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Poorly trained doctors are making wrong diagnoses and dishing out outdated or even incorrect treatment in large parts of India, according to a study
The article in Health Affairs journal detailing the results of a scientific study performed recently in India (The Hindu,December 6, 2012 ) serves to underline what has long been suspected but rarely articulated or discussed on meaningful fora — Just how much do our doctors know? How accurate are they in making a diagnosis and how appropriate is the treatment they recommend?

If the study is any indication, the answer should be alarming. In Delhi, the rate of correct diagnosis was as low as 22 per cent and the rate of correct treatment was less than 50 per cent. This meant that patients in this study had only a one-fifth chance of having their disease diagnosed correctly and less than half got the correct treatment. The study focussed on primary care providers and in rural Madhya Pradesh it has found that in 42 per cent of the cases, unnecessary or even harmful treatment was prescribed.

There may be limitations with the study (it covered medical and non-medical providers, qualified and unqualified) and undoubtedly there are centres of excellence where the rates of correct diagnosis and treatment would be higher. But the study has drawn attention to the massive problem of poorly trained doctors making wrong diagnoses and dishing out outdated or even incorrect treatment in large parts of India.

It is widely acknowledged that the quality of the emerging doctors in India is not uniformly what it used to be. There are many new colleges, especially private, where the standards are not up to the mark as they just do not have enough clinical material or patients to teach the students, and there are far too many students who possibly should not be in a medical school (disinterest, parental pressure, poor academic capability, etc.) in the first place. The quality of the faculty is patchy at best.

All this means the doctor who emerges from the medical school is often a health risk to the patient. Doctors in India have no legal compulsion to keep re-training themselves. They are not audited on any quality of care measures and it is pretty much a case of being free to do whatever one wants after the basic qualification is obtained.

In a government set-up in most parts of India, the average patient encounter time with the primary care physician is three minutes or less and this includes the time taken for writing out the prescription. This means the doctor is effectively making a decision on the diagnosis and treatment option in two minutes. Clearly, it is unlikely that in two minutes the doctor would get all inputs (symptom taking, history, physical examination, etc.,) to make a persistently accurate diagnosis. Sometimes, the doctors have pre-defined prescriptions that are written out and then handed over to the patients based on the symptom complex.

All this means that millions of patients could be getting the wrong treatment and incorrect diagnoses, leading to disability or death. Since we are not even measuring the accuracy of diagnosis and appropriateness of treatment, we simply do not know how big the problem is. There has been a strong reluctance to address the issue and take corrective measures. It does appear that no one really wants to rake up this matter for fear of what may emerge from a Pandora’s box. As this study has shown (despite its small sample size and limited scope), there could be a huge problem and it needs to be addressed now.

The first step would be for the government to commission more such studies on a larger scale to continually assess the quality measures. This will at least give us scientific evidence of the size and scale of the problem. The second is to institute and fully integrate protocol-based diagnoses and treatment systems into the teaching programme for medical students. The third step would be to make doctors take a test every five years to assess if they have updated their skills. Doctors who fail could be given a grace time of a year or two (and multiple attempts) to pass the test, failing which, their licence could be suspended. The fourth step could be to use technology with applications like clinical decision support systems to improve the quality of care delivery. All these are vitally important patient safety measures.

The tragedy is that our society seems indifferent to the fact that visiting a doctor may actually be injurious to health. Perhaps, it is our belief in destiny or karma that makes us reluctant to fight for this cause. There are very few strong patient bodies or consumer groups that take these issues up with the state or medical associations. A society that does not fight even for something as basic as quality health care, perhaps, deserves the health care it gets. The next time you visit your doctor, remember that your odds of getting the right diagnosis and treatment may be even less than that from the toss of a coin.

(The writer is a consultant in Internal Medicine. He can be reached at sumanthcraman@gmail.com)

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Seems to be a serious matter, if the study has been properly done. Kindly give the reference link to the study here so that proper inferences may be drawn.

Thank you!

There may be limitations with the study (it covered medical and non-medical providers, qualified and unqualified) and undoubtedly there are centres of excellence where the rates of correct diagnosis and treatment would be higher.

Right conclusions cannot be drawn with the above limitation. If you are concerned about the right diagnosis (the question of the right treatment comes only after this step), is it the allopathic diagnosis, homoeopathic diagnosis, ayurvedic diagnosis or the siddha diagnosis or the Tibetan or the Chinese diagnosis? Which one? When one sees the umpteen sciences involved in the treatment, it is not judicial to judge only through the allopathic point of view. 

I hope this study is not biased to Indians only..The world is watching..Once you go out and practice your professions,
you might be degraded and down looked  by other foreign medical practitioners.

I still believe Indian Doctors are excellent and good doctors..I hope they will follow up this study to a more positive and promising one. Not an erring Indian doctors.

this is true..

Yah profession to business hogaya hai,  (dont mind sir)

Allah (GOD) SAVE US

YES------YES------------YES This is bitter truth.I am putting & emphasing strongly on the capacity of 32 years of experience as general practioner,served in the Govt. Hospital of Rural & district level,now a Consultant Pathologist& General Practioner,the study cited above is happening daily.I will add further,doctors forgotten their ETHICS & HIPPOCRATES OATH rather took profession as business,endulged in Dichotomy by liasoning with the drug company,

MR,retail medicine shop,Diagnostic center runned by untrained person{Footpath Lab.}without doctor.Hence without proper diagnosis,treatment obviously will be irrational.Patients are loaded with unnecessary investigations,presriptions loaded with number of unrequired medicines.

                          Therefore this is high time on part of each doctor,doctors associations including IMA,state & National Medical Registration councils,IMC and Govt to think seriously to stop this at the earliest.

I dont know what audience or reader I'm addressed to but the news has two aspects, all in all it has strengthened my views expressed in my blog in hindi-- shailesh001.jagranjunction.com\ satyamev jayte (in hindi) .
one is -- when we talk in public and when we're mulling internally. Every irresponsible or unprofessional act mars the esteem of whole medical field(Indian & non-Indian although I keep to Indian scenario only). Today in India there are 2.5 times more private colleges than govt and most of the pvt colleges belong to politicians and businessmen whom main motto is to make money and he does it by moulding, greasing and manouvering by any means. I have close experience with such institutions and I have found gross flaws rather havocful. And its because the govt has made it a point to make its vested politics and else's business through education. THE REPUTATION OF MEDICAL FRATERNITY IS ESTABLISHED BY HARDWORKING MERITORIOUS GOOD STUDENTS FROM GOVT COLLEGES WHILE ITS DESTROYED BY THE PVT COLLEGE PASSOUTS. So the brunt of the bad acts are bourne by the good doctors who are not responsible for the same.
Anybody who reads this will make an outcry and will only grab a proper doc cos the crook doc will either slip away being already very prepared and secondly being more resourceful to evade any actions and also any action against them doesnt hurt them as they have other means of livelihood. But when such news comes in air people only throng to the govt, which itself is the culprit, and govt will only take hard actions against right docs, its very pitiable. So, when you send out untrained and 'dirty doc' as I say, how can you expect a better performance?
but rather than giving a kneejerk response we have to understand what we have to do.
All this is known to the police, media, bureacrats and politicians but they will only target the medical community who are the soft targets and dont hit back!
But the onus is only on us to rectify it or atleast to move in the direction.
But even most of our own medic friends are ignorant and indifferent..I know most of them are doing their primary duty but their secondary duty also is to safeguard their own professional interests beside fighting for their field (medical), their Institution, their teachers and batchmates and also fight for the country in that order. Specially in the kind of state we're in right now.
Remember, education and medical knowledge is gven to the world by us only and none else first or anytime in times and sadly we're passing into these helm of things.
When you raise bad doc expecting true act is futile. After you have trained and taught your medical student with all grill and heat the diagnosis becomes his or her professional judgement, sure. My college King Georges at Lucknow is known for its clinical training all over the world for last 125 years!! And when I see other of my freinds I find the difference. Myself, being a faculty and working in medical education I know that there is huge difference between a student securing whopping marks in MCQs and performing aptly in the ICUs! I plan to study this aspect. But even i suspect in right direction and am confidant of establishing the suspected truth but how do I get it to meaningful end? The one at the receiving end i.e. pubic doesnt know this and when this is taken to them most of them only reflexly atack a right conducting doctor and tat I dont want. I appeal all of you if yu could take it to the public in rightmost way do that , you can also share my blog (as mentioned above) which is already wellread to make ourselves explained. If you know of other ways or wish to advice do it on my blog or my email.
Thanks for a very meaningful talk.

Dr Shailesh Gupta. sanj001@gmail.com

We need medical education to bring out specialists directly unlike the system of running behind entrance for basic medical degree and later for P.G. A system as practiced in some other countries where the medical education is 7 years or longer with diversification into specialty of choice after 5 year basic education

Secondly and most important, we have to introduce the system of family medicine practice where by all patients will be thoroughly screened by his G.P instead of rushing directly to the specialist or  super specials as seen toady which only depletes the high end care /system when and where needed. Why rush and overload neurosurgery for a head ache which can be  a visual problem /just a migraine or beginning of cold.Like wise why all sneezing will have to see E N T specialist and chest pains by cardiologist and all pains by ortho surgeon

Attachments:

yes, it is true.

 

But why is this happening . It is all because of giving recognition to DNB. In what way DNB is equal to MD.

Majority medical colleges have DNB fellows as faculty from resident to professor level who teach what they know.

That is basic education is not proper to new  generation doctors.

why so many mushrooming private colleges without proper faculty , facilities and patients

Why a single enterance exam for medicine & engineering is not implemented.

why so many mushrooming deemed  universities.

The answer is simple.

The IMC , health & family welfare ministry want to make crores of black money. It is followed by private medical,dental,engineering colleges and deemed universities. So the people who are responsible for all these are again people only. Then why you want to show your finger at doctors only for wrong diagnosis & treatment.

when you are manufacturing such doctors by giving huge capitation fees in lakhs to crores, then you should be ready to take wrong treatment from them.

Dont cry foul & give wrong comments & suggestions that there licence to be cancelled etc.

if u cancel a license to a qualified doctor who will take care of his family & commitments.

First try to eleminate crores of quack doctors practising in india if u can rise hue & cry.

and dont ever say that qualified doctors once again has to pass / score in exams every year / 2-5 years.

They can be subjected to compulsary training / conference/CME attendence  that is the only way of some education.

Here coming to discussion on Diagnosis, I would like like mention few thoughts of experience. Whether diagnosis is helpful for prognosis or treatment? Properly diagnosed but patient is not cured. this is happening in many case. Giving less importance to patient and individuality. Don't know the concept of suppression?. Skin disease suppressed but nasal irritation and discharge started,nasal discharge suppressed ear discharge started. Named skin disease as  scabies or ring worm, eczema, named nasal problem as rhinitis and ear problem as otitis media. Here the question is what is the use of diagnosis if you don't know the real cause of disease, and concept of suppression. appending germ as cause for disease. how far this is true? Aiming single symptoms is it cure? Outwardly expressed symptoms is always related with internal metabolic disorder, a group of expressions. In this connection how far we are making diagnosis correct. There is confliction between doctors  for a diagnosis made, is it not? http://homeoresearch.blogspot.com      http://ushahomeopathy.com

The main responsibility has to be on the Medical Council . They are the licensing body for medical practitioners,and the body in charge of recognising  and accrediting medical institutions. Derecognise inferior standard medical colleges.

In Malaysia, every medical practitioner has to renew his/her practising certificate yearly. Conditions are enforced to obtain renewal e,g CME points. This forces one to keep up with the progress in the medical field.

Totally agreed to dr Sanjeev Kumar. Also if they want us to do justice to a patient by giving him right amount of time then it should be from govt initiative to produce doctors and implement measures (not the negative ones which babus often suggest the govt.) to retain the talent in India. This article does talk about two minute time given by an Indian doctor to the patient but has the author talked about the skewed doctor patient ratio prevailing in India ? Articles quote it to be 1 doctor for 5000 people, in US it is 1 Doc to 200 but in fact it is much worse in India. In fact it is great Indian doctor is able to see 100 to 150 OPD daily single handed!!! Either the population has to go down or you have to produce more doctors and invest more in health care sector which our govt is not willing to do since it consider it as a liability rather than an asset. It's time our govt seriously start thinking about investing in Heath care.
One more thing this article mentions about continuing medical eduction for doctors to keep up with the time!! But after seeing 100 to 200 patients daily will a human 40 yrs old or more have the strength to study and learn and retain??
One more thing even if it implemented what if 50% doctors fail to pass the test?? You will cancel the licence ??? Snatch the degree?? What you will surely do is to make other doctors job more difficult I mean let me see you working 24 / 7 now seeing 400 patients and giving 1 min to each patient or may be less.!!! Hahahaha

One more thing this article does not mention about the quakes ojahs babas and other people like them in India whO claim to correct certain illness by doing something ??? Who is checking their competency level ?? I mean are they under any CME. Do they have licence??
It is very easy to tell doctors in India that they are lacking somewhere because they are doing their best despite all the brickbats thrown at them ? It's time people should have some understanding about being a doctor and we can do justice to patients but govt and people should understand the situation and try to find solution rather that being critical.
Think of demand and supply it is as easy as that!! Believe me we still try to do maximum justice possible but think and appreciate the fact we are also humans our aspirations and dreams are equal to others if not more!

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