Saturday, November 15, 2008

Man, Medicine and Money

“Sir, but outside they said that I need to undergo a surgery. How come you are telling me that it is not required?” asked the patient worried.
“You do not have a trouble which needs surgery. These medicines are enough to provide relief” replied the counselor. But the patient is not convinced. He questions again, only to get the same reply, this time sternly. He moves out of the room, wondering if the hospital really provides any services.

These are few patients that we come across in our arena. To some of this kind, I myself have answered, who were bold enough to stop me and ask. I told them two stories that I was a witness to: One of my mom and another of my granny. My Mom was told in Mumbai that she needs to undergo knee surgery because she had arthritis. Doctors were ready to put her on an operation table the very next day. But she did not want to. So, she waited and when she came here, visited our hospital for a second opinion. Here the consultant declined surgery prospects, as the doctor had done in the above incident. She was advised physiotherapy and few exercises. It’s been more than a year now. One who could not sit on the ground, struggled walking more than half a kilometer a day, was now fit to sit on the floor and carry on actively with her work.

My granny suffered another ailment which, as per the doctors in Mumbai, had to be cured through surgery. By the time they were to decide if surgery was required or not, they had gobbled up more than half a lakh. They repeated something which was already performed and had concluded with the same results. This was unasked for, yet was made ‘part of their study-process’. If this was not enough, surgery and non-definite outcome was all that they could offer us. What to do? Simple. Got her here, showed it to our surgeon. Who, as usual, declined surgery and finished the stuff with a procedure which was piece-meal. End result - less pain, better output.

It is not to say that every ailment can been cured with minor procedures, and surgeries are hyperbolic representations. But, surgery is performed when surgery is the only option. Minor procedures are undertaken to tackle the minor issues. These minor issues do not require surgeries. If one asks any surgeon, they will emphasize that surgery is the last resort and is only the last option for any surgeon. First they will like to get rid of the diagnosed problem with medicines, and anything that is not a surgery. But invariably, these ‘outside’ doctors have suggested surgery to many a patients who do not need it.

Anyone will say it is because of money. If they want to mint money, they will ask for more money, unnecessary money. It is very easy to point out and blame them. But an inquiry to this action tells us it is because of the way they have become doctors. They studied in years when every other colleague who was an engineer or a journalist or a model was minting money. These future doctors were spending lakhs of their parent’s money, when their counter-mates were giving the same amount, monthly, to their parents. By the time they have a ‘minting’ good qualification, almost whole of their youth (about age from 15 to 30yrs) is over.

Finally when they start practicing medicine, how can one expect them to indulge themselves in social service! They too need money to survive. They too, have the responsibility of taking care of their parents, especially these parents who have spent a fortune on their child.

One argument can be, one should realise in the beginning itself about the scarcity existing at the end of this tunnel, glooming the promised light and refrain from entering this profession.

A New Look

All said and done, money one surgeon gets, currently, is a huge sum and covers up for the debts within few initial years. After which everything is a bonus. The question that gets raised now is the balance aspect. Balance between the number of years spent to become a doctor, amount of money spent in doing so, money charged to recover the expenditure and security of future. If these aspects are looked at, properly calculated, then there might be a ray of hope or a black-hole, depending on the outcome of the calculations.

If education system can improve its standards and get a person degree at a faster pace, then that would be appreciated by all the to-be-doctors. Apart, if a person decides to become a doctor at an early age, then provisions to help such students might improve the student’s quality of life by helping him/her reach his/her’s goal earlier. With the repercussions, this doctor might be in a better situation early.

Second aspect is, money spent in getting the degree. If there is any possibility of reducing the currently placed cost against these studies, then that too would not put much pressure on the parent’s of students. As a result, more students might get into this field. This might lead to reduced cost for patients, thanks to competition that might start and theory on survival of the fittest. This will also enable a person with a ‘social service’ heart to get into it, without much reservation.

This was just at thought. Incase it helps, a new face might emerge, a bit more human this time.

2 comments:

  1. Hi rampy, nice post.

    Another thing that medical education needs is sensitisation. The med students should be sensitised about the ailments in rural areas/public dispensaries, impact of illiteracy of healthcare, post-op lifestyle rollback etc. Otherwise, students often enter the profession with only the "corporate" picture. Many suggest a compulsory internship in a rural/public clinic, but that would only prolong the course period !!

    Also, medicine seems to share a bench or two with "subjective" streams like law and accounts, where one can always invoke the "matter of interpretation" argument to explain one's decision. In spite of the objectivity in inputs collection, the final decisions still remain the doctor's discretion call. True, to-cut-or-not decision is often based on pay-or-not, but if you set aside dishonesty for a moment, doctors still differ on what's good for a patient based, often, on the same data sheets !! And since it's a specialised domain, the aam aadmi often has only a cursory understanding of the picture. If he aligns himself with Doctor A's decision instead of B, because it is, say, "palatable", no one knows whether A or B will prove to be right in the long run. It can always be argued that "a timely surgery might have prevented worsening". This law-enabled phenomenon of doctors gettings sued, sometimes complicates matters. The benefits of medical consumer activism, I think, reaches only the activists !! For the rest, doctors are always put on the defensive and forced to take the most conservative decision ordering maximum no. of tests and often repeating them bcos who knows who is going to sue you tomorrow.

    This, coupled with deep specialization streams are among the reasons, why medicine is getting "impersonalized" day by day. Most often, you get "assigned" to Room No. 6 or Room No. 5 and whoever is the doctor on duty meets you. Remember to ask his name, bcos mostly you may not get to meet the same doc again, you may collect reports directly from the reception. (Name-boards help a lot). Remember, in the olden days, there used to be such a thing called "Family Doctor", whoever even mentions that nowadays ?

    Movie Recommendation: Beyond Borders. Apart from capturing sensitisation and the difficulties faced by aid workers in healthcare, it also depicts compassion fatigue, sometimes found in situations of benevolent medical help.

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  2. More thoughts of mine on healthcare and open-source is linked from here :

    http://whirlmind.blogspot.com/2008/01/fresh-upma-and-old-bindi-fry.html

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