Friday, August 28, 2015

 Resurrection of MBBS and Family medicine, Can it check quackery in India?

It is a burning problem with no policy maker paying attention to.
Certain issues in India are beyond comprehension and logic. Realms of intelligent understanding fail to find a reason, let alone search for solutions!
How can AYUSH graduates be allowed to practice modern-medicine? (But remember: MBBS graduate writing an occasional Ayurvedic medicine get penalised by court!) A simple "devils rush in where angels fear to tread" promotion by esteemed governments!
Forget their validity, government support or political backing; AYUSH graduates practicing modern-medicine do great; in fact, fabulous! Many of them are more successful than MBBS graduates with same years of practice!
How can someone who does not even have any formal understanding of our pharmacology be more successful than someone who has studied our medications systematically for more than 4 years?
Some of the reasons that come to mind are:
  1. AYUSH people know that their graduation is the end of academic journey for them. For most of them, it is a surrogate entry into modern-medicine. So, they start their practice preparations by 2nd year of AYUSH course by doing night duties or becoming a helper to some busy practitioner. They gain their half-baked knowledge and full blown confidence from there!
  2. AYUSH graduates are conservative! Most of them know their limits. Whenever something even remotely challenging is encountered, they wash their hands-off by generating massive fear in patients, thereby referring to a better place!
  3. AYUSH graduates are over-cautious! They want to gain confidence of patients by fast relief. To achieve this, they indiscriminately use higher antibiotics, stronger analgesics, cocktail regimes and so on. Since they have no idea of scientific medicine or antibiotic resistance or ethical practice, they have no moral obligation either. "Ignorance is bliss" applies to them the best!
  4. AYUSH graduates are over the top! They know what our ignorant masses want and they give "what people want"! One IM injection is mandatory for them! One AYUSH practitioner in my place is so busy that he does not even allow the patient to raise the sleeve of shirt; he gives injection into the deltoid region over the shirt of patient. And he has so many admirers for that quality!
  5. AYUSH graduates pose inexpensive! Most of them charge under Rs.100/- per consultation with few paracetamol tablets, some weird colored cough syrup and an IM injection (usually diclofenac), all inclusive. Many of them do all this within 5 minutes! I have seen AYUSH graduates seeing (not consulting; they cannot!) around 100 patients per day on an average! But their cocktail prescriptions involving higher antibiotics cost quite an amount. Most of the patients do not understand the concept of "total expenditure" but are very satisfied with a doctor who charges less!
  6. Since AYUSH doctors know only bits and pieces of pharmacology of modern-medicine, they rely heavily on medical reps of sub-standard pharma companies and local chemists. It is an extremely ugly nexus with of unethical brutes promoting each other! As with any other unethical nexus in India, this only gets stronger with time!
One can probably go on endlessly with this. Advantage of listing this is only when some punitive action can be taken or when it needs to be systematically countered. Otherwise, it is as good as yellow journalism!
How to counter this? We cannot trust government to help us. Most of the governments are against doctors of modern-medicine for unknown reasons! We have to find a solution ourselves!
We can start with some possible solutions. It cannot happen overnight. Lots of cumulative and continuous efforts are needed. But the beginning should happen somewhere too!
  1. If some sort of forced discipline can be brought to qualification of duty doctors in hospitals and nursing homes, it would be a major boost. Any place employing non-MBBS doctors for treating patients with modern medical practices should be brought to the notice of patients. Awareness of patient community should be enhanced in this regard. They should be encouraged to force the hospitals to disclose the qualification of every doctor, including duty doctors, ICU resident, OPD/Ward assistant involved in treating them. Legal action against hospital should be threatened by patients for making non-MBBS doctors serve their medical needs. Every case of medical negligence should be evaluated for involvement of non-MBBS doctors.
  2. The concept of ethical medicine and judicious use of antibiotics should be informed to public through mass-media, newspaper articles and public speeches. Protocols for approaching and treating routine OPD problems should be drawn and should accompany the prescriptions.One of the major ways to cut down the cost to patient is by bringing
  3. the facilities together. A system should be developed where the overall profit sharing happens. Small centres with 3-4 consultation chambers with an attached pharmacy and a small lab should be established. Here, MBBS doctors would act as the back-bone of system with few on-call specialists. The MBBS doctors should charge less from each patient. At the end of month, cumulative profit from all the sources should be shared by all service providers. This way, everyone wins. The take-home at the end of month is higher for everyone. Of course, this involves some "taming down the ego", but is worth it for long run!
  4. The nexus of bad pharma companies and AYUSH graduates practicing modern-medicine should be broken. Generics from reputed pharma companies dispensed by MBBS doctors through their pharmacy is very useful in this.
  5. Every established General Practitioner should mentor at least one MBBS students per year in skills and art of general practice. Those who are unsure of competition can mentor MBBS students from outside place. Professional bodies like IMA should facilitate such mentoring. It is mutually beneficial for MBBS community. Technology can be of great use here. Some portal should act as liaison between those who can mentor and those who seek mentoring.
  6. A good corpus should be generated by donations from hospitals and established practitioners to team up with few banks to provide loans for MBBS (not AYUSH quacks!) graduates at lowest interest possible to establish comprehensive clinics with pharmacy and lab. This will transpire to reducing cost of basic health-care with passing time.
  7. Every MBBS doctor who wishes to make a career in general practice should be trained free-of-cost intensely for 6-12 months under some good hands. This can be non-government arrangement facilitated by professional bodies like IMA in collaboration with senior GPs and second-tier hospitals with a decent pay-package for service of MBBS graduate. Both the parties will be immensely benefitted.
  8. A strong association of family physicians should be created attached to already existing professional bodies of specialties. It should be onus of all the specialists to support the association of Family Physicians in any way possible - financial to academic to legal to supportive and so on. The symbiosis will win than half-hearted fractionated fight.
I sincerely believe that there is no suggestion mentioned above which cannot be attained! It needs few good people with strong will power and dedication. And the best part of these suggestions are - they do not involve Government at any point!
It is not just the question of our survival but also the issue of restructuring the health-care pyramid of our country. Since we cannot rely on government or policy-makers to help us, it is high time to help ourselves. Unity is strength and we should strengthen the base of medical care by mutual support.
I would strongly seek criticism of the suggestions mentioned above with all possible corrective measures. Also, additional feasible suggestions are vehemently encouraged. If even an iota of idea flashes to anyone reading this, please take few minute to pen it down. It may be the most contributory suggestion for future! Please don't kill any positive measure you think which can potentially work!
We need a beginning; we need to be supportive; we need to fight a massive battle - not just for ourselves but for our children, our future, our masses and our final good!
Please be generous with whatever comments you have. All caustic ones are as welcome as compliments!

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