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Saturday, 23 August 2014

INFORMED CONSENT IN ALTERNATIVE TREATMENTS: HOMOEOPATHY


Informed consent in Alternative Treatments:

Definitions:
alternative medicine
noun
noun: alternative medicine
1.     any of a range of medical therapies that are not regarded as orthodox by the medical profession, such as herbalism, naturopathy, and crystal healing.

Alternative medicine is any practice that is put forward as having the healing effects of medicine but is not based on evidence gathered using the scientific method
Complementary medicine CAM is the abbreviation for Complementary and alternative medicine. Integrative medicine (or integrative health) is the combination of the practices and methods of alternative medicine with conventional medicine.

WHAT IS ALTERNATIVE MEDICINES? 

The term Alternative Medicine means any form of medicine that is outside the mainstream of western medicine or conventional medicine as practiced a majority of doctors today. This term is loosely used to over all forms of medicine except allopathy. In 1973, the Medical Faculty of the University of Rome convened the first World Congress of Alternative Medicines and the provisional program contained no less than 135 therapies.

Alternative medicine exists in all cultures to some degree and terms such as traditional medicine, indigenous medicine or folk medicine etc. are used to describe such practices. These medicines date back hundred or even thousands of years depending on the country and culture concerned.

There are more than 100 systems of alternative medicines still in practice all over the world.  Every country, region or area has its own traditional system of health and medical cares such as for the Chinese it is acupuncture, for the French, magnetic healing; for the Germans, Heilpraxis; for the English, Herbalism; for India, Ayurveda with Siddha being widely practice in the southern part of the country; for Japan, Shiatsu etc.

The most popular forms of alternative medicine are Ayurveda, Homeopathy, Naturopathy, Yoga, Acupuncture, Acupressure, Magneto therapy, Shiatsu, Herbalism, Meditation, Aromatherapy, Bach Flower Remedies, Chromo therapy, Diet therapy, Hydropathy and Reiki.

Alternative Therapies

The following is a guide to some alternative therapies

Acupressure

Similar to acupuncture, but using finger pressure rather than fine needles on specific points along the body to treat ailments such as tension and stress, aches and pains, menstrual cramps, arthritis.

Acupuncture

Fine needles are inserted at specific points to stimulate, disperse, and regulate the flow of vital energy, and restore a healthy energy balance. In addition to pain relief, acupuncture is also used to improve wellbeing and treat acute, chronic, and degenerative conditions in children and adults.

Aromatherapy

Using "essential oils" distilled from plants; aromatherapy treats emotional disorders such as stress and anxiety as well as a wide range of other ailments. Oils are massaged into the skin in diluted form, inhaled, or
placed in baths. Aromatherapy is often used in conjunction with massage therapy, acupuncture, reflexology, herbology, chiropractic, and other holistic treatments.

Astrology

Astrology is a humanistic attempt at trying to understand the cycles that we share with the forces in the Universe. The planets have corresponding ruler ship to certain vitamins, minerals, cell salts, herbs, metals, colours and parts of the body. Through the chart, one can look to see what natal health conditions exist. Through these precepts, we can then look at the present and into the future to see what areas of our lives are being affected and potentially how we can head off ill health and promote wellness.

Atlas Orthogonal

Atlas Orthogonal is a chiropractic program to evaluate and correct subluxation based on scientific and biomechanical procedures. By incorporating the latest advancements in scientific technology, chiropractors can calculate, in precise detail, the vectors specific to an individual subluxation pattern, and program their instrument with the specific correction vectors to deliver the adjustment without any manipulation at all.

Ayurvedic Medicine

Practiced in India for more than 5,000 years; ayurvedic tradition holds that illness is a state of imbalance among the body's systems that can be detected through such diagnostic procedures as reading the pulse and observing the tongue. Nutrition counselling, massage, natural medications, meditation, and other modalities are used to address a broad spectrum of ailments.

Auricular Therapy

Ancient Egyptian writings state that pain can be relieved by stimulating certain points on the ear. In the 1800's, several publications indicated that there were several techniques of cauterization and manipulation of the ears to aid certain disorders. Many benefits can be achieved by massaging and palpating specific points on the ear.

Alexander Technique

the Alexander Technique is a method that works to change (movement) habits in our everyday activities. It is a simple and practical method for improving ease and freedom of movement, balance, support and coordination. The technique teaches the use of the appropriate amount of effort for a particular activity, giving you more energy for all your activities. It is not a series of treatments or exercises, but rather a re-education of the mind and body.

Autogenic Training 

It is a century-old European method for achieving relaxation based upon passive concentration and body awareness of specific sensations. Its effectiveness has been shown in relieving many stress-related disorders including anxiety, tension, insomnia, and examination stress. Persons with chronic medical conditions ranging from migraine, colitis, irritable bowel syndrome, diabetes, high blood pressure, to thyroid disease and many other conditions have also been shown to benefit from the practice of autogenic training.

Anthroposophical Medicine

Anthroposophical Medicine involves an internationally organized group of people who think that Rudolf Steiner (an Austrian physician, 1861-1925) found the ultimate truth - the anthroposophy. Steiner said: By anthroposophy, I mean a scientific investigation of the spiritual world which will bring to light the weaknesses and half-truths not only of science but also of modern mysticism. It is a method which, before attempting to investigate the spiritual worlds, first develops psychic powers not normally used in daily life or in current scientific research.

Auto-Urine Therapy

This practice comes from Yoga and is the use of one's own urine as food, medicine, restorative, transforming agent and immune system booster. It is sometimes called 'Your Own Doctor'.

Holotropic Breathwork
It is a simple yet powerful technique for self-exploration and healing, based on combined insights from modern consciousness research, depth psychology and perennial spiritual practices. The method activates non-ordinary states of consciousness which mobilize the spontaneous healing potential of the psyche. Sustained effective breathing, evocative music, focussed energy work and mandala drawing are components of this subjective journey. 'Holotropic' literally means 'moving towards wholeness'.
Biofeedback

A method of monitoring minute metabolic changes in one's own body with the aid of sensitive machines. The technique is used especially for stress-related conditions such as asthma, migraines, insomnia, and high
blood pressure. Clients learn to make subtle adjustments to move toward a more balanced internal state by consciously visualizing, relaxing, or imagining while observing light, sound, or metered feedback.

Bach Flower Remedies

A system of herbal remedies devised by Edward Bach; these floral remedies can supposedly alter the disharmonies of personality and emotional state that trouble us all from time to time. These remedies are mostly aimed at curing emotional states rather than physical ones.

Cellular Therapy

Cellular therapy also called live cell therapy, cellular suspensions, glandular therapy, fresh cell therapy, siccacell therapy, embryonic cell therapy, and organotherapy -- refers to various procedures in which processed tissue from animal embryos, foetuses or organs, is injected or taken orally. Products are obtained from specific organs or tissues said to correspond with the unhealthy organs or tissues of the recipient. Proponents claim that the recipient's body automatically transports the injected cells to the target organs, where they supposedly strengthen them and regenerate their structure. The organs and glands used in cell treatment include brain, pituitary, thyroid, adrenals, thymus, liver, kidney, pancreas, spleen, heart, ovary, testis, and parotid. Several different types of cell or cell extract can be given simultaneously -- some practitioners routinely give up to 20 or more at once.

Chromotherapay or Colour Therapy

The use of colour (usually in the form of coloured light) to produce beneficial or healing effects.

Colon Therapy

The therapeutic goals of colon therapy are to balance body chemistry, eliminate waste, and restore proper tissue and organ function. Colon therapy releases toxins, cleans the blood, stimulates the immune system, and aids in restoring the pH balance in the body. Colon Therapy, also known as colonics, is believed to relieve a wide range of symptoms related to colon dysfunction.

Chelation Therapy

Chelation therapy is a series of intravenous injections of the synthetic amino acid EDTA, designed to detoxify the body. It is also often used to treat arteriosclerosis. Most frequently, this is administered in an osteopathic or medical doctor's office.

Chinese (Oriental) Medicine

Oriental medical practitioners are trained to use a variety of ancient and modern therapeutic methods - including acupuncture, herbal medicine, massage, heat therapy, and nutritional and lifestyle counselling - to treat a
broad range of both chronic and acute illnesses.

Chiropractic

The chiropractic views the spine as the backbone of human health: misalignments of the vertebrae caused by poor posture or trauma cause pressure on the spinal nerve roots, leading to diminished function and illness. Through manipulation or adjustment of the spine, treatment seeks to analyse and correct these misalignments.

Colonics

A colonic is colon irrigation, the irrigation of the large intestine with sanitized, filtered water under gentle pressure to wash out or detoxify it of stagnated faecal material; it is a full intestinal enema.

Counseling/Psychotherapy

This broad category covers a range of practitioners, from career counsellors to psychotherapies who treat depression, stress, addiction, and emotional issues. Formats can vary from individual counselling to group therapy. Some
therapists may also incorporate bodywork, ritual, energy healing, and other alternative modalities as part of their practice.

Cupping 

It is a traditional Chinese medical technique which applies suction to diseased parts of the body using ceramic glass or bamboo cups in order to increase the regional circulation and thereby promote healing. In very ancient times the horns of animals were used for this purpose.

Craniosacral Therapy

This is a manual therapeutic procedure for remedying distortions in the structure and function of the craniosacral mechanism - the brain and spinal cord, the bones of the skull, the sacrum, and interconnected membranes. It
is used to treat chronic pain, migraine headaches, TMJ, and a range of other conditions.

Dance/Movement Therapies

Dance and/or movement therapy uses expressive movement as a therapeutic tool for both personal expression and psychological or emotional healing. Practitioners work with people with physical disabilities, addition issues, sexual abuse histories, eating disorders, and other concerns.

Dentistry, Holistic

Holistic dentists are licensed dentists who bring an interdisciplinary approach to their practice. They may incorporate such methods as homeopathy, nutrition and acupuncture into their treatment plans. Most holistic dentists emphasize wellness and preventive care while avoiding silver-mercury fillings.

Dowsing

Dowsing is an ancient art of searching for hidden things (water, precious metals, etc) using one of the senses that many of us are not even aware of possessing; reportedly 80% of people have this special gift - an ability to sense things not perceptible to others. Some of these people do not need any extra tools to do that - they just KNOW where the best place to dig a well is or where the gold treasure is hidden.

Ear Candling

primarily used for wax build up and related hearing problems; ear candling is also used for ear infections and sinus infections. Treatment involves placing the narrow end of a specially designed hollow candle at the entry of the ear canal, while the opposite end is lit.

Electropathy

Electropathy is a specialised system of therapeutics which involves the use of various forms of electric currents for medicinal purposes.

Fasting Therapy

Therapeutic fasting or fasting for health is a purifying and rejuvenating process by which toxic waste matters of the body are eliminated and regeneration of diseased tissues occurs.

Feng Shui

Ancient Chinese practice of arranging the home or work environment to promote health, happiness, and prosperity. Consultants may recommend changes in the surroundings - from colour selection to furniture placement - in order to promote a health flow of chi, or vital energy.

Feldenkrais Method

The Feldenkrais Method is a systematic approach to neuromuscular relearning. The method is suited to healthy people who want to increase the flexibility of their bodies and thinking, people with neurological and movement disorders, and those who want to achieve excellence in the arts, sports, or any endeavour.

Flower Essences

a method of alleviating negative emotional states that may contribute to illness or hinder personal growth. Drops of a solution infused with the captured “essence" of a flower are placed under the tongue or in a beverage. The practitioner helps the client choose appropriate essences, focusing on the client's emotional state rather than on a particular physical condition.

Gem Therapy

A relatively recent discovery in the field of alternative medicines, it involves the use of specific gems to treat specific ailments.

Herbalism

an ancient form of healing still widely used in much of the world, herbalism uses natural plants or plant-based substances to treat a range of illnesses and to enhance the functioning of the body's systems. Though herbalism is not a licensed professional modality in the United States, herbs are "prescribed" by a range of practitioners.

Heliotherapy

Heliotherapy is the science conducted on the positive effects of the sun and is an effective tool in boosting the body's immune system.

Holistic Medicine

A descriptive term for a healing philosophy that views a patient as a whole person, not as just a disease or a collection of symptoms. In the course of treatment, holistic medical practitioners may address a client's emotional and spiritual dimensions as well as the nutritional, environmental, and lifestyle factors that may contribute to an illness. Many holistic medical practitioners combine conventional forms of treatment with natural or alternative treatments.

Homoeopathy

A medical system that uses infinitesimal doses of natural substances - called remedies - to stimulate a person's immune and defence system. A remedy is individually chosen for a sick person based on its capacity to cause, if given in overdose, physical and psychological symptoms similar to those a patient is experiencing. Common conditions homeopathy addresses are infant and childhood diseases, infections, fatigue, allergies, and chronic illnesses such as arthritis.

Hypnotherapy

a means of bypassing the conscious mind and accessing the subconscious, where suppressed memories, repressed emotions, and forgotten events may remain recorded. Hypnosis may facilitate behavioural, emotional, or attitudinal change such as weight loss, or smoking cessation. It is also used to treat phobias, stress, and as an adjunct in the treatment of illness.

Hydrotherapy

It is defined as the scientific application of water for therapeutic purposes. Water may be used at various temperatures, in different modes and in different forms.

Iridology

the diagnostic system based on the premise that every organ has a corresponding location within the iris of the eye, which can serve as an indicator of the individual organ's health or disease. Iridology is used by naturopaths and other practitioners, particularly when diagnosis achieved through standard methods is unclear.

Kinesiology

Kinesiology is the study of the human body during movement. There are many disciplines within Kinesiology including anatomy, biomechanics, exercise physiology, motor control, motor learning, neuromuscular physiology, sports psychology, and philosophy. Kinesiology graduates enter a variety of careers and graduate programs related to the understanding of how the body works including medical school, physical and occupational therapy schools, athletic training, and other health professions, public school teaching, sport and exercise related fields, the military, business, and law.

Lymph Drainage Therapy

Therapy to drain and improve the lymphatic vessels, a system of tubes or canals through which lymph is carried from different parts of the body.

Massage Therapeutic

a general term for a range of therapeutic approaches with roots in both Eastern and Western cultures. It involves the practice of manipulating a person's muscles and other soft tissue with the intent of improving a person's well-being or health, and may include, but not be limited to, effleurage, deep tissue, percussion, vibration, and joint movement.

Magnetotherapy

The art of healing by the application of natural and artificial magnets to the diseased parts of the human body. It is a clinical system by which human ailments are treated and cured through the application of magnets to the body of the patients.

Midwifery/Childbirth Support

Midwives provide education and support during pregnancy, assist the mother during labour and delivery, and provide follow-up care. Practitioners of childbirth support include childbirth educators, assistants, and doulas (women labour coaches who also provide postpartum home care).

Native American Herbology

Native American healers and spiritual leaders seldom travel far from their homes and even more infrequently publicize their work - it is not the way. However, there is a body of knowledge about the herbal treatments used by various Native People. Much of the information has been tested and incorporated into our present herbal therapies.

Natural Products

Products composed of organically grown plants and containing no chemicals. These products may be used cosmetically as well as for health and nutrition.

Naturopathic Medicine

Naturopathic physicians work to restore and support the body's own healing abilities using a variety of modalities including nutrition, herbal medicine, homeopathic medicine, and orient medicine. A primary health-care system which emphasizes the curative power of nature, treating both acute and chronic illnesses in all age groups.

Network Chiropractic

this refers to a network of independent chiropractic offices that use Network Spinal Analysis, a method characterized by the sequential application of a number of gentle, specific adjusting techniques. Care progresses through a series of levels that parallel spinal and quality-of-life changes.

Ohashiatsu

A system of physical techniques, exercise and meditation used to relieve tension and fatigue and induce a state of harmony and peace. The practitioner first assesses a person's state by feeling the hara, the area below the navel. Then, using continuous and flowing movements, the practitioner presses and stretches the body's energy channels, working in unison with the person's breathing.

Oriental Diagnosis

it is a diagnostic procedure by which the patient's pulse is examined to detect disease according to traditional Chinese medicine.

Osteopathic Medicine

Osteopathic physicians provide comprehensive medical care, including preventive medicine, diagnosis, surgery, prescription medications, and hospital referrals. In diagnosis and treatment, they pay particular attention to the joints, bones, muscles, and nerves and are specially trained in osteopathic manipulative treatment - using their hands to diagnose, treat, and prevent illness.

Physiotherapy

It is a wonderful manipulative technique by which the deformities of an individual are modified in order to notify the body and the vital organs in accordance with the principles of naturopathy.

Pyramid Healing

A potential healing method using pyramidal structures.

Radiesthesia

The use of of dowsing or divining to diagnose disease and select remedies. It can be used to diagnose any condition according to leading practitioners. Basically, it is simply a method of arriving at a diagnosis and treatment using the human being as the diagnostic instrument.

Radionics

A therapy that has grown up around the ability of the human being to use radiesthesia together with simple instruments to help in the diagnosis of disease in animals, plants and humans and then to treat this disease at a distance without the presence of the patient.

Reconstructive Therapy/Prolotherapy

Reconstructive therapy uses injections of natural substances such as dextrose, glycerin, and phenol in order to stimulate the growth of connective tissue and this strengthens weak or damaged joints, cartilage, ligaments, and tendons. This therapy is used to treat degenerative arthritis, lower back pain, torn ligaments and cartilage, carpal tunnel syndrome, and other conditions.

Reflexology

this modality is based on the idea that specific points on the feet and hands correspond with organs and tissues throughout the body. With fingers and thumbs, the practitioner applies pressure to these points to treat a
wide range of stress-related illnesses.

Reiki

Practitioners of this ancient Tibetan healing system use light hand placements to channel healing energies to the recipient. While practitioners may vary widely in technique and philosophy, Reiki is commonly used to treat
emotional and mental distress as well as chronic and acute physical problems, and to assist the recipient in achieving spiritual focus and clarity.

Rolfing

A massage technique using deep manipulation of the fascia (connective tissue) to restore the body's natural alignment, which may have become rigid through injury, emotional trauma, and inefficient movement habits. The
process involves ten sessions, each focusing on a different part of the body.

Shiatsu

The most widely known form of acupressure, shiatsu has been used in Japan for more than 1,000 years to treat pain and illness and for general health maintenance. Using a series of techniques, practitioners apply rhythmic finger pressure at specific points on the body in order to stimulate chi, or the vital energy.

Sound Therapy

The use of sound waves to heal.

Tibetan Medicine

Evolved as a synthesis of Tibetan, Chinese and Persian Medicine, and even Ayurveda. These remedies include indigenous herbs, fruits, flowers, metallic powders and minerals given in tablets, and are especially effected in
treating rheumatism, asthma, gastritis, diabetes and many neurological disorders.

Unani

Involves the use of plants and herbs, these remedies are known to provide cures for diseases such as sinusitis, leucoderma, rheumatism, jaundice and elephantiasis.

Vision Therapies

Through exercise and relaxation techniques, vision may actually be improved to the point that glasses may no longer be needed. Therapies are typically offered by licensed optometrists and ophthalmologists.

Vitamin Therapy

a complementary therapy of vitamin usage combined with other treatments to address a range of illnesses and to enhance the functioning of the body's systems. Assists the immune system in combating diseases such as Chronic
Fatigue Syndrome and HIV/AIDS.

Wellness Restoration

A comprehensive program designed to increase muscle mass by using adequate nutrition, supplementation, anabolic steroid therapy and resistance weight training to prevent/reverse wasting in HIV disease.

Yoga Therapy

The use of yoga to address mental and physical problems while integrating body and mind.

The main purpose behind enumerating the long list of CAM treatments is too portrait to the reader the exhaustive nature of alternative treatments available to the society, every nook and corner of the cities or interiors there is presence of the variety of treatments available .Also many of the above enumerated maybe completely out of practise or extremely rare yet they are present. It is very important for us to know the nature of each of it as we may face them sometime in future!



SUPERSTITION:
superstition
ˌsuːpəˈstɪʃ(ə)n,ˌsjuː-/
noun
noun: superstition
1.     excessively credulous belief in and reverence for the supernatural.
synonyms:
unfounded belief, credulity; 
antonyms:
o    a widely held but irrational belief in supernatural influences, especially as leading to good or bad luck, or a practice based on such a belief.
plural noun: superstitions

synonyms:

The antonym for superstition is SCIENCE!!!
Thus it goes without saying that science has always had its battle with superstitions and INFORMED CONSENT, in case of superstitions will hold a back seat, as I have pointed earlier also SOUL CONSENT,
Universal Consent,
Healing consent.
These methods are used in many of the above pathies.
HOMOEOPATHY AND INFORMED CONSENT: An example of the CONSENT FORM used By Homoeopathy Practitioners.
Name and location of practitioner:
Lisa Amerine, N.D.                                               Dee Warner, F.N.P
Purehomeopathy                                         pureprimary care           
600 W. Emma St                                         600 W. Emma St
Lafayette, CO 80026                                            Lafayette, CO 80026


Licenses
Dr. Amerine holds a current licenses issued by the State of Arizona Naturopathic Physicians Board of Medical Examiners.   Dee Warner, F.N.P. holds a current license in Nursing with the State of Colorado.  License numbers are on file.

Naturopathic Doctors are not licensed as primary care physicians in the state of Colorado. There are certain services that our doctors cannot provide, such as writing prescriptions and performing routine screening exams. Nurse Practitioners are licensed in the state of Colorado and can provide prescriptions and any diagnoses needed.  Naturopathic medicine and Homeopathy are not a substitute for conventional medical care. It is recommended that you continue services with your primary care physician.

Experience and Training
All of the doctors at purehomeopathy hold N.D. degrees from the Southwest College of Naturopathic Medicine. Their training includes:
Four years of post-graduate medical instruction
Studies in basic sciences, conventional diagnosis, pharmacology, and natural therapies including homeopathy, botanicals, nutrition and hydrotherapy
1200 hours of clinical training
Medical degree accredited by the Council on Naturopathic Medical Education (CNME) and The Higher Learning Commission of the North Central Association of Colleges and Schools.
Two-step licensing exams, including basic science and clinical boards, administered nationally by NPLEX

Payment and fees
The doctors at purehomeopathy are not contracted with insurance providers. We do accept payment from Health Savings Accounts (HSA) and Flex Spending Accounts (FSA). Payment to purehomeopathy is expected at the time of service, via cash, check, or visa/mastercard/discover/amex. See attached schedule of fees and services

Appointments can be changed or cancelled up to 24 hours before the scheduled time. Missed appointments are subject to a $50 missed appointment fee. 

You will be notified if there are any changes of services or charges.

Product Sales
Homeopathic medicines and nutritional supplements are available to purchase through purehomeopathy. This is a service that is available for your convenience. You are not required to purchase items recommended by your doctor from purehomeopathy. You are free to purchase these or similar products at the retailer of your choice.
SIGNATURES:_________________

In this paper I would like to show how I , tackle Informed consent in my daily practise and also try to answer some questions that may arise in this process.
So what information should we as Homeopaths give to patients to ensure they are able to give their 'informed consent'.

How homeopaths tackle the tricky issue of informed consent?

 Do we set out some of the controversial aspects of homeopathy, the current lack of understanding of how homeopathy might work, and so on?

Do we allow patients to make their own informed decisions on the back of this information, or do we make that decision for them?

Homoeopathy is a very complex science based on the laws and thus I as a homoeopath will get furious in case homeopathy was called PSUEDOSCIENCE,
Not getting into the bureaucracy of medicine here’s is a SCIENTIFIC UNDERSSTANDING OF EVIDENCE BASED HOMOEPATHY

Homoeopathy is based on the natural or Fundamental laws. These laws are in accordance with the established scientific laws of the universe. The same laws apply and hold good in homoeopathy, hence it is called the scientific system of medicine. The laws of nature cannot be changed or cannot change. They remain for ever and so does the homoeopathic laws.. The fundamental laws of homoeopathy are as follows,
1. Law of Cure:
a. Similia Similibus Curentur.This is the law underlying the cure and its knowledge to the mankind was known since ancient period. It is recorded in the manuscript of ancient hindu religion.It was known by Aristotle and was appplied by Hippocrates in treating some cases.
b. Cure takes place from above downward, from within outward, from the more important to the less important organ, and in the reverse order of the onset of the symptoms.
Cure doesn't simply mean the disappearance of symptoms. Their disappearance must be as per the anove law. Every true cure that has taken place has followed this law of direction and will follow the same in the future.

2. Law of Action:
Action and reaction are equal and opposite.

3. Law of Quantity and Dose:
The quantity of action necessary to effect any change in nature is the least possible; the decisive amount is always a minimum, an infinitesimal.

4. Law of Quantity:
The quantity of drug required is in inverse ration to the similarity.
This means in patients where there is greater similarity between the indicated drug and disease symptoms, then the less quantity of drug is required.

5. Law of Quality:
The quality of the action of a homoeopathic remedy is determined by its quantity, in inverse ratio.

6. Law of Biological development:
Function creates and develops the organ.

7. Law of Disease Development:
Functional symptoms are produced by the vital force in exact proportion to the profundity of the disturbance. The functional symptoms precede structural changes.

8. Law of Use governing the homoeopathic remedy:
The dose and quantity that will thoroughly permeate the organism and make its essential impress upon the vital force is that which will affect the functional sphere of the individual.

9. Law of Repetition(for Proving):
Never repeat the dose while symptoms are manifest from the dose already taken.
The above law guides the physician while proving the drugs in healthy human beings to discover the symptomatology of the drug. The symptoms are developed in natural cycles during proving.

10. Law of Repetition(for Cure):
Never repeat your remedy so long as it continues to act.

11. Laws of Proving:
These laws deal with various types of substances for proving. These laws are in accordance with the above laws of action, law of quantity and dose, law of quantity and law of quality.
i. Any drug which in its natural state affects the vital energy but little will develop a proving only in a high potency.
ii. Any drug which in its natural state disturbs the vital energy to functional manifestations only may be proven in a crude form.
iii. Any drug which in its natural state disturbs the vital energy to destructive manifestations should be proven only in a potentiated form.

Homoeopathy has a rich Historical value also where Dr.Hahnemann who was actually an allopathic physician has worked tirelessly for years and proved every drug. Eventually formed the science  of cure that is known as Homoeopathy.
Every  new Homeopathy patients who enters my clinic  fit into one of two categories.
1.)Some arrive at an early stage of their illness because they have already decided that they do not want to go through the Modern medicine route of drug-based treatment.
2.) second have gone through the modern medicine route, some for many years, and found that their health has not improved, or has gradually declined.
In both the scenarios I don’t not take for granted that the patient knows enough about their illness, and its treatment by Homeopathy, to ensure that they can make an 'informed choice' about it. I sit with them spending enough time and explaining various aspects I always start with the question; HOW MUCH DO YOU KNOW REGARDING HOMOEPATHY? Maximum times its to my relief I have found that potential patients have already done considerable research into Homeopathy, and/or have heard about it from former patients who have been treated successfully. But nevertheless the question remains important. What patients say in response to it will determine what the Homeopath needs to say to enable them to make an 'informed choice' about proceeding with Homeopathy. Like for example after the news of MMR vaccines causing autism in children, many parents met me with the queries of making HOMOEOPATHIC PROPHYAXIS an option for the new born, with the onset of such queries it became important for me to understand the rules laid down for newborns, diseases like TUBERCULOSIS
POLIO
MUMPS
MEASELS
SMALLPOX
Are very dangerous and I hold a very important responsibility of giving prophylaxis to my young patients.
Here the Consent was very important for my safety because though homoeopathy only deals with PROVED DRUGS which are then USED AS MEDICINES, it can be difficult and tricky.
Before giving any prophylaxis to my patients it was made sure that a complete understanding was given to the parents.
A 5years prophylaxis course was designed for the children from birth to 5years of age, and a safe method was proposed and very stringent protocol is observed.
Homoeopathic Prophylaxis (HP)( Homoeopathic Disease prevention without needles)
Happy Homoeopathy Clinic is now Bringing Homoeopathic Vaccination (no Needles!!) to you
In association with Kate Birch.
A complete program from birth till 5 years of age
Homoeopathic Prophylaxis (HP) System for your child.
This will have raised many questions in your mind
This service will be available at
Saifee Hospital- every Thursday between 8.30AM till 11.30AM with
HAPPY HOMOEOPATHY CLINICS
Dr.Fatema Palgharwala—09762688352.
For crisp information kindly read on, for more kindly meet the Doctor at the above time.
How can we stimulate immunity without killing the person?
How can we mimic natural responses diseases to disease with artificial means?
HP works to stimulate your child’s immune system in a natural and gentle way so as to stimulate immunity to specific diseases without damaging the immune system. HP is the introduction to disease agents in the attenuated form of a homeopathic dilution. No disease is present, no toxic adjuvants included. Some immune system response such as mild temporary fever or discharge is the expected outcome, of stimulating the immune system in this way. The result is a healthy immune system, with learned immunity to a variety of infectious agents without side effects.

The Problem with Vaccination
Disease is injected straight into the blood
Bypassing general immune system receptors
Delayed febrile response if at all
Period of agitation prior to cellular response
Cellular activity is delayed as general immune system is not activated
Viral particles remain in body
Immune system confusion from all the stimulating and suppressing action of the adjuvants

Resultant Symptom Picture
Recurrent fevers
Sicknesses that don’t resolve
Repetitive ear infections
Allergies, asthma
Behavioral changes
Pervasive Developmental delays
Food sensitivities
ADD, ADHD
Disturbances in brain function
Autism

Similarities between Vaccination and Homeoprophylaxis
Aim to prevent disease
Introduction of a disease agent into the body to stimulate immunity prior to exposure to disease
Differences
    Vaccination                                                                             
Material dose
Adjuvants
Germ injected directly into the blood stream
Multiple diseases given at once

Homeoprophylaxis
Energetic dose
No adjuvants
Imprint of the germ and discharge in response to the germ
Administered orally
Single disease at a time

 My patients should know how does homeopathy work?
Usually I have experienced it is not important! Indeed, it is probably not important for patients who seek help from any medical discipline. Patients know that they are ill, and that they want to get better. And it is not my experience that patients want to sit through a long, philosophical lecture on the working mechanism of any particular medical therapy!

So I usually keep the explanation (or answer) to this question quite brief, mentioning the homeopathic principle of 'treating like with like', and briefly describing 'remedy pictures', and 'symptoms of illness', and the importance in Homeopathy of matching the two together. If patients want to ask further questions about this (and most don't) I will try to provide them with answers, based on my understanding.

However, one important point should be made in response to this question. This concerns the nature of the healing process, and how this will be driven by the body, and not by the homeopathic remedy. All the remedy does is to seek to assist the body to do so - it will not do so in its own right. Remedies are not 'wonder cures', all they do is to 'nudge' the body towards its self-healing task.

In addition, every patient should be told that Homeopathy works best when it is used as part of a 'holistic' strategy, which stresses the importance of good diet, exercise, and other life-style factors. 

Another Important question put forward by patients. Is homeopathy an effective treatment for their condition or illness? And how safe is it?

Safety.
I usually begin with the latter - safety. I tell them that homeopathy is safe, and will not cause 'side-effects', 'adverse reactions', or indeed, cause disease or death. To support this, I will give a brief description of how remedies are made - by serial dilution and succussion. I will then affirm that if, together, we arrive at the wrong remedy it will do absolutely no good whatsoever - but likewise it will do no harm!
Thus showing my patients that homoeopathy is completely safe and never cause a side effect in medical dosage.
 Talking about safety of homeopathy medicines in this case
Citing the case of a homeopathy overdose
Juggankhan v State of Madhya Pradesh (1965)1 SCR 14]
Date of Decision: 10.08.1964

The appellant, a registered Homoeopathic medical practitioner under the Madhya Pradesh Homoeopathic and Bio-chemic Practitioners Act, 1951, issued a pamphlet advertising that he inter alia treated Naru (guinea worm). Believing this, Smt. Deobi, aged about 20 year visited the appellant's clinic. along with some member: of her family, for treatment. The appellant administered 24 drop. of mother tincture stramonium and a leaf of dhatura. However, soon after taking the medicine, Deobi felt restless and ill and despite administration of antidotes, she died the same evening. In the trial for murder under section 302 of the IPC, the appellant was convicted. When the matter reached the Apex Court, the Court considered whether. in view of the nature of the appellant' offence he was rightly convicted under s 302 of the IPC. The Court agreed with the lower Courts that Deobi' death resulted from poisoning. However. after considering the material, the Court found it could not be established that the administered dose was fatal or that the appellant had administered stramonium drops and dhatura leaf with the knowledge that it was likely to cause death. But the court observed that stramonium and dhatura leaf were poisonous and in Homoeopathy dhatura leaf was never administered as such. In fact. in no system of medicine, except perhaps Ayurvedic, was: dhatura leaf given as a cure for guinea worms and that the appellant prescribed the medicine without thoroughly studying the effect of giving 24 drops of stramonium and a leaf of dhatura. The court held that it was a rash and negligent act to prescribe poisonous medicines without studying their probable effect. The Court also held that though it was true,as ruled in , John Oni v King [AIR (1943) 30 PC 72], that care should be taken before imputing criminal negligence to a professional man acting in the course of his profession, even then it was clear that the appellant was guilty of a rash and negligent act and hence liable for conviction under s. 304A, IPC.

 Effectiveness of my Homoeopathy treatment and medicines
It is then quite easy to move on to discuss effectiveness. I have always felt it important to tell patients that in order to be effective, a correct or 'similar' remedy has to be found. If such a remedy is found there will be some measure of improvement in the condition or illness. If it is not there will be no improvement. At this stage I always feel that it is important to manage expectations. There are no guarantees. This is especially important, perhaps, when a patient has arrived after homeopathy has cured or successfully treated a friend or relative (the source of most new referrals). My hair loss patients always come looking for more hair on their head and always refer automatically and yet as a physician I cannot claim that every bald head will get hair, reasons will be based on age, body dynamics, diagnosis. Etc.
A classic case of Hydrocephalus which I came across in March 2013 was a rare occurrence and this one case which fetched me the whole village as my client.

Homoeopathy case-taking is a very exhaustive process and often makes patients nervous and tired, yet it’s the most important part of treatment with us, I make my
  patient aware about homeopathy, that the treatment process needs to be a partnership, and that it is not an 'expert-client'  relationship. Although the Homeopath may have all the training and knowledge needed to determine a remedy that is 'similar', he/she can only arrive at this if the patient is able to openly, honestly and with insight, explain and describe their symptoms. 

Understanding the concept of sign and symptoms is very VITAL in Homoeopathy practice
Definition of Sign
1: one of a set of gestures used to represent language
2: an objective evidence of disease especially as observed and interpreted by the physician rather than by the patient or lay observer <narrow retinal vessels are a signoff arteriosclerosis>—see brudzinski sign, chvostek's sign,homans' sign, kernig sign, physical sign, placental sign,romberg's sign, tinel's sign, vital signs, von graefe's sign;


Definition of symptom

: subjective evidence of disease or physical disturbance observed by the patient <headache is a symptom of many diseases> <visual disturbances may be a symptom of retinal arteriosclerosis>; broadly : something that indicates the presence of a physical disorder


This means that the patient is a vital part of the process. Even the most skilled and experienced Homeopath has to depend on the patient for the treatment to be effective.

Normally I will also tell patients that I am likely to ask some strange, and sometime intimate questions, and that these questions will often appear to have little relationship to the illness or disease being treated (at least, not in conventional terms).

In my experience, Homeopathy works best when it is conducted within a professional relationship that is open, honest and transparent. And I know of no reason why the homeopath-patient relationship should be based on anything else!

Homoeopathy prescription:
 After the above methods and  arrangement for the same is made the patient is now aware about the methods to be used, I follow the method of APPOINTMNET AND MEETING THE CLIENT on the given time, this makes it easy for me and client to understand and work together,
The diagnostic reports, surgical reports and earlier prescriptions have to be submitted for scrutiny before the consultation, a fee structure is explained and payment options given.
 Complete case taking is performed and followed by required diagnostic tests are prescribed,
A complete physical examination is then commenced and all notes taken.
Homoeopaths like me have become modern and we prefer video case taking instead of sitting and writing out every point, and this is a very IMPORTANT AREA for INFORMED CONSENT IN HOMOEPATHY PRACTISE,
The Patient is made completely aware that I am making a VIDEO RECORDING, during the consultation, patients generally consent for this method and ask questions about privacy and it is made sure that it is followed.
The video recording of surgical processes is also made by many hospitals and surgeons which is made it important for Doctor-Patient safety.

Thus a complete holistic approach is achieved here,
After completion of case taking and examinations and diagnostics, a Homoeopathic Prescription is made, which states the
HOMOEPATHIC PRESCRIPTION:
DATE.
NAMES.
REMEDY NAMES.
DOSAGE .
TIME OF DOSAGE.
PERIOD OF DOSAGE.
FOLLOW UP CRITERIA.
DIET REGIMEN.
DIET RESTRICTIONS.
EXERCISE REGIMEN.
EXERCISE RESTRICTIONS.

The general understanding in India is that Homoeopaths make their own medicine and supply to the patient, yet this is a MYTH and not always correct,
A proper prescription and the client will decide where the homoeopathy medicines can be bought from.
A proper address of the pharmacy is always supplied for ease to the patient. And a proper invoice for medicine bought is supplied.
Thus in practice it is observed that every aspect of healthcare and CONSENT TAKING proper communication is achieved.
In my observation homoeopathy is no different than any other pathies and the ETHICS will never change and rather should never change.

Looking at the opposite factor which is also possible and is an invitation for trouble
For CAM practitioners is
The alternative medicine world is faced by a theory which says that these pseudoscience’s are NOT EVIDENCE BASED SCIENCES there is not enough research and evidence that a particular organic substance will cause cure, while Homoeopathy and Ayurveda have little acceptance in the Modern Medicine in India the case is complete No in US UK OR Canada where these science hold No status, reason being that the science according to them is NOT EVIDENCE BASED,
The area of Informed Consent is jeopardized by CAM because,
The intrusion into “conventional” medicine of implausible and unproven treatments by supporters of CAM, and those who will benefit from their support, does not alter the ethical and legal obligations of physicians to be truthful with their patients. Medical ethics demand that such treatments not be offered. If they are recommended, ethically the physician has, at the very least, a duty to disclose implausibility and lack of evidence of effectiveness. Legally, physicians offer such treatments at the risk of being sued for battery based on the claim that patient consent is nullified by misrepresentation if implausibility and lack of effectiveness are not disclosed. Alternatively, if the CAM treatment results in harm, physicians risk suit under a negligence theory. It should be easy enough to prove by expert testimony, under the physician standard of disclosure that implausible and ineffective treatments would not be offered by a reasonably prudent physician. Under the patient standard, a jury would be hard pressed to conclude that a reasonable patient would find it immaterial to that the proffered treatment lacked scientific plausibility and evidence of effectiveness.

Ethical Duty of Informed Consent and CAM
I understand that certain treatments should not be offered to patients, even if the physician believes they are unlikely to result in harm to the patient. Which would include any treatment which:
a. is implausible on a priori grounds (because its implied mechanisms or putative effects contradict well-established laws, principles, or empirical findings in physics, chemistry or biology),
b. lacks a scientifically acceptable rationale of its own,
c. has insufficient supporting evidence derived from adequately controlled outcome research, or
d. has failed in well-controlled studies done by impartial evaluators and has been unable to rule out competing explanations for why it might seem to work in uncontrolled settings.
 Such treatments are called “quackery” and beyond doubt it is unequivocal that “doctors should not truck with quackery” and that “physicians should not offer or accede to patient demands for unproven treatments.”
For example When a patient enters a homoeopathy clinic and presents a case of Classical Gall-Stones requiring surgery and intervention, it is my duty as a clinician to explain the same to my patient and not simply take the case and handle is medically and give homoeopathic drugs and wait for the gall-stones to melt, which is seldom possible, although in my theory books it is possible, there has to be a discretion in me that includes modern medicine and its helpful areas. The same is expected from the modern medicine practitioners; while we physicians understand this point or view it is very important for the law also to understand this, when a modern medicine practitioner would refer a case to a CAM practitioner and vice versa the patients consent is considered to be understood as trust, it will be difficult if patients were allowed to sue us on meager basis.
Patients have a range of expectations of their physicians, with different patients looking for different things, which may include hope, compassion and comfort. However, patients universally seek effective and safe treatment; they want to be cured. Consequently, the legal and ethical systems that establish the parameters within which physicians practice must demand at the very least that physicians utilize their skills and knowledge to offer patients treatment which they reasonably believe will actually treat the condition from which they suffer. This minimum requirement precludes physicians form offering as medicine something that is not – even if it will, in a psychological or emotional sense, make the patient ‘feel better.’ To do otherwise misleads the patient about what ultimately matters — that she is receiving treatment for her condition. . . . The very fact that it is a physician who prescribes the therapy will endow the treatment with a false sense of legitimacy. . . . Patients do not expect physicians to succumb to fads or illegitimate pressure to provide treatment that has no reasonable chance of helping the patient. In medicine, that hope is inspired by scientific proof, whether or not the treatment is conventional or alternative.
If offering CAM to patients is ethically contraindicated, and the basis of that conclusion is, in part, a physician’s fiduciary obligation to be truthful with their patients, and the corresponding desire of patients for treatments that are actually beneficial, then, a fortiori, a physician offering implausible and unproven CAM treatments would have an ethical obligation to tell patients about that very implausibility and lack of efficacy.


MEDICAL LAWYER AND ETHICS CONSULTANT http://www.healthlibrary.com/helptalks.php?action=list&speaker_id=739


COMPARATIVE STUDY OF INDIA AND UK: INFORMED CONSENT


Comparative study of India and UK


Doctors, owe their clients a duty to disclose any conflict of interest that has arisen and to inform their clients. There are many ways in which this may arise in practice—for example, if a doctor has conducted a client's case negligently. Doctors are in breach of their professional code of conduct if they fail to comply with these duties.
A patient approaching a doctor expects medical treatment with all the knowledge and skill that the doctor possesses to bring relief to his medical problem. The relationship takes the shape of a contract retaining the essential elements of tort. A doctor owes certain duties to his patient and a breach of any of these duties gives a cause of action for negligence against the doctor. The doctor has a duty to obtain prior informed consent from the patient before carrying out diagnostic tests and therapeutic. Though a doctor may not be in a position to save his patient's life at all times, he is expected to use his special knowledge and skill in the most appropriate manner keeping in mind the interest of the patient who has entrusted his life to him. Therefore, it is expected that a doctor carry out necessary investigation or seeks a report from the patient. Furthermore, unless it is an emergency, he obtains informed consent of the patient before proceeding with any major treatment, surgical operation, or even invasive investigation. Failure of a doctor and hospital to discharge this obligation is essentially a tortious liability. A tort is a civil wrong (right in rem) as against a contractual obligation (right in personam) – a breach that attracts judicial intervention by way of awarding damages. Thus, a patient's right to receive medical attention from doctors and hospitals is essentially a civil right. The relationship takes the shape of a contract to some extent because of informed consent, payment of fee, and performance of surgery/providing treatment, etc. while retaining essential elements of tort.
The liability of a doctor arises not when the patient has suffered any injury,
but when the injury has resulted due to the conduct of the doctor, which has fallen
below that of reasonable care. In other words, the doctor is not liable for every injury
suffered by a patient. He is liable for only those that are a consequence of a breach of
his duty. Hence, once the existence of a duty has been established, the plaintiff must
still prove the breach of duty and the causation. In case there is no breach or the
breach did not cause the damage; the doctor will not be liable. In order to show the
breach of duty, the burden on the plaintiff would be to first show what is considered
as reasonable under those circumstances and then that the conduct of the doctor was
below this degree. It must be noted that it is not sufficient to prove a breach, to merely
show that there exists a body of opinion which goes against the practice/conduct of
the doctor.
With regard to causation, the court has held that it must be shown that of all
the possible reasons for the injury, the breach of duty of the doctor was the most
probable cause. It is not sufficient to show that the breach of duty is merely one of the
probable causes. Hence, if the possible causes of an injury are the negligence of a
third party, an accident, or a breach of duty care of the doctor, then it must be
established that the breach of duty of care of the doctor was the most probable cause
of the injury to discharge the burden of proof on the plaintiff
.
 However, in some cases like a swab left over
the abdomen of a patient or the leg amputated instead of being put in a cast to treat the
fracture, the principle of 'res ipsa loquitur' (meaning thereby 'the thing speaks for
itself') might come into play. The following are the necessary conditions of this
principle.
• Complete control rests with the doctor.
• It is the general experience of mankind that the accident in question does not
happen without negligence. This principle is often misunderstood as a rule of
evidence, which it is not. It is a principle in the law of torts. When this
principle is applied, the burden is on the doctor/defendant to explain how the
incident could have occurred without negligence. In the absence of any such
explanation, liability of the doctor arises
Normally, a doctor is held liable for only his acts (other than cases of vicarious
liability). However, in some cases, a doctor can be held liable for the acts of another
person which injures the patient. The need for such a liability may arise when the
person committing the act may not owe a duty of care at all to the patient or that in
committing the act he has not breached any duty. A typical example of a case where
such a situation may arise is in the case of a surgery. If a junior doctor is involved as
part of the team, then his duty, as far as the exercise of the specialist skill is
concerned, is to seek the advice or help of a senior doctor. He will have discharged his
duty once he does this and will not be liable even if he actually commits the act which
causes the injury. In such a case, it is the duty of the senior doctor to have advised him
properly. If he did not do so, then he would be the one responsible for the injury
caused to the patient, though he did not commit the act.
In India in the case of Dr. Laxman Balkrishna Joshi vs. Dr. Trimbark Babu Godbole and Anr[1]., and A.S.Mittal v. State of U.P[2].,
the appellant had performed reduction of the fracture, that in doing so he applied with the help of three of his assistants excessive force, that such reduction was done without giving any anesthetic but while the patient was under the effect of the morphia injection, that the said treatment resulted in the embolism, or shock, which was the proximate cause of death, that the appellant was guilty of negligence and wrongful acts, and awarded Rs. 3,000 as damages.
 It was laid down that when a doctor is consulted by a patient; the doctor owes to his patient certain duties which are:
(a) Duty of care in deciding whether to undertake the case,
 (b) Duty of care in deciding what treatment to give, and
 (c) duty of care in the administration of that treatment.
 A breach of any of the above duties may give a cause of action for negligence and the patient may on that basis recover damages from his doctor. In the aforementioned case, the apex court interalia observed that negligence has many manifestations – it may be
 1.) active negligence,
2.) collateral negligence,
 3.) comparative negligence,
4.) concurrent negligence,
5.) continued negligence,
6.) criminal negligence,
7.) gross negligence,
8.) hazardous negligence,
9.) active and passive negligence,
10.) willful or reckless negligence,
11.) or negligence per se.
Black's Law Dictionary defines negligence per se as “conduct, whether of action or omission, which may be declared and treated as negligence without any argument or proof as to the particular surrounding circumstances, either because it is in violation of statute or valid Municipal ordinance or because it is so palpably opposed to the dictates of common prudence that it can be said without hesitation or doubt that no careful person would have been guilty of it. As a general rule, the violation of a public duty, enjoined by law for the protection of person or property, so constitutes.”
In the case of Samira Kohli vs. Dr. Prabha Manchanda and Ors[3]., the apex court held that consent given for diagnostic and operative laparoscopy and “laparotomy if needed” does not amount to consent for a total hysterectomy with bilateral salpingo opherectomy. The appellant was neither a minor nor mentally challenged or incapacitated. As the patient was a competent adult, there was no question of someone else giving consent on her behalf. The appellant was temporarily unconscious under anesthesia, and as there was no emergency. The respondent should have waited until the appellant regained consciousness and gave proper consent. The question of taking the patient's mother's consent does not arise in the absence of emergency. Consent given by her mother is not a valid or real consent. The question was not about the correctness of the decision to remove reproductive organs but failure to obtain consent for removal of the reproductive organs as performance of surgery without taking consent amounts to an unauthorized invasion and interference with the appellant's body. The respondent was denied the entire fee charged for the surgery and was directed to pay Rs. 25000/- as compensation for the unauthorized surgery[4]. http://www.imlindia.com/content/Samira.Kohli.v.Dr.Prabha.Manchanda.pdf
Such cases bring to light the situations in India and its patients and doctors  how much am I as a doctor under pressure and my patients need how much to consider and trust me and my opinion, why so much emphasis on these areas why lack of trust?
Why are the friendly neighborhood doctor skipped and a surer specialist approached even for a minor headache? Why fancy life insurances? And health and wellness packages available in corporate hospitals and fancy clinics all over the globe?
One doctor travelling all over the globe and handling maximum number of patients?
International and national consumer running towards a handful few and expecting maximum care, how can an overworked doctor give equal time to all his patients?
What about those who are below the poverty line and cannot afford these treatments,

In India, majority of citizens requiring medical care and treatment
Fall below the poverty line. Most of them are illiterate they cannot comprehend medical terms, concepts, and treatment
Procedures. They cannot understand the functions of various organs or the effect of removal of such organs. They do not have access to effective but costly diagnostic procedures. Poor patients lying in the corridors of
Hospitals after admission for want of beds or patients waiting for days on the roadside for an admission or a mere examination, is a common sight at all major hospitals all around Mumbai where I have worked and experienced,
For them, any treatment with reference to rough and ready diagnosis based on their outward symptoms and doctor’s experience or intuition or so called expert judgment  is acceptable and welcome so long as it is free or cheap; and whatever the
Doctor decides as being in their interest, is usually unquestioningly accepted. They are a passive, ignorant and uninvolved in treatment procedures. The poor and needy face a hostile medical environment - inadequacy in the number of hospitals and beds, non-availability of
Adequate treatment facilities, utter lack of qualitative treatment, corruption, callousness and apathy. Many poor patients with serious
Ailments (eg. heart patients and cancer patients) have to wait for months
For their turn even for diagnosis, and due to limited treatment facilities,
Many die even before their turn comes for treatment. What choice do these poor patients have? Any treatment of whatever degree is a boon or a favor, for them. The stark reality is that for a vast majority in the
Country, the concepts of informed consent or any form of consent, and choice in treatment, have no meaning or relevance. With my personal experience since I have majorly worked in the area of chronic disease and Cancer management, even the slightest hope of recovery makes the patient rally behind me , being an ethical person I will always follow my ethics and although sometimes when the clear picture of the condition is communicated and found that the hospital hasn’t done anything but simply relieving the symptoms doesn’t make any difference to the the patients although they are spending over this unrequired treatment, this state makes me remember the internship days when I was posted at the hospital IPD, where we are supposed to be working in shifts for Day and Night , the one problem we would face during our work was FAKE DISEASES, the patient would learn some classic symptoms and present them to us and ask for admission in the hospital this was a dilemma we would face ? The reason being that those were RAINY SEASON days and there wasn’t any shelter from rains outside, thus these people would flock towards hospitals and fake diseases symptoms and stay and occupy these beds!

The position we doctors face in Government and charitable hospitals, is also unenviable. They are overworked, understaffed, with little or no diagnostic or surgical facilities and limited choice of medicines and
Treatment procedures. They have to improvise with virtual non-existent facilities and limited dubious medicines. They are required to be committed, service oriented and non-commercial in outlook. What choice of treatment can these doctors give to the poor patients? What informed
consent they can take from them?
This condition was very beautifully portrayed in an HINDI FEATURE FILM
Munna Bhai M.B.B.S. is a 2003 Indian comedy directed by Rajkumar Hirani and produced by Vidhu Vinod Chopra. The story involves protagonist Munna Bhai (Sanjay Dutt), a goon, going to medical school. 
While Munna Bhai's skills as a medical doctor are minimal, he transforms those around him with the "Jadoo Ki Jhappi" ("magical hug") and the compassion he shows towards those in need. Despite the school's emphasis on mechanical, Cartesian, impersonal, often bureaucratic relationships between doctors and patients, Munna constantly seeks to impose a more empathetic, almost holistic, regimen.
IS THIS POSSIBLE IS YET A QUESTION MARK.

 On the other hand, we have the Doctors, hospitals, nursing homes and clinics in the private commercial sector. There is a general perception among the middle class public that these private hospitals and doctors prescribe avoidable costly diagnostic procedures and medicines, and
subject them to unwanted surgical procedures, for financial gain. The public feel that many doctors who have spent a crores  for becoming a specialist, or nursing homes which have invested several crores on diagnostic and infrastructure facilities, would necessarily operate with a purely commercial and not service motive; that such
Doctors and hospitals would advise extensive costly treatment procedures and surgeries, where conservative or simple treatment may meet the need; and that what used to be a noble service oriented profession is slowly but
steadily converting into a purely business.
 But unfortunately not all doctors in government hospitals are paragons of service, nor fortunately, all private hospitals/doctors are commercial minded. There are many a doctor in government hospitals who do not care about patients and unscrupulously insist upon ’unofficial’
payment for free treatment or insist upon private consultations. On the other hand, many private hospitals and Doctors give the best of treatment
without exploitation, at a reasonable cost, charging a fee, which is reasonable recompense for the service rendered. Of course, some doctors, both in private practice or in government service, look at patients not as
persons who should be relieved from pain and suffering by prompt and proper treatment at an affordable cost, but as potential income-providers/
customers who can be exploited by prolonged or radical diagnostic and treatment procedures. It is this minority who bring a bad name to the entire profession.
 What we are considering in this case, is not the duties or
obligations of doctors in government charitable hospitals where treatment is free or on actual cost basis. We are concerned with doctors in private practice and hospitals and nursing homes run commercially, where the
relationship of doctors and patients are contractual in origin, the service is in consideration of a fee paid by the patient, where the contract implies that the professional men possessing a minimum degree of competence
would exercise reasonable care in the discharge of their duties while giving advice or treatment.
Here arises a question of having a menu card for a doctor is it possible to centralize the costs of treatments and diagnostics?
Even the Clinicians who are engaged in research in a variety of ways, both directly and indirectly are not out of this obligation. Ethical review and approval should be obtained in all cases of research on human subjects. The primary justification for research is the expected benefit in improved treatments or prevention of disease. Thus, the justification is overwhelmingly utilitarian and the ethical judgment involves assessment of likely benefits and potential harms. All engaged in clinical trials have duties of care and should consider how best these can be discharged.

In UK also the scenario is same. During the 1980s in England, the Department of Health issued a circular allowing practitioners, under limited circumstances, to discuss with and apply family planning procedures to minors (<16 years of age) without the express consent of their parents. Mrs. Gillick, a mother, challenged this in a court of law to get this advice declared illegal. The judgment in Gillick v West Norfolk and Wisbech Area Health Authority [1984] was in favor of the Health Authority ruling that a minor was capable of giving consent to contraceptive therapy provided she was of sufficient mental maturity to understand the implications. This ruling was overturned by the Court of Appeal on consideration of the duties and rights of parents and their right to be informed sufficiently to carry out these duties. The Department of Health with the support of the British Medical Association (representatives of medical practitioners in the UK) appealed to the House of Lords (The highest appeal court in the UK) who backed the original judicial decision by a majority of 3:2 allowing practitioners to make a judgment about the maturity of a minor and to give contraceptive advice and treatment without the consent of the parents
In 1982 Mrs. Victoria Gillick took her local health authority (West Norfolk and Wisbech Area
Health Authority) and the Department of Health and Social Security to court in an attempt
to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without
parental consent.
The case went to the High Court where Mr. Justice Woolf dismissed Mrs. Gillick’s
claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of
Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favor of
the original judgment delivered by Mr. Justice Woolf:
"...whether or not a child is capable of giving the necessary consent will depend on the
child’s maturity and understanding and the nature of the consent required. The child must
be capable of making a reasonable assessment of the advantages and disadvantages of
the treatment proposed, so the consent, if given, can be properly and fairly described as
true consent."
The ‘mature minor’ principle is now commonly referred to as ‘Gillick-competence’ and is widely applied in practice, although it is fraught with difficulties. Essentially a practitioner may be justified in providing advice and treatment without the expressed consent or knowledge of the parents where:
1) the girl concerned is considered capable of understanding advice
2) she could not be persuaded to inform her parents or to allow the doctor to inform them  (implicit in this is that the practitioner should try to persuade her to inform her parents)

3) she is very likely to have sexual intercourse with or without contraceptive treatment or advice (withholding such treatment or giving it is unlikely to influence her sexual behavior)

4) Without contraceptive advice or treatment her physical and mental health is likely to suffer (she is at risk of sexually transmitted disease or may become pregnant)

5) Overall it is considered to be in her best interest on the balance of probable benefits and potential harms. The obligation is firmly imposed on the doctor to attempt to persuade the girl to inform her parents or to allow him/her to do so.

This approach is an attempt to act in the ‘best interest’ of the girl considering that where possible it is best that parents are involved. It balances this with the right of parents to be informed to carry out the duty of care to their child. The paramount concern, however, is the best interest and health of the child.
In the UK the healthcare system is not like India
Let’s enumerate the differences and see what we achieve
Healthcare in England is mainly provided by England's public health service, the National Health Service, that provides healthcare to all permanent residents of the United Kingdom that is free at the point of use and paid for from general taxation. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay.
The National Health Service (NHS) is free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care.
The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948.
 quality of care and environment; access to treatments, medicines and screening programmes; Respect, consent and confidentiality; informed choice; patient involvement in healthcare and public involvement in the NHS; and complaints and redress. The constitution:-
Defines rights regarding access to health care which will be
·         free of charge
·         non-discriminatory
·         never refused on unreasonable grounds
·         obtainable from any UK NHS provider or with pre-approval from any EEA or Swiss public provider
·         assessed by the local NHS to meet locally assessed needs
and pledges that access to health care will be convenient and easy to access within defined waiting times; based on decision making that will be clear and transparent, and that transfers from one provider to another will be as smooth as possible and that patients will be involved in all relevant discussions.
With regard to rights regarding Respect, consent and confidentiality the NHS gives patients the right to
·         be treated with dignity and respect.
·         accept or refuse treatment that is offered, and not to be given any examination or treatment without valid consent.
·         be given information about your proposed treatment in advance, including any significant risks and any alternative treatments which may be available, and the risks involved in doing nothing.
·         privacy and confidentiality and to expect the NHS to keep their confidential information safe and secure.
·         access to their own health records. This will always be used to manage treatment in the patient’s best interests.
And pledges that it will share with patients any letters sent between clinicians about their care.
Patients are given rights in relation to informed choice including the right to
·         choose their own GP practice, and to be accepted by that practice unless there are reasonable grounds to refuse
·         express a preference for using a particular doctor within your GP practice and for the practice to try to comply.
·         make choices about their NHS care and to information to support these choices.
The NHS also pledges to inform patients about the healthcare services available locally and nationally and will offer easily accessible, reliable and relevant information to enable patients to participate fully in their own healthcare decisions and to support them in making choices. This includes information on the quality of clinical services where there is robust and accurate information available.
Doctors status in the UK
Doctors in training
Doctors in training earn a basic salary and will be paid a supplement if they work more than 40 hours and/or work outside the hours of 7am-7pm Monday to Friday.

In the most junior hospital trainee post (Foundation Year 1) the basic starting salary is £22,636. This increases in Foundation Year 2 to £28,076. For a doctor in specialist training the basic starting salary is £30,002. If the doctor is contracted to work more than 40 hours and/or to work outside 7am-7pm Monday to Friday, they will receive an additional supplement which will normally be between 20% and 50% of basic salary. This supplement is based on the extra hours worked above a 40 hour standard working week and the intensity of the work.
Specialty doctors
Doctors in the specialty doctor grade earn a basic salary of between £37,176 and £69,325.
Consultants
Consultants can earn a basic salary of between £75,249 and £101,451 per year, dependent on length of service. Local and national clinical excellence awards may be awarded subject to meeting the necessary criteria. 
General practitioners
Many general practitioners (GPs) are self-employed and hold contracts, either on their own or as part of a Clinical Commissioning Group (CCG). The profit of GPs varies according to the services they provide for their patients and the way they choose to provide these services.

Salaried GPs who are part of a CCG earn between £54,863 to £82,789 dependent on, among other factors, length of service and experience.
Private Practice in UK
‘Independent Practice’ and ‘Private Practice’ are synonymous terms meaning practicing medicine out with the umbrella of the NHS. Private practice existed long before the creation of the NHS, and it continues today in parallel with the NHS.
Private practice does allow surgeons to practice more independently of NHS targets and diktats. Private Practice allows more direct one-to-one care for patients, without a need to rush. Private practice can indeed be greatly rewarding, both emotionally and professionally, but like most worthwhile things, it does require hard work and commitment.
Patients receiving private healthcare fall into two groups: those with private medical insurance policies (about 80% of patients) and those who self-fund (about 20%).
Of those doctors undertaking private practice, the large majority also work in NHS Consultant posts, doing their private work in their spare time, outside of and on top of their NHS commitments. A small proportion of doctors work in full time private practice only.
The amount of private practice varies considerably across the country, with the greatest density being around London and the South-East.
Any registered medical practitioner can, in theory, undertake work privately. However, in reality, there are a number of practical barriers.
First, private medical insurance companies do not have their own mechanisms for assessing quality and suitability of doctors for being recognized as specialists. They therefore rely on specific benchmarks, including the need to be on the GMC’s Specialist Register and to have successfully gone through an Advisory Appointments Committee (AAC), which is part of the NHS Consultant appointment process. Second, by law, private hospitals have very strict criteria for awarding practicing privileges to doctors using their facilities. These help assure patients that they are being seen by experienced and fully trained registered specialists.
Balancing Private and NHS work
Whether a surgeon decides to undertake work in the private sector is a personal decision, which can be influenced by many factors.
Under the new consultant contract, there are rules governing how you balance NHS work with private practice. If you do not have 11 or more programmed activities in your job plan, you are expected to offer the first portion of any spare time to the NHS in preference to any private work.
There is a Code of Conduct for Private Practice, jointly agreed by the DH and BMA. This code ensures that your private work does not disadvantage NHS patients.
When a surgeon has patients under their care within the NHS, the patients tend to be looked after by a large team, including a variety of grades of trainees. Care in the private sector is generally delivered entirely by the consultant. Private practice is therefore a significant commitment, which has to be handled effectively on top of all the many commitments of the busy NHS Consultant.
Factors such as geography and specialty can also influence a surgeon’s decision to undertake private practice. Some specialties have relatively low rates of private practice whilst others, such as cosmetic surgery, feature very strongly.

 I thus find a stark difference in the conditions in UK and India in variety of areas which sums up to the total care standards at both the places.

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