 "The entire health care delivery system needs an overhaul: S S Agarwal")
On June 22, nearly 15,000 doctors from government hospitals in New Delhi went on strike to demand that basic conveniences be made available to them. These included the maintenance of a doctor's security from angry patients and access to toilets, among other things. S S Agarwal, national president elect of the Indian Medical Association, speaks to Manavi Kapur about the need to upgrade existing infrastructure before creating new medical facilities
Are doctors in Delhi justified in their demands? Is there a real shortage of doctors in government hospitals?
Yes, they are justified, but these are not their demands - they are requests. The issue is about optimally utilising facilities. This lack of utilisation does not allow us to deliver our professional skill. Not only doctors, manpower, as a whole, is less at hospitals - paramedical, nursing and administrative staff is in short supply. A doctor is the leader of health care services, but the problem is not restricted to him. Each doctor requires six other staff to work to his optimum capacity at a hospital.
How can the existing facilities be upgraded to make the environment friendly for doctors and patients alike?
There is a dire need to upgrade medical facilities and make sure that they are being utilised properly. Infrastructure needs to be improved with small-scale interventions. Unless we strengthen existing facilities, making new infrastructure is a mistake. Without a systemic change, the new facilities will eventually end up at the same stage as the old, existing ones are in.
Small steps can help. For example, whenever a patient comes to the hospital, he can't reach the doctor and has to go through many hoops before he finally reaches the right place. We need volunteers at the entrance level - proper guidance will calm them down and enforce a system. This will also reduce the stress that is put on doctors and health care professionals.
Another thing that can be done is improving cleanliness and ventilation - basic steps that can go a long way to help matters. Even if we plug one gap at a time, we can make a huge improvement. Medical professionals and policy makers need to look at things at a micro level - 50-75 per cent of the problems can be solved like that.
Can a public-private partnership model take the load off government hospitals? Are there apprehensions to that end?
Public-private partnership has become a mere idiom. A partnership means equal holding and requires an MoU to be signed. The government has created the clauses on agreements and told the private hospitals to come and work at those conditions, or not at all. But this will have no success in the long-term. Partners need to sit and talk together and design specific models for specific cases. We can't blindly use a universal model that is based on those in countries abroad. This is not like making a standardised car in a factory. Our broad guidelines can be the same, but they need to be nuanced and case-based.
All the government does is to act as a thaanedar and show facilities and doctors their faults. Unless it starts focusing on what needs to be done rather than what is wrong, it will bring even the private hospitals down to the same level as government hospitals.
Are the legal provisions to protect doctors sufficient?
We need a desire and orientation from the authorities to implement these legal provisions. This cannot be done at an individual level. Local politicians, social media and mainstream media think doctors are to blame and have created an atmosphere that is hostile towards medical caregivers. This why we need protective laws to begin with. Everyone thinks doctors are god and so they must behave in a god-like manner. But if doctors are gods, that makes hospitals and clinics temples. And if those people who visit the temple do not maintain its sanctity and grace, how can their prayers ever bear fruit?
There will always be exceptions in every profession, and we too have certain bad doctors who taint the profession. But we should not take this as a rule. The question is not just about doctors' protection but about the entire medicare enterprise. A central law protecting the interests of both patients and health care professionals will go a long way in bridging this gap.
Are doctors in Delhi justified in their demands? Is there a real shortage of doctors in government hospitals?
Yes, they are justified, but these are not their demands - they are requests. The issue is about optimally utilising facilities. This lack of utilisation does not allow us to deliver our professional skill. Not only doctors, manpower, as a whole, is less at hospitals - paramedical, nursing and administrative staff is in short supply. A doctor is the leader of health care services, but the problem is not restricted to him. Each doctor requires six other staff to work to his optimum capacity at a hospital.
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The entire health care delivery system needs an overhaul and all of human resources come under that. We need to start seeing the problem as a whole.
How can the existing facilities be upgraded to make the environment friendly for doctors and patients alike?
There is a dire need to upgrade medical facilities and make sure that they are being utilised properly. Infrastructure needs to be improved with small-scale interventions. Unless we strengthen existing facilities, making new infrastructure is a mistake. Without a systemic change, the new facilities will eventually end up at the same stage as the old, existing ones are in.
Small steps can help. For example, whenever a patient comes to the hospital, he can't reach the doctor and has to go through many hoops before he finally reaches the right place. We need volunteers at the entrance level - proper guidance will calm them down and enforce a system. This will also reduce the stress that is put on doctors and health care professionals.
Another thing that can be done is improving cleanliness and ventilation - basic steps that can go a long way to help matters. Even if we plug one gap at a time, we can make a huge improvement. Medical professionals and policy makers need to look at things at a micro level - 50-75 per cent of the problems can be solved like that.
Can a public-private partnership model take the load off government hospitals? Are there apprehensions to that end?
Public-private partnership has become a mere idiom. A partnership means equal holding and requires an MoU to be signed. The government has created the clauses on agreements and told the private hospitals to come and work at those conditions, or not at all. But this will have no success in the long-term. Partners need to sit and talk together and design specific models for specific cases. We can't blindly use a universal model that is based on those in countries abroad. This is not like making a standardised car in a factory. Our broad guidelines can be the same, but they need to be nuanced and case-based.
All the government does is to act as a thaanedar and show facilities and doctors their faults. Unless it starts focusing on what needs to be done rather than what is wrong, it will bring even the private hospitals down to the same level as government hospitals.
Are the legal provisions to protect doctors sufficient?
We need a desire and orientation from the authorities to implement these legal provisions. This cannot be done at an individual level. Local politicians, social media and mainstream media think doctors are to blame and have created an atmosphere that is hostile towards medical caregivers. This why we need protective laws to begin with. Everyone thinks doctors are god and so they must behave in a god-like manner. But if doctors are gods, that makes hospitals and clinics temples. And if those people who visit the temple do not maintain its sanctity and grace, how can their prayers ever bear fruit?
There will always be exceptions in every profession, and we too have certain bad doctors who taint the profession. But we should not take this as a rule. The question is not just about doctors' protection but about the entire medicare enterprise. A central law protecting the interests of both patients and health care professionals will go a long way in bridging this gap.