Category: Indian Healthcare

Neuro and Spine

The torture of being “Just MBBS”

The average salary of a fresh medical graduate (MBBS) at private hospitals in sizzling cities like Bangalore,

Hyderabad, Chennai and Mumbai is much lower than an entry level call center employee. At most cities this income cannot support a lower middle class living.

Even when we talk about employability in small towns, rural setups and government setups, there is a big dearth of vacancies. In under-developed states like Bihar, for every available post for a salary of USD 400 per month public sector medical officer job there are hundreds of applicants for every district.

The health system clearly does not have necessary capacity to employ the existing workforce of fresh medical doctors passing out every year.

So where exactly the newly qualified doctors are disappearing to? Interestingly majority of the medical graduates are engaged in postgraduate entrance test for the first 5-10 years of their career and youthful lives instead of fruitful engagement with the health system.

I am sure that all of you who have been through the “Just MBBS” phase wouldn’t agree more.

While having an interesting discussion with one of my friends Dr Nitiraj Gandhi (Clinical Services Manager with a prominent Corporate hospital in Bangalore), on the pathetic conditions being faced by Junior doctors in India, one of his statements really gave me an insight on healthcare industry’s perception towards fresh MBBS graduates.

“Today’s MBBS has little to offer in addition to Web MD or such sites. They themselves (more than 90%),are apprehensive at making a diagnosis. In contrast MD and MS are extremely well equipped in terms of knowledge and expertise and at par with the best in world. Its a pity that post MBBS, few are equipped to practice while most are busy preparing for pg and memorizing stuff. The art of apprenticeship is a lost one today.”

Is it that something is wrong with the Medical education system or is it something else?

In India, most fresh graduates are involved in majority of nursing and clerical activities like giving injections, indenting medicines for the ward, doing dressings, putting IV fluids, drawing blood for investigations, transporting them to the lab and collecting results, carrying blood bags from the blood bank to the ward and collecting X rays. This work has to be done 365 days without a single leave, and duty hours extending upto 28-32 hours at a stretch!

This kind of work and work schedule will definitely suck out any left over knowledge, capability to analyze, capability to innovate and above all the capability to diagnose and prescribe medicines in a manner which is optimum for the patient.

There is a widespread resistance to change in the above situation because in a teaching hospital they are a cheap resource available with no prescribed rules on the nature of work, work hours, work days and holidays by the government.

Then you have our so called professional leaders in MCI and senior professors in Medical colleges who think that all of this is fine because that is what they have also been through. This notion that “You got to do it because we did it”, is what is taking the standard of Indian clinicians on a downward spiral.

For all categories of employees in India, we have some rules and laws laid down to prevent human resource exploitation. But to this date nobody bothers to take care of this under paid, over worked and underutilized brilliance we know as CRRIs, “Just MBBS”, “Junior doctors” or “Duty doctors”.  

Let’s Support Thiruvarur Interns:First batch interns in Thiruvarur medical college are threatened by the Dean that he…
Posted by SLAVE CRRI on Thursday, April 9, 2015

References

Kumar R. The leadership crisis of medical profession in India: ongoing impact on the health system. J Fam Med Primary Care [serial online] 2015 [cited 2015 Apr 10];4:159-61. Available from: http://www.jfmpc.com/text.asp?2015/4/2/159/154621

The Arogyada
www.arogyada.in
April 10, 2015 / by drsandeep.net

Sorry state of Emergency Departments of Indian Government Hospitals

The origin of this post comes from the concerns over the deficient universal precaution practices and instrument sterilization in emergency departments at government hospitals. In the course of my education and career, I have worked/ observed the practices in quite a few government hospitals across India.

I am currently working at a government hospital in Tamil Nadu. As a part of my job I am regularly posted in the emergency department of the  hospital where we are supposed to see the trauma patients.

My hospital is a mid sized tertiary care government hospital. Our emergency department gets around 50-100 patients/day with varying degrees of trauma. The majority of cases(50-60%) come with minor lacerations which need to be sutured, after doing the math it comes to around 25-50 patients per day of cases for whom we do suturing and dressing. Whereas there are larger hospitals which get 3-4 times of the above numbers daily. So you can just get an idea of the big number of patients that visit the emergency departments of government hospitals for outpatient emergency care everyday.

But speaking of the supplies of few basic things required for suturing wounds like sterile gloves, suture materials, sterile suturing instruments and dressing materials; many a times we are forced to follow practices which may possibly directly contribute to spread of communicable diseases such as HIV and Hepatitis B.

I am sure if you have ever worked in a government hospital emergency department/ casualty in India you will agree that sterile gloves, sterile instruments and sterile dressing materials are considered a luxury and are always in short supply. Ever heard somebody asking you to complete 6 debridements /dressings with 3 gloves? This is a common argument given for not wasting the [disposable] sterile gloves!

Being publicly funded and providing crucial healthcare free of cost, I am aware that there is not much you can ask for in a government setup. But cutting upon the basics is definitely a thing to worry about, both from patient and healthcare provider perspective. On one hand, the patients come to the hospital to be cured and not to get infected with another unrelated disease. While on the other hand, it is the front line healthcare providers who put their life at risk just because of unavailability of basic supplies such as soap for hand wash and gloves for  patient/ self protection.

Will end this blog post with a question: Is your hospital emergency department actually one of the factors contributing to the incidence of HIV and other blood borne communicable diseases?

If you are an administrator or a decision maker in any of the government hospital in India, it is the time for a little introspection and action.

The Arogyada
www.arogyada.in
February 10, 2015 / by drsandeep.net

Therapeutic target identified for antihypertensive action of a polyherbal Siddha medicine called Venthamarai chooranam (VMC)

An animal study was conducted by Babu CS et al at Centre for Toxicology and Developmental Research (CEFT), Sri Ramachandra University, Chennai to identify the therapeutic target for the antihypertensive action of a polyherbal Siddha medicine called Venthamarai chooranam (VMC).  It was concluded that VMC alleviates hypertension via AT1R and eNOS signaling pathway in 2K1C hypertensive rats.

VMC upregulated eNOS expression which in turn improved plasma nitric oxide and decreased SBP in hypertensive rats. It down-regulated AT1R and simultaneously upregulated AT2R expression in comparison to vehicle-treated 2K1C rats. Further, renal TNFα and IL-6 expressions were down-regulated while TRX1 and TRXR1 were upregulated by VMC. VMC potentially interacts with renin-angiotensin components and endothelial functions, and thereby exerts its antihypertensive action. 
This is the first study to demonstrate the mechanism of anti-hypertensive action of VMC in an animal model of renovascular hypertension.
The Arogyada
www.arogyada.in
April 12, 2014 / by drsandeep.net

Family Medicine Clinics in India: The Next Big Thing for Indian Healthcare?


By Astha Gupta, MSc(BioMed) MHA PAHM

Healthcare in India has fast moved away from general practice to super specialised medicine. As a consequence the erstwhile family physician who had detailed knowledge of his patient’s lifestyle, family history and clinical history has somewhere gotten lost. Family Medicine is a branch of medical sciences which aims to provide comprehensive and continuing healthcare for individuals of all ages and genders. A popular branch of practised medicine across the globe, it provides for the first line of treatment and preventive care. In India, very recent times have seen a resurgence of this concept with a few private players stepping into this arena. The next few sections highlight the potential for this stream of healthcare in India and the challenges associated with it.

Models of Family Clinics 

1. Single Practitioner
A decades old model followed within the Indian market, it typically involves a single physician catering to a small local population. Services provided may range from only consultation to limited pharmacy, basic diagnostics and small procedures like suturing. Word of mouth is the most commonly employed tool for marketing. Mainstreaming and expansion of this model is extremely difficult since it is largely person dependent.

2. Practice Association
Continue reading this post…

The Arogyada
www.arogyada.in
April 2, 2014 / by drsandeep.net

My daily dose of Air Pollution in Hyderabad

Past few weeks I have been observing municipal employees in Hyderabad burning waste in open in the stretch between Road no 10, Jubilee Hills and the areas around the KBR park, my route for going to work. I see at least 10-12 heaps of waste burning just in this 4 km stretch everyday and that is just a small part of the larger picture across other areas of Hyderabad and other cities in India. Open burning constitutes up to 20% of overall air pollution in some of the big cities in India.

I am sure we guys from India are so used to such open burning of waste, that our brain has just stopped responding to the sight and the discomfort of suffocation caused by it. Many a times we just pass by a burning pile of waste holding our breath pretending that
we didn’t inhale that smoke full of carcinogens, failing to realize that it is not just the momentary exposure which will kill us but the overall degradation of air quality in and around our locality, our workplace and the places we visit on regular basis. It is that daily silent dose which is doing the work as we speak.


The worst part is that the open burning of waste is being done by the employees of the municipal authority which is supposed to regulate the air quality in the city (posting the pics along).

For those who are not aware, typically smoke constitutes mainly of particulate matter, hydrocarbons, carbon monoxide, sulphur dioxide and carcinogenic dioxins/furans. Air pollution is a significant risk factor for various diseases including increased frequency of respiratory infections, chronic heart diseases, hypertension and lung cancer, according to the WHO. Apart from our health, our actions are also catalyzing climate change (read here how air pollution from Asia is affecting world’s weather).

Of all the causes of air pollution, I guess it is relatively easier to prevent open burning of waste. Even then, I am not aware of any regulation against the open burning of wastes in India neither are there any awareness campaigns or at least some advertisements in mass media which can change this behavior of people around.

Hope somebody takes a notice of this!

Do share this post and your stories too so that our voice can be heard. 

The Arogyada
www.arogyada.in
January 27, 2014 / by drsandeep.net

Differences between Healthcare Systems of India and the UK

Continuing with our series on comparison of Indian healthcare system with various healthcare systems across the  globe, here are some gross differences.

The Indian healthcare system, though evolved from its colonial roots of the British empire, started with many similarities but has not been able to maintain the strength of its public arm and consequently the private arm has far overtaken and established deep roots in the Indian healthcare scenario.

——–
UK:
A healthy proportion of 9.6% of the GDP is spent towards healthcare expenditure.Public spending contributes to 81.7 percent of overall healthcare expenditure.

India:
4.1% of the GDP is spent on healthcare expenditure while the public spending is as low as 1.2% of the GDP or 26.2% of the total expenditure(2010).

——–
UK:
Healthcare is publicly funded from general taxation, and is free to all permanent residents.There is also a thriving private healthcare sector which is considerably smaller than its public equivalent. The cost of private healthcare is mainly covered via private health insurance.

India:
Majority of healthcare expenses are out of pocket with private sector playing a major role. There is no single universal scheme covering the entire population. Though there are a multitude of health benefit schemes at central and state level for specific sections within the population.


———
UK:
Fifteenth best in Europe and eighteenth in the world (amongst 191 member states in the World Health Report, 2000)

India:
Ranked at 112 in the world (amongst 191 member states in the World Health Report, 2000)

———
UK:
Coordinated care is a norm. For elective care, patient has to visit a General Practitioners (GPs) first who acts as a referral authority for referral to specialists and super-specialists as necessary.

India:
Coordination of care is weak, almost non existent. Anybody can directly approach any specialist or super-specialist without proper referral system in place.

———
UK:
Single holistic health services under National Health Services(NHS) England cover entire spectrum of primary to tertiary healthcare, acute to chronic services and vaccination to adult screening programs.

India:
Multiple centre and state level programs which cover same issues amongst the same set of beneficiaries on one end. For instance, maternal health has schemes such as Janani Shishu Suraksha Karyakram (JSSK), Janani Suraksha Yojna (JSY)  and Indira Gandhi Matritva Sahyog Yojna (IGMSY) running in parallel apart from innumerable schemes in every state. On the other hand there is no focus on other set of health issues like geriatric health.

———
UK:
Pharmacies (other than those within hospitals) are privately owned but have contracts with the NHS to supply prescription drugs. Systematic and only on prescription sale of drugs is the standard practice.

India:
Pharmacies are predominantly privately owned by single owners with no affiliation to public health systems except for licensing
formalities. There is indiscriminate sale of drugs over the counter including antibiotics leading to a very imminent risk of widespread bacterial resistance

The Arogyada
www.arogyada.in
January 17, 2014 / by drsandeep.net

Five Key Challenges for Indian Health Insurance Industry

In the current scenarios Indian health insurance industry can be considered to still be in its infancy. The next few years posit a plethora of challenges. Have highlighted key five areas of concern.

1. Lack of standardised transactions between the insurer and hospitals or the insurer and insured. This often results in individual interpretation and methodology for processes like claims and pre-authorization

2. Use of non-standard terminologies with regards to treatment protocols and care plans. In fact absence or minimal documentation and implementation of standard care pathways become a cause of conflict with regards to services covered/not covered for payment via the insurer. This gets further aggravated with extremely poor usage and implementation of ICD codes

3. Skewed penetration (much higher in urban India than rural) of private health insurers within the Indian population leading to asymmetric distribution of risk. This ultimately on one hand bleeds the insurer, on other hand hits the insured due to higher premiums and finally also the hospitals due to higher rejection rates

4. Non SLA based transactions between hospitals and insurers. Response time and request closure time for crucial transactions like pre-auth filling, pre-auth approval, claim filling, and claim approval is still not a strictly followed dimension.

5. Both hospital and insurer hold sensitive patient data but we are still far from having any form of implementable India specific law or guidelines to protect and securely exchange patient data between two major pillars of healthcare industry

The Arogyada
www.arogyada.in
January 8, 2014 / by drsandeep.net

Can Indian ‘healthcare’ survive a business focused hospital set up?

Working for a hospital I thought it was my karmic duty to insist on price revision as per current industry norms, to impress on consultants to promote utilization of our pharmacy and diagnostics (for better drugs and accurate results for the patients!!) and off course maximum conversion to inpatient services. After all, EBITDA had to be above the red mark to keep the institution viable.

This was until yesterday, when a leading specialist at another leading hospital refused to even go through the previous case sheets of one of my relatives until a costly scan he was suggesting was done at the facility suggested by him. Another revelation in this tryst was that some hospitals now have stop watches in the cabins of consultants so as to double up consultation fee as soon as the management accepted time is up.

I always had a perception that consultants are treated as the final authority in majority of hospitals today. However, this experience of a hospital where consultants are understandably under strict instructions from the management was repellent from a patient perspective.


The same day had more experiences in store. Another famous consultant working for a mid – sized hospital (read mismanaged and unpleasant) attended to my relative with patience, appropriate clinical concern and had no bearing upon where the drugs and investigation came from as long as they were from an authentic source. However I had no answers when I was faced with a question from my relative that why this famous doctor has moved from a five star hospital to this one and not a ladder up may be a seven star hospital?

Contradictions galore, questions remain constant.

Are we headed towards a commercialized Indian Healthcare where patient is at the bottom of the food chain?

How to bring patient in focus for business minded managements?

A questionable change in the patient perception that a star hospital will house best of the consultants and a small hospital will not.

I leave you with this final question to ponder upon:

Can ‘healthcare’ survive a business focused hospital set up?

The Arogyada
www.arogyada.in
August 25, 2013 / by drsandeep.net

Five key differences between Indian and US healthcare systems

Just a FYI post to understand the basic differences between Indian and US healthcare system. This kind of comparative study can help us understand the good features and flaws in both the systems.



  1. In India the total expenditure as percentage of GDP is as low as 4-5 %. Whereas in US it is well beyond world standards, as high as 16.2 % of GDP. With highest per capita expenditure in the world US is ranked on 37th position, which indicates that increasing expenditure on healthcare is not the only solution to improve the health status of the citizens. On the other hand, India ranks quite low and stands at 112 which is well below countries like Sri Lanka(76) and Bangladesh (88). 
  2. The Indian Healthcare system can be considered as a Mixed Healthcare System where there is a government health infrastructure which provides healthcare at primary, secondary and tertiary levels. In addition to this there is a strong presence of private healthcare infrastructure which is growing stronger by the day with decline of trust of people in public hospitals. While in US the system is majorly privately funded where the employers are supposed to fund for the employees working with them. There is public funding is available only for unemployed people who cannot afford to purchase health insurance.
  3. Out of the pocket payments account for 70% of healthcare costs in India which warrants a work up on strengthening of financing mechanisms like insurance. On the other hand in US the out of pocket expenditure stands at around 10-12%.
  4. With the perspective of  outcomes, in India the Life expectancy at birth m/f (in years) is 63/66 while that for US is 76/81. Another important factor is Probability of dying under five (per 1000 live births) which indicates the load of infective diseases which affect children and the ability of the healthcare system to deal with them . In India the Probability of dying under five is as high as 66 per 1000 live births while that of US is 8 per 1000 live births.
  5. India has a universal health care system run by the local (state or territorial) governments. Government hospitals provide treatment at taxpayer expense. Most essential drugs are offered free of charge in these hospitals. However, the fact that the government sector is understaffed, underfinanced and that these hospitals maintain very poor standards of hygiene forces many people to visit private medical practitioners.. The United States does not have a universal health care system; it is a proposed reform. The Obama administration health care reform, the Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act of 2010, seeks to have near-univesal healthcare insurance coverage to legal residents.
The Arogyada
www.arogyada.in
September 1, 2011 / by drsandeep.net