At least 300 sick people and their families sleep on pavements outside the All India Institute of Medical Sciences (AIIMS) in New Delhi every day, having traveled from across the country to get medical treatment. They often wait for days, if not months, to get treated for diseases that could easily have been treated in neighbourhood civil hospitals. Despite appreciable economic progress and scores of new AIIMS and medical colleges being set up since I began my MBBS education at the institute in 1975, the situation has remained largely unchanged.
Why, then, do patients still turn to a handful of trusted hospitals for treatment? Change can happen. After all, India successfully eradicated polio and controlled new HIV infections, but such purposefully executed programmes are unfortunately an aberration, not the norm. Healthcare is still not an election priority because the benefit of improved public health delivery unfurls slowly over years and does not win governments immediate votes.
If the system fails at one level, it can be fixed, much like plugging a small leak in a boat. But when the boat has multiple holes, it needs to be parked at a docking bay for an overhaul. India’s public health system needs an overhaul because despite the mushrooming of public and private hospitals and clinics, public healthcare remains dismal. National programmes to control diseases are periodically revised and strengthened, but the results remain subpar.
There is need for tighter regulation and transparency in the private sector, but knee-jerk reactions such as the capping prices of diagnostic tests and treatments, waiving off hospital bills and temporarily suspending licences following cases of negligence cannot stem the rot.
Change has to begin in medical school. When I was doing my MBBS, one of the professors would start his evening ward rounds with students at 7 pm and finish at midnight, and leaving us starved because the cafeteria closed at 10.30 pm! Poor regulation of medical education over the years has led to few classes being held and morning lectures almost never taken even at prestigious medical colleges in Delhi. The poor quality of training is reflected in the quality of resident doctors, who now graduate with skills what should be taught at beginning of an MBBS course. Fund allocation to research is low and researchers poorly paid, which results in most trying to publish poor-quality work in predatory journals to embellish their resume to find work overseas.
Public attitudes need to change too. The compliance to treatment is poor, with many people opting for untested alternative therapies, traditional beliefs and fake social media tips. When a patient succumbs to illness, the last medical caretaker is often the target of the family’s ire when death is usually a result of a mix of ignorance, poor lifestyle and environment, late diagnosis, poor compliance or expensive treatment.
What’s needed is a dynamic execution committee under the health ministry involving states, medical associations, and other stakeholders, including private hospitals and patients, with a mandate of at least 10-15 years to oversee health indicators and steer locally-meaningful research, make lasting plans, and take punitive action, when required.
The eroding trust between patients and doctors must be re-built through transparency and improved communication between clinicians and patients. Ethics and empathy are essential to ensure good clinical outcomes, but patients must also remember that the execution of medical practice is never perfect. Physicians have the right to earn an honest living like everybody else, just as patients have the right to the best possible treatment.
Padma Shri Dr Anoop Misra is a senior endocrinologist and the author of Diabetes with Delight