Health&life

Gospels of an Indian Doctor – Love Will Heal the World

‘You’ll meet more angels on a winding path than on a straight one.’ – Daisey Verlaef

Medicine is one of the most sought after vocations and doctors are regarded as most respectable members of the society and most valuable resource of a nation. It is a field that keeps you on your toes, with each day bringing the unexpected. You can’t possibly prepare for every potential scenario, and can’t rely on a translator or a phone app. A career in medicine is definitely no walk in the park.

Globally, doctors suffer from being absent to their own families, being overworked, poor marriages and cliques of uncertainties. The profession comes at the personal cost and is an arduous and lengthy process and the people who hang in there from beginning to end are optimistic and gritty. All of the hard work and sleepless nights help fuel the passion and determination throughout the entire career.

Nowadays, most of the people regard doctors as money minting machines which totally and literally blemishes our professional image. People forget that a doctor also has to pay for rent, electricity, water, salaries and taxes, that too at commercial rates. The medical profession also has a financial draw. Pursuing a career in medicine is far from a quick ‘rags to riches’ story. Few unfortunate incidents are projected by the government, media and society as the face of this profession. There is an uncivilized manner of the unabated media trial on doctors.

There is a sense of deficit of trust between doctors and patients. We have to take spot decisions in emergency situations. There is no need to blame the doctor for the malaise in every situation. Distraught families no longer blame God or fate for the death or disability of loved ones; they blame the doctors who treat them. The human body is full of surprises, and each person might react differently to a medical treatment.

Moreover, corporate philosophy is not in sync with a medic’s moral duties and on the contrary, ethical conduct comes as a doctors’ responsibility and has to face the brunt of public distrust and anger.

The inadequacy of the healthcare system to address the disease burden of entire nation is not to be blamed on doctors. The doctors being the face of healthcare end up being the easy target for the problems in healthcare system.

A unique aspect of India’s health care sector is the limited availability of formally trained health care providers. We need much more investment in health care system and need more and massive regulatory channels to continue to grow our expertise. Do we actually record or report the subjective activity of how our patients are feeling rather than just evaluate the course and prognosis. Evidence-based preventive services can save money and provide high-quality care by helping people avoid unnecessary tests and procedures and are effective in reducing death, disability and disease.

We talk about analyzing data and outcomes, setting goals yet again, looking at trends and statistics from various medical health records, and sometimes we even succeed in identifying the key areas in need of improvement.

We have completely neglected preventive, pro-motive, rehabilitative and public health measures. COVID-19 came at the right moment, the moment of human indiscipline, and the rest is history. The loss is common; we have a whole community in fighting this pandemic together. The human race has been shattered by several pandemics since time immemorial. The warnings had come earlier in form of SARS and MERS.

Globally, doctors who have treated patients with COVID-19 are dying in alarming numbers. As the pandemic sweeps worldwide, confirmed cases of COVID-19 are rising by each day and the toll on the country’s physicians in particular is heightening fears that the magnitude of the outbreak may be much worse than is being officially reported. Most of the doctors get the disease because we lack the necessary protective equipment to be used against it.

If the hospitals don’t take care of their doctors, the system will crash across the board. Nonetheless, the coronavirus crisis might serve as an urgent wake-up call to solve chronic problems that hospitals have faced for years.

Doctors across the world are facing similar predicaments, made all the more acute by the government’s failure to protect them, to provide tests, and to supply enough protective equipment. And every time a doctor falls ill, a health-care system that is already strained edges closer to its breaking point. The pandemic is putting a spotlight on systemic issues in health care, they hope to address.

Although there have been waves of praise toward medical professionals on social media, lauding their work at the front lines of the crisis, with people worldwide singing and thanking their doctors from apartment balconies and homes, healthcare workers are experiencing traumatic experience of combating this little-known enemy.

The pandemic shows the cracks in the for-profit medical-industrial complex. As a result of the pandemic, there’s renewed interest to push for a structural shift that incentivizes hospitals to prioritize preventative health-care for all people, regardless of race or income bracket, over elective procedures that currently generate more revenue.

We need not tamper with the laws of natural discipline and realise that maybe, we aren’t the smartest of species. Our selfish overwhelming greed has no boundaries; it is limitless and is encroaching and disturbing other natural habitats.

We would have to leave behind all our pseudo egoism, petty politics, barbarism, racism, religious bigotries, terrorism, wars and focus and concentrate on mending and maintaining the natural laws which we have tampered with and destroyed. In situations like this, it’s very easy to lose faith and to live in fear of the headlines and the unknown.

There’s a lot of speculation afoot, but we will continue to work together to help make this planet a safer, more inclusive, and more compassionate place to live. COVID-19 crisis has revealed, the true nature of our society, and is testament to the inequalities between us. The virus preys on inequalities in immunity and so does the response to it.

The pandemic is clearly exposing the strength and weaknesses of healthcare systems in every country and highlights the obstacles and inequities in gaining access to healthcare

India has seven doctors for every 10,000 people, half the global average, according to the World Health Organization. Data from the Indian Medical Association shows the country needs more than 50,000 critical care specialists, but has just 8,350. Such a shortage of doctors means small facilities in India’s $55 billion private hospital market are ill equipped to provide critical care even as numbers seeking private healthcare rise because the public health system is in even worse shape. Clinicians in India are burdened with an overwhelming volume of patients.

Government health expenditure is very low, in fact, it is the lowest out of all BRICS countries. Although government initiatives are in place, currently, they are not mobilised effectively to optimise healthcare delivery.

Moreover, patients don’t act proactively and often visit a hospital only when the disease has reached an advanced stage. This can be attributed to lack of awareness about diseases, care and services available.

Looking at the pace of achievements of the targets so far and future targets, there is a need to focus more on framing of the policies in terms of building capacity of existing human resources, enhancing further allocation of finances dedicated toward health care, identifying areas through operational research, which can enhance quantity and quality of care for health care in India. There is a need for comprehensive approach towards disease management, better coordinate care plans to help patients to better manage and comply with their treatment programmes.

What should we conclude?

In India, we have internationally recognized faculty, outstanding facilities, the resources of major teaching hospitals, a large and varied patient population, that combine to provide an environment which leads to skilled physicians and surgeons. We need to look to focus on all the three pillars- education, research and faculty development.

We also need to evolve, promote and encourage high quality, high volume practices and concepts in community programs which are affordable, accessible, sustainable, cost effective and replicable. Given the advances in technology and the accruing evidence of their effectiveness, now is the time to take stock of the changes we can and must make to improve the assessment and training of physicians in the future.

Research experience and supervision, experience in clinical research such as clinical trials, experience in health service or epidemiology research, quality and system improvement and audits, experience in clinical audits, or experience in quality improvement project, adverse event reporting and root cause analysis should form an important part of health care system.

Whether we become clinician-educators, research scientists, business leaders, or private practitioners, we will consistently be among the leaders in the field. By aggressively promoting the development of sophisticated educational tools in tandem with technology, medical education can be revolutionized.

Improving the quality of health care at the system level requires a focus on governance issues, including improving public-sector management, building institutional capacity, and promoting a culture of data-driven policies.

It is vital for governments, implementing agencies, and researchers working in India to collaborate on evidence-based approaches to improve the quality of health care and its outcomes. The healthcare system anywhere in the world has its own share of plethora of challenges. Each and every healthcare system is unique, in its composition as well as adaptability. The challenges we are facing are all addressable and are opportunities for finding implementable solutions.

The improved data to clarify the problems and challenges in providing high-quality health care along with the ability of national and state governments to take appropriate action to improve the quality of care and a well organized overall governance and accountability will definitely go a long way.

Physicians have a responsibility to provide care for ongoing and immediate medical problems, but because they must balance this responsibility with that of prevention in the limited amount of time they have with patients, they are not meeting goals for preventive service provision. If they do take the time to provide preventive services, encounters are lengthened significantly and at the expense of other services.

Choosing the best available services is a laudable goal in light of the time pressures faced by physicians. It would be preferable, however, to pursue solutions that do not require clinicians to abandon applicable and effective services. Alternatives that extend beyond the current model of face-to-face patient care, such as group visits with physicians and nurses, use of health educators or dietitians for counseling, and various forms of patient education through telephone or print or electronic media, should be explored further.

Let’s reclaim our future, to build a happy life despite an imperfect past, even if, the future looks as bleak as the present.

-Dr. Anu Gupta (One of the Prize Winners of Article Writing Competition 2020 in the 25-44 Years Age Group)

Picture Credits: medicaldialogues.in

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