Saturday, April 28, 2012

Health services or commercial dealings?.

I have been reading full page advertisements in newspapers about new hospitals that continue to come up in almost all major towns in India. Most of the new hospitals offer a five star service to the prospective patients. These spanking hospitals have the latest diagnostic machines and clinical investigation procedures and wide publicity is given in the news media to these facilities. There is a trend in some western and mid western countries to travel to India for medical treatment because of the relatively low cost, compared to their native countries. Even in my home city of Pune, spanking new hospitals with most modern machines and latest treatments have come up in several places. During last few years, I have visited some of these places on number of occasions, for making calls on sick friends and relatives, who unfortunately due to some sickness or other, had to get admitted to a hospital. I have always felt impressed with the standard and quality of medical help that is tendered to the patients by most of the new hospitals. On the negative side, the treatments are prohibitively expensive, to put it mildly.
A friend of mine was suffering from an incorrigible ailment for number of years. He was being treated by a medical practitioner, who had looked after my friend and his family for at least four decades. This Doctor, who was of about the same age as my friend, was considered by my friend and his family as their 'Family Doctor or Physician' and was always consulted on each and every health related issue. Unfortunately, this medical practitioner was attacked by some hooligans in his house and was severely injured and subsequently lost his life. Having lost a Doctor, who had been giving them consultation over a long period of time, my friend and his family were suddenly at a loss and did not know, whom to consult in the future and who would be able to give effective treatment to my friend's ailment.

These days, one can see on every street corner, nameplates or boards of dozens of so called medical specialists, who give consultation only in a certain area of specialization. However a medical practitioner with a private practice and who can give general, broad based consultation has become an absolute rarity these days. Luckily my friend did find a new medical practitioner with a general practice and started consulting him and continued his treatment for more than an year. Later, my friend's health deteriorated suddenly and he became gravely ill. When his family contacted the new medical practitioner and requested him for a home visit, he simply refused to do any home visit and asked the patient to be brought to his dispensary. When he was told that the patient was in no condition to travel , the medical practitioner asked that he should be taken to a hospital in an ambulance.

When a patient is taking regular consultation from a medical practitioner, his flat refusal for a home visit, particularly when the patient is gravely ill, appears to me a very bad and almost cruel professional behaviour. Unfortunately, this is what is becoming a norm and a standard practice now in India. Since I have lived abroad for some time, I am very well aware that in most of the advanced countries, this is the standard practice followed. I could have never imagined that medical practitioners in India, would be picking up this practice so soon, when all other things differ drastically, compared to advanced countries of the world.
In the advanced or developed countries, within minutes of your telephone call to emergency medico service, a well equipped ambulance, stocked with all emergency treatment gear and well trained staff turns up at your doorstep and takes the patient within minutes to an emergency ward of a hospital. In my home city of Pune, after making several calls to many ambulance services, one might manage to get an ambulance after a period of half or full hour. This ambulance would have no trained staff or any emergency treatment medicines or gear. This ambulance, in many cases, could also double up as a hearse.

I fail to appreciate this blind copying of the behavioural pattern of the doctors from the advanced western countries by medical practitioners in undeveloped and poor country like India, when they are fully aware that alternate patient care infrastructure is just not available and the patient is going to be truly inconvenienced. I frankly believe that this kind of setting up of an arbitrary norm does not suit the profession of medical practitioners, which is considered as the most honourable profession in the world.

Fifty or Sixty years before, when I was a kid, or for that matter, even fifteen or twenty years ago, the concept of a family Doctor was well entrenched in Indian society. This Doctor would know the health peculiarities and problems of almost everyone in the family. This ensured that proper and just treatment would always be tendered to every member of the family. If an illness took a turn towards being serious, family Doctor would advice about getting the patient admitted to a hospital and would also attend to him personally to see that proper treatment is being given. This concept made the family Doctor the most trustworthy family friend. In the present day system, this bond of trust no longer exists and consulting a Doctor has become just a business deal like getting a service of a plumber.
With this kind relationship between the Doctor and his patient, the aspect of personal care and warmth is long gone. Today, whenever a patient comes for consultation, the relationship has reduced to a straight forward business procedure of examining him, ask him to carry out as many tests as are available, prescribe medicines and finally collect fees from him. Previously, medical practitioners could diagnose patients just by looking at them and carrying out simple checkups. Today's specialists would not prescribe any medicines unless at least blood and urine tests are conducted. There are basically two reasons for this. Firstly, Doctors are unwilling to accept any risk and secondly for the Doctor, a patient is just a client. Once proper medical treatment is prescribed to the patient, Doctor feels no subsequent liability towards the patient.

This new order of things, shift the responsibility of deciding, whether to go to a hospital or to a private dispensary on the patient or his relatives. Naturally most people feel that if they make a wrong choice and there are any serious consequences, the consulting physician can just shun any responsibility and blame the patient for inaction. Due to this fear, people tend to visit the hospitals even when, what they need is simple home medication.

Many so called super specialists these days, procure expensive diagnostic or operative equipments at huge costs. Sometime these equipments may cost more than a few Million. After that, unless that Doctor has enough number pf patients, who are treated with the equipment, Doctor can not recover his investments and make profits. To achieve this, many practitioners start insisting about treatment with those equipments, even when the patient has no real need for that treatment. Heart bypass surgery, Angiography and Angioplasty are some of the common treatments that are being carried out, even when they are not a must. In fact, it is not surprising that some hospitals are seen advertising the machines they have, to attract the patients.

A common man feels at loss to face this new order. In most of the cases these new treatments are prohibitively expensive and very few people can afford them. Avoiding any treatment as long as possible, Consulting friends, books or internet and self prescribing the medicines is being done by many. In the advanced countries, general standard of public medical facilities is firstly fairly good and in most cases, treatment is free. One does not mind making use of these public facilities in these countries except may be by the super rich. In India, the costs of private treatment are becoming prohibitively expensive on one hand and the quality, efficiency, cleanliness and standard of free public hospitals is so poor that no one wants to go there. An average person faces an 'Hobson's Choice' while deciding about the private medical treatment.
Caring for your health in India, is no longer a simple issue of consulting a Doctor. 
28th April 2012 

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