While defending the NMC bill, the union health minister gracefully acknowledged the existence of midwives, primary health providers, pharmacists etc., to provide health care delivery and assistance to people even in countries like US and other far developed European Union countries and there is nothing wrong in training nurses and other supporting staff of clinicians to make them as hero in a limited budget movies (rural areas).
The point of our health minister although resonates intellectually a great idea but in reality it has several harsh sides as well. Indians are not fully educated. Further majority of people are poor, having earning just to meet both ends of life, absolutely for half to quarter a day. Further the society is stacked separately into rich, middle income, poor, very poor and slum. The above clear demarcation may not be that obvious in rural India however in rural parts also such stratification exist deeply although the boundary to our naked eyes may be evanescent.
When we employ nurses, community health workers, midwives, pharmacists etc., to provide health delivery, naturally the new force is gifted largely to poor, very poor and people living in slum dwellings and not to the rich class.
Such cost effective health service provider base is necessary because most of the so called qualified MBBS doctors are far too costly Porsche car even to rich, let alone poor. Many doctors in private practice may keep the consultation fee very small but would ensure various other means to juice the patient such as subjecting the patient to unwanted diagnosis, medication, surgery etc.
Some doctors (told by someone) even lure the patient initially by saying they would directly deal the medical expense of the patient with insurance agency and then would make the insurance agent to explain to the patient that the insurance does not cover the following and hence the patient has to bear the coast of what is not covered in the insurance. In fact the patient may make double payment for the treatment; one by way of insurance coverage and the other being, all those expenses that are not covered by insurance.
The above cruel reality only had compelled Modi government to reform the medical education and service on war-footing. If doctors (not all) had ever showed bare minimum ethics and followed minimum values in their medical profession the need for such stringent law itself would not have raised. The above opportunity was also well exploited by several institutionally qualified AYUSH vaidyas in rural India by engaging in full-fledged allopathic practice causing medication health fraud.
Knowing little to nothing about own system like how Tridosha helps in diagnosis, how vata, pitta and kapha and their subtle differences are read, how they contribute to various diseases, how the admixing of several herbs can become a drug, where is evidence of pharmacokinetics and mechanism of action etc., but still many AYUSH vaidyas, more so some Siddha vaidya claim their enormous expertise in allopathic system as well.
The unfortunate side of the NMC bill is that once the government designate community health providers or nurses or paramedics as doctor to poor people, the poor people have to live and die only with such system and their health care delivery system would never elevate to the next level.
In US and EU countries not just law is strict, but people are also reasonably disciplined and are self-restrained from breaking law. But in India the educated people are the one most often break the law than the illiterate. And hence, the new supporting actor turned hero (transformed doctor) is likely to engage in treatment adventurism at the expense of poor people fully due to the ignorance of both the health provider as well as the patient.
The only solution to the above problem is to designate all those ‘nascent breed of doctors’ as health providers and never allow them to use the prefix Doctor. Once the tag doctor is not there with the medicine dispensing person, people will be a little aware of the limitations of the treatment and hence would approach a proper doctor when the treatment response is poor.
Similarly AYUSH must be defined as paramedical wellness and health providing system than as medical science and so are the vaidyas by forbidding them from using the prefix doctor.
Giving limited permission to all those trained staff to dispense drugs based on broad list of complaints is not a bad idea but we should not allow them to exploit the gullibility of poor people by allowing them to self-designate as doctor.
Only when AYUSH vaidyas are strictly brought back to AYUSH than engaging in cross pathy, AYUSH can be promoted and developed. By hyping the greatness of AYUSH, funding the system from public exchequer and finally allowing the viadyas in private practice to engage in cross pathy would only defeat both AYUSH as well as our health delivery system.
When the health minister defended the bill by citing the examples from US and EU in parliament, let us also remember India is different and all Indians are not Gandhi and all those bear the name Ram are not Lord Ram.
The tag ‘doctor’ is if barred from use by the stop-gap arrangement staff to dispense drugs, we can achieve a reasonable level of health delivery at community level and also can prevent the exploitation of innocence of poor people by those health providers designating themselves as doctor who know everything like how some Siddha vaidyas claims that they are more knowledgeable in modern medicine than MBBS doctors.
We are sure PM Modi will look into certain ground truth and will ensure the suffix doctor is not liberally and lavishly used by health providers and institutionally qualified AYUSH vaidya.
S Ranganathan
