Pearl D'Souza
Daijiworld Media Network - Mangaluru

Mangaluru, Jul 3: Doctors Day, a day to celebrate those in the noble profession came and passed by us on July 1 in the midst of growing frustration about the dismal state of healthcare, and incidents of manhandling individual medical practitioner. Without brushing aside the criminal behaviour of a few doctors, how justified is the recent phenomena where sincere doctors get beaten up? Do doctors not have a right to work in an atmosphere of peace? To find out if there was something more to the field than what met the eye in this alarming phenomena, Dr ShreeKumar Menon, registrar, Yenepoya University, helped give some perspective to the issue, while noting possible solutions.

Pointing out to a possible reason that caused bitterness among people, Dr ShreeKumar said, "People expect instant relief to the patient, who would always be expected to walk out hail and hearty. But people must also be accepting of eventuality, the fact that death will come."

Further in the conversation he brought to fore possible systemic failures that may have snowballed and led to disruptions in the doctor-patient relationships.

Dr ShreeKumar Menon

Affordability

Indians use 77.3% of out of pocket expenditure on medicines. The shocking figure shows a dire need for affordable healthcare system.

"Exorbitant cost of medicines, lack of transparency during treatment, and improper functioning of 'cashless' insurance, have caused an enormous pressure among patients in private hospitals," pointed Dr ShreeKumar.

Solutions

As immediate corrective measures, retrospecting on the incidents of violence against doctors, Dr ShreeKumar suggested a revision in medical curriculum to accommodate 'ethical aspects'. "Lack of sensitivity in dealing with distressed patients and relations, frays tempers and causes altercations. At present, core subjects are given more importance, and not much focus is on thoughful interaction with patients, which may make doctors sound curt," he said.

As possible solutions Dr ShreeKumar suggested, "Generic medicines or the 'unbranded' variety would reasonably bring down treatment costs. This has been implemented in Bangladesh, a country with an exceptional healthcare system in place. Besides, hospitals must build confidence among the patients and their kin by clarifying the course of treatment. When the doctor explains the problem, the available options, and the intricacies involved, it puts the patients at ease. Half the problem is solved by the behaviour of the doctor. And finally, a well functioning cashless insurance policy, with reasonable premiums, will do good."

Public Trust

"When doctors cannot detect sickness and start the process of elimination, but the patient dies waiting in the process, the hospital cannot be blamed, as much is done in good faith and professional competence. Yet, institutes remain responsible for the claims and facilities they announce, as public trust rests upon those claims," said a humanities professor.

Dr ShreeKumar pointed out that problems arise when hospitals overcharge despite no availability of the luxurious standards that are mostly 'self-certified'. He said, "As there is no categorisation of hospitals at present, there is no clarity on what facilities are available. This agitates people. People are distressed because healhcare is made unaffordable. To clear the air, there must be standardization of hospitals. Institutions must be graded into categories and charges must be fixed accordingly, so that people know what facilities are available and how much it would cost them."

Primary Healthcare Centres

National Sample Survey Organisation, in 2006, found that 20% of urban and 28% rural households of those who decided not to seek medical care for ailment cited financial constraints as reasons.

Thus, a dire need for state intervention, through primary health centres, which are ironically in a dilapidated state and in need of care themselves. Moreover, these scarcely equipped centres have further reduced affordability to healthcare with the introduction of user fees. It was bound to impact the poor.

Although Karnataka is among the states to have seen significant increase in the number of PHCs during the 2005-2015 period, and a state with an overall surplus of 856 PHCs, the condition of public healthcare systems remains a pressing problem. Shortages of healthcare facilities and staff in PHCs plagues the system.

"If PHCs are maintained and monitered properly, they would be an affordable option. But now, doctors are not moving to rural service. Nurses too are insufficient in number. The government also feels it is not worth to spend on the system and is neglecting the sector. If there was a 50:50 initiative by the government and the private sector, where the former provides the staff and medicines, and the latter, the basic infrastructure, then there would be a possibility of it functioning well," opined Dr ShreeKumar.

Another doctor who had a rural posting during her time as a medical student pointed out to the lack of infrastructure and staff in the PHCs. "The rise in mortality rates is also owing to the lack of transport or ambulance facilities to shift the patient from his or her house to the PHC. The problem is not restricted to the lack of infrastructure within the centres, but also the lack of facilities bringing patients to them," she said.

A healthy population being a major requisite for a hardy nation, and doctors putting in their best to work in a system which allows little scope for improvement, there is much to identify with the plight of doctors, who too work to make the world a better place.