<div>It is ironic that our nation has been unable to maintain the standards in patient’s health management. The case study begins from medical schooling, where no uniform standards of education are laid down. The corrupt administration has further weakened the education system in both government and private medical colleges. Admission to medical schools also happens through paying money and then you pass out paying some more money. And then you set up practice to reap returns on your ‘investment’. This vicious cycle prepares you for the greedy ploys of pharmaceutical and medical implant industry - for using sub-standard drugs and implants on patients, which leads to patients suffering, especially in fracture management.</div><div> </div><div>At our hospital, we receive patients with badly conducted fracture surgeries and when we analyse them we see how simple it was to avert that disaster. The reasons are classifiable as: Improper implants for a fracture, lack of understanding mechanics of fracture and implant, lack of proper instruments to apply them and poor quality of implants.</div><div> </div><div>Implant failure can occur in both branded and local implants. Failure in branded implants is because of ignorance of surgical techniques. In non-branded implants, it is due to poor quality metals, poorly polished surfaces, mismatch between screws and implants allergies – precipitating infection and loosening. Surgeon’s understanding of the mechanics and skill in applying the branded implants is the key to success.</div><div> </div><div>Many failed bone unions are among educated city dwellers who, like Sunetra, have not asked questions or discussed the treatment with their surgeon, but fearfully submitted themselves to bad fracture management. Good quality branded implants when understood perfectly, can only deliver success. </div><div> </div><div>Why did surgery No. 1 go wrong? Why did the surgeon have to re operate? Did Sunetra have a choice? Had her first surgery been done right, there would not have been a second or a third. Her second surgeon preferred to use a local made intramedulary SS nail. ‘Local’ only means not of accepted quality. This one fails too and Sunetra goes to a third surgeon, who repeats surgery…! </div><div> </div><div>It is very sad that for a simple fracture, she had to spend Rs 4 lakh. What she got in return was pain, loss of job and income, inability to perform routine activities, and disruption to the lives of all family members. That some surgeons advised her to leave the fracture as it was and not look for repair, saying now bone cannot unite, bone has inherent problem – is a function of the same inattention to what we bring into the medical profession that I alluded to in my opening paras. During both her fourth surgery on her right arm and her sixth on her left arm, we see her recovery because her body received what was compatible with the human system. </div><div> </div><div>This brings us to local and branded implants. Imported implants have stood the test of time and have been in use over decades all over the world. The metallurgy is significantly different and hence the quality is far superior. Their resistance to fatigue and strength are superior to locally made implants. Even the screws are different and made using precision tools which is critical for their matching with the plate. This is what helps implants perform. Sadly this is not obtained with the local plates. </div><div> </div><div>Could the problem have been identified sooner? There were enough signs that her fracture was not uniting. Had the first surgery ensured a strong fixation, the patient is asked to perform daily exercises, but in her case she was immobilised. When she was unable to do the exercises it should have rung warning bells. Fracture leads to immobilisation, stiffness, which makes movement painful. This requires intense rehabilitation and will power. There appears to be no follow up or audit. </div><div> </div><div>Healthcare in India begs honesty and ethical standards on the part of healthcare providers, and informed decision making and responsibility for one’s health, from the patients. Every healthcare centre has the responsibility, the duty to provide best quality care, employing experienced skilled surgeons, quality medical equipment, safe implants and accessories and no compromising health for profit. </div><div> </div><div>Profit is an automatic outcome of honest services. The doctor should remain “Next to God”. </div><div> </div><div><em>The author, Dr Mukesh Jain, is a leading orthopedic surgeon of Muzaffarnagar and has successfully operated over 25,000 patients during his 30-year career</em></div><div> </div><div>(This story was published in BW | Businessworld Issue Dated 29-12-2014) </div>
