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.
Animal
Rights
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.
Conclusion
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.
1 comments:
Well written...
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