By Dr M Kamath Ammembal
MD, DGO, DNB, MRCOG
Mangaluru, Nov 15: I was hoping to cover some of the potential negative effects of the KPME Act amendments in this issue. However, some of the reader-comments have made me realise that there is significant trust deficit between public and doctors! This has prompted me to address this deficit urgently.
Interestingly, in a letter dated November 7, 2017, honourable health minister of Karnataka has suggested that "there is a huge information asymmetry" between private medical establishments and the patients. KPMEA amendments hope to correct the same. This "information asymmetry", to my understanding, means absence of detailed education and counselling by the private doctors regarding the ailment, absence of justification for particular tests and investigations requested, lack of explanation regarding different treatment options available and absence of justification for the cost of treatment.
This, in my opinion, is a valid observation but this information asymmetry exists across the board and includes government doctors and is not limited to private doctors. Every patient, irrespective of whether he/she is attending a private or government facility, has a right to be educated and counselled as mentioned above. In other words, the entire medical community should be expected to follow basic minimum standards in this regard.
I was trained at some of the premier institutes in this country before moving on to the UK for further training. I had to first pass a licensing exam to allow me to practise in the UK. The exam requires basic skills such as appropriate communication in complex clinical scenarios, attention to patient confidentiality, privacy and dignity apart from clinical skills. Over the number of years I trained in that country, I observed that these vital skills were inculcated in the medical graduates at a very early stage in their professional life. In fact, I had to "unlearn" some of the faulty behavioural patterns I had acquired in the course of my education in India.
The medical education in India is unfortunately quite archaic when it comes to the above mentioned skills. The focus is more on learning disease than understanding the patients’ concerns. The Medical Council of India still focuses on outdated benchmarks such as number of beds in the hospital than quality of training and treatment before certifying medical colleges.
In my observation, the medical graduates who pass out of Indian medical colleges have significantly better clinical and surgical skills when compared to their UK and European counterparts. Most doctors in India work 24x7, 365 days a year and are extremely hardworking (as a consultant in the UK, I used to work only 5 days a week - 9 am to 5 pm and earn three to four times what a comparable consultant earns in India). Despite this, they lose out due to the absence of any targeted training in communication, leading to "information asymmetry". This, along with a few stray cases of mismanagement and unscrupulous behaviour by a minuscule section of the medical fraternity, leads to dissatisfied patients and breakdown of trust between doctor and patient.
The governments (Central and State), if serious about eliminating this information asymmetry, should urgently reform medical education and prioritise patient dignity and rights over everything else. Senior members of the medical fraternity have particular responsibility in initiating these reforms. The public should lobby for overhauling of medical education at grassroots level instead of blaming the hapless doctors who are actually the victims of a very dysfunctional system and not culprits.
About the author: Dr M Kamath Ammembal is a consultant gynaecologist with keen interest in public-private partnership in achieving health indices comparable to the developed world. He was a consultant at Hinchingbrooke NHS Trust, UK, before returning to Mangaluru and setting up Ammembal Women's Health.
Also Read: