September 6, 2016
To make it clear in the beginning itself, the intent of this column is not to blame anyone – be it the public, the government or the doctors, nor to glorify the medical practice or doctors or to explain the plight of doctors.
Then why this column at all?
This is only to outline the status of health care/medical practice in India (both from the public and a doctors’ perspective) and the perception about the same in a very simple, lighthearted manner. I don’t intent to hurt anyone and if anyone feels so, excuse me for that.
This piece reflects only my personal views and I do agree that there could be many other view points which I shall be very happy to debate in a very friendly manner. This is the beginning of a series with discussion on various aspects in the health industry.
Now, the topic
What do you do when you have an headache? Drink a coffee? Take out a paracetamol from your medical kit? Over the counter Saridon?
What if the headache doesn’t subside? Every family member will start to graduate into doctors with a prescription of their own. From hot soups to juices to astringents to referrals. By the time your headache is complemented with enough of this advice, you friend rings up to suggest a neurologist friend of his and gets an appointment fixed.
At the hospital
You are sitting in front of the neurologist room waiting for your turn. Listening to your story for not more than two minutes, the neurologist asks for a CT scan to rule out internal pathologies. You pay a few thousands to make sure you are alright (just a tension headache) to get a few better painkillers prescribed from the neurologist.
So here comes the usual statement ”The doctor ripped me a few thousands for nothing and has given me some basic painkillers which I could have taken anyways”.You friend may add “This doctor always asks for a CT …I don’t understand why ?” Remember the doctor was his friend?
So lets try asking the doctor. “Whats the need for a CT scan?” The answer could most probably be “I’m a specialist. I cannot afford to miss any major pathologies.”
The question everyone wants to know , especially after having a normal report “Was the investigation necessary?”, “Did the doctor perform an unnecessary investigation ?”
I completely agree with this question and everyone has the right to ask about it. But does that really mean what the doctor did was unnecessary or in simple terms wrong? No,he isn’t .He’s a super-specialist who always thinks of bigger more complicated reasons, and has to. So, if both are right, then who’s wrong? Its the system.
A system where a layman with a simple headache which could otherwise be possibly treated with basic painkillers landing at a neurologist’s clinic. Where is the general practitioner or a family physician in this system. You don’t require a pilot to drive your car.
Why is this an issue in health care? Is it because the specialists are aplenty and affordable? May be. That was secondary to the need which I shall discuss later. Its not only in private sector, this is also seen in the government sector too.
The concept of primary health care and its role in medical practice has been completely forgotten by the community (by community I mean the public and the health care providers) and the policy makers. There has been a misconception that primary health care is for the rural areas and tertiary for the urbanites. The tiers are for everyone.
Technically, the primary health care providers comprising the general practitioners ought to be the maximum followed by the secondary level with physicians and then the specialists who should be the least within the tertiary care centres. But on the contrary, we now have a large number of specialists doing all the three. And this paves way for the game of blame.
Health care in UK
Lets take for example, the health care system in the United Kingdom that is completely funded by the NIH, a governmental agency. In this system, no patient can go to the second tier without the general practitioner referring and to a specialist without a secondary tier physician referral, unless someone can afford to pay all by themselves which is usually possible only by a few.
So the specialist spends all his time and energy on complicated/high risk cases needing most attention without actually having to waste time on patients as mentioned above. Simpler problems will get filtered with necessary treatment in the first or the second tier with minimum burden to the patient and resources.
By resources I mean the so called ‘unnecessary CT scans’ and the time and energy of health care providers.Many developed countries have established similar systems like this with efficient management of resources.
India actually has a system, but has faltered at multiple levels making it unsustainable. I personally believe we need to create a diligent system, suiting our local needs, both for the benefit of the patient and the doctors.
(The writer is Head of Bariatric Surgery, Gem Hospital & Research Centre, Coimbatore)
Disclaimer: The views expressed above are the author’s own