I qualified in India in 1995 and did my post graduate studies in General surgery in India before moving to UK/NHS in 1999. I worked predominantly in Emergency Medicine in UK for 21 years before relocating to India. I have now been working in India for the last 5 months and these are some reflections based on my experiences in India so far. Some of the points I make might be controversial and might showcase emergency medicine in India in poor light. This is not a criticism from a position of 'look how great NHS is' but more of a regret that Indian healthcare in general and emergency medicine in particular could do better for the Indian population.
First of all, healthcare in India is great if you have the money or the insurance to pay for the hefty bills. In addition, because of increased funding for healthcare over the last two decades the quality and range of services provided in government hospitals is excellent. The number and quality of private hospitals in India has made a tremendous leap in the last two to three decades. India and its top-notch private hospitals are not only providing international quality health care for its citizens but also have become a hub for foreign nationals from a variety of countries who come to India as healthcare tourists. A significant number of excellent doctors from India are not just renowned in India but are widely respected in international circles and have become trainers and teachers for aspiring young doctors from all over the world. This is the truth about the penthouse suites of Indian healthcare. But the rest of the building in general and importantly its foundations are in a poor state.
The major problems I noticed in India over the last few months are.
1-Lack of standardization and quality control in medical services and medical education
This is by far the biggest problem in India. You could literally go to two different health care establishments with a few kms of each other and have vastly different experience as a patient. The simple reason is that medicine and healthcare is dependent too much on the individual brilliance of the doctors rather than the preferred reliance on better healthcare systems. The same is true of medical education at all levels from MBBS to post graduation to specialization in subspecialities (organ specific). There is no standardization of education and training. So, you could go to two different clinicians with identical qualifications with very huge variance in the quality of care they provide because one has trained in a better institution and the other has trained in a substandard institution.
2-Low percentage of individuals with some form of health insurance policy
Too frequently I see patients being denied appropriate emergency care because of lack of financial resources. This is in spite of various state and central government schemes to cover the emergency healthcare needs of people with low financial resources. The reasons for this are complicated. Most people are unaware of such government schemes, many private institutions have stopped supporting these schemes because the government was not reimbursing the expenses incurred as guaranteed by these schemes.
3-Lack of healthcare regulation
There is no governmental body which is overseeing the quality of healthcare provided by individual clinicians or by health care organizations. This means there is essentially a situation where the reliance is completely on self-regulation of individuals and organizations. There are certain bodies like NABH which are trying to play the role of a regulatory body. However, this is like school inspector visiting schools and hospitals simply play the game of appearing to have everything in place just during the NABH visits.
4-Lack of quality and standardized primary care physicians
Universally this the one simple step which would provide the biggest improvements in overall healthcare provision in any country. Unfortunately, in India both the public and the medical professionals have very little respect for this area of medicine. Everybody wants treatment from a specialist even when the condition is simple and just needs a primary care physician. This leads to unwanted escalation of cost of treatment of simple conditions. Fortunately, there is a small but growing tribe of well-trained primary care physicians who are starting to make a difference in this field which has been overlooked by everyone including the medical community.
5-Lack of quality and standardized prehospital medicine
The number of lives lost in emergencies because of the deficiencies in this area of medicine is heart breaking. I frequently see patient who come in dead or almost dead to the emergency department simply because simple measures have not been initiated at home and enroute to hospital. This can only be achieved if we vastly increase the number and quality of trained prehospital health care professionals -doctors, nurses and paramedics who are working in prehospital medicine. If I had to choose only one of the above five deficiencies that needs to be corrected, I would choose this simply because the current situation in India is inhumane. However, all the above five deficiencies are somehow interlinked to each other and complement each other if appropriate corrective measures are taken.
Finally Indian citizens would benefit from better education on health-better diets, better lifestyles, training in BLS and first aid (which should be mandatory for all adults). The health minister and health administration of each state should be more proactive to rectify these huge deficiencies in India if India truly wants to become a 'developed nation'.
Thank you for your patience in reading this little write up. Please feel free to add your comments and opinions below.
