Expensive dream or a disaster self bought: Pay millions to be a doctor (#NEET)


Reluctance of candidates to wrap up  expensive medical college seats is just an indicator of aspiring medical student’s   better understanding of  the cruel reality about medical education. Becoming a doctor is not easy these days. Paying crores is like  getting into a trouble zone and getting yourself entrapped into a system of exploitation. It  may be alright for candidates who are from rich backgrounds.  But for the candidates whose families are not  strong financially, it may be self bought disaster. Steep rise in fee of medical colleges has been huge, beyond logic and is injustice to the meritorious.  One advantage of inappropriate media bashing of doctors, recent assaults against doctors has  given some wisdom to  innocent students, who  used to just enter into a system of entrapment unknowingly. Choosing medical career and then trying to place your feet into post graduation, spending crores in all these situations is akin to  falling victim to  a system of entrapment.  Some one paying for it in millions and  crores is an absurd thought  and  highly ill advised. For the candidates who are not financially strong, it may be difficult to even recover the money spent, what to say about the time and youth wasted in  getting a degree which may or may not be that worth.

Therefore it may become  dream turning into nightmare  for the people who can not afford.  Lower merits combined with not so good medical colleges   may produce thousands of degree holders but not good doctors.  Recent sporadic campaign of stray cases projected as generalization  by media has definitely diminished respect for profession. Individually most of the doctors may be working hard honestly but they are uniformly painted in the same colours due to misplaced priorities of the media. Society has already developed a prejudiced mind towards doctors.   Since these projections are created by outside agencies, doctors even with hard work and doing work honestly  may not be able to change the perception that has been created. Damage to profession has been immense and it is nearly impossible  task to reverse the mistrust generated and  undo the damage. If individually doctors are doing good and media continues the negative projection, the sad situation will persist. All efforts by doctors  in this direction are like oil  on the sand.

In  nutshell, this toil and trouble for years, buying a seat, paying millions or crores and becoming a doctor does not save you from vulnerability of court cases and wrath of public. Rather suboptimal training and capabilities makes them  more vulnerable to problems. It may be alright if some one with strong financial background  decides to be a health manager or administrator.

Real problem of mediocrity remains as such. Candidates with higher merit will be left behind as candidates who can buy and pay more will get in. This process  will be called as “lawful selection” along with diluted merit .This process makes count number of degrees distributed under various conditions attached to it other than merit.  But  just number of   degrees will not provide better doctors for future.

“NEET – NOT So NEAT” : Courtesy switch to Percentile system?


Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who   secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college.  Even   an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 20 -25 % marks also becomes eligible to become a doctor. What is the need to dilute and shortlist around half a million for few thousand seats. Answer to that is simple.  To select and find only those students from millions, who can pay millions to become doctors.  

      Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession. By allowing a intentional dilution of quality  can be advantageous only to  few and detrimental to others.

  • Beneficiaries are rich candidates, medical colleges who collecting fee and may be public who will get numbers of doctors. Surplus of doctors is thought to be an advantage to society. But here quality is least of the consideration.
  • Disadvantage to students, who are meritorious but can’t pay, and possibly society in long run, who is deprived of good quality doctors.

 

 

  •      A lower eligibility cut-off would mean that students with even lower percentage       of    marks will be eligible for MBBS
  • Last year, 11,114 students who scored 270 or less out of 720 got admission into medical colleges, mostly in private colleges
  • By the percentile system, last year, a student scoring 270 was within the 80th percentile

 

NEW DELHI: The results of the National Eligibility cum Entrance Test (NEET) for MBBS admissions for 2018 announced on Monday showed even lower cut-offs than last year. The cut-off for the unreserved category is down from 131 out of 720 marks last year to 119 this year, while the one for the reserved categories has dropped by a similar margin from 107 to 96. Over 7 lakh students from the 13 lakh plus who appeared for the exam have qualified to join medical college.

A lower eligibility cut-off for NEET would mean that students with even lower percentage of marks will be eligible to get admission for MBBS. In case you thought just being eligible would not allow those with poor scores to get admission, here’s what happened last year. Over 4,300 students who scored 180 or less in NEET actually got admission to MBBS. The overwhelming majority of them in private colleges, where high fees make it difficult for those with meagre means to join even if they have the marks.

A score of 180 out of 720 is the minimum mark a student would get if they got 40% of the answers right, even if they got all the rest wrong, with the negative marking scheme in place in NEET. Of course, 40% is the pass percentage in most exams. In terms of percentage, 180 out of 720 is a mere 25%. But going by the percentile system of NEET, 180 in 2017 meant the student was within the 64th percentile, well above the 50th percentile cut-off for the unreserved category.

Last year, 11,114 students who scored 270 or less out of 720 got admission into medical colleges, once again mostly in private colleges. If a student got half the answers right, he could not have got less than 270. Before NEET, the minimum eligibility criteria for MBBS admission was 50% through various entrance exams though the quality of some of the exams conducted by colleges themselves was dubious. By the percentile system, last year, a student scoring 270 was within the 80th percentile.
Incidentally, because there are no cut-offs specified for individual subjects within NEET, there were several cases last year of people who qualified and got admission into medical colleges with scores of zero or even negative marks in chemistry or physics. With the cut-offs dropping further this year in terms of percentage marks (though remaining the same in percentile terms), chances are we will see a repeat of worse this year.

If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way  forward.  So children have to be careful while choosing medical careers from the beginning.

A famous axiom “as you sow so shall you reap” has an application to health system in this scenario, so people should not rue scarcity of good doctors.  

Expensive Medical college education (NEET) & poor health system: systematic root rot


Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who   secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college.  Even   an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 20 -25 % marks also becomes eligible to become a doctor. What is the need to dilute and shortlist around half a million for few thousand seats. Answer to that is simple.  To select and find only those students from millions, who can pay millions to become doctors.  

      Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession. By allowing a intentional dilution of quality  can be advantageous only to  few and detrimental to others.

  • Beneficiaries are rich candidates, medical colleges who collecting fee and may be public who will get numbers of doctors. Surplus of doctors is thought to be an advantage to society. But here quality is least of the consideration.
  • Disadvantage to students, who are meritorious but can’t pay, and possibly society in long run, who is deprived of good quality doctors.

 

Dilution of Merit :

  • Before NEET was made mandatory in 2016, the cut-offs for admission were 50% marks for the general category, and 40% for the reserved categories. From the 2016 admission year, these were changed to 50th and 40th percentile, respectively, opening the doors to candidates with just 18-20% marks in the NEET aggregate. Thereby candidates securing 5% marks (physics) and 20% in  biology are also eligible to be doctors (times of India).
  • The student with the highest NEET marks among those admitted into the private university had lower marks than the last student admitted to the open category in each of the government colleges.
  • In the private university, the fees for the MBBS course are Rs 64 lakh compared to just Rs 4 lakh in the government colleges.
  • when NEET was introduced, many private colleges increased their tuition fees many fold.  This  ensured that meritorious students without money would never get admission. The tuition fee is fixed arbitrarily to cater to only rich or super rich students. (times of India)         System of medical business and  medical education is created based on willful dilution of merit.   Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it especially those candidates who may have invested in heavy fees or bought a seat in medical colleges with hefty amount. Some of them, who invested millions for becoming doctors, will be even probably unable to recover their investments. The students with strong financial backgrounds may be more benefited as they can become health  investors or health managers. But for others, it could be a dream turning into a nightmare.

    If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way  forward.  So children have to be careful while choosing medical careers from the beginning.

    A famous axiom “as you sow so shall you reap” has an application to health system in this scenario, so people should not rue scarcity of good doctors.  

NEET: Buying an expensive medical college seat & want to be doctor.  Worthless and unfair


At a time when students, parents and even doctors are uncertain whether opting for medical college along with the vulnerability and risk associated with   becoming a doctor is worth it or not, some are naive enough to pay millions as fee for medical education and for securing a seat  in medical college. The noble intentions of NEET were to minimize wastage of seats due to multiple admission procedures running concurrently and to do away with the variable criteria for selection used for admissions. But  there has been unregulated steep increase in fees of private medical colleges. So in the end, seats remain unfilled and may be a kind of auction, whosoever can pay millions, takes the seat.

        Going by selection of candidates as doctors, If given a choice, by whom  a patient will like to get treated? A candidate who scored 30 % marks or a person getting 60% or 80%  marks.   NEET eligibility getting lower and  a  candidate getting around 30 % of marks  may be able to secure a degree to treat patients.  What will be the deciding factor? The criteria as to why a person with 60%  marks will  not be given a seat and with 30% marks will be able to secure. It will depend upon, whether  a student  is able to pay the exorbitant fee or not. Present system and mechanism of admission permit and accept such huge  variation! That strange equation is acceptable in lieu of money paid!

It is ironical that the medical profession is regulated, but medical business or medical education is not.  Such business of producing doctors based on their paying capacity should be clearly trounced for the benefit of public. Foundations of healthcare should be on touchstone of merit, ethics and character and not based on business deals. Therefore meritorious students, especially from average backgrounds, who opt to become doctors feel cheated when they pay massive fee to buy a seat. It is an insult to the very virtue of merit which should have been the sole criteria for these admissions.

Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it especially those candidates who may have invested in heavy fees or bought a seat in medical colleges with hefty amount. Some of them, who invested millions for becoming doctors, will be even probably unable to recover their investments. The students with strong financial backgrounds may be more benefited as they can become investors or health managers. But for others, it could be a dream turning into a nightmare.

   Buying a seat may be a compulsion for many as a  result of entrapment into a system. Once aspiring child  decides to be a doctor  and there may not be any other way forward.

A famous axiom “as you sow so shall you reap “  has an application to health system. As NEET has been implemented and there has been some effort to find out information about  admissions to medical colleges, at least tip of the  iceberg is getting visible.  More you know or read the news items about NEET, more one is convinced that industry  selling medical college seats has been quite powerful and practically, every technique to sell seats is prevalent to by pass the merit and deny seat to deserving candidates. These meritorious children, who are denied seats could have been   good doctors and   real custodian for the health of people.  But if for some reason, business prevails and government fails to prevent this cruel and corrupt selling of medical seats, an Einstein brain is not required to  guess the whole malaise prevalent in health system.  Foundation  of  medical system is suffused with sand rather than touch stone of merit.

Astronomical and unreasonable fee of medical colleges without proper facilities and medical education can be born only by investors and not good candidates.   It is the people and society, who will be the real sufferers in future. Therefore resentment to such system should come from the society.

If every one is happy by the arrangement, then one has to introspect, whether  society really deserve  kind of  doctors, they wish.

NMC Bill and bridge course, a suggestion: How to create doctors for area of need, if required?


Crosspathy is dangerous to human race and potential global catastrophe because of antibiotic resistence.  All  allopathic medicines are hazardous chemicals in inexperienced hands. Incorrect and massive use of antibiotics will  cause antibiotic resistance, which has global ramifications. From this angle, it is a retrograde step. When all over the world, need is being felt that there has to be better control of antibiotic prescription.  We are entering an era, where antibiotics are getting useless and more so because of rampant misuse of antibiotics.  Rather than exercising a better control, it will be a catastrophic to human race world over by causing antibiotic resistance.

Will  thousands of alternate medicine graduate will dispense all antibiotics,  anticancer , anti diabetic , cardiac medications? It is hard to think about hundreds of potentially dangerous medicines being given without structured training and  proper exams in this system of crosspathy.

Following steps should be taken before implementation:

 

Main Aim; to create doctors  for area of need. (AON doctor)

  1. To identify areas of need; most basic step is to identify the areas of need, where doctors are not available. Government should identify area of need and implement the scheme in selected areas, and with  selected simple drugs. Such areas should be such that which do not have medical facilities or lack doctors. Areas which already have doctors will not accept the diluted  or suboptimal care, for example urban population.
  2. Limited seats-To identify the number required; let us say start with pilot project of  selecting 500 to1000 such doctors. All the lakhs of alternate doctors  can not be allowed to prescribe allopathic medicines. It will put the community at risk.

 

  1. To identify the skills required for the area; for example emergency, for paediatrics or obstretics and gynaecology, trauma.
  2. Willingness to work in area of need- to identify the doctors: have a written competition from all candidates who apply for bridge course. To identify doctors who have given willingness to work in these areas of need. People who perform well should be taken for bridge course  only on limited seats. Bridge course should not ne free for all.
  3. To develop a structured bridge course, which should be around one year after comparing the course of MBBS and the course done by the candidate.
  4. Admission and exit in the bridge course should be through exam and limited seats.
  5. Bridge course and allopathic medicines should not be made free for all, that any body can dispense it. We can get benefit only if is specific to needs of people. If everyone is allowed to practice allopathy in all locality, it will be a global hazard besides our community as well.
  6. These trained doctors will have an undertaking to serve in area of need only. For a period at least 10 to 20 years.
  7. Number should be limited but training should be good.
  8. A special course needs to be designed separately for one year, so that people in area of need do not get substandard care

Without proper planning and implementation and identification of area of need, this bridge course will not benefit anyone, rather it can be disastrous.

 

 

NMC bill, Medical crosspathy and antibiotic resistance : recipe for potential global catastrophe


   Genesis of a system, where every body will suffer and no one is beneficiary.  There has been lot of debates going on  about the Government willingness to allow crosspathy. There has been indications in newspapers about possibility of government  allowing Ayurvedic,  homeopathic and Unani medicine graduates and others  to practice modern allopathic medicines.  Most importantly which medications will be allowed to be practiced? Will  thousands of alternate medicine graduate will dispense all antibiotics,  anticancer , anti diabetic , cardiac medications. It is hard to think about hundreds of potentially dangerous medicines being given without structured training and  proper exams in this system of crosspathy. No one is bothered about the fact that every allopathic medicine is a potential hazardous chemical, if not used properly.

              It will be done through some bridge course. The structure and effectiveness of the said course is yet to be knowm. Whether it will be of 3 days or 3 months?  Who will be able to do it ? whether some level of efficiency  will be expected or every body will be allowed to just dispense allopathic medicine. What ever some one may argue, bridge courses can not be substitute to proper training for these complex diseases and drugs. Following may be side effects of dilution  of medical education and crosspathy:

  1. Alternative or ayurvedic medicine systems themselves: detrimental to these systems themselves because of many reasons. If  the  ayurvedic doctors   start allopathic practice, how we expect ayurvedic stream to florish and respected. It will be diluted to no end. After few years no one will be left will ayurvedic practice.  In my opinion it is a death sentence to ayurvedic system.

       Secondly,  the decision is not respectful to ayurvedic stream itself. Stream of                Ayurveda will suffer.

  1.  Public and patients: crosspathy clearly means a diluted and suboptimal medical services. Government may create few area of need and implement the scheme in selected areas, and selected simple drugs.
  2. Allopathy will be clearly a sufferer. If every body can practice allopathic medicine, why one should go for rigorous training. It will discourage the people who have opted and got admission to allopathic courses. They are paying and slogging hard for their training.
  3.  Dangerous to human race and potential global catastrophe:  All  allopathic medicines are hazardous chemicals in inexperienced hands. But  incorrect and massive use of antibiotics will  cause antibiotic resistance, which has global ramifications. From this angle, it is a retrograde step. When  all over the world,  need is being  felt that there has to be better control of antibiotic prescription.  We are entering an era, where antibiotics are getting useless and more so because of rampant misuse of antibiotics.  Rather than exercising a better control, it can be a catastrophic to human race world over by causing antibiotic resistance.
  4. have our public and people given consent for such diluted medical  excellence and services? It is  public  ultimately who  accepts  a decision for suboptimal medical service. Government may create few area of need and implement the scheme in selected areas, and selected simple drugs. But that also has not been planned.

 

25 factors -Medical treatment costs becoming expensive: are doctors responsible?


Although doctors are blamed for expensive medical treatment, but the real cause  is the aberrant evolution of medicine and medical education to almost an industrial model. There has been tremendous rise in health care  expenses in last few decades and it is usually borne by the government, taxpayer, insurance or patient himself. Discontent is all the more if patients  are unable to bear these expenses and if the results are not as per  expectations ( realistic or unrealistic).

Following features have led to increasing dependence on investors in medical field which then has to run along the lines of an industry to ensure its financial viability-

1.Newer technology and  rapid advances in newer innovations in medical fields  for improvement in diagnostic and newer treatment modalities. If a hospital or doctor does not upgrade, it will be regarded as  having obsolete technology.  Most of these medical technologies  are extremely expensive and owned and marketed  by big multinational companies who  sell them.

Since cost involved is very high, there can be various types of deals involved between  middlemen  involved in selling and buying these equipments and technologies. Doctors  are the  end users of these technologies, but  not part of business process. They are actually the consumers and users  for  these technologies.

2.Expensive real estate:  A self made doctor at the start  or even during his life time, does not have the kind of finances  to build  a hospital which needs a large parcel of land with commercial location. Therefore there  is a need for big investment or investor to pitch in and invest funds.  And if they invest, obviously they would look for some returns.

3.Equipping the Hospital: Building of hospital with the  infrastructure  and equipping it well needs lot of money and investment which only an investor can provide. Same is true for maintenance of equipment, bills,  insurances, AMC  etc.

4.Staffing of Hospital: A hospital needs lot of skilled human resources, health care being a highly labour intensive industry.  Doctors , nurses,  technicians, para medical, administrative and clerical staff is required.  Employment of non medical  in hospital industry too has been increasing because of various regulatory requirements and complex processes other than just treating patients.

5.High regulatory requirements:  globally the requirements of regulatory authorities have been sky rocketing and it requires  a lot of manpower to maintain such data. Getting accreditation etc are  processes which requires manpower, time, and a legal team. All these legal  requirements are expensive.

6.Consumer protection act:  This single important factor can increase the cost of  healthcare for the patient. As doctors are increasingly scared of being dragged to court, they are always on backfoot and are forced  to do defensive practice. Investigations are required for documentation. Patient and courts will ask for proof and goes by documentation.  Medical problems are very complex and  sometimes it is difficult to judge  the future course of disease or decisions for surgery, or how patient will behave before or after surgery. A doctor, thus, will always try to play safe legally  in present scenarios. Because everything he does will be scrutinized later, with retrospective wisdom,  by courts. And   since doctors manage  so many patients everyday, they never know which one will harass and deceive them  later.  Mistrust has increased to such an  extent that patient relatives do not understand even if things are told in good faith and in patient’s interest.  Summarily doctors have to safeguard themselves from treatment as well as legal and  documentation hassles.

7.Expensive legal services:  Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors. Increasing mistrust and unhappiness in patient’s mind definitely does not  help patients and doctors. Strangely  doctor’s fee are quite low but lawyers charges them astronomical amounts, which are beyond any logic.

8.Increased expectation of patients : People want exceptional care, best in the world with best technology,  that also at a price less than  even a meal in restaurant, and then they want a quick relief!!  This is an expectation almost impossible to fulfil. Even government hospitals, which are funded by taxayer’s money find it difficult to provide free treatment with quality.

9.Large claims given by courts:  in a country where people  fight with their parents, brothers and  sisters for money and property, it will be naive to think that idea of making money from doctor  does not exist. With court compensations going into crores, doctors  can sense many times that some patient relatives  try to use the opportunity. They have nothing at stake so they try to make some noise on social media and harass the doctor in court or on social platforms. Even for patients, who had poor prognosis at the very onset of treatment, relatives can create problems. Doctors have no protection from these nuisanse. All these factors further enhance insecurity in doctor’s mind.

  1. Expensive and time consuming Medical education, on sale: Although an open secret , as reported routinely in news, medical seats are big business. Each private medical college seat sells for huge money. Such doctors, who have purchased seats have already  behaved as investors. Once these  doctors are in practice, they will try to  recover the investment. This can obviously push up the health care costs not to mention vitiation of the medical fraternity.

11.Requirement for maintaining huge data and audits:  to maintain standards, to have accreditions, for medicolegal issues , large data storage, audits and surveillance is required. These systems also need  new systems and manpower.

12.Employment of large numbers of  non-medical personnel:  earlier management work was handled by doctors. All senior doctors were given small and differnet  departments of  administrative work at very little  or no extra cost. But now for all these works separate administrators  are appointed. Now a days ratio of doctors to nondoctors is higher as compared to previous years. Increased regulatory and  and insurance system needs more non- medical staff.

But  productivity of hospital still remains by  doctor-patient interaction.  This change in arrangement in Hospitals has caused  increase in costs and hence pushed the health care  expenses. Advantages and disadvangages of these changes  in arrangement will be known  with time in future.

13.Non regulation of  businesses  associated with large health care industry: for example pharma industry,  suppliers , biomedical, equipments, consumables. Such individuals,  although play important part in medicine, cost, sale and purchase, but are largely  unregulated. Unlike doctors, who are regulated by multiple governing bodies. But doctors are  often perceived  as culprits for these costs escalation.

 

14.Increasing extinction of Single doctor and  small setups: for them it will be difficult to keep pace with newer technology and buying expansive equipments. It will be difficult  for them to manage requirements of new medical system, legal problems . At the most they will continue to provide cheap medical services,  but for only common and simple ailments. It will be difficult to manage serious patients and sick and complex patients in view of high public expectations . These set ups are under severe security threat and pressure because of non – acceptance of even genuinine complications of treatment.  As legal requirements increase,  these systems will become unviable and option of common public for cheaper, friendly services may become extinct. So it will decrease  the  easy and  sometimes last option of  doctors to settle with a small set up. Chances of them to work for investors  and insurance companies will increase, and they will be cheap labour for industry.

15.Medical and health Insurance becoming indispensible:  Insurance companies are every where.  They sell policies to patients , as well as doctors.  In fact, they are  positioned between doctor and patients. They make money from both sides. Obviously more expensive the treatment, more dependence on insurance. Therefore a cycle has been set up.  Increase in  insurance cost  will push health care  more expensive and a vicious cycle is set up. One should not be surprised, if in future treatment to a large extent will be dictated by insurance companies.

 

16.Conversion to a industry:

Because of above reasons Medical and health care has become an industry and needs investors. So as it is business proposition. Funded by investors and run on commercial principles, the  doctors are being slowly reduced to  skilled labour, alienated from the core.

  1. Aging, multiple diseases : as life expectancy is increasing, it is leading to multiple diseases and more complex diseases  and new expensive treatments.  In this changed scenario and  all people  want to prolong life as much as possible. Cost of prolonging life with multiple problems is quite high. It consumes more medication and resouces and hence consequently pushes up the cost of medical treatment.

18.Evolution of complex infections:

    Advent of antibiotics   and germ theory was thought to be game changer in medical history. But because bacteria proved to be smarter than humans and acquired resistant. New and expensive antibiotics have been gradually being rendered useless. Need for more antibiotics is causing treatment to be costlier.

 

19.Evolution  of  advanced treatment:  Invention  of Expensive and new diagnostic techniques along with highly technical treatments by industry is not without added cost.  Although it may be useful in certain patients, but how much it will help overall in masses, for general treatment, as it increases the  cost of overall treatment.

20.Increasing  need for heightened security:  It is not uncommon to have mobs causing physical harms to medical workers  and  damaging hospital properties. These incidents have caused increased need for security for the premises and adding to the cost.

 21.Complex interplay of various industries eg pharma industry and consumable industry:  large  number of consumables pharmaceuticals, sutures,  surgical instruments, IT industry, drugs, implants, medical supplies are required.  These industries supply their items on a price commanded by them and there is complex interplay  of various industries.

  1. Non uniform and variable care and cost:  each city has multiple hospitals. Care and cost varies in  every set up. Even all government set ups are  not uniform in facilities and cost. Private setups  vary in cost and care, to the extent of  maximum possible variations. All this non-uniformity has created confusion in the mind of patients and variation in financial issues.
  2. Poor public health care facilities: due to less expenditure on health care, government health care facilities have been under developed.  Less  investment by government has given way to private health care to flourish.

24: Conversion to a industry model  and entry of Investor: all the above investments are very expensive. Doctors usually do not have that much money to invest. Therefore   Investors and financers  have become indispensible part of health.   once investor invests money, it will be driven on business principles.

 

  1. Future course: I do not see in future that this arrangement is going to change , rather it will be strengthened more and more and quality care will become more costly. Doctors will  be totally  alienated  from financial  and business aspect, because industry will  not be sustainable without an investor.

 

As we look at reasons above, Doctors are no where in the financial picture and  to be blamed for increase in overall health cost.  But since only doctors are visible part of industry, who treat and interact with patients, often they are blamed for  the cost. They have actually being alienated from financial aspect, barring small percentage of doctors, who are financially literate. Consequently, the doctors who will be unable to entrench themselves in the business milieu will be unfit  in future and hence extinct.

Aberrant Evolution of medical profession: will it help the patient?


With advances in medical science, simultaneously there has been aberrant evolution of medical profession, education, regulation and medical industry. By provoking controversy about doctors for varied reasons, medical industry and law has been positioned between the doctor and  patient and  taken a center stage in health care. Till now, doctor patient interaction was the central point of the health industry, a core around which medical industry revolved. But now   this interaction, treatment and  almost everything is controlled by industry and regulated in some manner. There have been technical advancements to promote better treatment and diagnosis but these, at the same time, increase the cost of treatment, involvement of industry and hence dependence on investors.

 There has been advancements, but are they in right direction?

Discouragement  of medical fraternity:  The adage “To err is human” probably does not apply to the doctors anymore. Doctors are definitely regarded different from rest of the humans and are not supposed to have privileges that other persons of humankind are guaranteed. Hence they are harassed often for any adverse clinical outcome even though it may be because of poor prognosis of patient. They work under continuous fear and stress and are punished for each small or big error.

Commercial evolution of medical education: medical student are now forced to pay exorbitant fee with lower standards of education.  

Evolution in medico legal  procedures:  extensive and complex communication, technical advancements and legal interactions has taken a toll on the doctors. But more importantly, how that has improved the patient care or  doctor patient relationship? I feel, it has created fear in mind of doctors and deterioration of doctor patient relationship.

 Evlution of Doctor patient relationship and Trust :In all the complexity, trust between doctor patient has taken a hit. A good paternistic relationship, now has been converted to more of a legal one. Trust has been replaced by  mutual fear.

Evolution of Complex medical regulation and documentation: There has been overzealous regulation of medical profession. Time and resouces which should have been utilized for treatment of patients,  has to be used for complex documentation.

Evolution of media and social media: Painful retrospective analysis of work of doctor by media, courts and public contuse. Decisions which doctors has to take in moments are analysed retrospectively by everyone with wisdom of hindsight over years, without understanding complexities involved.

Evolution of Insurance sector: increasing cost of treatment and  medicolegal component has made both patients and doctors paying to insurance companies.

            This kind of aberrant evolution of medical profession has increased the problems of doctors and patients and it is not helping anyone. Ultimately it will help everyone except doctor and patient. Ultimately discourage the excellence in medical care.

 

Swachh Bharat obstacle: declare “open defecation free zone” only if free of infectious, toxic dog & animal poop


I truly admire and applaud Mr Narender Modi, Hon’able Prime Minister for drawing attention of 100 billion people to the issue of cleanliness outside their homes. No one had ever thought that a Prime minister would refer to this so called trivial issue and make a heartfelt appeal to people. Lot of public interest has now been generated and there is a race among public officials to get their area declared as free from open defaecation. Even celebrities and movie actors like Amitabh Bachchan, Akshay Kumar have backed this cause. All these efforts are really appreciable, but the prime credit still goes to Modiji who spearheaded this movement.

But there is still a serious issue, which is a stumbling block to the realisation of a ‘Swatch Bharat’ dream and remains unattended. I want to draw attention of everyone  towards the problem of animal poo in our country. It is all around us. It is an obstacle to fulfilment of Swachh Bharat Abhiyaan and  a pan-Indian problem. It is actually even a bigger health problem than open defecation by humans. Humans defecate in country side and in open fields. But stray animals and dogs are everywhere. Owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

       Life threatening infections : As a doctor, I would like to bring to your notice that dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. A dog’s digestive system can handle just about anything that it eats and this makes its poop very toxic. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. These heavy loads of bacteria increase the risk of infections in the community. But pregnant women, children and people with suppressed immune systems may are more prone to these infectionsMany diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like  Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms,    Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources in our country. This can lead to a widespread source of waterborne illnesses. Dry  poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment.  This may be an important cause of high rates of community acquired infections among our population.

             Transform health of the country: Hence it should be mandatory that all the  dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering and eventually reduce use of antibiotics. It can help reduce mortality, morbidity, drug resistance and medical costs by preventing many infections. It is my request to highest authorities to create awareness, form policies about disposal and control of animal waste and implement them strictly  to  bring a turnaround in infection rates in our country.

      It is missing key component  TOWARDS A SWACHH BHARAT. My request is to create awareness and form proper policies by higher authorities to cure millions and reduce infections in whole country.

 

If you agree please sign the petition

 

https://www.change.org/p/prime-minister-of-india-swatch-bharat-declare-open-defecation-free-zone-only-if-free-of-infectious-dog-animal-poop?recruiter=821371489&utm_source=share_petition&utm_medium=copylink&utm_campaign=share_petition

 

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