Petition for kind consideration: Sh Narender bhai Modi ji, Honorable Prime Minister of India
PMO, Raisina Hill, South block, New Delhi
Paradigm Shift : Patient Care to Health Care
To shift focus from patient care to ‘Wellness and Health’ is the right way. Becoming a patient entails loss of autonomy and dignity, where his / her every action is controlled by a third party; may it be a doctor, nurse, ward attendant, technician, guard or lift operator. Respecting human dignity is a central, moral and social aim when it comes to either health policy or everyday medical care. A patient is a passive recipient of the actions of medical professionals. Doctors act on their subjects; patients are acted upon. Medical professionals give medical care; patients receive it. In a case of PIL filed to deal with farmers’ suicide the Supreme Court had held that ‘compensating the farmers’ families after they have committed suicide is going the wrong way’. It directed the government to create such conditions that farmers do not commit suicide. Similarly allowing a large segment of population to lose health/ fall sick in the absence of wellness services and lack of basic infrastructure and then providing them medical treatment/ICU care at a huge cost and uncertain outcome is going the wrong way. Governments need to take care of the health of its citizens to preserve their health through healthy lifestyle. This will improve productivity and economy and lead to drastic reduction in patient care expenses.
B.Sc. Course in Wellness and Healthcare : Not Doctor
Many dignity violations occur when patients feel they are regarded as objects, rather than as persons worthy of equal respect. This also implies unbearable expenditure on medicines, tests, surgery, transport, room rent etc-all avoidable if simple healthy lifestyle measures are taken by the persons/population as a whole under the guidance of a wellness consultant, who may be a graduate ‘B Sc in wellness and healthcare’, instead of a doctor. The courses in ‘ B Sc in wellness and healthcare’ can be introduced in those universities who offer allied healthcare courses and not in medical colleges. These graduates can be made responsible to take care of the health of a pocket of community, covering the entire population. Focus shifting from sickness to wellness offers a new model of healthcare. This will save 70-80% people from going to the hospitals for expensive / risky medical treatment. This will curtail the need for more doctors or new medical colleges and without increasing budget, most of the population will remain healthy and productive, with no loss of man hours. This will also provide jobs to millions of youth all over the country.
Affordable Medical Treatment : More Medical Colleges is NO ….. NO
The “exorbitant” cost of medical treatment in India drew the attention of the Supreme Court which told the government to “do something” to make it affordable, as the people were unable to get treatment due to the “huge cost”. The apex court’s remarks assume significance as the National Pharmaceutical Pricing Authority (NPPA) had recently said that non-scheduled drugs and diagnostic services constituted major components of charges billed to patients in four private hospitals in Delhi and national capital region (NCR) with margins as high as 1,192 per cent or even more. Need for teaching ethical and affordable care to students and doctors is paramount. Ethical health can be achieved with ‘Minimum medicine, Maximum health’ approach. ‘Say no to all toxic drugs and sparing use of prescription drugs’, should be taught to all concerned.
There is a great need to improve the existing medical colleges and hospitals rather than opening new ones esp. with acute shortage of trained manpower in patient care as well as teaching faculty all over the country. Govt. Medical College Patiala, once a premier institute is a living example of apathy and neglect, which needs to be revived. New colleges may have good buildings, but not well trained faculty and it will produce un-trained doctors. This implies risk to the community and loss of scarce national resources.
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Ayushman Bharat Yojna 2018 can succeed only if the pilferage/profit is not allowed and it is implemented as a mission, by good/well trained doctors. Emphasis needed on wellness and prevention and not so much on patient care. We can reduce the hospital load by 70-80%.
Need for Second Opinion Centers
Since some needless surgery is being conducted in some public/private hospitals due to extraneous resons, it would be prudent to have facility of second opinion before going for surgery e g knee replacement, heart stents, uterus removal, cataract IOL etc. Even services of retired senior doctors/specialists can be utilized for the purpose. Our NGO is willing to provide specialists free of cost, for this purpose at Chandigarh, if such a move comes from the government. This will prevent many avoidable surgeries and unethical interventions
S C Judgment : right to Live with Dignity
Supreme Court on March 9, 2018 said a person has the “right to die with dignity” and can make an advance “living will” authorizing the withdrawal of life support systems if in the view of doctors he or she has reached an irreversible stage of terminal illness. In the historic decision, the top court said right to lead a healthy life also includes “leaving the world in a peaceful and dignified manner” and an adult “has right to refuse medical treatment including withdrawal from life saving devices.” Chief Justice Misra spoke about how societal pressure and fear of criminal liability by relatives and doctors ultimately led to the suffering and the undignified death of the patient. Liberty, dignity and autonomy are essential to the pursuit of happiness and to find meaning in human existence.”
GOI needs to frame a comprehensive law to follow the judgment of S C and give dignity to the dying and the dead.
Hospital Ethic Committee
There is a need to constitute ethic committees consisting of experts in each specialty of medicine in every tertiary hospital, to decide and segregate at the time of admission; ‘this patient unlikely to be cured, and this patient is likely to recover’. After this exercise incurable patient is shifted to hospice or sent home to prevent further torture of the dying person, and avoid national wastage of scarce tertiary care. This will also save loss of life time savings of the patient/family or from debt or financial ruin. The same committee can take a view on ‘how long to keep the life support system and when to remove it’, as directed by the Supreme Court vide supra viz. passive euthnesia
Comprehensive help to senior citizens: Medical emergency or demise Need for dignity and help has been felt for citizens, esp older couples or singles living away from their children who suddenly fall sick or suddenly die. In such eventuality the spouse or the single person is rendered helpless to shift the patient to hospital or to arrange last rites.. If a mechanism is evolved by the Govt. with the combined efforts of the Red cross, police, RWAs, senior citizen’s forum, by which a phone call could bring the needed help to transfer the patient to hospital or arrange last rites in a dignified manner, it will go a long way to mitigate the distress of the persons concerned. As of now such help or care is unavailable.
Most of these recommendations have been discussed in a seminar, where top professionals were speakers and houseful of elite audience. It was organized with the help of GOI at Mahatama Gandhi state institute of public administration Punjab.
Dr. R.Kumar, President SPEAK India (Society for Promotion of Ethical and Affordable Health Care) Phone : 0172 2770499, M : 9876016232, Address : House No. 232, Sector 16 A, Chandigarh 160 015, Website : www.speakforhealthyindia.com