Friday, March 16, 2012

Angst , awareness and action

Angst , Awareness and Action, a book written by my friend , Jay Desai, and published by Pearson, was launched yesterday. The book focuses on the importance of accountability , in order to improve governance in India. It's a well-written book , and it set me thinking as to how we can apply its lessons to improving healthcare within India.

There is a lot of angst within the healthcare system and patients are often unhappy and dissatisfied with the quality of medical care they receive. They complain that doctors don't have the time to sit down and talk to them ; and that they do not bother to explain what's going on, as a result of which patients ( and their family members) are often left in the dark about their treatment. There's also a lot of unhappiness within doctors themselves , because they feel they are overworked , overburdened and underpaid. The first step to resolving angst is to be aware of the fact that there is a problem , so that we can then take intelligent action in order to resolve this.

The central issue which this book highlights is that of accountability , and at first blush it might seem the solution to the problem is to make doctors more accountable to patients . However, that's not what I'm proposing at all. While technically ( and legally) it is true that doctors are accountable to their patients , in reality this is a right which is extremely hard to enforce . When things go wrong, this kind of attitude causes patients to look for scapegoats , and it's very easy to blame the doctor for being negligent when the outcome is bad , even when the doctor is blameless.

It’s very hard to prove medical negligence ; and trying to enforce accountability in a court of law just ends up creating a lose-lose situation. The truth is that trying to ensure accountability from someone else ( whether this other person is a bureaucrat, politician , judge or doctor ) is extremely hard.Link

A more enlightened approach would be to help patients ( the end-users) to become more accountable for the quality of medical care which they receive. Patients are not helpless , and they do play an active role in their own healthcare, even though this is not often explicitly acknowledged. This is a much more practical solution , because it's possible for people to change their own behavior, while changing the behavior of the system is extremely hard.

The philosophy behind Information Therapy is that patients are the largest untapped healthcare resource ; and that by empowering patients with information and holding them accountable for the quality of care which they receive, they will be able to make much better use of the medical resources which are available to them through doctors and hospitals.

While this is not possible for all medical encounters ( for example, during an emergency); and can be challenging to implement ( when patients are illiterate), this is a better approach, because it’s the patients who have the most at stake, and they are the ones who will be most willing to change, provided the system provides them with the tools to do so !

While it may seem that I'm turning the concept of accountability on its head, the reality is that we can only be accountable to ourselves - and if you approach this problem from the perspective of personal empowerment , we are far more likely to get good results, rather than have to depend on the system ( or some other player within the system ) to provide these results to us.

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