IASbhai Daily Editorial Hunt | 1st Dec 2020

“Either write something worth reading or do something worth writing.” – Benjamin Franklin

Dear Aspirants
IASbhai Editorial Hunt is an initiative to dilute major Editorials of leading Newspapers in India which are most relevant to UPSC preparation –‘THE HINDU, LIVEMINT , INDIAN EXPRESS’ and help millions of readers who find difficulty in answer writing and making notes everyday. Here we choose two editorials on daily basis and analyse them with respect to UPSC MAINS 2020-21.

EDITORIAL HUNT #270 :“Health Policy : Knowledge vs Expertise Battle in Medicine | UPSC

Health Policy : Knowledge vs Expertise Battle in Medicine | UPSC

Dr. George Thomas
Health Policy : Knowledge vs Expertise Battle in Medicine | UPSC

Dr. George Thomas, an orthopaedic surgeon practising in Chennai, is the former editor of the ‘Indian Journal of Medical Ethics’

      HEADLINES:

A misguided policy that cuts deep into patient safety

      CENTRAL THEME:

It is impossible for Ayurveda to incorporate surgical techniques while ignoring the other domains of modern medicine

SYLLABUS COVERED: GS 3 : 4 : Medicine : Medical Ethics

      MAINS QUESTION:

Surgery is one branch of medicine where knowledge can only be acquired through apprenticeship — that is, the learner needs to be guided by an expert.Comment -(GS 3)

      LEARNING: 

  • Surgery : A Branch of Medicine
  • Apprenticeship is the key
  • What constitutes safe surgery ?
  • Deepening inequity
  • Way Forward

      INTRODUCTION: 

HEALTH POLICY : KNOWLEDGE VS EXPERTISE BATTLE IN MEDICINE

The basic requirement of medical practice is the safety of the patient.

  • CARDINAL BRANCH : Surgery is a branch of medicine in which poor training can have dramatic and disastrous results.
  • LESS DELIBERATION : This is the strongest argument against the ill-advised move of the State to allow graduates in Ayurveda to practise surgery.

Health Policy : Knowledge vs Expertise Battle in Medicine | UPSC

Health Policy : Knowledge vs Expertise Battle in Medicine | UPSC

      BODY: 

APPRENTICESHIP IS KEY

  • INTERDISCIPLINARY BRANCH : Surgery in the present era is an interdisciplinary endeavour.

A well-trained anaesthesiologist keeps the patient free of pain.

  • SPECIALISTS : Other specialist doctors address any other illnesses that the patient has before surgery can be safely performed.
  • HIGHLY TRAINED DOCTORS : The well-trained surgeon must have a good knowledge of the structure of the human body in health and disease.
  • EXPERIENCE COUNTS : It takes many years and much exposure before a graduate in medicine can safely perform surgery.
  • COGNITIVE FUNCTIONING : Importantly, the surgeon needs to know when not to perform surgery, a skill commonly called clinical judgement.
  • SKILLED HUMAN RESOURCE : These skills are difficult to teach and difficult to master. Errors in surgery can be devastating.

EXAMPLE
Data from the United States suggests that up to 4,000 surgical errors occur each year despite well-considered controls on who can perform surgery.

  • LEGAL CODE : Besides professional codes, legal mechanisms have been developed to ensure safe medical practice.
  • CONSUMER PROTECTION ACT : In India, the Consumer Protection Act serves as an incentive to modern medical practitioners to provide high quality health care.
  • ACCESSIBILITY AND POVERTY : Even this legal mechanism is not accessible to the poor.

It is quite clear that there is no shortcut to safe surgical outcomes.One simply cannot get away from it ; safe surgery requires years of training.

  • COMPETENCE WITHOUT KNOWLEDGE : The idea of competence without comprehension should not beguile us into believing that surgery is a suitable subject for its application.
  • KNOWLEDGE-BASED ERROR MODEL : Anecdotes of people not educated, but able to perform complex tasks should be understood in the framework.
  • PROFICIENCY BY BIRTH METHODOLOGY : Some complex tasks are a set of repetitive steps where the person acquires proficiency merely by practice.

Using a complex machine without knowing how it works. 

  • INTELLIGENCE AT DISPATCH : The above method is not applicable in surgery where novel situations are often encountered and a good knowledge base is essential to solve problems which may not have been previously encountered.

[wc_highlight color=”yellow” class=””]ALSO READ : WHO WINS ? AYURVEDA VS MODERN MEDICINES 2020[/wc_highlight]

WHAT CONSTITUTES SAFE SURGERY

  1. EVOLUTION OF MODERN MEDICINES :Modern medicine is an integrated whole in which specialties have developed from the understanding that the knowledge base.
  2. PROVEN TECHNIQUES : Modern medical training consists of a basic degree during which the fundamentals of the functioning of humans in health and disease, and techniques to diagnose illnesses are taught.
  3. DOMAIN EXPERTISE : Increased knowledge in various domains is obtained through post-graduate training.
  4. All these domains work together in order to ensure safe surgery.
  5. SAFE PRACTISES IN MODERN MEDICINES : It is impossible for Ayurveda to incorporate surgical techniques while ignoring all the other domains of modern medicine and still perform surgery safely and effectively.

The above equations are all important questions and have implications for policy in health care.

  • CRITICAL DECISION MAKING : Important decisions with potential to seriously harm thousands of people should not be casually made without clear answers.
  • MISGUIDED DESIRES : Safe and effective health care should not become a casualty of a misguided desire to protect indigenous systems.
  • DEVELOPING SCIENTIFIC TEMPER : Traditional knowledge in India has become the victim of self-serving apparatchiks who have fossilised it, preventing its development and growth.

Human knowledge is a universal resource, ever growing.

  • A PERFECT BLEND : The way forward is to incorporate traditional medical systems into modern medicine.

Health Policy : Knowledge vs Expertise Battle in Medicine | UPSC

      IASbhai Windup: 

COULD DEEPEN INEQUITY

  • MEDICAL CARE VS RESOURCES : The quality of medical care received in India is highly dependent on personal resources.
  • PATRONS OF AYURVEDA : Surgical facilities manned by graduates of Ayurveda will be patronised only by the very poor who do not have the resources to access modern medical care.

This will further entrench the existing grossly unequal access to health care.
 

  • PREJUDICES AND BIAS : An epidemic of catastrophic complications, disproportionately affecting the poor can be expected if surgical procedures are performed by the poorly trained.
  • ACUTE SHORTAGE OF HEALTH PERSONNELS : There is a shortage of trained medical personnel in rural areas.
  • INCREASING THE INTAKE : The only way to address this is to greatly increase the number of government medical colleges.
  • DEDICATED POLICY FRAMEWORK : This will take a few years, but it is a safe and effective policy.

Safety of patients should not become a victim of misguided policies based on poor understanding of what safe surgery requires.

       SOURCES:   THE HINDU EDITORIAL HUNT | Health Policy : Knowledge vs Expertise Battle in Medicine | UPSC

 

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