November 2017, Volume 1 / Issue 3

AFPI Karnataka Qu*rterly Newsletter

President’s Letter

Hello everyone,

We are pleased with the positive reviews received for our previous two editions of the newsletter which places a great sense of responsibility on us. But I am sure our expe- rienced and energetic editorial team with a focus on bringing high quality content in the newsletter, will not disappoint our esteemed readers.

This newsletter provides me with a chance to reflect on what the state chapter of the

academy has been able to achieve in the last three months, particularly in relation to the

areas identified in the last newsletter. The first area identified was the maintenance and strengthening of the Academy‘s strong collaborative ethos. We *re pleased that the last quarter saw AFPI Karnataka conducting two major collaborative events in the form of a DNB resident’s orientation program and a practice oriented program on mental health disorders. Orientation program conducted in collaboration with Rangadore memorial hospital saw the residents enga*ing in highly interactive deliberations through the day and it was heartening to see the residents going back confident and reassured about their career in Family Medicine. Another collaborative event on ‘Psychiatric disorders in Fam- ily Medicine’ generate* a lot of interest and interaction among a well-attended delegates, mostly family practitioners.

Since the last edition a number of strategies have been put in place by our scien- tific and research committee. Notable one is an initiative by Dr B C Rao and Dr. Rama- krishna Prasad to create an opportunity for young doctors to evolve as researchers/ scholars. We hope and wish this initiative will meet with great success. Once again it’s my earnest requ*st to all readers to actively participate in making this newsletter an interest- ing and enriching magazine for family practitioners by way of documenting reflections of your practice experiences and writing articles. Looking forward to your active contribu- tion and valuable feedback.

Col (Dr.) Mohan Kubend*a

AFPI Karnataka will be hosting the next National confer- ence of Family Medicine & primary care (FMPC) at Bangalore in the year 2019

Editorial Note

Family medicine as it is known is a fledging specialty. It is heartening to know that more and more youngsters are taking to this and those coming out of institutions are setting up their offices.

How can some of us who are already esta*lished help these beginners? One way is to refer patients loc*ted in that area of practice. Another is to advice on methods of practice such as book keeping, reception, follow up strategies, networ*ing with other doctors and institutions, offering services to neighboring offices, schools, colleges, technology companies, and utilizing the office as a collection center for labs, subletting extra space to other doctors on a time

share basis are all possible ways of increasing footfalls and revenue without resorting to un-

ethical practices.

We hope that more and more young doctors start their own practices as there is a strongly felt need for them in the community.

President
Col (Dr.) Mohan Kubendra mohankubendra@gmail.com

Secretary
Dr. Bhaskara Puttarajanna drbhaskarap@gmail.com

Vice President
Dr. Ramakrishna Prasad dr.rk.prasad@gmail.com

Treasurer
Dr. Ravikumar Kulkarni ravikumarkulkarni@yahoo.com

Scientific Chair
Dr. Jaya Bajaj jayabajaj@gmail.com

Editorial team
Dr. B. C. Rao badakere.rao@gmail.com

Dr. Roshni Jhan Ganguly roshnijhan@hotmail.com

Dr. Ramakrishna Pr*sad dr.rk.prasad@gmail.com

Inside this issue

AFPI News

OSCE Workshop for Second Year Residents

On Aug 22, 2017, a regional OSCE workshop was conducted by the USMKLE Department of Family Medicine under the leader- ship of Drs. Geeta Pangi, Smruti Haval, and Sunita Bidari. Dr* Ramakrishna Prasad represented AFPI Karnataka. It was truly a high quality experience for all participants. Participants (mostly DNB Family Medicine Residents) had come from Ma- harashtra (Pune/Mumbai), Andhra Pradesh (Puttaparti), and Karnataka. In the morning a few lectures orienting participants to OSCE w*re organized. Later, after writing stations, there were interactive scenarios in the afternoon. Scenarios had been carefully chosen that required thinking at 2-4 cognitive skill levels and covered the breadth of family medicine. Organ- ization was smooth and seamless. The workshop started on

time and ended on time. Since the department of Family Med-

icine at USMKLE has been conducting OSCE examinations for several years for their undergraduate medical students from Malaysia, they have accumulated a significant amount of expe- rience. Additionally, Jawaharlal Nehru Medical College, Bel- g*um (JNMC) has a well-developed medical education unit that lent its expert support. It is hoped that the department

will conduct such workshops at regular intervals and emerge

as a regional center for excellence in FM education and evalu- ation that serves the North Karnataka, Maharashtra, and Telengana regions.

DNB Family Medicine Orientation

Program, Rangadore Hospital

AFPI Karnataka takes pride in hosting the second DNB Family Medicine orientation program . This was conducted on 3 ^rd Sep- tember 2017 at Rangadore Memorial Hospital, Bangalore. The aim of this program was to welcome new residents into the AFPI family and to help final year residents understand the ex- amination pattern and future career prospects. *enowned fac- ulty members across Karnataka volunteered to present differ- ent topics conveying the agenda of the program. The program was very efficiently executed by the Rangadore Hospital resi- dents Dr Shweta, Dr Kritika and Dr Deepa !

The program commenced with Dr Mohan Kubendra talking about the concept of Family Medicine followed by Dr Swapna Bhaskar enlightening us with the existing curriculum and the rotations. Dr Madhu Muddiah helped us understand “How to

utilize in-patient postings to improve out- patient practice.” All

these sessions turned out to be interesting and interactive.

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AFPI News

DNB Family Medicine Orientation Program Contd.

The topic “Leadership and communication skills as a Family Physician” was dealt by Dr Ramakrishna Prasad and Dr Pallavi Hoskote. This indeed gave us an insight into the important skills required to be a good family phy- sician. Dr Srividhya emphasized on valid points required to achieve milestones of evaluation in the DNB *rogram. A few mo*ths back when OSCE was first introduced in the ex*m format of DNB , there was a lot of unsurity and fear among residents. Dr Roshni Jhan G*nguly helped residents get familiar to the OSCE exam pattern with her presentation.

Another very less spoken topic on “How to handle stress during post graduate training” was very well explained by Dr Ja*a Bajaj. Scholarships and Publications in Primary care has often been less heard of and hence this was high- lighted by our own Mentor Dr B C Rao and Dr Rama- krishna Prasad. Last but not least Dr Mohan wrapped up the program focusing on career options after completion of residency.

Overall a very engaging program with a v*ry interactive audience – Truly successful!

Mental Health Update for Family

Physicians

The Mental Health Update for Family Physicians was held at People Tree Hospital, Yeshwantpur on 10 ^th of September, 2017.

This was organized by AFPI Karnataka in collaboration with People Tree Maarga and The Live Love Laugh

Foundation. It was well attended and brought togeth-

er a diverse group of healthcare professionals includ- ing family medicine specialists, psychiatrists, counsel- lors, postgraduates, and medical students. A notable feat*re was multiple collaborative presentations involv- ing FM specialists and psychiatrists. Besides didactics, role play was effectively used by several presenters.

Upcoming AFPI Events

AFPI Quarterly CME on Paediatrics in collaboration

with Rainbow Hospital, Venue: TBA, Date 5th Dec. tails will be announced soon

De-

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AFPI News (In Pics)

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Real Time Learning

Management of heart failure in family practice

Drawn from the Friday night [30/6/17] discussion E*pert- Dr Girish Godbo*e, Consultant intervention Car- diologist, Vikram Hospital,
Moderator- Dr Syed Mubarak, Family Physician

Heart Failure

Definition
HF is a clinical syndrome characterized by typical symp- toms like breathlessness, ankle swelling and fatigue that may be accompanied by signs like elevated jugular ve-

nous pressure, pulmonary *rackles and peripheral edema

caused by a structural and/or functional cardiac abnor- mality, resulting in a reduced cardiac output and/ or ele- vated intracardiac pressures at rest or during stress.

Typical Symptoms and Signs

Symptom*

Signs

Dia*nostic algorithm for a diagnosis of HF (refer next page)

Recommendations for Diagnostic tests in pa- tients with heart failure

Recommendations to prevent or delay the devel- before the onset of symptoms.

opment of overt heart failure or prevent death

systolic dysfunction.

Pharmacological treatments indicated in pa- tients with *ymptomatic (NYHA Class II-IV) heart failure *ith reduced ejection fraction

Sacubitril i* recommended as a replacement for an ACE-I

to further reduce the risk of HF in ambulatory patients with HFrEF who remain symptomatic despite optimal treatment with ACE-I, beta- blocker and MRA.

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Diagnostic a*gorithm for a diagnosis of HF

Treatments that may cause harm in HF patients

T*ke home

prove their clinical status, functional capacity and quality of life, prevent hospital admission and r*duce mortality.

ated.

NSAIDs and Pioglitazone to be avoided in HF.

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Gleanings

New 'Extreme' CVD Risk Category

According to the American Association of Clinical Endo- crinologists (AACE) and *he American College of Endocri- nology (ACE), “the lower the LDL cholesterol the bette*, regardless of where your LDL is to begin with."

AACE/ACE now recommend LDL goals of < 55 mg/dL, < 70 mg/dL, < 100 mg/dL, and < 130 mg/dL for individuals

at extreme, very high, high/moderate, and low risk for

cardiovascular events, respectively.

Extreme-risk goals: LDL < 55 mg/dL, non-HDL < 80 mg/ dL, apolipoprotein B (apoB) < 70 mg/dL

History of premature ASCVD (< 55 years of age in men, < 65 in women).

What are BRCA1 and *RCA2?

BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair dam- aged DNA and, therefore, play a role in ensuring the sta- bility of the cell’s genetic material. When either of these *enes is mutated, or altered, such that its protein product either is not made or does not function correctly, D*A damage may not be repaired properly. As a resu*t, ce*ls are more likely to develop addition*l genetic alterations that can lead to cancer.

Speciic inherited mutations in BRCA1 and BRCA2 increas e the risk of female breast and ovarian cancers, and they have been associated with increased risks of several addi- tional types of cancer. Togeth- er, BRCA1 and BRCA2 mutations account for about 20 to 25 percent of hereditary breast cancers 1 and about 5 to 10 percent of all breast cancers 2. In addition, mutations in BRCA1 and BRCA2 account for around 15 percent of ovarian cancers overall. Breast and ovarian cancers asso- ciated with BRCA1 and BRCA2 mutations tend to develop at younger ages than their nonhereditary counterparts.

A harmful BRCA1 or BRCA2 mutation can be inherited from a person’s mother or father. Each child of a parent who carries a mutation in one of these genes has a 50 per- cent chance (or 1 chance in 2) of inheriting the mutation. The effects of mutations in BRCA1 and BRCA2 are seen

even when a person’s second copy of the gene is normal.

What other cancers have been linked to muta- tions in BRCA1 and BRCA2?

Harmful mutations in BRCA1 and BRCA2 increase the risk of several cancers in addition to breast and ovarian cancer. BRCA1 mutations may increase a woman’s risk of developing fallopian tube cancer and peritoneal cancer. Men with BRCA2 mutations, and to a lesser ex- tent BRCA1 mutations, are also at increased risk of breast

cancer 9.

Men with harmful BRCA1 or BRCA2 mutations have a higher risk of prostate cancer. Men and women with BRCA1 or BRCA2 mutations may be at increased risk of pancreatic cance*. Mutations in BRCA2 (also known as FANCD1), if they are inherited from both parents, can cause a Fanconi anemia subtype (FA-D1), a syndrome that

is associated with childhood solid tumors and develop-

ment of acute myeloid leukemia. Likewise, mutations in BRCA1 (also known as FANCS), if they are inherited from both parents, can cause another Fanconi anemia subtype.

Who s*ould consider genetic testing for BRCA1 and BRCA2 mutations?

Because harmful BRCA1 and BRCA2 gene mutations are relatively r*re in the general population, most experts agree that mutation testing of individuals who do not have cancer shoul* be performed only when the person’s indi- vidual or family history suggests the possible presence of a harmful mutation in BRCA1 or BRCA2.
In December 2013, the United Stat*s Preventive Services Task Force recommended that women who have family members with breast, ovarian, fallopian tube, or peritone- al cancer be evaluated to see if they have a family history that is associated with an increased risk of a harmful mu- tation in one of these genes.

Several screening tools are now available to help health care providers with this eva*uation. These tools assess fam*ly history *actors that are associated with an in- creased likelihood of having a harmful mutation in BRCA1 or BRCA2, including:

woman or the same family

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Gleanings

When an ind*vidual has a family history that is sugges- tive of the presence of a BRCA1 or BRCA2 mutation, it may be most informative to first test a family member who has cancer if that person is still alive and willing to be tested. If that person is found to have a harm- ful BRCA1 or BRCA2 mutation, then other family mem- bers may want to consider genetic counseling to learn

more about their potential risks and whether genetic

testing for mutations in BRCA1 and BRCA2 might be appropriate for them.

If it is not possible to confirm the presence of a harm- ful BRCA1 or BRCA2 mutation in a family member who has cancer, it is appropriate for both men and women who do not have cancer but have a family medical histo-

ry that suggests the presence of such a mutation to have

genetic counseling for possible testing.

Some individuals—for example, those who were adopt- ed at birth—may not know their family history. In cases where a woman with an unknown family history has an early-onset breast cancer or ovarian cancer or a man with an unknown family history is diagnosed with breast cancer, it may be rea*onable for that individual to consider genetic testing for BRCA1 or BRCA2 mutation. Individuals with an unknown family history who do not have an early-onset cancer or male breast cancer are at very low risk of having a harm- ful BRCA1 or BRCA2 mutation and are unlikely to bene- fit from routine genetic testing.

Professional societies do not recommend that children, even those with a family history suggestive of a harm- ful BRCA1 or BRCA2 mutation, undergo genetic testing for BRCA1 or BRCA2. This is because no risk-reduction strategies exist for children, and children's risks of de- veloping a cancer type associated with a BRCA1 or BRCA2 mutation are extremely low. After chil*ren with a family history suggestive of a harm- ful BRCA1 or BRCA2 mutation become adults, however, they may want to obtain genetic counseling about whether or not to undergoing genetic testing.

Do inherited mutations in other genes increase the risk of breast and/or ovarian tumors?

Yes. Although harmful mutations in BRCA1 and BRCA2 are responsible for the disease in nearly half of families with multiple cases of breast can- cer and up to 90 percent of families with both breast and ovarian cancer, mutations in a number of other genes have been associated with increased risks of breast and/or ovarian cancers. These other genes in-

clude several that are associated with the inherited dis-

orders Cowden syndrome, Peutz-Jeghers syndrome, Li- Fraumeni syndrome, and Fanconi anemia, which in- crease the risk of many cancer types.

Most mutations in these other genes are associated with smaller increases i* breast cancer risk than are seen with mutations in BRCA1 and BRCA2. However, re- searchers rec*ntly reported that inherited mutations in the PALB2 gene are associated with a risk of breast can- cer nearly as high as that associated with inherit- ed BRCA1 and BRCA2 mutations. They estimated that

33 percent of women who inherit a harmful mutation

in PALB2 will develop breast cancer by age 70 years. The estimated risk of breast cancer associated with a harmful PALB2 mutation is even higher for women who have a family history of breast cancer: 58 percent of those women will develop breast cancer by age 70 years. PALB2, like BRCA1 and BRCA2, is a tumor suppressor gene. The PALB2 gene produces a protein that interacts

with the proteins produced by

the BRCA1 and BRCA2 genes to help repair breaks in DNA. Harmful mutations in PALB2 (also *nown as FANCN) are associated with increased risks of ovari- an, pancreatic, and prostate cancers *n addition to an increased risk of breast cancer. Mutations in PALB2, when inherited from each parent, can cause a Fanconi anemia subtype, FA-N,that is associated with childhood solid tumors.

Although genet*c testing for PALB2 mutations is availa- ble, expert groups have not yet developed specific guide- lines for who should be tested for, or the *anagement of breast canc*r risk in individuals with, PALB2 mutations*

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Case Report

A Case of acute swelling of hand

Mrs. S, a 40 years old lady, while walking in her home gar- den, on the afternoon of 6/6/17 at [Coimbatore] felt an itch around the middle of her right mid finger. She noticed a small bleb by night and by next morning the bleb had en- larged with re*ness and swelling. She also had severe pain in that area radiating to the hand. She sought help at the local clinic and the prescription showed the following medi- cations: Inj. of avil, oral cetirizine, hyphenac, and amox- yclav. The wound was also dressed at that facility.
The adhered dressing was removed with some difficulty and this is how the hand looked on the morning of 9/6/17.

She is non diabetic, with normal blood pressure, had no tion up the forearm.

fever but complained of severe pain in the hand with radia-

On examina*ion, the wound looked clean with dusky swell- ing on the dorsum of the finger and the hand, spreading up to the wrist. Finger movements were possible but painful. The area was also tender to touch.

The problem here was to differentiate between a reaction to venom and an infection, as the treatment approach is very

different for the two conditions and it was important to

make an accurate diagnosis.

By the rapidly with which the lesion developed, *t was thought to be a reaction to insect venom, despite the fact that the patient did not notice or see an insect actually bit- ing her hand. As the reaction was severe and ongoing, it

was felt that the patient would benefit with a short course

of steroids. Acco*dingly, she was advised to take predniso- lone 20 mgs twice a day, Allegra 120 mgs once a day and paracetamol 650 mgs as and when required, amoxyclav

was continued and she was instructed to do wet dressings at home. She was asked to report back after three days.

She returned after 6 days and this how the hand looked.

There was no pain, movements were near norm*l and ex- cept fo* slight swelling around the scar, there were no other complaints. The scar looked healthy and there was no evi- dence of slough underneath. She, on her own had stopped all medications after three days! She came on July 10nth for some other problem and this is how her hand looked. The*e was no longer any pain, the eschar had dropped off.

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Discussion

Family physicians often face this dilemma of differentiat-

ing acute inflammation caused by infection from that of other acute inflammatory conditions. Local examination is often inconclusive. Careful history taking helps in the diagnosis as it was in t*is case. This case was posted on our Family Medicine telegram group where there was a diversity of opinion between members with several mem-

bers including a surgeon leaning towards infection as

opposed to allergic reaction. The recommended action was antibiotics and wound debridement. However, I felt that given rapidity of development of *ymptoms, this was consistent with an allergic reaction to insect venom, hence chose to use a steroid.

Dr. B C Rao badakere.rao@gmail.com

Practice Experiences

Practice *xperien*e 1

My experience with Menke’s

In our busy clinical practice we may miss u*common diseases; which we may have only read about or rarely seen. The following is my experience with one such dis- ease, which, fortunately has a happy ending.

It was one of those busy clinic hours a month back. In the waiting room there were a few patients. The next ap- pointment was a family of three - husband, wife and their 9 month old son. The little boy was suffering from dry skin related eczema and I started taking relevant history and examining him e.g. allergy symptoms, cold and cough etc. However, during examination I found the kid to be slightly abnormal. He showed no social smile, no

expressions, and was small for age. The thing which

stood out to me was his HAIR-STYLE! He had spiky hair as if h* had used hair gel and the hair was soft and brit- tle.

Curiosity got the better of me and I asked the parents if their kid was suffering from some other disorder. The

lady was surprised and asked me for my diagnosis. I

blurted out the first thing I thought of was MENKE’S KINKY HAIR SYNDROME. The parents were surprised at my spot diagnosis.

This kid had been treated for seizures, hypotonia and failure to thrive before the syndrome was finally diag- nosed by a pediatric dermatologist. We discussed about the syndrome and treatment involved.

Menke’s kinky hair syndrome is an X-linked recessive disorder t*at affects copper metaboli*m in the body caus- ing accumulation of copper *n certain organs and deple- tion in others. The gene involved is ATP7A gene that reg- ulates ATPase enzyme. The features are, sparse kinky hair, unusual facial features like pudgy cheeks, hypother- mia, being small for age and jaundice.

The syndrome was first described by Dr. John H. Menke and treatment was introduced by Dr. Bibudhendra Sarkar.

The treatment is regular injections of ATPase enzyme. The enzyme used to be prepared by Amrita institute, Ko- chi (AIMS) and which the patient’s family used to get administ*red every 21 days. However, AIMS had stopped production of the enzyme. The patient and family were in

a lurch as the condition was life-threatening, if not treat-

ed.

In a desperate attempt, the family contacted Dr. Menke. To their surprise, not only did Dr. Menke respond, he even connected them with Dr. Sarkar, the inventor of the treatment! Dr. Sarkar’s office was more than helpful,

and, informed them that the enzyme is currently being

manufactured by the department of Pharmacy* Christian Medical College Hospital, Vellore.

The patient’s family was happy that their cost of travel- ling and lodging every time they traveled to Kochi (min 50000/-) would be saved. Also the form of enzyme avail- able at Ve*lore needs administration every 90 days, as against 21 days of the earlier version.

I have been following up w*th the patient family on a reg- ular basis as cases like these are rarer than we think (he is the 5 ^th reported case in India). This child could have been easily misdiagnosed as simple dry skin eczema. My happiness stems from the fact that I could be a part of this happy story.

Dr. Saurav Kisalay, Dermatologist, St. Philomena’s hos- pital, Bangalore
drkisalaysaurav01@gma*l.com

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Practice Experien*es

Practice Experience 2

Palpitation cure

Mrs. S sees me once in six months for checking her blood pressure and hypothyroidism. Generally both used to be under control. She has a BP instrument at home and her bimonth*y record helps me to adjust the dosage of the

medicines she is on.

*his visit ho*ever was early and on phone she even fe*t I needed to see her at home as she was feeling very tired, on second thoughts she felt it easier and quicker to see me at my clinic. She *p*eared fairly ok, no breathless- n*ss, sat comfortably, all vital signs including the blood pressure were normal. I wondered what was happening. Has she become a diabetic? I asked her, she said, “I did my blood sugar and it was normal”. What about your thy- roid? Sh* said, “there is still three months’ time for that test”.
“What about medication?” S*e told me that she had stop*ed thyroxine two months back. This took me by sur- prise, as Mrs. S has been a very compliant patient and knew the consequences of stopping the medication. I asked her – “why?”
She said, “my friend was asked to stop this drug by her cardiologist as she was havin* palp*tations and she told me the medicine can have this side effect, so I stopped taking”. “She may have had palpitations, but why you stopped’? I asked. She said in all earnestnes*, “I stopped it before I got the palpitations like she did”. I had no an- swer to this logic of hers.

Now we were back to square one, it t*ok me half an hour of explaining the safety and that only over dosage can cause the heart rate to go up causing the palpitation that her friend is supposed to have experienced. I also told her to tell her friend that no cardiologist worth his salt will advise a patient to stop the drug. What he said must have been misinterpr*ted or misunderstood by this lady who in turn gave this rather unsolicited advice to Mrs. S and made her suffer. Her TSH values were sky high and

took another six months and 3 to 4 visits to set her right.

I am forever surprised to see educated patients, ade- quately *riefed, suddenly stopping the medication, just because some friend told him or her to stop. How come lay advice often scores over expert advice? At least in Mrs. S’s case a *ardiologist was involved, hearsay or oth- erwise, but it has happened in my practice, infrequently

though, without any doctor getting involved. Strange, is

not it?

Dr. B. C. Rao badakere.rao@gmail.com

There’s no doubt that attending a c*nference is a profes- sionally rewarding experience. Personally for me attend- ing WONCA Europe Conference on the sidelines of my family vacation at this beautiful city Prague was a unique experience.

This massive conference was attended by about 4000 delegates, with over 500 ‘posters’ per day and over 200 invited speakers. There were 10 concurrent oral sessions on diverse topics. I remember many well organized con- ferences but this one was a cut above all not just for the diversity of sessions but also for the logistic arrange- ments. The sign posting and live streaming of sessions in different halls at the r*ception area was quite innovative and an effective way of giving directions and avoiding confusion.

For me, the timing was perfect. I was lucky to be there at the venue just when the session I was most interested in

was to begin. A session on ‘person cente*ed care - policy

meet* practice’ It was nice to explore how policymakers and practitioners could find common ground, share ex- periences and make sure that Family Medicine is given ample attention and taken into due account before poli- cies are operationalised.

Another part of the conference that left an impression

was an informal open ses*ion held in the corridor where a random delegate is given 5 mins for presentation, fol- lowed by group discussion. This exercise opened my eyes to small group dynamics during the review and critiquing stage. Interactive skill stations at the venue and an orga- nized visit to practice area were thoughtful endeavors.

Of course, one of the most rewarding things about con- ferences is the ab*lity to network with colleagues and ‘digest’ the new information we are hearing about. It was my first exposure to meet the who’s who of Family Medi- cine from Europe region which I consider a holy place for Family Medicine but I preferred to interact with someone as a novice and analyze their understanding of Family Medicine and their aspirations. I sat at a random table with people I didn't know with the hope of making new friends. It was amazing to see the clarity of thoughts on Family Medicine and it’s development among very young doctors, some of them just *assed out of Medical school. I see this as an impetus f*r my journey and although I still have many questions and options for the direction in which I woul* like to work, I was primarily inspired to keep learning.

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Wonca Europe conference was a delightful change in substance and direction. The process of learning how Family Medicine is perceived and practiced has been en- lightening for me. I have attended several medical con- ferences but rarely have I felt that I truly had so much to learn. My take-away from this one day learning was in- spiration to delve more into Family Medicine education and a desire to explore my own questions regarding prac- tice and seein* if what I am doing as a family practitioner is beneficial to me, my peers and to the community. Overall, this *as an exceptional and memorable experi- ence.

Col (Dr.) Mohan Kubendra mohankubendra@gmail.com

The Sp*ce Route Movement

‘The Spice Route’ is the WONCA South Asia Region working group for new and future doctors who have an

intere*t in family medicine/general practice. It aims to

promote excellence in this field and to address the chal- lenges pertaining to global health. The creation of this group was inspired by the work of similar WONCA groups for new and future family/ general practitioners around the world: the Vasco de Gama movement in Eu- rope, the Rajakumar movement in the Asia-Pacific re-

gion, Waynakay in the Ibero-americana region, and

NAFFDONA in the North America region. There was ac- tive participation from approximately 80 new and future family / general practitioners from India, Nepal, Paki- stan, Sri Lanka and Bangladesh.

To learn more about the Vision, Mission, and Activiti*s of

the Spice Route Movement, I welcome you to visit the

website http://www.globalfamilydoctor.com/groups/ YoungDoctorsMovem*nts/TheSpiceRoute.aspx

Social Media Presence: Twitter: @TSRmovement;

Facebook: https://www.facebook.com/ TheSpiceRouteMovement

Membership:
The Spice Route Movement presents some excit*ng o*- portunities for young family physicians. Again details are on the website.

FM360 – FAMILY MEDICINE 360:
This is a global exchange program for those in Family Medicine/General Practice training and in the first five years of family medicine practice. It is supported by WONCA. It enables participants to spend up to four weeks visiting the Primary Health Care system of a dif- ferent country, and includes host practices from all over the world. This Program is based on objectives, planned by the visitor and agreed by the host, in order to justify the quality of the exchange. During these four weeks, the visitor is expected to shadow the activities that take place at the host practice and to accompany the host in other community-oriented activities.

Note: For legal reasons, all activities are observational and visitors *annot engage in any clinical or administra- tive work.

The Spice Route Movement India Representatives:-

Dr Mohammed Idris Shariff – National Chair, Email:- idris.shariff@outlook.com ; Mobil*: +91-9980851134

Dr Vikram Cheryala – National Secretary, Email:- vikram.chery@gmail.com ; Mobile : +91-7411012090

Dr Kunal Doshi – FM360 Coordinator, Email:- dr.kunaldoshi@gmail.com ; Mobile : +91-8130205671

The National Chapter plan of action 2017-2020:-

of their training opening up research/publication oppor- tunities for young doctors.

Dr. Mohammed Idris Shariff idris.shariff@outlook.com

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MASALA

Today I sent a

patient with diabetes with epigastric dis-

comfort for an ECG.

He came back wit* ECG, looking worried. I asked him what happened , snatching ECG from his hand.

He said " I have sinus problem sir" Perplexed I asked " who said so ?".

He pointed to ECG and showed me "sinus rhythm" print- ed on it.

Ravikumar Kulkarni ravikumarkulkarni@yahoo.com

An inspiring poem
“I bargained with Life for a penny,

And Life wo*ld pay no more,

*owever I begged at evening When I counted my scanty store;

For Life is just an employer,
He gives you what you ask,
But once you have set the wages,

Why, you must bear the task.

I worked for a menial's hire,
Only to learn, dismayed,
That any wage I had asked of Life, Life would have paid.”
― Jessie B. Rittenhouse

www.afpikarnataka.i*

This place is open for advertisements. To place an advertisement, please contact our edi*orial team.

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