<div>The narrative of Sunetra’s prolonged travails with impersonal doctors and mishandling hospitals, with a side story of Paritosh to reinforce that theme, profiles the ugly side of our healthcare system. Counterposed is the compassionate and professionally competent figure of Dr Madhav Surya who presents the reassuring face of empathetic and ethical healthcare. Such a conscientious and caring attitude should ideally be the norm but sadly is a rarity in recent times.<br /> </div><div>The skewed relationship of doctors with their patients arises from the asymmetry of information that renders the latter helpless and concentrates the decision making power with the former. The exercise of this power is presumptuously paternalistic at its best and callously exploitative at its worst, in the warped world of commercial healthcare. The prohibitively high financial cost of healthcare, a burden even to the middle class, is bad enough but the biological costs of improper medical treatment compound the suffering.</div><div> </div><div>The kind, caring and trusted family physician of yore, who identified himself with the patient and considered her health and wellbeing to be his prime responsibility, has vanished into history. As technology advanced rapidly and large hospitals proliferated, medical care became increasingly impersonal and commodified. With organised private healthcare aiming for profit maximisation, the lexicon changed to label doctors as ‘providers’ who sell services to ‘consumers’ or ‘clients’. Even the public hospitals, which are expected to provide care that is untainted by profit-line concerns, become rude and inconsiderate under the pressure of mounting crowds and insufficient resources.</div><div> </div><div>It is widely recognised by economists all over the world that health is a classic case of ‘market failure’, where the relationship between the ‘supplier’ of services and those who ‘demand’ (need) care is imperfect. This is because doctors have the knowledge and skills that place them at a height well above their patients, when it comes to making decisions. Without even basic information about the nature of their illness and available treatment choices, patients have no option but to passively accept whatever is advised by their doctors. </div><div> </div><div>This asymmetry of information and power can be reduced by ethical conduct on part of the doctors who not only prioritise the patient’s interests but also willingly share information with them. With the doctor playing the role of an informed facilitator, the patient and her family too have an opportunity to participate in decision making. The outmoded paternalistic model will then yield place to a desirable partnership model. The education of health professionals, in their formative period, must impart medical ethics and infuse humane values to make such a transformation possible. A Patient Charter of Rights is also being adopted in many countries.</div><div> </div><div>The asymmetry is also reduced by patients and their families seeking out information on their own, from other doctors or the internet. This does not always assure accuracy or applicability to the specific case. However, it will at least enable an informed and intelligent conversation with the treating doctor. The doctor too must take the wishes and concerns of the patient on board while helping to choose among the treatment options.</div><div> </div><div>With rising costs of healthcare, the ‘affordability’ factor too distorts decisions. Ideally, this should not detract from the right treatment being provided. Of course, it does not mean that only imported, branded high-cost devices or drugs are the best. Indian made generic drugs and Aravind’s artificial eye lens (for post-cataract care) are inexpensive but reputed across the world for quality.</div><div> </div><div>Private health insurance is not affordable to many and is also very selective in the medical conditions it covers. A system of universal healthcare is the only way the world of medicine can provide appropriate care, relevant to patients’ needs and respectful of their rights. Even as many counties are moving towards this, the High Level Expert Group constituted by the Planning Commission developed a comprehensive framework for implementing it in India (www.uhc-india.org). That is the roadmap we need to adopt if the pain of Sunetra is not to be perpetuated across the lives of millions of other vulnerable Indians. </div><div><br /><em>The author, K. Srinath Reddy, is President, Public Health Foundation of India (PHFI). The views expressed are personal</em><br /> </div><div>(This story was published in BW | Businessworld Issue Dated 29-12-2014) </div>
