Skip to main content

Why "Regulations" Are Often Not Helpful Solutions

The other day I saw an impassioned plea from a doctor asking associations to "regulate the profession". The reason they cited was that healthcare is turning commercial and often this goes against the best interest of the patient.

One of the many things I learned in National Law School listening to Prof Nandimath and others is that "regulations" come with their own set of problems.

Let us look at it more closely.

First, what is the problem we are trying to solve? The healthcare system in our country (many other countries too, perhaps) have huge flaws in it that lead to suffering and poor quality of care for the end user (the patient). Medical training is focused on the wrong parameters (recent change of UG curriculum to a competency based curriculum is proof of this). Distribution of healthcare providers is disproportionately concentrated in urban areas. Healthcare is episodic. Government policies are weakening public health system. (Public health system, even otherwise, has a huge set of problems of its own). Private healthcare is becoming increasingly commercialized with doctors themselves becoming silent or vocal salespersons of treatment that costs more and earns more profit rather than treatment that the patient actually needs and prefers.

Where is the problem? If you can find out a single problem as the "root cause" you perhaps are being too optimistic. There are problems everywhere, many cross cutting factors are responsible. Many factors are outside anyone's control. Many factors require complex solutions that span economics, politics, education, and other dimensions of the nation.

Sure, we need to start somewhere. Can we look at regulation of the profession as one possible starting point out of many? Let's take a deeper dive into that.

When someone says "we need more regulations", what do they actually mean?

Regulation is always a top down thing. There needs to be a regulatory body or a regulator. And then this regulator has to control or rule over the regulated. Who constitutes a regulatory body? People with various backings, various moral stances, and various external forces acting on them. Who appoints these people? What is the process of selection? Who keeps them accountable? Who are they answerable to? What lobbying power do large establishments have on them? What lobbying power do patients have on them?

Let's say we found a perfect, ethical, practical, reasonable, diverse, sensitive, enthusiastic, energetic regulatory body. Such a regulatory body often "regulates" through policies or guidelines. Now when it comes to policy, there are two more fundamental issues.

First is formulation of policy. For the sake of simplicity of understanding, let us call it "law". What are the considerations one has to have when a law is framed? It has to protect the vulnerable from the extremely powerful. It should not prevent progress. It should not be in contradiction with the Constitution. It should be sensitive to the needs and demands of the society, while at the same time being considerate of the needs and demands of the professionals. Imagine creating a one-size-fits-all law in a large country like India. What is practical in urban India may not be practical in rural India. What is practical among literate people may not be practical among illiterate. Sometimes things that make a lot of sense to the policy maker in their office room may make no sense in real world practice.

Despite all that even if a policy gets formulated, there is the question of implementation. In a country ruined by corruption and with single states that have population larger than most other countries, how should policies get implemented? Who will enforce implementation? Technology is usually thrown around as a solution. But technology has deep limitations, especially in solving problems that are fundamentally because of what is inside the devious human mind.

"Regulations" don't come easy.

But, when ill-devised regulations come in, they can become really harmful to the entire ecosystem. There are countless examples and discussing the demerits of each is out of scope of this article.

What then is a better solution? The answer is that there is no simple or single solution to most of world problems. It takes patient and broad thinking, years (or generations) of effort, and commitment from all the stakeholders to work towards solving the problems to arrive at solutions. Sure, regulations may also be part of that solution. But even those regulations need to be the product of deep engagement from everyone. Pushing things onto others' plate is not going to help. What is helpful is if those who complain are also making an attempt at the solution.


Popular posts from this blog

"Risks" vs Risks

Decision making is almost always complicated by uncertainties. The more information that can provide context, the more stakeholders that are part of the decision, the better the chances of reaching a good decision.

In the past few weeks, world leaders have had to make very difficult decisions. Lock down entire country? Put money into healthcare? Risk economic disasters to prevent health disaster?

I guess the biggest problem they would have faced in making these decisions is uncertainty. Because medicine is a field of uncertainties. The first thing a doctor learns when helping patients is that they can never be sure of anything other than the fact that they have to act. Diseases, cells, organisms, molecules, environment, human behaviour - there are a lot of moving parts in medicine. Parts that you can't control. Parts that you can't even predict.

A doctor is a performance artist who uses an imperfect science to help alleviate suffering. In Osler's words, "Medicine is …

Anatomy paper 1 RS 2 RGUHS 2013 December question paper

My roommate says this one was easy too.

Pharmacology RGUHS question papers December 2012

Try solving these

Lessons One Should Learn From Shehla Sherin's Death

If you do not avoid news like me, you would have heard about the tragic death of a 10 year old in Wayanad a couple of days ago. You can search the name and find the story on your own, but a few facts are established already.

Shehla Sherin had her foot go into a hole on the floor of her classroom and was afraid a snake bit her in that incidentThere was delay in taking her to the hospitalAnti-Snake venom was not administered at the local hospital, and the child was referred to a tertiary care center at least an hour away.Child died on the way. I won't unnecessarily go into speculations on what other things happened on that fateful day, but having managed emergency department in a rural hospital for over an year, I will use this sad death to illustrate two very important lessons for every doctor.

Lesson 1: Never take any complaint lightly, even if the circumstances lead you to think otherwise There are two ways patients can come in. There are people who exaggerate, and people who down…