Pioneer Health

Good, bad & same old

Good, bad & same old

Stunning medical discoveries like immunotherapy in childhood leukemias, increasing aggression against doctors, poorly skilled private practitioners, shocking rural healthcare system and public angst against the medical community defined a rather tumultuous year which also saw a revamped National Health Policy with big promises

yearend is a  good time  to look through the rear mirror and evaluate the year gone by, to be satisfied with milestones created and  learn not to repeat mistakes of the past. The relentless research in medicine promises to bring in treatment for hitherto untreatable diseases or promise a better cure in future.

Immunotherapy in childhood leukemia, experimental ultrasonic therapy to break  neuronal amyloid plagues in Alzheimer’s disease, augmented reality to train doctors in surgeries, corneal contact lens to monitor glaucoma and deliver medicines, stem cell induced synthetic blood especially for rare blood group individuals, and newer drugs  for age-related macular degenerations are some exciting medical discoveries in different stages of patient trial.

The developments in data transfer and analysis are going to be a big boost for  medicine as well. The use of  smartphones and wearables will enable the monitoring of health parameters and, hence, faster intervention without visiting hospitals. The future seems bright for us all.

 However, the challenges of medical healthcare administration, delivery, cost and quality remain the Achilles’ heel for most nations across the world, especially low-income countries like India. The inequality in healthcare is disturbing, to say the least. The rural health care structure managed by the Government is in a shambles. There is a huge gap in doctor-patient ratio. The poor rural and taluka level infrastructure is a disincentive for most doctors aspiring for better life quality and good education for their children, after years of hard training.

The high ethics of service and nobility of profession are evaporating in the face of daily life difficulties. The staff is inadequate in most places and operation theatres non-functional. Perpetual shortage of quality medicines is rife. Corruption in medical supplies procurement, pilferage and political patronage in transfers are serious stumbling blocks in good healthcare.

Private healthcare providers in most places are poorly skilled or simply quacks. The conditions are worse in backward and tribal  areas. The Government only resorts to temporary and ineffective measures like taking bonds for compulsory rural services from medical graduates and providing financial incentives.

The only way out of this morass is providing better connectivity, building long-term social and physical infrastructure, involving corporates and NGOs and providing medical advice using telemedicine.

The national health rural mission launched by the Central Government aimed at strengthening rural infrastructure but widespread corruption nullifies its potential benefits. It has become a parking place for retired doctors as the pay structure doesn’t attract the young and the talented.

The Government recently announced the National Health Policy, 2017, which promises to increase public health spending to 2.5 per cent of the GDP in a time bound manner. It also guarantees healthcare services to all Indian citizens, particularly the underprivileged. The policy aims at strengthening the public healthcare system and also envisages ambitious improvement in healthcare indices, like mortality rate.

It all sounds so good and noble but the track record of successive Governments doesn’t evoke confidence. The existing bureaucratic system has to be dismantled. Accountability has to be fixed for all, doctor not always being the fall guy.

Another perpetual complaint of doctors is non existence of a transparent transfer policy. The influential ones get away with the prize postings, with no rotation to far flung areas. Many States have very lucrative transfer rackets, allegedly patronised by the politicians. I hope Governments will show more will in delivering good quality healthcare  to rural and semi urban areas in 2018.

The secondary and tertiary healthcare in urban centres is no different. It is either too costly or unavailable. The Government managed hospitals are overwhelmed as the referral systems of patients has totally collapsed.

In view of the poor service at district levels, patients rush to urban centres overcrowding them, making   the dream of health services to all, impossible. The waiting period for urgent surgeries is in years, the rich rush to private hospitals by choice and the poor, mired in poverty, are forced to seek alternative costly treatment.

The overburdened doctors are bound to make more mistakes and judgement errors. The recent tragic incidents lower faith in medical healthcare and often points towards systemic flaws in skill and medical training. The system leaves the patients fuming and bitter and doctors unhappy and grumbling. The entire healthcare delivery system has to be revamped and strengthened.

For too long, the Government neglected medical education. The arrival of private medical colleges on the scene further muddied the waters. They are run by influential trusts and are often short on infrastructure and teaching faculty. They have developed a cosy relationship with regulating authorities, getting favourable decisions in terms of seat allocations and recognition. The merit is often compromised  for pecuniary gains. The final product quality is anybody’s guess. This is going to choke medical healthcare with poorly trained doctors compromising quality for decades.

The recent adoption of National Eligibility Cum Entrance Test promises to address some of the issues. Another step in the right direction is the National Medical Council Bill, 2017, that aims to  replace the Medical Council of India.

The bill proposes provisions for a  common entrance and licentiate exam. It also promises to improve quality of healthcare professionals  in the long run. The Indian Medical Association is objecting to some of its provisions. Ideally, their concerns should be addressed before the draft is finalised.

I am personally in favour of exit exams as it will filter out non-serious candidates and give level playing field for all. It seems a little harsh to medical graduates in the short run but will eventually benefit the passionate and honest doctors.

I wish that healthcare takes cenrtrestage in Government policy in 2018.

  • Research in medicine vowed to bring in treatment for hitherto untreatable diseases
  • Some good medical discoveries were immunotherapy in childhood leukemia, augmented reality to train doctors in surgeries and newer drugs  for age-related macular degeneration
  • Developments in data transfer and analysis a big boost for medicine
  • Use of smartphones & wearables enabled monitoring of health parameters and, hence, faster intervention without visiting hospitals
  • Challenges of medical healthcare administration, delivery, cost and quality remained the Achilles’ heel
  • National Health Policy, 2017, vowed to increase public health spending to 2.5% of GDP
  • The high ethics of service and nobility of profession evaporating in the face of daily life difficulties
  • Private healthcare providers continued to be poorly skilled or simply quacks, especially in backward and tribal  areas.
  • Private medical colleges muddied waters. Merit compromised for pecuniary gains
  • Major problem area was non-existence of a transparent transfer policy 


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