Sunday, September 1, 2013

Illness Management and Wellness Advancement: Willpower as the Tipping Factor

Modern medicine has progressed tremendously to scale newer heights of diagnostics and therapeutics. Several surgical, biomedical, bioengineering, pharmaceutical, biological, nursing and rehabilitation approaches are now available to render sophisticated treatment options to illnesses. One may postulate that thanks to globalization of medical knowledge, availability of private investments and the development of generic pharmaceutical industry, these healthcare options are accessible, though not either universally or affordably. Even assuming that these become available and accessible, three factors remain the most critical ones in making the best use of these options for enabling wellness for the general population. The first is the hospital infrastructure. The second is the medical insurance system, The third is the patient and his or her caregivers.   

In all the above, the medical divide is a stark reality that differentiates the developed economies and the emerging economies and the rich and the poor in the respective economies. The best of the hospitals and the equipment are understandably available more in the developed countries. A host of medical insurance schemes are also well established in the advanced countries. The importance of nursing and care giving, during illness and in the recovery phase, including sensitivity to the risks of hospital induced infections is also well understood in the mature economies. Unfortunately, attention to these is not necessarily a function of the economic wellbeing of a nation, or vice versa. China and India, for example, could be amongst the Top 5 economies of the world. It is, however, unclear if they would be amongst the Top 5 healthcare infrastructures of the world.
Healthcare constraints
Healthcare is one of the areas that received amongst the lowest levels of investment in India’s economic planning. Healthcare has traditionally received no more than 1.5 percent of India’s GDP. This compares adversely with the global median of 5 percent of the GDP. The healthcare system is burdened by stagnant public health infrastructure marked by dated equipment, inadequate hospital beds and poor nursing.  As a result, despite the costs of treatment, even indigent population is forced to depend on the few private hospitals. At a macro level, a hospital count of 15,000 and a doctor population of 400,000 is grossly inadequate for a population of 1.2 billion of India which has additional problems of infant mortality, hunger and malnutrition, poor sanitation and hygiene, lack of clean water and prevalence of tropical diseases.
Medical insurance is completely unheard of in the rural areas, where 70 percent of India’s population lives. Even in urban areas, insurance is inadequate and highly capped and rarely cashless. The geriatric population which needs the healthcare insurance disparately has little access to insurance beyond a senior age. Pre-existing illnesses are often excluded. The Indian patient and the caretaker ecosystem are also equally affected by the emerging market syndrome of low disease awareness, poor medical transparency and inability to evaluate options. Lack of centers of excellence for individual specialties (on the lines of US and Singapore hospitals) also affects the ability of patient population to reach to the best option in the least possible time. Most hospitals in India vie to be multi-specialty hospitals rather than super-specialty hospitals, spreading out investments and medical attention too thin. All the factors discussed above point to the long haul that is ahead for the Indian healthcare sector
Will for nil-illness
There is a great need for a thematic redefinition in the Indian healthcare sector.  Just as the industry benefits from thematic campaigns such as Zero Defects, and demographics are influenced by Single or Dual Child campaigns, healthcare could benefit from a Will for nil-illness. While aging and terminal illness are, no doubt, inevitable concomitants of life, illness can be reduced with conscious effort and deliberate will. That is because sufficient knowledge on optimal healthcare exists today but deployment of the knowledge has been anything but patchy. The principal participants in the Indian healthcare paradigm namely, the governments, the investors, the hospitals, the insurers, the drug makers and the patients must demonstrate a strong degree of will to take the healthcare paradigm to the next level. Will is required because this upgrade requires the participants to consciously move forward independent of normal metrics such as cost, revenue, profit and occupancy.
Will connotes the ability to control one’s thoughts and actions in order to achieve what one wants to achieve; it is a feeling of strong determination to do that particular thing what one wants to do. Whenever a person or an entity needs to accomplish something extraordinary, the starting point is neither a plan nor an action, neither is it a slogan or a credo. The starting point is the will to accomplish that something extraordinary. Given the state of the Indian healthcare, the paucity of resources, and the disadvantaged state of Indian patient population all the stakeholders require a tremendous willpower to lift healthcare to acceptable limits. Fortunately, there are a few levers that can lead to a significant boost to the willpower of all the stakeholders. A discussion of the concept of just the three critical stakeholders - hospitals, doctors and patients - points to the need for will as the key driver of the healthcare change in India.
Willpower for the hospitals
Hospitals serve as the infrastructure for the noble objective of saving lives and ensuring good health. It is necessary that hospitals are established and operated to support the basic objective rather than on profit-driving metrics. India has the most spaciously designed and luxuriously operated hotels or offices. India is also home to some of the best Indian factories, in several sectors, automobiles, pharmaceuticals and white goods, for example. Unfortunately, however, even the best of the hospitals in even a metropolitan city of India leaves much to be desired, in terms of designs and layouts.  Should the hospital system wait for a regulatory institution like Indian Hospitals Authority to be set up or it should, on its own, emerge as the role model of proactive self-development and self-regulation is a question that should engage all the right-thinking people of the country. The answer obviously lies in the latter. That’s where the willpower of the founders and administrators of hospitals and clinics would count.
To keep the best hospital practice as an objective far above revenue and profit means that hospitals need to be designed for the future. The first designs of any hospital or clinic themselves must provide for well-categorized spaces for outpatient services, emergency services, intensive care services, room and ward services, diagnostic services, support services and waiting rooms for each of the above. Hospitals which are designed like pharmaceutical factories with clean environment for patient consultation, diagnosis and waiting, and aseptic core for operations and intensive care are the best bet for promoting patient welfare. It requires tremendous willpower on the part of founders, investors and administrators of hospitals and clinics to keep the clean and aseptic conditions in hospital design and management above any other revenue or profit considerations.  
Willpower for the doctors
Doctors are God’s instruments to save lives and promote good health. The ratio of doctors to patient population is extremely unfavorable in India which makes each doctor see far more patients than he or she could do justice to on any particular day. Not only that, doctors tend to practice across several hospitals taking away long hours in commute. It requires tremendous willpower for doctors to spend the requisite amount of time on each patient in both outpatient and ward stays. A complete understanding of the patient’s medical history, current medical issues, diagnostic requirements, analysis of diagnostic results, physical examination, day to day readouts and general counseling, together with pre-surgical, surgical and post-surgical actions as well as an appropriate level of enquiry with, and advisory to, the patient’s caretakers and caregivers constitute the total doctor-patient interactive requirement. Indian doctors, fighting for every minute of their time, hardly are able to do justice to the virtuous patient treatment paradigm that is required for effective healthcare. It requires tremendous willpower for doctors to preferentially recognize the “care-value” of time over the “money-value” of time.
When time is in short supply, doctors need to collaborate with each other to optimize the time for patients jointly. It is not uncommon for the doctors and surgeons of different specialties to visit their ward patients at different times, going through the progress severally and coming up with treatment options from diverse, and often unconnected, angles. If only doctors and surgeons move as teams, their own time as well as the patient’s time will be optimized. This aspect of inter-doctor collaboration, including explicit physician-surgeon interface as well as a related aspect of inter-hospital networking would go a long way in conserving time for the time-pressured medical fraternity. This, however, is easier said than done. It requires a level of will that drives down individual egos and overcomes professional competitiveness amongst doctors. There is yet another dimension of will that is relevant; updating themselves constantly with sophisticated medical and diagnostic equipment, tools and techniques and the use of information technology for medical care requires even accomplished doctors to be humble students.
Willpower for the patients
When the medical system is inadequate, a large measure of responsibility lies with the patient himself or herself to be healthy, first of all never to become patient except by way of destiny. Even genetically predisposed individuals, can adopt appropriate lifestyle changes in terms of work, stress, diet and exercise to prevent illness and ensure wellness. Individuals should commit to their and their families’ health insurance from the beginning of their careers and save also beyond that to be prepared for critical illnesses. A proactive and preventive mindset for wellness requires significant willpower at an individual level. The best of efforts, however, may not prevent illness. While acute illnesses may be manageable, chronic illnesses such as degenerative Alzheimer’s and Parkinson’s and completely unexpected cardiac attacks and vascular strokes require tremendous willpower on the part of the patient, and the caretaker group.
The human body is an amazing creation of the Almighty, which is vulnerable for unanticipated calamities but also is capable of reconstruction and rejuvenation; the healthy parts supporting the affected parts to recover. With positive mindset and unswerving diligence, patients facing chronic diseases can still turn the corner and become normal or near normal.  The Hindu Business Line in its Weekend Life Feature on August 30, 2013 carried a real life story titled “A Fresh Innings for Vijay” describing how a middle aged corporate senior executive afflicted by a sudden stroke worked hard not only to become normal but also discover new faculties ( Clearly, conditioned rejuvenation as well as inexplicable miracles are possible in human medical endeavor. It requires a positive approach and an indomitable will on the part of individual-patient to regain normalcy, with the support of the caretaker group comprising the immediate his or her family, friends, caregivers, colleagues and employer.
Life is precious that needs to be insulated from illness and reinforced with wellness. For a healthy life, positive willpower is even more precious.
Posted by Dr CB Rao on September 1, 2013               


1 comment:

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