychologically, you perceive a threat, which triggers a response from your amygdala. Goleman calls this process an "amygdala hijack." From this point on, the remainder of the representative's message becomes irrelevant, as it never engages the prefrontal cortex and the information is not absorbed.
If we are to have any hope of having our message heard and understood by our patients, we need to become skilled at not triggering a state of psychological fear. To do so means we must learn to be perceptive listeners and careful observers of small details that give us a glimpse into the lives of patients and enable us to understand their values, goals, challenges and interests over time. Effective salespeople know this tactic, and they gather pieces of important information about their customers. Effective physicians must do the same, using the skills in the next step.
We must learn to be perceptive listeners and careful observers of small details.
2. Uncover patients' actual needs
Perhaps the most critical skill in uncovering the needs of a client or patient is the skill of inquiry. Central to good dialogue, inquiry involves asking questions with a spirit of curiosity and with a goal of trying to understand how others perceive the world around them. Great salespeople probe to meet customer expectations and to see how they can be of assistance in the future. In essence, they establish themselves as trusted partners and lay the foundation for future business, even if they may not be of immediate assistance.
At first glance, the way to uncover patients' needs may seem straightforward: Simply ask an open-ended question such as, "What brings you in today?" But there is more to it than that.
Many cases of patient dissatisfaction can be traced to an inadequate discovery of patient needs. For example, I recently saw a patient who indicated, when I asked, that she had come to get her iron levels checked. Given the hectic nature of the day, I was tempted to draw the lab tests and call it a day. Suspecting that this would not have met her needs, I responded with interest: "It sounds like this is worrying you. What brings you to want to get these levels checked?"
As the conversation unfolded, she proceeded to tell me that she had resolved to improve her health by losing weight. Her plan included eating right and exercising, but she said that she lacked the energy to exercise. She had done some preliminary research that had led her to think about her iron levels. As a result of our conversation, we were able to enhance her trust, gain insight into her goals and identify other areas where our office's clinical services could be helpful. By taking the time to probe a bit deeper, we created the foundation for a stronger long-term physician-patient relationship.
I use this approach often, especially with new patients or with those who come for annual physical exams. Asking patients to describe how they see themselves in five years and how I can help them attain their goals is a good starting point. Physical exams become "game plans" for meeting needs over time, and they allow us to pace our progress.
Rather than hearing patients' complaints and immediately responding with a solution, dig deeper.
3. Think dialogue, not monologue
Just as physicians dislike salespeople who seem to dominate the interaction, patients dislike us when we do the same. The days of patients accepting prescriptive and paternalistic advice from their physician are nearing their end. Leave the didactic monologues behind.
Instead, ask questions, explore values and make a connection with every patient. Rather than hearing patients' complaints and immediately responding with a solution, dig deeper. Find out how their problems affect their day-to-day lives, or how they have approached the problem and what their results have been. Support their internal knowledge, and recognize that they often do know their own bodies. Only after they have finished speaking should you address other options. Ask patients how these other options sound in the context of their overall goals.
"The close" is a sales term that describes the phase of the interaction during which the salesperson obtains a commitment from the customer to close the deal and proceed to the next step. The timing of this step, however, is critical for success. You can't get people to "sign on the dotted line" before they are ready. If you push it too soon, you'll instill a sense of mistrust and even anger.
How do you know if a patient is ready? One technique is called a "test close." For example, if a patient with uncontrolled diabetes says he's too busy to exercise, try saying: "It sounds like time has been your biggest concern when it comes to exercising. If we could find an exercise plan that doesn't take a lot of time, would you be willing to move forward?"
If the proposal is acceptable to the patient, then you can move to the "close." In this example, it may be prescribing just 15 minutes of walking three times per week. In our practice, we would then ask, "Does this approach sound OK to you?" to confirm a commitment or invite negotiation.
Effective salespeople always follow up with their customers on prior sales to determine whether they were satisfied with their solutions. They also follow up just to say hi, which demonstrates that the customer is important to them.
Physicians should do the same. I also ask patients to follow up with me by phone or e-mail in a week to update me on how our plan is working, or, even better, I ask permission to contact them within the same time frame. If you don't have time to follow up yourself, have your staff call patients after their visits to ask how things are going, whether their goals are progressing and whether they would like to make another appointment to see you. Patients appreciate when our office staff is able to support them as they work toward their goals. Your office can also show patients they are important by sending birthday cards, e-mailing health tips and pursuing other avenues of contact. These build commitment and place minimal burden on your staff.
Happier, healthier patients
Developing strong patient relationships with high levels of satisfaction is challenging, but it is a realistic goal. These lessons can provide fresh insight into our approach with patients and can lead to a greater understanding of patients' needs and increased levels of compliance. The trust that evolves will create a foundation we can build on for years to come.
» Selling a treatment plan to a patient involves converting a sense of apathy to a sense of urgency.
» To gain your patients' trust, show interest in their values and goals
» Be a good listener and refrain from dominating the conversation during visits.
KEY POINTS
• Effective listening and inquiry will help you uncover patients' real needs and goals.
Sunday, May 27, 2007
MEDICAL ETHICS
MEDICAL ETHICS
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 are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.
Principles of medical ethics
- A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
- 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.
- 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.
- 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.
- 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.
- 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.
- A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
- A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
- A physician shall support access to medical care for all people.
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Dr Marwah
Procurement of Medicines Part II Agreement with Chemist
Procurement of Medicines Part II
Agreement with Chemist
( as per the tender document)
1 SUPPLY OF MEDICINES
1.1 Sufficient stock of standard quality of medicines at all times will have to be maintained by the supplier, to avoid inconvenience to the Government/CGHS beneficiaries.
1.2 In case of failure or refusal on supplier's part to supply the medicines to the purchaser / beneficiaries within the time as provided in clause 17 hereunder, the contract is liable to be terminated /cancelled at supplier's risk and cost. Any extra cost involved in arranging supply from alternative source will be recovered from the supplier. It is in addition and without prejudice to the deduction in clauses 17 & 18 hereunder.
1.3 The supplier will indicate batch number, name of manufacturer, date of expiry in the indents at the time of supplying the drug to the concerned CGHS Units/Dispensaries.
1.4 (a) The medicines/drugs to be supplied will be of standard quality. In case it is found that any particular medicine's date is expired, found not of standard quality, substandard or spurious, supplier's (Appointed Authorised Chemist) firm will be liable to be blacklisted for a period of 5 years besides other legal action that may be initiated. In case the supplier fails to supply indented drugs/medicines, the purchaser will be entitled to procure the same from other chemist and the supplier will be liable to reimburse in full the price paid by the purchaser. However the supplier will be allowed to claim what would be payable to him for the medicines as per agreed terms and conditions.
(b) In case of indent for specific brand of medicines, the same shall not be substituted. If any such case is noticed during subsequent scrutiny after or before the payment, then supplier will be penalised for Rs.1000 + cost of the specific brand of medicines for each such default.
1.5 Indented medicines for the beneficiaries to be supplied in individual packets by the designate local chemist.
1.6 The payment for NA items to be made to the beneficiaries on a fixed date / day by the local chemist / their representative, at the Dispensary.
1.7 Short supplied medicine to be sent through courier at the residence of the beneficiary at the cost of the local chemist.
2 AUTHORITY SLIP
In case an Authorised Medical Attendant of the Dispensary concerned gives any 'By
Hand' Authority Slip to a beneficiary, the medicines will be supplied immediately to the beneficiary for a period as mentioned in the slip or for 7 days, whichever is less.
3. LIFE PERIOD OF MEDICINES
Every medicine has its own shelf life period mentioned on the label of medicine. The shelf life of article supplied should not have passed more than half of its shelf life at the time of supply.
4. PACKED SUPPLIES:
Supplies are required to be made in original packing of manufacturer. The packing should approximately be nearest to the total quantity demanded of any particular medicine/drug on any particular day.
5. COLLECTION OF PRESCRIPTION FOR SUPPLY
The Authorised Chemist or his representative should collect local Purchase Indent on the basis of which supplies are to be made, from the unit allotted at the closing hours of unit/dispensary on every working day.
6. PERIOD UP TO WHICH SUPPLY ORDERS WILL BE PLACED:
Supply orders will be placed against the contract up to the last date of the contract.
Orders received even on the closing date should be honored in accordance with the terms of contract even though the last date of the contract may have expired on the date of supply of articles.
7. DELIVERY OF SUPPLIES
The delivery of supplies in full will be made on the next working day by 8.30 a.m. or at the opening hours of unit/dispensary, whichever is later, at the premises of the dispensaries indenting the supplies or in case of emergency at the residence of the patients as directed by CMO I/c of the dispensary/unit. In the event of non-supply of indented medicines in time as aforesaid, Rs. 500/- will be deducted from the bill of the Chemists for each delay.
8. ITEMS NOT AVAILABLE WITH THE AUTHORISED CHEMIST
In case the Authorised Chemist for any reason fails to supply any item in time indented by the dispensary, the beneficiaries concerned shall be entitled to purchase the medicines from the open market. The Authorised Chemist will be liable to reimburse, in full on the spot, the amount incurred by the respective beneficiaries on production of
Cash Memo, duly certified by the M.O. In-charge of the dispensaries concerned. The
Authorised Chemist shall be entitled to claim the amount from the CGHS, which will be limited to the extent admissible in terms of contract on the basis of accepted offer and other conditions of the contract. The chemists shall enclose such cash memos with the bill and total discount/ deduction made on such cash memos should be reflected in the claim bill.
9. ITEMS REQUIRED IN EMERGENCY
When an emergency arises outside the working hours of the dispensary or on holidays, the Authorised Medical Attendant in the CGHS Dispensary may procure the items as required from the open market. The Authorised Chemist will be liable to reimburse, in full on the spot, the amount incurred by the respective Authorised Medical Attendant on production of Cash Memo, duly certified by the M.O. In-charge of the dispensary concerned. The Authorised Chemist shall be entitled to claim the amount from the CGHS, which will be limited to the extent admissible in terms of contract on the basis of accepted offer and other conditions of the contract. The chemists shall enclose such cash memos with the bill and total discount/ deduction made on such cash memos should be reflected in the claim bill.
10. PRESENTATION OF BILLS:
(i) The Authorised chemist shall present the bill to respective unit for the supplies made during each fortnight (1 to 15 & 16 to 30/31) within ten days of closing of each respective fortnight. The bill should clearly indicate the details of the supply made each day. The bill should clearly indicate the details e.g. Name of the item, Name of
Manufacturer, batch no., date of manufacture & expiry date, prescription slip no. with date, rate, discount as per contract etc. or any other information required by the purchaser.
(ii) The bill shall be supported by the following documents:
The original indent along with the certificate from the Medical Officer In charge of the dispensary under his/her signature, with date, seal of the office for receipt of the items indented giving names of the drugs, their quantity and rate charged, shall accompany the bill. The incomplete bills not equipped by any of the particulars mentioned above, will not be entertained.
11. MISCELLANEOUS
- 11.1 The Director, CGHS, New Delhi reserves the right to enter into parallel contracts simultaneously or at any time during the period of this contract, with one or more chemists.
- 11.2 One Chemist can quote for only one group/area as per list attached. Offers for multiple groups/areas shall be rejected out rightly.
- 11.3 The bidder should have its establishment within five (5) Kms. distances by shortest motor able route from the dispensaries/Hospital (Affidavit to be submitted). The suppliers, in the vicinity of the CGHS dispensary/Unit meeting all the requirements, may be preferred. However, this could not be considered as the only criteria for appointment. The CGHS reserves the right to appoint the chemist on the same terms and conditions for any other dispensary / hospital / Unit. (within five (5) kilometres distance by shortest motor able route from the establishment) if otherwise found eligible.
12 CORRUPT OR FRAUDULENT PRACTICE
- 12.1 The CGHS requires that the Bidder/suppliers/ contractors under this bid observe the highest standards of ethics during the procurement and execution of such contracts.
- 12.2 In pursuance of this policy, the terms are set forth as follows:
- "corrupt practice" means the offering, giving, receiving or soliciting of any thing of value to influence the action of the public official in the procurement process or in contract execution; and
- "fraudulent practice" means a misrepresentation of facts in order to influence a procurement process or a execution of a contract to the detriment of the CGHS, and includes collusive practice among Bidder (prior to or after bid submission) designed to establish bid prices at artificial non-competitive levels and to deprive the CGHS of the benefits of the free and open competition;
- 12.3 The CGHS will reject a proposal for award if it determines that the Service Provider recommended for award has engaged in corrupt or fraudulent practices in competing for the contract in question;
- 12.4 The CGHS will declare a firm ineligible, either indefinitely or for a stated period of time, to be awarded a contract if it at any time determines that the firm has engaged in corrupt and fraudulent practices in competing for, or in executing, a contract.
13 PENALTIES
13.1 In case of indent for specific brand of medicines, the same shall not be substituted. If any such case is noticed during subsequent scrutiny after or before the payment, then supplier will be penalized for Rs.1000 + cost of the specific brand of medicines for each such default.
13.2 The delivery of supplies in full will be made on the next working day by 8.30 a.m. or at the opening hours of unit/dispensary, whichever is later, at the premises of the dispensaries indenting the supplies or in case of emergency at the residence of the patients as directed by CMO I/c of the dispensary/unit. In the event of non-supply of indented medicines in time as aforesaid, Rs. 500/- will be deducted from the bill of the Chemists for each delay.
14 TERMINATIONS FOR DEFAULT
The CGHS may, without prejudice to any other remedy for breach of contract, by written notice of default sent to the bidder terminate the Contract in whole or part:
a. If the bidder fails to provide any or all of the services within the period(s) specified in the Contract.
The above document may be beneficial for the smooth running of dispensary.
Dr Marwah
b. If the bidder fails to perform any other obligation(s) under the Contract.
Engaged in corrupt or fraudulent practices in competing for or in executing the Contract
15 RESERVATIONS RIGHT FOR APPOINTMENT OF MORE CHEMISTS FOR
EACH CGHS UNIT
The Director, CGHS, Nirman Bhawan, New Delhi reserves the right to appoint any number of Authorized Chemists for each unit. The Director, CGHS, Nirman Bhawan, New Delhi also reserves the right to allocate, reallocate the dispensaries, existing and new ones under the CGHS that may be set up during the currency of the contract.
Director, CGHS, Nirman Bhawan, New Delhi also reserves the right to decide which contractor shall normally serve which unit. Without prejudice to the right, emergency purchases can be preferred from any of the contractor irrespective of such allotment of unit to each Authorized Chemist for purchase of normal supplies.
16 INDEMNITIES
The bidder shall indemnify the Government against all actions, suits, claims and demands brought or made against it in respect of anything done or committed to be done by the bidder in execution of or in connection with the work of this contract and against any loss or damage to the Government in consequence to any action or suit being brought against the bidder for anything done or committed to be done the execution of this contract. The bidder will abide by the job safety measures prevalent in India and will free the CGHS from all demands or responsibilities arising from accidents or loss of life, the cause of which is the bidder's negligence. The bidder will pay all indemnities arising from such incidents without any extra cost to CGHS and will not hold the CGHS responsible or obligated. The Government may at its discretion and entirely at the cost of the bidder defend such suit, either jointly with the bidder or single in case the latter chooses not to defend the case.
17 PAYMENTS
The authorized chemist shall claim payments twice a month. Payments of the bills presented will normally be arranged in 4 to 6 weeks from the date of presentation of the bill. However, the contractor shall make no claim from the Government of India in respect of interest or damages, in case the payment is delayed for any reasons. The payment has to be through ECS for which bidder should give requisite detail of bank address, Account No. etc.
18 ARBITRATION
The contract is based on mutual trust and confidence. Both the parties agree to carry out the assignment in good faith. If any dispute or difference of any kind whatsoever (the decision whereof is not herein otherwise provided for) shall arise between the CGHS and the Bidder in connection with or arising out of the Contract, whether during the contract period or completion and whether before or after the termination, abandonment or breach of the contract, shall be referred to and settled by the Director General Health
Services, Ministry of Health & FW, Government of India who shall within a period of sixty days after being requested in writing by the Bidder, give written award of his decision to the Bidder. The decision of the Director General of Health Services will be final and binding.
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Dr Marwah
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