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Dr. PRANAV PANDYA Director ,

Medical Ethics and Holistic approach in Medicine. Dr. PRANAV PANDYA Director ,

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Dr. PRANAV PANDYA Director ,

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  1. Medical Ethics and Holistic approach in Medicine Dr. PRANAV PANDYA Director , Brahamvarchas Research Institute All World Gayatri Pariwar, Shantikunj, Haridwar, Himalayas email : shail@del2.vsnl.net.in

  2. The Challenges of 21’st Century in new Millennium for all 01)Crisis of Energy 02)Eco-Devastation 03)Terrorism 04)Drug Trading 05)Epidemics

  3. Holistic Management Holistic (holism) implies an approach or process, which enables integration of multiple streams.

  4. Holistic Management “I have just passed through one of the greatest moments of my life. I have found the oneness between the macrocosm and microcosm. I have seen the whole universe within one atom.” - Swami Vivekananda (During travel in Himalayas – Almora, 1891)

  5. Holistic Management Holism, thus is an awareness state which realizes and feels that the whole, the One is the origin, the source, while parts and streams are all only its numerous manifestations or derivations.  Ekam Sad Vipra Bahoona Vadanti Jivo Brahmaiva Na Parah

  6. Holistic Man Management for Doctors as Leaders of Society Doctor community has a special role to play, as they are dealing with Human being as a Patient as a whole – a summum bonum of material and Conscious.

  7. Holistic Man Management for Doctors as Leaders of Society Doctor has to provide or arrange for emotional, physical and spiritual support and he must be compationate, unhurried and open. There is much to be gained by the laying-on of hands. Pain should be adequately controlled, human dignity maintained and isolation from family avoided.

  8. Few Dilemmas & Chaos for Treating Physicians • Physician is God for relations of patient under palliative care. • Too many expectations. • Physician’s own stresses. • Inability to manage time, Timewasters playing major role. • Ethical, Cultural and spiritual issues involved. • Financial constraints. • Political interferences.

  9. To the Western Management : The worker is all, MAN stands no where, Worker is a hired commodity. This is SOULLESS Management Disregard of human approach, Loss of Human Values and erosion of human touch in Organizational Hierarchy are the results.

  10. Yoga approach to Management Entire Cosmos is an intricate web of interpenetrating things and events. The bootstrap image of reality put forward by Geoffrey Chew shows that Boot straps cannot be loosened any where without so loosening it every where and it cannot be tightened up at every other point as well. So complete and uncompromising is the UNITY and INTERDEPENDENCE.

  11. The Cardinal assumptions of Spiritual approach in management are : • Harmony • Interdependence • Unity • Creativity • Evolutionary possibilities

  12. Definition of Ethics Ethics is the systematic study of voluntary actions which make up everyday conduct and behaviors of Human Beings.It can be descriptive or normative. Contd ..

  13. Thomas Vicary • Chief Surgeon to Henry VIII in 1548 • Wrote first English text book of human anatomy • “A profitable treatise of the anatomie of body of man.” • * The first chapter was Medical ethics

  14. Hippocrates' oath • Greek Physician Hippocrates of Cos (460-377 BC) gave first written statement. This oath was a unique and comprehensive statement of Medical ethics. Today we all forget about the details of this oath.

  15. Medical practice and ethics • * In the care of sufferings, physician needs technical skill, scientific knowledge and human understanding. • * Tact, sympathy and understanding are expected of physician, for the patient is not mere collection of symptoms, signs, disordered functions, damaged organs and disturbed emotions.

  16. Medical practice and ethics • * Physicians has to understand that patient is human, fearful and hopeful, seeking relief, help and reassurance.

  17. Expanding role of Physician • Genetics in medicine • Medicine on Internet • Distant therapies • Cost effective medical care

  18. Few ethical issues which need attention • Amniocentesis or Ultra sound for gender discrimination • MTP, Abortions, a roaring practice biggest lure • Elderly patients and their care, lack of support from relatives, fear of loneliness

  19. Few ethical issues which need attention • 4. Assisted suicide and active Euthanasia. A disputed issue whether patient or kins have the control over the end of life. Violation of sanctity of life is also an issue. • 5. DNR orders. In a patient of CPR, DNR orders should be written with reasons. It can also disrupt a peaceful death

  20. Few ethical issues which need attention • 6. Financial incentives, although intended to reduce inefficiency and waste one may withhold beneficial care • 7. Lack of malpractice insurance in India. Still no awareness in doctors about upcoming legal disputes

  21. Few ethical issues which need attention • 8. Luring by pharmaceutical companies, lavish gifts for doctors increase the cost of health care • 9. HIV infection and occupational risk. Fear of fatal infections, specially with HIV and multi-drug resistant TB patients. Needs proper training

  22. Challenging Issues • * Increasing no. of elderly • persons all over : almost 2/3rd of global population in developing world is going to be above 60 • * Care of dying patients: Often overlooked, priorities are other patients. VIP v/s common man.

  23. Challenging Issues • * Organ Transplants : Lack of awareness about HLA typing and role of relation/ blood relative. Financial constraints driving poor persons for donating their organs. • * Stem cell revolution : Future is bright but needs ethical constraints and more scientific studies

  24. Challenging Issues • * Genome and Cloning – Technological wonders: Spiritual issues involved, control has to be not the beaurocracy or idiosynchratic physician. More research needed on beneficial aspects and for inborn errors of metabolism. Issue of upbringing and Sanskars carries more value

  25. Challenging Issues • * Health system getting bankrupt and costs high: State has no funds and privatisation (Apollokaran) has increased in the society. Carporate culture is hitting smaller nursing homes and doctors.

  26. Challenging Issues • * Complimentary and alternative medicine emerging fast: This in fact is the need of time and has to be made more scientific so as to be accepted. USA is running institutions on its training, India still not in the race. Shantikunj has an option in its Universities by opening R&D in this field.

  27. Challenging Issues • * Impaired Physicians: Clinician having alcohol abuse, drug abuse, psychiatric/medical illness place patients at risk. Colleague physician has to intervene. • * Pain Management and Reassurance: Most significant medical crisis today. Alleviation of suffering gives 80% relief and good feedback.

  28. Challenging Issues • * Depression as the topmost killer by 2015 : Going to be worse than CAD, Malignancies, HIV and epidemics. Already stress prone persons looking healthy but ill are on increase in society, a threat to humankind. Consumeristic life-style has to be reshaped. Spirituality to be inculcated in day to day life and Ayurveda with CAM to be promoted more and more.

  29. Holistic Management • Holistic / Holism is the state of profound emotional unity, purity and harmony between individual and universal. Only this approach will pave way for righteous living and congenial physician-patient relationship.

  30. Brahmavarchas Research Institute A center for research and training on art of living and CAM

  31. Stress on Karma Yoga in Geeta has been referred as “ Yogah Karmasu Kaushalam” What is Kaushalam It is a very different order of “skill” that Sri Krishna has in mind, as may be seen here – “ the liberated who has united his reason and will with divine Rises to a higher law beyond good and evil Action done in yoga is not only highest but also wisest, the most potent and efficient even for the affairs of world. “ Yoga is skill in all works - Sri Aurobindo

  32. Stress IS A non-specific response of the body to any demand made upon it or to an external stimuli.

  33. Eustress ( CONSTRUCTIVE STRESS ) RHYTHMIC CYCLE OF ACTIVITY & TENSION STRESS EXPERIENCED AND COPED ACTIVITY ENERGY TIME TENSION

  34. DISSTRESS ( DESTRUCTIVE STRESS ) IMPROPERLY COPED STRESS LEADING TO ATASTROPHIES TOO MUCH ACTIVITY TENSION DEPLETION OF ENERGY HIGH ACTIVITY TIME ENERGY TENSION LOW ACTIVITY TOO LITTLE ACTIVITY TENSION DEPLETION OF ENERGY

  35. BURN OUT STRESS SYNDROME ( BOSS ) A DEBILITATING PSYCHOLOGICAL CONDITION BROUGHT ABOUT BY UNRELIEVED WORK STRESS FIVE STAGES OF BOSS (1) HONEYMOON (2) FUEL SHORTAGE (3) CHRONIC SYMPTOMS (4) CRISIS (5) LOSING THE MARATHON Main Back Quit Next

  36. BURN OUT STRESS SYNDROME ( BOSS ) FIVE STAGES OF BOSS 1 HONEYMOON: INITIAL EUPHORIA,HABITS ARE SPOILED. 2 FUEL SHORTAGE:DEPLETION OF ENERGY. FATIGUE,INSOMNIA,ESCAPE ACTIVITIES. 3 CHRONIC SYMPTOMS: MORE FATIGUE, AILMENTS LIKE IHD, IRRITABLE BOWEL, MYALGIA, BRONCHIAL ASTHMA, PEPTIC ULCER & DEPRESSION. Main Back Quit Next

  37. BURN OUT STRESS SYNDROME ( BOSS ) FIVE STAGES OF BOSS 4 CRISIS: PESSIMISTIC OUTLOOK, ENHANCED ANXIETY, DOUBTS ABOUT OWN CAPABILITIES, ESCAPE MENTALITY - TENSION HEADACHE, CHRONIC BACKACHE, HYPERTENSION, SLEEP DISTURBANCES. 5 HITTING THE WALL: LOSING THE MARATHON. COLLAPSE. Main Back Quit Next

  38. BITING NAILS, CLENCHING FISTS, CLENCHING JAWS DRUMMING FINGERS GRINDING TEETH HUNCHING SHOULDERS PICKING AT FACIAL SKIN TAPPING FEET TWO JOBS AT A TIME TOUCHING HAIR OFTEN TOO HURRIED OR LOUD TALKING TOO CONSCIOUS ABOUT BEING ON TIME SIGNALS OF STRESS Main Back Quit Next

  39. SIGNALS OF STRESS MOOD SIGNALS ANXIETY , DEPRESSION ,FRUSTRATION, HABITUAL ANGER OR HOSTILITY, HELPLESSENSS, HOPELESSNESS, IRRITABILITY, RESTLESSNESS Main Back Quit Next

  40. SIGNALS OF STRESS BEHAVIOURAL SIGNS AGGRESSION , DISTURBED SLEEP EMOTIONAL OUT BURSTS ,LEAVING JOBS UNDONE ,OVER REACTIVE Main Back Quit Next

  41. RUST OUT STRESS SYNDROME (ROSS) JUST REVERSE TO BOSS PERSON HAS STRESSUNDERLOAD HOW TO GET RID FROM ROSS 1 STAY ALERT 2 TAKE RISK 3 AVOID ISOLATION 4 STRETCH FOR SUCCESS 5 OVERCOME OBSOLESCENCE Main Back Quit Next

  42. Common disorders produced due to stress * Sinus Tachycardia * HighBlood Pressure * Ischaemic Heart - Disease * Diabetes Mellitus * Hyper Acidity, PU syndrome * Ulcerative Colitis * Migraine, tension headache, Chronic backache * Allergies, Asthma * Thyrotoxicosis *Auto immune disorders *Menstrual Disorders * Anxiety Neurosis, Obsessions

  43. HEADACHE TRIGGERING STRESSES (SPECIALLY IN INDIA) • Heat and harsh sunlight. • Humidity • Missing meals (skipping breakfasts) • Hormonal factors • Stress related to heavy studying (class x,xii and above students) • Travel stress (crowded suburban trains/buses etc.) • Obnoxious odors, perfumes, agarbattis • Noises.

  44. Stress Management STRESS IS NOT-- Merely nervous tension. IT IS * Always the non-specific result of damage * Something to be avoided COMPLETE FREEDOM FROM STRESS IS DEATH

  45. Concept of Stress in Indian Thought SankhyaDarshan mentions about Klesa and Dukha. Klesa has its origin in root “Klis”, which means to torment or afflict pain. Klesa in Sankhya is generally due to fundamental non-cognition - avidya or ignorance.

  46. HOW TO MANAGE STRESS * Change in dietary pattern: Tryptophan Rich Food, Vegetarian Diet. * Subtler exercises - ASANS (Postures) & PRAGYA YOG. * PRANAYAM: Churning of Vital energy. * Proper reading habits -“SWADHYAY” For Self- Introspection. * Proper relaxation -“SHAVASAN”, Yog Nidra. More to follow...

  47. HOW TO MANAGE STRESS * Proper meditation upon flame,ocean,colors, ragas. * Music therapy - “MANTRA CHIKITSA”. * Pulverized herbal powders - “AKOUSHADHI CHIKITSA”. * Homa therapy, Yagna. * Avoid isolation, become part of society and devote time for social & selfless service. Main Back Quit Next

  48. STRESS PROOFING LIFESTYLE You must learns The art of being The art of relating The art of thinking The art of becoming The art of organizing The Art of Living Main Back Quit Next

  49. BALANCED DIET • New salad combinations • Fruit nuts and raw vegetables • Raw or steamed/boiled vegetables • Fiber rich diets whole wheat flour boiled rice beans and pulses potatoes with skin • Fruits as alternatives to pies • Sprouted Pulses /wheat grass SATVIC Main Back Quit Next

  50. Meditation IS : * A CLEANSER OF OUR MENTAL GARBAGE. *OUR DAY TO DAY NECESSITY. *GIVES RELIEF FROM MENTAL CONSTIPATION.

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