Public Health Was Always Broken, You Are Just Noticing It Now

There is this nytimes article about how one pregnant lady who was also breathless couldn't find appropriate care despite going to multiple hospitals. I find it nothing surprising. Our country's public health system has never been able to provide appropriate care to people with medical emergencies (or for that matter, any health issue). Maybe now people are noticing because it comes on news.

There is a limit to how many emergencies can be handled at a time by a small medical team. Even in tertiary care government hospitals, this "team" is a very small one. It usually includes a couple of young doctors - either doing their internship or their residency. And a couple of nurses. And a couple of janitors. It is the same whether you are talking about the ICU or the emergency room of any department. There are no mechanisms for requesting extra hands when there is a spike in cases at any moment. Crises are handled by expediting care (many a times at the expense of quality and/or completeness).

Imagine this. You are attending to a very difficult accident victim with multiple dangerous bleeds and possible head injury and suspicious breathing. As you are assessing their breathing, another patient comes in with severe pain abdomen. The other doctor stops assisting you and goes to assess the patient with pain abdomen. And then comes in another patient who has a open fracture on both bones of one lower limb. Who on earth is going to take care of this new patient? Well, let's say the other doctor gives a pain killer to the patient with pain abdomen and let them settle down thus relieving themselves to attend to this new patient. At that moment comes in yet another patient with a head injury. What happens now?

It becomes worse in the ICU. You could be in the middle of a procedure and there could be a new patient coming in with lots of things to be taken care of. And another patient could crash as this is happening. There are so many things that can go wrong at the same time. But there aren't ever enough trained hands.

It is in such situations that doctors refuse to take patients. They know that they can't give justice to anyone if they take in more patients, especially critically ill. This is where "referral to higher center" happens. Anything can happen, actually - misdiagnosis, unnecessary investigations, miscommunication, death, so on.

What is the way out?

Of course, there are a lot of things that maybe potential solutions. But I do have one idea which seems sane.

Proper "professional" education in colleges

Nurses can perform any intervention done in an ICU if they are trained and empowered to do it.

Medical students should be made capable of handling cases on their own.

In an academic institution there is no dearth of learners. If learners are properly trained and given "professional" education, they can share a lot of workload. Similarly, our country needs to stop putting the doctor at the center of everything and start allowing other professionals like nurses to do more things.

Above all, there needs to be a culture of quality and improvement. This has to be built from within colleges. When such highly trained teams focused on quality come together, they can do debriefing, build protocols, and create Standard Operating Procedures for managing cases. They will figure out the weaknesses of the system and ask for infrastructure upgrade and many other things necessary to be done to improve the overall system.

Unfortunately, we are stuck in "long case, short case" mode in medical education. And this is not going to help the country.

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I am a general practitioner rooted in the principles of primary healthcare. I am also a deep generalist and hold many other interests. If you want a medical consultation, please book an appointment When I'm not seeing patients, I code software, advise health-tech startups, and write blogs. Follow me by subscribing to my writings