Healthcare in need of a dose of course correction

It took the death of several infants at Gorakhpur’s BRD Hospital earlier this year to bring to the fore, again, the dismal state of our hospitals.

Contrary to expectations, this did not provoke the kind of action it should have across the country to improve the lot of patients. And 2017 comes to a close with equally distressing incidents involving children, this time out of private hospitals Fortis and Max.

In Gorakhpur’s public hospital, children died from a combination of reasons, including the lack of oxygen at the hospital. At Fortis, parents distraught over their child’s death from dengue found their agony compounded by the ₹16 lakh bill handed to them. The bill included unacceptable margins of upto 1,700 per cent on consumables, as outed by the National Pharmaceutical Pricing Authority.

And at Max, a baby was passed off for dead, only to be found alive later.

Such incidents are not limited to a few States. The year has seen fissures in healthcare by way of protests by doctors in Karnataka, by nurses in Chennai and by ASHA (Accredited Social Health Activist) workers in several States, including Rajasthan, Gujarat and Karnataka. The reasons for unrest vary from stringent laws being proposed for doctors to inadequate wages for nurses and ASHA workers.

Healthcare is ailing, say health experts calling for introspection and course correction at different levels.

“We are paying the price for not paying attention to micro aspects in healthcare,” says Vishal Bali, co-founder of Medwell Ventures. Bali, who had headed the Fortis and Wockhardt chain of hospitals, points out that healthcare has grown on favourable macro factors like a growing economy, demand for healthcare vs its actual supply and so on.

But it is time to focus on the supply-side of skilling doctors, nurses and, paramedical staff. Among the changes needed are increased government spending on healthcare and the establishment of more teaching and training institutions.

Responding to the call for better governance, Bali says the effort should be to self-regulate. An enabling entity like TRAI (Telecom Regulatory Authority of India), which looks at grievances of customers and the industry, could be a good idea. But that mechanism should be developed here and respected by everyone in healthcare, he says; it should not be a political tool.

Representing the “collective conscience of the medical community,” Dr KK Aggarwal, National president of the Indian Medical Association, says 2018 has to be one of “introspection”. “People have grievances against doctors. The doctors are unhappy, we have to see where we are going wrong,” he says.

There is a mismatch of doctor-patient expectations, doctors treat more patients than they can handle because of shortages. In the US, four lakh errors are caused by medical treatments. So while errors are a risk in medical treatment, trust needs to be built through measures like medical audits.

Expressing his misgivings with the National Medical Council, which seeks to clean up medical education, Aggarwal says it replaces an elected body with an unelected one. State proposals to clamp down on unethical margins and referral practices should be done taking doctors’ concerns on board and not by making them work under pressure of constant punishment.

Setting the tone for introspection, Aggarwal says, “We are supposed to follow two bioethics principles: non-maleficence (first do not harm) and beneficence (welfare of all)... A compassionate attitude in practice is more important than the science. Poor, inconsiderate and uncompassionate communication is why most patients sue.”

Currently, there are too many imbalances in healthcare that result in disturbing occurrences, explains Bali. State health schemes are under-funded and partnerships with private institutions flounder as patient reimbursements are delayed. There needs to be an understanding on the ideal formula for sustainability of a hospital.

Calling for balance, Bali says, healthcare needs public and private institutions. And setting right the internal imbalances will address many of the disturbing incidents faced today.

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