Thursday, May 17, 2018

How Poor Patients are Trapped by Super Specialists

HOW POOR PATIENTS ARE TRAPPED BY ‘SUPER SPECIALISTS'

In 1875, a large-hearted Briton, Dr Stewart, the then Civil Surgeon of Cuttack, mooted out the idea of starting a medical school at Cuttack.
In this endeavour, he received the kind support and sincere patronage of the then Lt Governor Sir Richard Temple and Divisional Commissioner TE Ravenshaw. Thus was born the Orissa Medical School. Since then, Licentiate Medical Practitioners (LMPs) were trained in Odisha. In 1916-17, the Orissa Medical School was affiliated to the Bihar and Orissa Medical Examination Board started granting the LMP Diploma.
These dedicated LMP doctors were the backbone of medical service in Odisha. Whether he was a quack or qualified doctor was immaterial for a patient, what was important, his reputation in that locality. They had more practical knowledge and knew the family background of their patients. Difficult cases were referred to towns but in most cases due to transport problem people used to leave patient’s cure on destiny.
The British domination over Odisha began in 1803 and brought changes in the political, economic and social environment of the region. The British faced health problem as the climate of Odisha was different from other parts of British India. Many of them suffered from smallpox, cholera, malaria and diarrhoea. The Maharaja’s council of ministers in general and Pandit Godavarish Mishra in particular worked assiduously to prevail upon the Medical Council of India, as a result of which, the Orissa Medical College was born on June 1, 1944, admitting the first batch of 22 students into the MBBS Degree course.
When we were medical students (60s), there was neither super specialist nor any reservation quota. A MBBS doctor was equally competent to deliver a child by CS or do an emergency appendicetomy.
Remember no ultra sound or CT scan for any pain abdomen—it’s clinical and team decision. Only good students used to joined MD/MS or other post graduation course with success rate of only 30 to 40 per cent.
Rich students or sponsored students used to go to England for MRCP or FRCS or FRCOG.
For our patients, it’s not the degree or super specialist but they want transparency and empathy and sympathy from a doctor. Nowadays, a super specialist is supposed to come in a BMW or Mercedez, behaves very roughly with poor patients or shabbily dressed persons. They are all “byasta daktor” (busy for nothing doctors), one has to wait the whole day for appointment. The super specialist concept has ruined the medical culture. Fragmented in to pieces but a patient is not a machine but a living creature-a human being. Even we have super specialist for only one disease as if there is no life but disease.
Except filmdom and medical world, ‘Super’ is never prefixed in a professional job.These super specialist run from one hospital to another because no hospital can afford to keep these ‘white elephant’ in full time job! Super specialization has increased healthcare cost and has added harassment to patients. It is consumerism, greed, decaying social system and a host of other factors responsible for the rot in the medical system.
The Government has opened many medical colleges in Odisha without realizing that without proper teachers and infrastructure, we would only produce substandard clinicians or Google doctors.
Probably we d not believe in quality but quantity, that’s why to satisfy vote bank politics, medical colleges are opened on roadsides without consideration for the teaching or paramedical staff. In Government hospitals, there are no posts for super specialist, hence these supreme doctors join Government jobs for pension, take leave to go abroad or join private hospitals.
People have lost trusts on hospitals and doctors. Due to fraud in the billing, many hospitals face the wrath of agitated relatives. Brain dead patients are unnecessarily kept on ventilators for days. A day in ICU means Rs 10,000 to Rs 15,000. Everyone wants to be treated by a super specialist as if he or she is a demigod! There is no unity amongst doctors because of super specialist and non super specialists. The super specialists terrorise the other doctors if cases are not referred to them. Like egocentric super stars in Hindi film industry, our super specialists behave the similar way with their patients, which is bad for a noble profession.
This term-super, is not used for teaching stuff or engineers or advocates or any other faculty. Now coming to question of super specialist, the author is of the opinion it’s not required in every hospitals in Odisha. A good MD medicine or MS can diagnose most of the diseases with minimum investigations. Clinical sense or intelligence of modern doctors now rest on smart phones not inside the grey matter of their brain. The empathy word is now confined to dictionaries.
Let’s take one example—a person comes to a ‘star hospital’ with vertigo. He would be asked to go to a neurophysician, who advises a dozen of tests and also refers to an ENT specialist. After CT, the super specialist advises for an MRI. But no one has taken a proper history from the patient. Actually he has spent a few sleepless night watching IPL with beer.
He has money plus insurance hence could afford to go to star hospitals. Once the IPL is over his vertigo would disappear. There are hundreds of such examples in every day medical scenario.
My suggestion to those rich and famous people is to help the society from the medical dragons.
Must have a hospital exclusively for senior citizens both male and female patients in small and big towns. Retired doctors can be given a daily wage basis payment for OPD service only.
There will be no investigations except few essentials ones, same day reports. Nominal charge at AIIMS rate, those who are investigation minded or doctor shopping type may go to corporate hospitals.
To summarise let’s produce doctors who are service minded not business minded, willing to treat common diseases, common people in the periphery.
Let us not create a ridge amongst doctors as ‘simple doctors’ and ‘super specialist doctors’, Instead of producing hundreds of substandard doctors let’s concentrate on quality not quantity.
(Dr Satpathy is an ex-Joint Director, SAIL)

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