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Excellent healthcare mirage or reality

Excellent healthcare mirage or reality

Private healthcare is reserved for privileged rich, public healthcare suffers from corrupt practices, medical negligence, technological and infrastructural handicaps and poor funding. The new chief minister of largest state of Indian union has taken a note of the pitiable state of sick care in his state and warned the doctors against illegitimately pursue government and private services simultaneously. In corporate set ups there is a risk of ‘paying through the nose, while risking one’s life’, since interventions may be done to meet the financial targets and not in the best interest of the patient.

I had the pleasure of knowing Dr. Vikram Shah a pioneering orthopedic surgeon of Shalby Hospitals at a Healthcare conclave and was impressed. His focus has been on providing excellent patient care. Because he now has a global reputation for being able to provide high quality care consistently, frugally and cost effectively, patients flock to him from all over the world. His trainees admire his work ethics.  This is a key ingredient of his success.  He would not waste money on frills which add to the patient’s cost, but don’t improve clinical outcomes. Because he’s a doctor, he has lots of clinical common sense, and he doesn’t get carried away by the latest toys or technology. It was inspiring to hear his heartwarming story! There is a need to emulate his example.

In search of excellent sick care, patients from across the length and breadth of India come to get treated at the All India Institute of Medical Sciences (AIIMS) in New Delhi. But many of them have to wait for several weeks because of insufficient number of hospital beds. The poor patient, along with his/her family members, continues to suffer and sleep outside the metro station near AIIMS in the bone-chilling cold.

Some Private hospitals in the country claim to possess excellent/sophisticated medical technology and specialist doctors. But these hospitals charge lakhs of rupees to treat serious diseases like cancer and heart problems and even minor ailments. Most Indians cannot access such expensive medical care because they earn less than a lakh rupee per annum. One of my relatives was once admitted to a private hospital following a medical emergency. Commenting on the cost of his treatment, he told me, “I went from being an above poverty line citizen to a below poverty line citizen.” There have been schemes such as the Jan Aushadhi campaign to provide 361 generic drugs at affordable prices and different price regulation policies, but their implementation has been patchy, said Lancet. For instance, kickbacks from referrals to other doctors or from pharmaceutical and device companies lead to unnecessary procedures such as CT scans, stent insertions and caesarean sections.

There is a complex medical-pharmaceutical nexus functioning in our country. Doctors are quick to prescribe medicines, mostly antibiotics, available at select chemist shops. Such a practice does not merely lead to financial exploitation of the patient since the medicines are only available at select shops with a high price but it may also lead to antibiotic overdose, which may in turn lead to antibiotic resistance. With prescription of generic drugs becoming mandatory, the discretion will pass on to the chemist, who are even more unscrupulous.

New York Times published an editorial titled “India and the Post-Antibiotic Era” in which it talked about the world entering a post anti-biotic phase. It mentioned that in India as many as “58,000 babies died from anti-biotic resistant infections” in 2013. A study conducted by UNICEF in Telangana’s Special Care Units (SCUs) found that in 13 of the 19 SCUs, newborns were being administered high doses of antibiotics in 55-98 per cent of the cases.  As per data available with World Bank, life expectancy in India (2013) at the time of birth is 68 years. In Japan and Iceland, the average life expectancy is 83 years whereas in China it’s 75 years. The data is reflective of how badly India’s sick-care system is faring internationally.

Surprisingly, the care of the healthy citizens so that they don’t fall sick is non-existent. Health givers have turned disease profiteers.

 

In good olden days, doctors were totally dedicated and could scold the patients or his/ her attendants for any non-compliance of medication or follow-up. Patients never minded doctors’ sermon and it was a common practice. It added to the prestige of the doctor for taking extra interest in the cure of illness.  Doctors worked for the benefit of the patients and not to please them. Things stand changed now. Greed has overtaken the good sense of certain doctors. Also slightest delay in providing medical attention, leads to aggression and rough behavior by the patient or attendants. If patient desires to be examined by a super-specialist only he will not allow MBBS doctor to even do the routine check up. Things multiply manifold if it is some sort of perceived emergency, sickness of children or labor. The doctor might have done exactly as per protocols or books if he or she has failed in communication, the half of faith and confidence in the Doctor is washed off.  Nowadays, doctors have to comply regarding line of management as per patients liking. There is no question of scolding of patients even for major flaws in obeying doctors’ orders. Notwithstanding disobedience and noncompliance, anything going wrong doctor is the easy target to vent their anger. Any delay of any kind, scolding, poor or incomplete communication definitely lands the doctor and hospital in trouble. Assaults have become common and doctor’s life and freedom to treat is in danger.

Can doctors offer excellent care in this scenario?

It is not a single hand clapping?

Doubts about doctors’ competence and honesty are pervasive as is evident from the practice of taking second or third opinion before starting treatment. It is hard to tell a good doctor from bad, separate a quack from a qualified practitioner, verify their degrees and claims of being specialists. Not long ago a skin specialist practiced as child specialist and an anatomist posed as physician of the elite class in a government hospital in the tri-city. Corporate hospitals can legitimately advertise their services but not doctors. Yet they use media to lure patients by (1) publicizing doctors’ availability schedule; (2) organizing lectures, seminars, etc; (3) making claims of breakthrough in treatment for media coverage even before these are validated by experts; (4) holding free medical camps; and (5) hiring PR firms for brand building and doctors’ interviews.

 

Lack of adequate knowledge can also lead to unnecessary hospitalization, procedures and operations, besides other extraneous reasons. Patient’s mindset of medical attention can lead to unnecessary tests cause direct financial, mental and physical damage, they can also lead to fraudulently wrong reports, unnecessary treatment, and significant increases in healthcare costs. See your doctor only when you have a problem.

 

Doctors, hospitals and insurance firms prey on people’s fear of diseases and collude to inflate treatment costs — for patients, governments and companies. While the scarce medical budget is drained by these sharks, those in need of real treatment are left high and dry. Prices of medical devices patients use are not displayed and profit margins are huge. The patient is vulnerable but trustful and the doctor exploits his trust. Recent drastic reduction in the prices of stents is illustrating example, where the prices have been cut from several lacs to a few thousands. The charge of inserting stents, where the need is not real is simple extortion! How can a hospital/doctor extort somebody’s life savings by performing an unnecessary operation, or to sexually exploit somebody trusting you with everything?

 

While doctors need to be looked after well and with a degree of respect by the society, the doctor has also to come up to the expectations of society to provide excellent care.

 

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