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KPME Act Amendments Part 2: The road to disaster is paved with good intentions


By Dr M Kamath Ammembal 
MD, DGO, DNB, MRCOG

Mangaluru, Nov 15: I was hoping to cover some of the potential negative effects of the KPME Act amendments in this issue. However, some of the reader-comments have made me realise that there is significant trust deficit between public and doctors! This has prompted me to address this deficit urgently.

Interestingly, in a letter dated November 7, 2017, honourable health minister of Karnataka has suggested that "there is a huge information asymmetry" between private medical establishments and the patients. KPMEA amendments hope to correct the same. This "information asymmetry", to my understanding, means absence of detailed education and counselling by the private doctors regarding the ailment, absence of justification for particular tests and investigations requested, lack of explanation regarding different treatment options available and absence of justification for the cost of treatment.

This, in my opinion, is a valid observation but this information asymmetry exists across the board and includes government doctors and is not limited to private doctors. Every patient, irrespective of whether he/she is attending a private or government facility, has a right to be educated and counselled as mentioned above. In other words, the entire medical community should be expected to follow basic minimum standards in this regard.

I was trained at some of the premier institutes in this country before moving on to the UK for further training. I had to first pass a licensing exam to allow me to practise in the UK. The exam requires basic skills such as appropriate communication in complex clinical scenarios, attention to patient confidentiality, privacy and dignity apart from clinical skills. Over the number of years I trained in that country, I observed that these vital skills were inculcated in the medical graduates at a very early stage in their professional life. In fact, I had to "unlearn" some of the faulty behavioural patterns I had acquired in the course of my education in India.

The medical education in India is unfortunately quite archaic when it comes to the above mentioned skills. The focus is more on learning disease than understanding the patients’ concerns. The Medical Council of India still focuses on outdated benchmarks such as number of beds in the hospital than quality of training and treatment before certifying medical colleges.

In my observation, the medical graduates who pass out of Indian medical colleges have significantly better clinical and surgical skills when compared to their UK and European counterparts. Most doctors in India work 24x7, 365 days a year and are extremely hardworking (as a consultant in the UK, I used to work only 5 days a week - 9 am to 5 pm and earn three to four times what a comparable consultant earns in India). Despite this, they lose out due to the absence of any targeted training in communication, leading to "information asymmetry". This, along with a few stray cases of mismanagement and unscrupulous behaviour by a minuscule section of the medical fraternity, leads to dissatisfied patients and breakdown of trust between doctor and patient.

The governments (Central and State), if serious about eliminating this information asymmetry, should urgently reform medical education and prioritise patient dignity and rights over everything else. Senior members of the medical fraternity have particular responsibility in initiating these reforms. The public should lobby for overhauling of medical education at grassroots level instead of blaming the hapless doctors who are actually the victims of a very dysfunctional system and not culprits.

 

About the author: Dr M Kamath Ammembal is a consultant gynaecologist with keen interest in public-private partnership in achieving health indices comparable to the developed world. He was a consultant at Hinchingbrooke NHS Trust, UK, before returning to Mangaluru and setting up Ammembal Women's Health.

 

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Comment on this article

  • Nagendra, Mangalore

    Thu, Nov 16 2017

    Certainly it is wrong for a layman or ayush doctor to judge a modern medical professional. Human mind and biology is not a predictable subject like physics and chemistry. Issue is about integrity and character and money. Professional negligence can only be judged by a person practicing that profession and a man of knowledge. Even a lay man judge can never judge a medical case. So all these problems are about human character and you say of people of no character will judge people who have some character at least.
    How do you judge character? I am shocked to see not one person is talking about meritocracy. I use the opportunity to appreciate some ones achievement as what it is all about. Be it in any field.
    It became too obvious when Rishi Kap[oor said that his family came up on merit, not nepotism. I tell students, look what is meritocracy? it is not caste, creed, colour, gender, financial status, height, weight. It is character. It is virtue. It is principles. The day politicians implemented social justice, they murdered meritocracy. They murdered character. They murdered principles. They murdered values. It is simple. They also killed dignity of labor. They killed equality. They ignored the poorest of the poor. Christian missionaries capitalized on that. They increased schisms, natural schisms. That created imbalance and violence. Islamists exploited the victims. I am seeing all this in a class room of medical college. It is too much in government institutions. Such filth is never seen in private institutions. I went to one medical college in Mumbai as examiner. One nice human being took me around to show his political group. Every one was whispering Sc St, Sc St. I mustered courage and asked the politically strong person! what is that I hear? He laughed and said they were discussing who would be the next principal! Regional quotas is the best reservation policy. No caste, creed, religion, gender, color should be considered in public life.

    DisAgree Agree Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Thu, Nov 16 2017

    We should try to emulate Cuba where education n high quality healthcare is totally free n controlled n paid for by the govt.!!

    Our systems r going the US way where many families go bankrupt funding for the same, which is DISASTROUS as costs r increasing exponentially mostly due to unethical practices n blatant use of costly evidence based medicine!!

    "The Cuban people enjoy better health outcomes in every category of measure: low infant mortality; low rate of depression and sickness in the elderly; and almost everything in between.
    Cuba has the lowest infant mortality and the lowest HIV/AIDS rates in the western hemisphere; they have a life-expectancy equal to that of the United States; and in addition to notable advances in vision and diabetes treatments, have numerous approved vaccines developed and approved for global use......(WWW)

    DisAgree [2] Agree [1] Reply Report Abuse

  • Vincent Rodrigues, Bengaluru/Katapadi

    Thu, Nov 16 2017

    All the lacunas in the act need to be thrashed by dialogue and discussions

    DisAgree Agree [1] Reply Report Abuse

  • Robert Pais, Mangalore

    Wed, Nov 15 2017

    The problem is not ayush doctors. The system needs regulation.
    This act is a step in the right direction. Over prescription of antibiotics and conflicts of interests with gifts from pharmaceuticals also need to be stopped.

    On defense of the reader who is well versed with medical jargon, doc sab , there are well educated people who have access to basic information.

    In other developed countries APRNs ( qualified nurses) can evaluate a patient prescribe medicines including psychiatric care. We have a long way to go.

    DisAgree [9] Agree [7] Reply Report Abuse

  • sharan, Mangalore

    Wed, Nov 15 2017

    If the reader knew the meaning of medical terms he would not have expected the obstetrician to wait with the patient after delivery as pulmonary embolism can occur anytime upto 6weeks after delivery & of course anytime in life even in non pregnant women.Post partum haemorrhage can occur soon after delivery..upto 2hrs usually but can occur upto a week too.Half knowledge is more dangerous than none.I do agree with the same person.s view that one doctor shouldn't see too many patients in too many places else care will be compromised.Then I wonder why patients select the busiest of practitioners for health care & even complain that the doctor doesn't give them enough time..worth pondering.

    DisAgree [5] Agree [6] Reply Report Abuse

  • Seetharama, MANIPAl

    Wed, Nov 15 2017

    In India the private health care in unfortunately unregulated. Doctors charge as they like. This is not correct. Unnecessary investigations are done. Unwanted surgeries are sometimes done. SOme Doctors have no humanity They only of money. Health care has become an industry. This is a sad trend. I personally feel there is a need to regulate care in India especially in private sector. If we unregulate things private care is going to be more expensive. I will tell you the stroy of my father. He had a CVA and was admitted to a nursing home in Mangaluru long back. He was given Insulin to control blood sugar. Unfortunately they gave him too much Insulin and he had less sugar in his blood and he died in the night unmonitored This was long back Those days Doctors are considered as Gods and no one questioned them. There need to be good regulation of Doctors Otheriwise it will only end up as a Money making thing!

    DisAgree [14] Agree [8] Reply Report Abuse

  • Dr.S.Kamath, Mumbai

    Thu, Nov 16 2017

    I am extremely sorry for your Father .You have a true case Could file a case under the Consumer Forum or Consumer Court .Also You can file a case in medical council of India ,Karnataka Branch at Bengaluru.Existing system of complaint redress is enough .You dont need an extra redressal committe with AYUSH Dr as one of the judge in that committe

    DisAgree Agree [2] Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Thu, Nov 16 2017

    In such a vast country how many afflicted patients would have actually won in India unlike?

    DisAgree Agree Reply Report Abuse

  • sri_elder, Karkala

    Wed, Nov 15 2017

    If ayurvedic doctors are not real doctors they should not use Dr with their name.
    They should use some other prefix so that public can clearly identify them.for example ADr.

    In medicine, ayurvedic doctor cannot performer surgeries. They cannot perform post mortem. But still recognised as Dr.?
    Just like deemed university?

    DisAgree [2] Agree [10] Reply Report Abuse

  • Gurudath, M'lore/Mumbai

    Wed, Nov 15 2017

    Many private hospitals to unnecessary test and procedures so that they can inflate the bill. Patients are also put on ventilator without checking if it is required. The same goes for oxygen. In a recent case my close relative who was admitted to a well known hospital here with just a diabetes complication was served a hefty bill for nothing. Doctors are given targets by managements to inflate bill. Pharmacies and pathology labs pay doctors for referring patients to them.

    Governments decision to control prices of coronary stents and some other implants has been working to the advantage of general public. Stringent laws are needed to put to stop unethical practices by doctors. Doctors are also one of the biggest generators of black money. That should be controlled too.

    DisAgree [15] Agree [5] Reply Report Abuse

  • sri_elder, Karkala

    Wed, Nov 15 2017

    I think there is no need of new laws since there are existing laws which need to be implemented correctly...

    Fixing of private clinic fees is something new... That's like voters fixing MLA salary...
    I think no MLA like to decide their salary by voters...

    DisAgree Agree [16] Reply Report Abuse

  • Ivar, Mangalore

    Wed, Nov 15 2017

    Dear Doctor,

    I am in no opinion that the doctors here lack knowledge or expertise. I even do not justify violence against doctors in case of any mishaps. But definitely I am for holding doctors responsible for mishaps.
    There are ample examples where an Obstetrician cares for a pregnant lady throughout the gestation but fail to attend the delivery of the same person if the delivery happens at night. Even if the doctor attends the delivery, there are many instances where doctor returns immediately after the delivery, totally ignoring the chances of postpartum haemorrhage. Shouldn’t we hold the doctor responsible for negligence if the lady dies of bleeding? When you finish one surgery in one hospital and rush to perform another one in different hospital, who is responsible for post operative thromboembolism if occurs? Will the nurses be able to diagnose or identify and treat PE?

    More than any Acts or Laws, a sincere introspection is the need of the hour.
    *Doctors in India should attend limited number of patients to whom total care can be extended.
    * Do not line up five or six surgeries a day, when you get exhausted, you are risking the lives of last patients in the queue.
    *Do not admit more patients in different hospitals and end up not doing justice to any one of them. *Recommend a second opinion voluntarily.
    *Overcome ‘greed’.

    The government should open up more medical colleges. I even suggest to nationalize all private medical colleges. Do not impose heavy fees for medical education so that doctors are not in a hurry to recover the education expenses. Let the KPME Act amendments be implemented. When people understand that medical profession is a very responsible and risky profession where it is not easy to make money, then the demand for medical seats will come down. People who really interested only, will join this profession. … Am I dreaming?? ;)

    DisAgree [13] Agree [8] Reply Report Abuse

  • Dr.S.Kamath, Mumbai

    Wed, Nov 15 2017

    Your Name is Ivar either you are not a Doctor or may be Doctor but still wants to remain as Non Doctor but still use so many medical jargon like Pulmonary embolism and postpartum haemorrhage. Now a days deliveries and surgeries are conducted in Hospitals and there will be Resident Doctors 24x7x365 days monitoring the patient in the event of any complications and appropriate treatments given as soon as possible .Hence there is no question of such an event .But still if happens they can be sued in Consumer courts or my Medical Council of India and due action will be taken
    But the larger worry is Non Doctors or AYUSH doctors pointing fingers at Specialist Doctors and saying this is wrong that is wrong without any basis is totally uncalled for and they spread such misinformation to patients as well
    You are telling Doctors should not see more patients means should see only 4 or 5 patients and KPMEA says Doctors fee should be restricted to Rs 15 that means he should earn just Rs 19500 a month less than a peon

    DisAgree [3] Agree [10] Reply Report Abuse

  • Dr.S.Kamath, Mumbai

    Wed, Nov 15 2017

    Correction KPMEA says Doctors fee Should be Rs 150 per visit

    DisAgree [2] Agree [6] Reply Report Abuse

  • SEETHARAMA UPADHADYYA, MANIPALA

    Wed, Nov 15 2017

    Fully Agree with your views
    Nationalise medical education and give good facilities at Goverment Hospitals
    ABolish private practice
    Let all doctors work under the Goverment
    Then automatically everything will improve
    PS ALL POLITICIANS MUST HAVE THEIR DISEASES TREATED AT GOVERMENT HOSPITAL>

    DisAgree [3] Agree [7] Reply Report Abuse

  • Dr.S.Kamath, Mumbai

    Wed, Nov 15 2017

    Dear Dr.Kamathmam the root cause of this assymetry are following
    1. Modern Medical system study which leads to MBBS degree has been over shadowed by parallel Doctors called AYUSH with degrees such as BAMS , BHMS and BNYS
    2. The place Family Physician which was occupied by MBBS Doctors have been over taken by these AYUSH doctors
    3. Now these AYUSH Doctors treat all patients and then refer in case the case is beyond their knowledge so also MBBS do the same .Then whats is difference between we AYUSH and MBBS these AYUSH doctors argue
    4.These AYUSH doctors are spreading lot of information about patients admitted in hospitals because they can never admit patients directly under their care .The specialist is always MBBS plus MD .Never BAMS plus MD
    5.These AYUSH always have jealousy and anger against the specialists.They are not bothered about the Medical code of ethics and MCI rules does not apply to them .It applies only to MBBS .These AYUSH doctors moment they see a patient will say this investigation was not required ,Patient died due to negligence bla bla bla
    6.To make the things worst KPME A 2017 has included on AYUSH doctor has the judge to assess whether there was any wrong doing by these MBBS or MBBS,MD Doctors or not .Look at the height of foolish ness of our Hon Health minister

    DisAgree [11] Agree [14] Reply Report Abuse

  • Dr M Kamath, Mangalore

    Wed, Nov 15 2017

    I agree entirely, sir. Life is much easier in western world where there is just one system of medicine! Regards

    DisAgree [3] Agree [13] Reply Report Abuse

  • Hilda pinto, Mangalore /Attavar

    Wed, Nov 15 2017

    This is little above board .. Some of us common people understand the KPME act and it's effect .. This surely not the need of the day ..but blaming the innocent Ayush doctors is not fair .. It's Thier profession they too need to live a life of dignity .. They too have professional degrees .. please

    DisAgree [8] Agree [5] Reply Report Abuse

  • Dr.S.Kamath, Mumbai

    Wed, Nov 15 2017

    A Chartered Accountant is given CA to practice Accountancy He should not practice like a Insurance or Mutual Fund agent Right ?
    BAMS means Batchelor of Ayurvedic Medicine and Surgery .If he practises Ayurveda then dignified and I know many who practice pure Ayurveda .I am not commenting on them .They are highly respected
    But if the Practice Allopathy ? and practice like Family Doctor giving Allopathin medicine ?
    Think Over

    DisAgree [2] Agree [17] Reply Report Abuse

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Title : KPME Act Amendments Part 2: The road to disaster is paved with good intentions


 
 
 
 

 
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