Clipped from: https://timesofindia.indiatimes.com/blogs/toi-edit-page/why-do-we-have-so-few-doctors-why-do-doctors-over-prescribe-medicines-and-how-the-covid-tragedy-is-an-opportunity-for-change/Sandeep Bansal
The writer is Faculty at Barts and the London School of Medicine and Dentistry, and Co-Founder of Carebyte
India’s healthcare system was always teetering on the edge, Covid-19 caused it to collapse completely. As an India-trained doctor in Britain, this has been painful to watch. Why has this happened and how can we implement change?
Bihar has 1 doctor for every 42,000 people and Delhi 1 for every 2,200 people, but both are a far cry from the WHO recommended 1 doctor:1,000 population. Lack of workforce is largely driven by attrition, with 30% of individuals with a medical degree not a part of the current workforce, a high proportion relocating to other countries. Around 10% of India’s doctors are practising in the US, UK and Australia. By 2030 India will have a healthcare workforce gap of 3.3 million.
One reason for this shortage is that many fresh medical graduates spend time studying for postgraduate entry exams to specialise. This is typically a 1-2 year period in which they are not a part of the workforce. We need to build training programmes which enable these medical graduates to work as doctors whilst progressing their training, much like what happens in the UK or US.
India allows fresh graduates to work as general practitioners immediately, without enough experience. In contrast, in the UK and US, to practice independently as a general practitioner or a family physician, there are 3-4 year postgraduate training programmes. This leads to unequal standards of care. Eventually and inevitably, a deep mistrust of the Indian healthcare system in the public eye has developed with many citizens taking multiple opinions to achieve a solution to their problems.
Having multiple specialties at hand with a touch of the button means that the Indian healthcare system keeps symptom management at its heart, instead of treating the cause and preventing diseases from developing. This results in patients being given inappropriate medication. Over-prescription of drugs is a major problem. For example, giving antibiotics for a viral illness.
Patients believe they are not treated until they are given medication. Many patients might therefore go to another doctor to get that medication. This is all due to the vicious cycle and belief that symptomatic treatment is the be all and end all.
A perverse incentive for revenue also exists. However, I would like to believe that for the majority it is the lack of guidelines and knowledge that leads to over-prescribing and diagnostics. According to a study in Madhya Pradesh, 10% of the population are using medication inappropriate at any given point in time. This number jumps to nearly 50% for those over 65. These medicines are causing far more harm than good. We have increasingly seen this during Covid, for example with the use of Ivermectin in India.
Nearly 80% Indians who died of Covid had existing conditions like diabetes, heart disease and other comorbidities. They are also the most likely to have long-term complications. If these comorbidities could be better controlled or even prevented, then these complications and deaths most likely would not have occurred. Even pre-Covid, 80% of deaths in India were due to non-communicable diseases and their complications. These conditions can be prevented. Of course medication has its place, but so do lifestyle measures.
The government needs to focus on educating citizens on why it is so important to be healthy. If there is one silver lining from Covid, it is that health has become a high priority for citizens and the government needs to strike while they are actively listening.
The business case for PM Modi’s government to do this is pretty simple: Between 2012-30 India will have had an economic loss of $4.6 trillion due to non-communicable diseases. To put this into context, it’s an equivalent economic loss to 2 national lockdowns in India for 21 days each, each year. PMJAY is a great imitative and will help 500 million to at least get access to healthcare when they need it. However, much like the UK where NHS was born in the post World War era, there is a chance, post Covid, to reimagine healthcare so people do not need to utilise the PMJAY insurance in the first place.
A better approach to patient care is needed; one that coordinates the care intensively while using a multidisciplinary team approach to prevent a disease. Good care coordination can direct the patient to the care he or she needs while reducing the number of specialist visits, procedures, tests, and imaging. Covid has exposed India’s healthcare system, but it has also given us the opportunity to change.
Views expressed above are the author’s own.