Wednesday, December 12, 2012

Healthcare provided by quacks and trained docs is no different in Capital

Spot the difference
By Dinesh C. Sharma in New Delhi

Healthcare provided by quacks and trained docs is no different in Capital

THE SPREAD of quacks or unqualified health providers in the national capital has been a cause of worry for many years.
Now a World Bank study has revealed that the quality of care being provided by trained or qualified doctors is no better than quacks.
The quality of care provided by doctors, irrespective of their training, was found to be poor when measured for parameters such as correct diagnosis, appropriate treatment, time spent and adherence to checklists of essential and recommended care.
A set of local people were trained and sent as decoy patients to 64 health providers practising in the city. Of them, 52 per cent had an MBBS degree, while 16 per cent possessed no medical qualification.
Volunteers were trained to behave as patients with unstable chest pain, asthma or a father of a child at home with dysentery. The study included about 250 such episodes of decoy patients visiting different clinics.
Decoy patients
Since the decoys went unannounced, they were treated as “ real” patients by healthcare providers. The rural part of the study was conducted in Madhya Pradesh. The outcome, published in research journal Health Affairs , is shocking.
“ In both Delhi and MP, we found only small differences between trained and untrained doctors in areas like adherence to clinical checklists, and no differences in the likelihood of providers giving a diagnosis or correct treatment,” said Jishnu Das, WB economist and a visiting fellow at the Centre for Policy Research, who led the study. “ This means training by itself is no guarantee of quality care”. “ The small differences between trained and untrained providers does not mean that there are no good doctors in Delhi or MP. As we all know, the top tier of doctors in these places are among the best in the world. What it does suggest though is that, even among doctors who are fully trained, there is enormous variation in the quality of care they are able to give to their patients,” Das explained.
The consultation time was as low as 5.3 minutes. The rate of correct diagnosis and treatment were just 21.8 per cent and 45.6 per cent respectively.
Experts admit the quality of care is poor but don’t approve of sweeping generalisations.
Dr Anil Bansal, head of the anti- quackery cell of Indian Medical Association, said the study reinforces the fact that there are gaps in medical education, resulting in unnecessary use of antibiotics, steroids and diagnostic tests. But, he said, the quality of doctors depends more on where they were trained because of the poor status of medical colleges in the private sector.
“ Most quacks start practicing after working as assistants or compounders with allopathic doctors. They use their half- baked knowledge gained from different sources. This is extremely dangerous for their patients,” Dr Bansal said.
No guidelines
Dr Chandra M. Gulhati, editor of Monthly Index of Medical Specialties , said: “ Usually doctors who have completed residency opt for post- graduation, not for rural jobs. There are no therapeutic guidelines, no continuing medical education, no supervision by peers. So, it is not surprising that there is little difference between the ‘ clinical skills’ and ‘ quality of medical care’ between qualified and unqualified healthcare providers.” A large number of primary health centres in rural areas, he said, do not have qualified doctors and are manned by half- baked pharmacists, nurses and compounders.
In Delhi, the public facilities are manned by qualified doctors.
“ In unauthorised shanties, where there are no government- run dispensaries, unqualified ‘ doctors’ reside and practice there. Only when patients do not get well, they go to either the public or the private hospitals,” Dr Gulhati said.
The study recommends that while improvements in physical infrastructure and making doctors available in rural areas is necessary, such measures alone are insufficient to improve the quality of health services provided.
“ A much broader debate on getting doctors to put all their knowledge into practice is required,” it said.
World Bank study found that doctors irrespective of their training were ‘ poor’ when measured for various parameters such as correct diagnosis and care

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