Reports of medical mistreatment by barefoot medical practitioners appear frequently in the media. Sometimes this even leads to death of the patient. But similar mistreatment is often done by Registered Medical Practitioners (RMPs) as well. One teacher suffered a minor fall in the school. The doctor told her that there was a hairline fracture and terrorised her by saying that she would become lame if she did not have a full cast put on. The poor lady paid two thousand rupees to put the cast. Back home her husband showed the X-ray to another RMP friend. He said there was no fracture at all. There was only an injury to the vein. He removed the cast and told them to do regular hot fermentation. Soon the pain was gone. It is clear that mistreatment is done both by barefoot and registered doctors. But mistreatment by a barefoot doctor is considered a crime while same mistreatment by a RMP is passed off as a mishappening.
It is also well known among medical circles that RMPs prescribe unnecessary tests because they get commissions from the labs. A lab owner in Delhi told this writer that Rs 20 out of every X-ray costing Rs 100 goes to the doctor. Doctors get commissions of Rs 500 to Rs 2,500 on every CT and MRI scan.
RMPs in government hospitals are no better. WHO’s World Health Report 2000 had pointed out that employees of the government hospitals serve themselves more than the public; they use government hospitals as a window for charging illegal fees; and being in command of more information, they mislead and fool the public into paying more. The Report further adds that government employees very frequently engage in illegal private practice during duty hours, charge illegal fees and use government hospitals to promote their private practices.
It is clear that both barefoot and registered doctors are equally dishonest. The solution, therefore, is not to put a lid on barefoot doctors and give oxygen to RMPs. Need is to regulate all doctors strictly. Regulation cannot be truly done by the government doctors who invariably come from the RMP stream. Worse, giving regulatory function to the Chief Medical Officer is putting the accused on the seat of the judge. Complaint against a Government RMP is heard by another fellow Government RMP. It is necessary to establish an independent regulator for all medical practitioners along the lines of Lokayukta.
Barefoot doctors are providing cure in distant rural areas. Government doctors are unavailable because they prefer postings in metros where they can earn big commissions by writing CT and MRI scans. Putting an end to the services provided by barefoot doctors will deprive these areas of all medical cure. Worse, reduced competition from barefoot doctors will enable RMPs to increase their charges. It is seen that the call for action against barefoot doctors is coming mainly from RMPs and not from the affected patients. RMPs want to remove competition from these barefoot doctors so that they can charge exorbitant fees from patients who have no alternative.
But we also need to make barefoot doctors accountable. Solution is to increase the supply of RMPs. This will lead to increased competition and bring down their consultation charges as well as commissions from labs. There is a need to establish a parallel stream of examination and registration for barefoot doctors. One aspiring to become Chartered Accountant has to pass certain examinations and do apprenticeship with an established CA. There is no need for him to attend four years of college. A similar examination system can be set up for barefoot doctors. They can be given the authority to prescribe medicines in a limited area. We can establish a graded registration system akin to the star-rating for hotels. Barefoot doctors can be given one-star rating and super-specialists can be given five-star rating. Registration of barefoot doctors will increase their accountability.
Another way to increase supply is to introduce a private examination system for RMPs. Many compounders, pharmacists and nurses have more experience than RMPs. They do not presently have the authority to write medicines. These may be registered as doctors if they are able to pass an exam just as ‘private’ candidates are allowed to sit in exams of BA.
The subject also has bearing on our tradition medicine system. There was no system of registration of vaidyas, astrologers and pundits. Young men became apprentices of a practicing vaidya and, in due time, became vaidya themselves. This system spontaneously led to decentralisation. Different vaidyas were free to evolve different methods of treatment. They also experimented with locally available herbs and made new formulations that were suitable to local climate, culture and eating habits.
This traditional system of medicine is now dying. One reason is that an experienced vaidya is treated as a unregistered doctor and his knowledge is declared illegal. Another reason is that vaidyas have started prescribing medicines produced in big companies. We should not blindly adopt the expensive centralised modern medicine system to the detriment of our inexpensive decentralised system.
(The writer can be contacted at bharatj@sancharnet.in)
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