Poorly trained doctors are making wrong diagnoses and dishing out outdated or even incorrect treatment in large parts of India, according to a study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the study has drawn attention to the massive problem of poorly trained doctors making wrong diagnoses and dishing out outdated or even incorrect treatment in large parts of India.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 firstname.lastname@example.org)