Hara-kiri is not a new word. The great Kalidas is infamous for cutting the same branch of the tree on which he was sitting. Society has not learned its lessons, cutting the same lifeline on which its life is dependent. Ironical as it may seem, it is not astonishing! If as a society we had the wisdom, we would not have had a “Nirbhaya” every day in some corner of our house.
COVID-19 Pandemic has shown the importance of the health sector in general and Health care workers in particular. If we remember the initial commotion where there were no protocols ready, shortage of PPEs, sanitizers, Hospital beds, and higher mortality rates in Mumbai and Delhi, where the disease stuck first, we can decipher that healthcare was not in the agenda. Then there were stories about the doctors being forced to attend COVID-19 patients without adequate gears. Doctors being coerced to open their clinics without even considering whether they and their staffs had a PPE and proper sanitization provisions required to treat COVID-19. As I write it today, many doctors never received any single PPE for them and their clinic staff when the news was that doctors should open the clinic and PPEs will be provided to them. Even today, the doctor’s staff coming to the clinics are not given the local train pass in Mumbai despite the identity card. How are the doctors supposed to see patients? One-man Show!
So, when we talk about Health care, Infrastructure is only one part of it. The other most important parts are the healthcare workers. And they need to be preserved. Doctors, among all of them, are the most valuable yet most vulnerable lot. Care for them, Get the best out of them. Some important points which need attention and deliberation about the pros and cons of the governments and the medical governing bodies are:
- Violence against Doctors or any healthcare Personnel: It should be considered a heinous crime and a central Law should be formulated. The protests against the violence on doctors led various governments to backfoot for some time. But I guess, no government is actually serious in addressing the issues which are pertinent to safeguard the physical and mental health of the doctors and health care workers. Additionally, the Government should provide police forces/ CRPF Forces to protect the doctors if required, and also run TV and media campaigns to inform the public. The most important thing apart from this is that any public figure should not speak any derogatory word about the professionals in general. Any malpractice/ bad conduct of any doctor should be dealt with as an individual. There are incidences when the whole community has been shown in a bad light by using casual words by the people in prominence. Can we Imagine, Doctors, are being beaten today for the death of a serious patient dying because of COVID!
- Consumer protection act: Are patients’ clients or are patients’ “patients”. Bringing the doctors in the ambit of the consumer protection act has been the single most backward step our country has taken. It has eroded the good relationships of “faith” between the doctors and the patients. There were provisions of addressing medical negligence in the Medical Council of India rule book and the same is sufficient. This additional sword hanging on the top of the head of the doctors has made the doctors defensive and has increased the cost of treatment. Medical science is not an exact science. 2 and 2 rarely make 4. Sixth sense, gut feeling, experience, everything forms a part of the treatment. You just need to create good doctors; the rest will be taken care of. Today, we treat the investigations, and every time a patient comes, a battery of investigations is prescribed. Nothing should be missed! Well in that case, every single patient with a sore throat should be tested for COVID-19, because not testing may miss the disease and thus the doctor would be negligent! And since the guidelines have come from the ICMR and the Governments, these bodies are also guilty of negligence. Does it ever stop? NO. When the government makes the public as consumers, they react like a consumer. This is the root cause of the commercialization of the medical profession.
A good doctor applies his/ her mind and wisdom to prescribe relevant tests, waits for their result, and if required orders more tests. There are no miracles and patience is required on the patients’ part also. Today it is estimated that more than 50% of the tests which are prescribed are not useful but are prescribed to complete the spectrum and for the fear of missing a “rare” finding. Who bears the cost? The patient. Result: we have various wellness programs and complete body check-ups with 100 tests, 200 tests, etc promoted by laboratory chains. From treating patients, we have come to treating lab values. As a Doctor, I can emphatically say that there is nothing called a complete body check-up. Relevant investigations after consultation by a doctor are the best way to go about.
There are many cases of threatening a doctor overtly or subtly to reduce the professional charge or to extort money in the name of consumer court. Ask any doctor and they will tell their story. Yes, after a successful lifesaving appendicitis operation, which a patient survives, he can theoretically sue the surgeon for a poor looking scar which impedes his/ her marriage and erodes the self-confidence!
On the Doctors’ front, they spend about INR. 20000 or more amount (on average) per year of their savings to protect themselves through medical indemnity.
Putting doctors in consumer court ambit is a western concept, and in a poor country like India where the ethos of medical practice has been very high, it is time that is should be abolished. “Doctors be treated with respect and patient with compassion and empathy”, is what we should be demanding as a society. Also, no other professional comes under this preview, then why only a doctor? If anyone has any issue, he or she can use the existing laws to address their problems.
- Registration renewal: Doctors are required to renew their registration every 5 years in most of the Indian states. It requires attending seminars and conferences to get CME points. Yes, the logic is good that the doctors need to be updated and with the latest advancement to be able to treat the patients better. But the lack of application of mind by the authorities has made it a joke. Only Modern medicine (ALLOPATHY) stream doctors are required to do so! AYUSH doctors don’t need to update! The number of CMEs required vary from state to state. And on top of it, the doctors have to pay for these seminars. The most illogical thing is that THERE ARE NO FREE SEMINARS/ CONFERENCES ARRANGED BY THE GOVERNMENTS OR MEDICAL BODIES. ON TOP OF IT, THE DOCTORS HAVE TO PAY FOR RENEWING THEIR LICENCES! This is a soft exploitation of the community. And lastly, why only for doctors! Is it not Discriminatory?
There are many more aspects that need to change if we want to take our healthcare to a better level and to make healthcare affordable. Will discuss some other aspects of this challenge in our next article.