Dr Aniruddha Malpani, an IVF specialist and a vehement supporter of patient advocacy and information therapy tells us why doctors sometimes are a hindrance in our healthcare system.
I was part of a panel at the Health 2.0 conference in Bangalore recently. The theme was challenging – How do we deliver health care to a billion Indians? There were lots of interesting presentations, and while listening to these, it dawned on me that doctors like me are actually part of the problem.
Traditionally, we have always thought of doctors as being the solution. The knee-jerk reflex is – let’s open more medical colleges and create more doctors, so that more patients will get better health care. Isn’t a shortage of doctors the biggest problem we face in India today? Aren’t we very short of hospital beds? Without enough doctors, how can we even start to tackle this huge problem?
Actually, the medical profession is the reason we have such a dysfunctional illness care system. Remember that doctors only get paid to treat ill patients – and they spend years training and becoming experts in managing sickness. Most doctors would not even be able to recognize a healthy person, because they only see sick patients, day in and day out!
The medical hierarchy make things even worse. It’s the specialists – the ones who spend many years mastering the technical minutiae a particular organ (for example, heart surgeons or neurosurgeons) – who are at the top of the heap. They look at life through a very distorted prism, because they only see rare and complex problems. They know a lot about very little, but because they are the leaders – the KOLs or Key Opinion Leaders – they impose this distorted perspective on the entire profession. They give guest lectures at conferences; they publish articles in prestigious medical journals; and they are awarded with prizes, honours and medals.
Because they naturally want to increase their workload and importance, no expert is even going to say – What I do is not important. They have an inflated sense of their self-worth, which is why every cardiologist is going to say – we need to spend more money on preventing and treating heart disease; while every neurologist is going to say – we need to spend more money on preventing and treating brain illnesses. They don’t have any ability to look at the big picture, because they are so focused on individual problems.
Look at the way the medical profession has changed the definition of what normal blood pressure is; and what a normal blood sugar level is. It seems that we are all pre-diabetics, waiting to get a heart attack, unless we see our doctor and take statins and a cocktail of other medications!
Doctors can only see problems – they cannot see health! After all, psychiatrists study mental illness, and know very little about mental health and happiness. I think doctors are useful as technical specialists, but that’s all!
Take my personal example. I am an IVF specialist and am very good at what I do, but the only patients I see day in and day out are infertile couples who need IVF. I never see fertile couples, so it’s quite easy to see how my perspective can get distorted! I am not the best resource to manage infertility problems in the community, and even though I maybe an infertility expert, I need to have the humility to accept this. In fact, I may end up causing more harm to the public, by advising unnecessary fertility testing for all married couples! Not only does my daily work cause me to become biased, I am also likely to provide advise which increases my workload, since I am a rational homo enonomicus.
Retired doctors can be a useful source of advice. They have enough maturity to understand how unimportant doctors can be in delivering primary health care. They can help to design protocols, which trained caregivers and medical assistants can deliver in the community. They will do a much better job than doctors will, because they are embedded in the community; and enjoy what they do. However, doctors need to learn to respect them, so that the public will do so as well, rather than think of them as being second class poorly trained doctors.
While it may seem that working under the constraints we face in India (poverty, illiteracy and a shortage of healthcare workers) is a daunting task, it also means that there is a great scope for coming up with novel solutions! There is no question that this is a huge challenge, but it’s a great opportunity as well. However, we cannot afford to be naïve and expect that the solutions are going to come from doctors!
