Art Of Medicine Consists In Amusing Patient, While Nature Cures Disease
Voltaire’s bon mot was “The art of medicine consists in amusing the patient, while nature cures the disease”. He may have been right in his time. However, today, things are very different. Modern medicine uses drugs and sometimes surgery, supported by counselling and lifestyle measures. How successful, has the alternative medicine which includes acupuncture, homeopathy, herbal medicine, art therapy, traditional Chinese medicine been during and in the aftermath of Covid? Should we rephrase Voltaire’s jest in the words of Edzard Ernst, Professor of Medicine, University of Exeter, “The art of alternative medicine consists in amusing the patient, while medics cure the disease” Emeritus Professor, University of Exeter, UK?
The Covid Pandemic has challenged the health care systems in every country. Countries in Europe and the US, probably with the best facilities suffered the most. The Indian health care is chugging on gamely despite the inadequacies. It is highly stressed and hard pressed to cater to its 1.35 Billion people. Our health care system may be large in absolute terms, but is small when compared to the population. Differences also remain in quality between rural and urban areas and between public and private health care which has been brutally exposed since a year now. Whereas several hospitals have converted 75% to 80% facilities to treat Covid patients, some have converted their all and still some others have had to completely stop treating the out patients or those with other serious medical problems for want of beds and appropriate medical facilities. The Covid has even exposed the reasonably better endowed private health care that has been prone to charge exorbitant, at times inconsistent, so much so that some States tried price capping with mixed results.
Our health care depends greatly on the private hospitals, which provide the bulk of the country’s medical treatment. With twice as many hospitals as in the public sector, it is the bulwark of our health care system. It boasts of an estimated 44000 hospitals as compared to 26000 public hospitals where the medical facilities may be free but woefully short on quality. Even this greatly varies between States. It is so skewed that most of the health care facilities are limited to just seven States. The Pandemic has struck at the roots, exposing the lack of investment in equipment, facilities and staff. Vacancies of staff at all levels, be it doctors or the para medical staff, have left the government hospitals struggling.
There certainly is a need to carry out regulatory reforms in the long run and beyond the emergency that the pandemic has created. The private sector needs a more systematic approach to regulation that is facilitating, enabling and not stifling. It is a serious concern that the health insurance is not provided to 86% rural and 81% urban population. Even the availability of doctors, specialists and para medical staff in our hospitals is found wanting. Yet, we are a popular destination for medical tourists, given the relatively low costs and high quality of our private hospitals when compared to similar in more advanced countries.
Where will the poor go if they fall sick or have an emergency? The PM Jan Arogya Yojana (PMJAY) launched two years ago by the government, to provide health coverage to approximately 50 crore citizens of India must be seen as a boon. With an average amount of Rs. 5 Lakh, it covers a majority of diagnostics, medicines, pre-hospitalization costs, and medical treatment expenses. That it supports cashless and paperless services, work in favour of nominees. Since September 2018, over 15,000 hospitals of which 50% are private across the country have been empanelled under the scheme.
The Union Ministry of Health and Family Welfare, during a recent parliament session informed that there are about 12.5 lakh doctors registered with MCI, in the country giving a doctor-population ratio of 1:1343. While only 3.71 lakh are specialist doctors, a majority of them are located in the states of Maharashtra, Tamil Nadu and Karnataka. Whereas only 67,000 MBBS doctors are produced each year, the bench strength seems to be insufficient. Be that as it may, the government last month issued a notification which authorises post-graduate practitioners in specified streams of Ayurveda to be trained to perform surgeries. However, the MCI opposed the move. One wonders if this is the only way to address the shortage besides raising several ethical and moral questions.
In pursuit of a long-term goal of addressing the need to provide adequate health care to all, the government launched the National Digital Health Mission (NDHM), which is a digital health ecosystem. Every citizen gets a unique ID that stores all the health-related information by the end of 2022 such as disease history, diagnosis, prescription etc. The intent of this exercise is noble and must be welcomed. However, the utility of such an exercise must be evaluated from a people perspective. Whereas it is expected to benefit both patients and healthcare professionals by storing the medical history, so doctors can provide better treatment for the patients, does it not infringe on people’s right to privacy? Will ensuring consent of patients be difficult? That it is voluntary is a positive. Does it really not need the patients to go through all the tests when consulting another doctor? To assume, it can save money & effort of patients may not be correct.
Digitisation of records certainly may bring transparency and accountability. Again, to assume that it in itself will reduce medical errors would be a little farfetched for they can arise out of multiple factors and not just improper use of recorded data. AI algorithms can use the data on prevalent diseases, it’s influence on gender, the vulnerable age groups & regions etc. to craft intelligent policies and schemes for an effective implementation. That the data reducing scope of false insurance claims may or may not be correct. The experience of US and UK must be gathered before digitisation of records may be attempted. For one it is expensive. Even though United States started digitisation of Electronic medical records (EMR) in 1970 it is still to achieve 100% coverage. UK implemented it in 2005 and discontinued in 2013 due to reasons such as insufficient planning, data security risks and lack of trust in healthcare professionals resulting in one of the most expensive healthcare IT failures.
The overall quality of the health care system estimated by Health care Index (HCI), is a function of professionals, equipment, staff, doctors, cost, etc. India with a HCI of 66.21 stands 42nd in a list of 93 countries where it is measured. It is time, this is raised at least 10 points. It is a matter of pride that Dr Harsh Vardhan, Minister of Health and Family Welfare, was recently elected the Chair of World Health Organization's Executive Board. In as much as saying that it is an honour for the country, it is only expected that his voice will make a difference in improving the medical health facilities in the country.
These are Covid times. Technology interventions made now will stay in future like all technology does. Many doctors have been using HIPAA compliant video-conferencing tools to consult patients. Would we see more of Telemedicine in future, where caring for patients happens remotely where the provider and patient are not physically present with each other? It certainly could be an option.
