- ಕೃಷ್ಣ ಶಾಸ್ತ್ರಿ - Krishna Shastry
- ಪ್ರಾಣಿ ಹಕ್ಕುಗಳು, ಶುದ್ಧ ಸಸ್ಯಾಹಾರ, ಪರಿಸರ, ಆರೋಗ್ಯ ಇವೆಲ್ಲವನ್ನೂ ಒಳಗೊಂಡ ವೀಗನಿಸಂ ಎಂಬ ತತ್ವದಲ್ಲಿ ನಂಬಿಕೆ ಇಟ್ಟಿರುವ ಒಬ್ಬ ಸರಳ ಕನ್ನಡಿಗ ನಾನು.
ನನ್ನ ಇತರ ಆಸಕ್ತಿಗಳೆಂದರೆ ನೀತಿಶಾಸ್ತ್ರ, ಸಾರ್ವಜನಿಕ ನೀತಿಸಂಹಿತೆಗಳು, ಸಾರ್ವಜನಿಕ ಆರೋಗ್ಯ, ಆವಿಷ್ಕಾರಗಳು, ವಿಜ್ಞಾನ, ಕನ್ನಡ ಭಾಷೆ, ಭಾಷಾನೀತಿಗಳು ಇತ್ಯಾದಿ.
I am a simple Kannadiga following veganism, that cares about animal rights, pure vegetarianism, environment and health.
My other interest include ethics, public healthcare, public policies, innovation, science & technology, Kannada language and linguistic policies.
Saturday, June 2, 2012
This article is part of a series of articles that I am writing in the wake of agitation by hospital staff in Kerala. Earlier articles that I wrote are as below:
In the articles so far we saw point of views of both employers and employees, as I have perceived. Before I go into the solution recommendations I thought it is best to ponder upon what an ideal healthcare system means.
Healthcare - Definition and Complexity
Once again, I am not taking the dictionary meaning of the term ‘healthcare’, but just trying to ponder up the meaning myself. To me, healthcare means “a conscious effort towards well being” or in simple terms “taking care of physical, mental and emotional health”.
But several more questions pop up when we think further about this term, thus making it one of the most complex subjects. Human being is a social animal, so how much of a responsibility an individual has towards his own healthcare and how much is collective responsibility of society? What is the right way of taking care of health? Unlike animals, human beings lack instinctive knowledge about protecting self and maintaining health, so how to ensure awareness? How to ensure effectiveness and efficiency? As you can see, all these questions make this a very complex subject.
Living vs. Healthy Living
Among animals, we see ‘survival of the fittest’ formula everywhere. Here ‘fitness’ is mostly ‘individual fitness’, though the group-living also helps to a limited extent. In case of human beings, we get additional strength through strong social setup, technology and science. Through this we are trying to defy natural selection and trying to play god.
These days we can see that people (who can afford big bucks) are able to use advanced assistance and prolong life. In some cases it has been perceived as boon, and in some other cases it has been perceived as curse. And thus it has started debate of how much is too much! At times, it seems like suffering has increased because people are deprived of quick death. In our society, among people who can afford hospitalization, how many die a natural and quick death?
I go blank when my mother states that if she gets too sick she should not be treated by specialists, she’d rather die quickly and peacefully. I wonder if it is that easy… Not always. Although the process of death may be quick if adverse health condition is left untreated, it won’t be very peaceful. So it will not be possible to just sit and watch a person suffer, especially if he/she is close to your heart. At the same time, I respect her line of thought, which has only become stronger after seeing the last days of many elderly relatives who went through unnecessary suffering due to hospitalization. Also, most of them eventually died in hospitals instead of their own homes.
So, where exactly does the concept of “preservation of life” fit in in the definition of “health”? Honestly, I don’t have a definite answer, I just wanted to bring this topic up so that I get your thoughts on this.. All I can say is that humans have not learnt how to face death gracefully.
A note about future: The ever increasing desire of human beings to beat death will probably lead to the sci-fi concepts such as human beings being cloned along with the mind and memories becoming a reality! And that might put an end to lot of sufferings. At the same time, as many sci-fi stories/movies have shown, such things are also associated with great risks.
Anyway, not all cases of health complexities revolve around life and death, at least directly. So, it does sound perfectly meaningful to discuss more about healthcare system.
Machine vs. Human
How much should we depend on machines for diagnosis, decisions and even treatments in recent times, and how has the role of doctors transformed? With the introduction of complex instruments, shape of healthcare system has changed drastically. A careful study of different stages of evolution related this aspect can help us think about this issue in more structured way, I think.
Evolution Stage 1
For a long time, doctors used simple ‘passive’ instruments like knife, needle, cloth etc. These tools did not ‘sense’ anything nor take any ‘decision’. Doctors had to check the patient physically and carefully take a call on what the ailment could be and treat accordingly.
Most of the medicines at that stage were natural, and it was a great challenge for doctors to get the combinations right and effectively treat ailments.
Evolution Stage 2
With progress in the mechanical and optical inventions, medical world moved towards instruments such as stethoscope and microscopes, which helped in diagnosis and decision making. Technicians developed lab procedures to test body fluids, which involved the used of chemicals . Not to forget electricity itself that enabled X-Ray machines due to which certain inner secrets no longer remained mysterious. These instruments helped doctors significantly, but doctors and related technicians still had the huge responsibility to decide on the diagnosis and treatments. In other words, instruments started sensing, but could not take decisions on their own.
During this time scientific study of “cause and effects” flourished and so did standard chemical formulations based drugs to treat patients. Drug manufacturing increasingly became automated, unlike earlier stages of manual preparations.
Evolution Stage 3
Another major transformation happened when instruments started ‘computing and evaluating’ in more complex fashion. For ex: lab analyzers started giving results themselves, automatic eye testing machines came up. Very complex machines like laproscopic machines also came into picture which demanded new skills by humans also. In any case, some more of the responsibilities started getting transferred to machines instead of human beings.
Computers also evolved during this period and helped in great deal of information storing, retrieval, search and sharing. And they have also started taking blame on some of the failures or mistakes.
Medicines also became extremely complex, and adding to the complexity are the politics and greed associated with it. In any case, this whole thing can be seen as a special machinery and it has started taking lot of responsibility and blames in many situations.
There are another set of instruments that help patients. Ex: simple spectacles, complex hearing aides and pacemakers etc. They are no doubt boon to mankind in most situations.
Pretty much this is where we are today.
Ongoing research and future evolutions
Currently a lot of effort is being put into making computers and machines smarter.
- Think about feeding lots and lots of diagnosis/treatment/success-failure data to computer and when a new patient is admitted, the computer can give better opinion than a doctor.
- Think about better precision surgery by a machine when compared to doctor.
- Think about a day when smart machines can copy your organs and create replica or create an entire replica of yourself!
Whether a day will come where we completely put our lives in the “hands” of machines or not, it is true that human beings involved in healthcare providing jobs are more dependent on machines than ever. An interesting adverse effect due to this evolution is decrease in human skills. Earlier, doctors had a lot of experience in diagnosis and with time they would gain significant knowledge, albeit at the cost of suffering/death of some patients. But now, no doctor can afford to gain such experience. Where does that leave the us, the mankind?
How would a perfect healthcare system look like in this case? We cannot say that evolution of better instruments or machines are bad, but an ideal healthcare system should ensure that human skills are not left underdeveloped due to high dependency on machines.
Natural Instincts vs. Artificial Dependency
With the evolution of modern healthcare system, it is not just people in healthcare providing field who have lost their edge in terms of experience and instincts, even common people have been experiencing this downward trend. As the civilization improved, the disconnect from nature became more and our natural instincts slowly started vanishing. Recent decades have been worse and people who lead comfortable lives have zero natural instincts, knowledge or skill. Thus, most of us are almost completely dependent on artificial methods to take care of our health.
An ideal healthcare system should ensure that people are not disconnected from nature to this extent. So, when we define such a healthcare system, its reach should go beyond just treating symptoms – it should redefine our overall lifestyle. It should pull us out from our comfort zone and make us face certain hardships –to ensure better overall healthy life. For ex: concepts like Yoga should be an integral part of the ideal healthcare system.
Traditional vs. Modern Methods/Medicines
When we envision an ideal healthcare system, we should also see how to ensure preservation of great knowledge that lies within traditional medicine systems, and how to identify and discard inferior elements in it. Current trend is to just blindly ignore it, and I believe by doing that we are losing valuable knowledge passed on by our ancestors.
A doctor’s judgment call based on patient’s affordability
Kindly think about this – is it acceptable if a doctor takes a judgment on the treatment for a patient’s ailment based on his/her own evaluation of the patient’s financial conditions? In other words, if a doctor feels that the patient is poor and recommends a cheaper but riskier line of diagnosis/treatment; Would it be right to do so, even if the doctor has the best interest of the patient in mind? Sometimes a doctor can see that the patient party is too emotional and unable to be practical, he/she might be tempted to suggest something that is good for everyone involved. But is this correct or should a doctor be highly dispassionate towards such factors and depend on the patient for every decision? (This reminds me of the principle -> ‘law is blind’)
Note: It is to be noted that if we allow such discretionary actions, a doctor could take a particular decision based on his knowledge and later project it as something that he had to do considering patient’s affordability. This is a risk and not easily provable.
Especially in societies where there is a big diversity in terms of financial affordability, whatever we suggest as a solution to this classic question, controversies and debates will keep erupting since there will always be certain percentage of patients who will be suffering either physically, mentally, emotionally or financially. There cannot be one single rule that can be applicable to all – there will always be people with different implicit and explicit expectations.
Above discussion brings back the question - , how should an ideal healthcare system look like? There is no answer because the surrounding situations are not ideal.
Comparison of 2 healthcare systems
Let us now compare healthcare systems in 2 countries. This comparison will unfold few more aspects of healthcare system.
Healthcare system in USA
Note: What I am writing here is based on what I have read and discussed rather than first hand experience inside hospitals or doctors’ offices in USA.
As I understand, in America, doctors typically put the burden of decision almost entirely on patient party. They make the patient aware of his/her condition to best of their knowledge and provide detailed explanation of possible diagnosis/treatments available, and also the probability of success/failure in each one. Do doctors there honestly believe that patients have the right to know OR do they fear a malpractice suit if they fail to seek inputs?
With too many acts governing healthcare, American healthcare system has become a very expensive business, is heavily insurance driven and associated with many litigations. Has it reached a state where it has indeed become very unfriendly for many Americans? How far have things changed due to changes introduced by Obama?
I don’t mean to say that health insurance is bad or that legal cases against doctors must not be filed. In fact malpractice and negligence among doctors are in check due to such law suits. However, should there not be a line beyond which we can say, it is too much?
Healthcare system in India
Traditionally Indians entrusted themselves in the hands of doctors with complete faith (or was it also due to no choice?) and this trend has not gone away yet. Even today it is not at all uncommon in India fora doctor to take a call on diagnosis/treatment plan on behalf of the patients without making patient party completely aware of the ailment, possibilities and risks. However, increasing number of patients (especially in urban areas) seek explanation from doctors about their ailments, and do not allow doctors to take complete control. It is also noteworthy that (due to huge ego or fear of incompetency) some Indian doctors are not yet ready to gracefully face questions from patients and answer them with patience. Some of them are slowly realizing that they have to change with time.
Also, trends such as ‘healthcare as business’, insurance driven healthcare (along with its ill effects), litigations – are also on the rise in India. In the last few decades there have been many good and bad changes in terms of quality, knowledge level, skill level and ethics among healthcare professionals. Many good Indian traditional medicine systems have been ridiculed and sidelined. ‘Prevention is better than cure’ is a forgotten mantra and people are steadily moving towards sedentary lifestyles, unhealthy eating habits, and banking on ‘modern healthcare’. Most doctors also don’t seem to be interested in promoting healthy lifestyles and instead, focus only on treating symptoms. All these are influenced by the western world, I guess, except probably in the area of healthcare education where probably Indians have become more short sighted than most nations. Are we (Indians) very good at embracing the bad and rejecting the good?!
Phew, too many things – when every aspect in a sector is undergoing change, it becomes difficult to say which aspect is influencing what and where the sector as a whole is headed towards. All we can say is that Indian healthcare system is undergoing way too many changes and we need to be on guard if we care about our health and future.
USA is just one example I took from western world - of course, one has to pick on the world’s big brother and may be because I am somewhat connected to that country due to my few years of stay there. However, many other western countries are rated better than USA in healthcare sector and they have adopted different models.
One interesting fact to be noted is that Kerala healthcare model was once praised by WHO as a great model. I am not sure as to the basis of such praise and if it is still at that level It is true that Kerala still provides healthcare at much cheaper rates compared to many other states in India. Unfortunately and to the concern of many, this scenario is about to change drastically due to many restrictions, rules and regulations, enforcements and salary hikes!
Role of insurance in healthcare
As we have seen in the comparison of healthcare systems in USA and India, insurance is an important aspect. Exactly where does this fit in an ideal healthcare system? I think insurance is a good concept, but it needs to be strictly monitored to ensure that it is not misused.
Of course, there will always be some percentage of healthcare providers who will exploit any system and use loopholes to their own profit, thus tarnishing their colleagues and the industry. We just need to try our best to avoid such situations.
Wages of healthcare providing people
What is a “fair” amount that can be taken from a suffering person/family? How much money is too much for a doctor? What is the right salary for hospital staff? These are also burning questions, especially since many people see healthcare system as one that provides “noble service”.
Though it is difficult to draw the line, an ideal healthcare system should not leave the care taking people dissatisfied. Entrepreneurs, innovators, service providers – everyone in this field deserve good money and comforts so that best in class don’t hesitate entering this field.
Most people, while discussing about good healthcare systems, conveniently forget the fact that animals are suffering more than ever in the name of healthcare for human beings. Today animals undergo unimaginable cruelty in the labs. Is this anywhere near the ideal picture of healthcare? On this note, traditional systems like Ayurveda are nearer to ideal as no one gets hurt to the benefit of another!
One may argue that scientific development is essential and ‘sacrifice’ of some animals in the process is unavoidable. However, should billions of animals suffer and die purely to serve vanity and compensate irresponsibility/ bad lifestyles of human beings?
Healthcare, a basic right with no responsibility?
Who is responsible for our health? Can we argue that healthcare is our right and it should be given to us even if we are not able to pay for it?
To some extent, I agree with the concept of free healthcare as basic right – beyond that it will sound like one of those idealistic and impractical equality theories. Anyway, what is important is that a right always comes with a responsibility. An ideal healthcare system should ensure that a person makes honest attempts to preserve and improve one’s own health, without which the right diminishes.
A combination of friendly insurance + incentives for taking care of their own health is one of the characteristics that I see in an ideal healthcare system.
Supporting policies and systems
I think the whole economics surrounding tobacco is twisted. The money spent on treatments and research of ill-effects of tobacco is much greater than the revenue earned by government and people involved, by selling tobacco and tobacco products. And of course there are ailments, suffering, deaths due to tobacco consumption. Yet, tobacco is not banned.
Is it a big joke to even try to envision an ideal healthcare system when the mankind is not mature enough to ban things like tobacco? The point is – it is important to concentrate on supporting policies and systems too when we envision an ideal healthcare system.
Talking about systems, imagine taking a patient with critical health to a hospital through bumpy roads and clogged traffic – an ideal healthcare system should address such things too.
As we see, defining a perfect healthcare system is not easy. As we invent newer and smarter machines everyday, we are losing our skills due to the dependency on them. We have come up with insurance systems to help unlucky people, but we are failing to reap it’s benefits due to dishonest and irresponsible people; we have discovered ways to prolong life, but all we seem to be doing is increase suffering because we fail to accept death as a natural process; we have made many scientific advancements very quickly, but we are causing a lot of harm to nature and animals in the process. Question is – Where are we heading towards? Can we learn to strike a balance?
To summarize, I think an idea healthcare system should have following characteristics, and it is to be noted that this cannot be envisioned without support from other good policies.
- Defines a good balance between ‘human effort’ and ‘playing god’ and operates accordingly
- Promotes ethical line of thinking among healthcare providers and gives confidence and relief to suffering patients
- Promotes new inventions to help all of us, but sees that human skills are also improved/enhanced continuously
- Extends help to unfortunate people, but ensures that people don’t become lazy and irresponsible due to free healthcare
- Helps us in recovering from ailments, reduces pain during illness/old age, and teaches us how to respect and welcome death gracefully
- Cares about health and well being of not only humans, but also of other species around
- Establishes and provides diverse systems for diverse population
- Ensures proper wages and facilities to workforce in the healthcare sector
Your comments/criticisms are always welcome.