India cannot afford the luxury of surgical/medical interventions for chronic diseases, but it can easily keep its flock healthy by preventive health measures and primary health care. In a landmark observation Chief Justice of India J S Khehar recently said in relation to a case concerning farmers’ suicides “paying compensation to the families of victims was not the real solution.  We feel that you are going in a wrong direction. Farmers take loan from banks and when they are unable to repay, they commit suicide. The remedy to the problem is not to pay money to farmers after the suicide, but you should have schemes to prevent the occurrence of suicides”. This applies to the issue of health care directly. Not allowing occurrence of disease is real health rather than providing tertiary care subsequently in advanced centers at huge cost and high mortality/disability. Do we need a direction from the Court ‘preventive and primary healthcare should be improved so that people remain healthy and need for tertiary care capital intensive hospital is minimized’? First you allow the people/populations to become victim of obesity and its complications like heart disease or diabetes or cancers or that of malnutrition and then you open big hospitals to deal with these complications at huge cost to the nation and patient. It is going in the wrong direction. Why can’t laws and efforts be made to reduce the curse of obesity and malnutrition?
Isn’t this a misnomer where sick care is being termed as healthcare? This approach is largely reactive as it results in intervention only when the health of a person declines. It’s a system that is wholly dependent on expensive drugs and invasive surgeries, opposed to health education, preventive measures and simpler, less expensive treatment alternatives. A good government is one which provides health care to its people so that they don’t fall ill and the yardstick for assessing the governance depends on the health parameters of the country. We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy. Giving treatment in public/private clinics after the person has fallen sick is not the target that a Government should aim at. Treating sickness is not health! Why to allow a healthy person to fall sick in the first place?

In the past doctors used to attempt to enhance what occurred in nature e g farm fresh foods instead of processed or canned ones. They fostered the tendency of wounds to heal, of blood to clot, and of bacteria to be overcome by natural immunity. Now they try to engineer the dreams of millions of bucks through technology and pharmaceuticals.  Oral contraceptives, for instance, are prescribed “to prevent a normal occurrence of pregnancy in healthy persons.  Therapies induce the organism to interact with molecules or with machines in ways for which there is no precedent in evolution. Grafts involve the outright obliteration of genetically programmed immunological defenses. The relationship between the interest of the patient and the success of each specialist who manipulates one of his “conditions” can thus no longer be assumed; it must now be proved.  But any charge against medicine for the clinical damage it causes constitutes only the first step in the indictment of modern medicine.  

Our behavior and lifestyle make us prone to illnesses that are chronic, complex, lifelong, and life shortening, all of which make them very expensive to treat. In the past, illnesses tended to be “acute,” meaning that they occurred and were treated, and the patients either got better or died. But today, most illnesses are chronic. If a man survives a heart attack, he is left with damaged heart muscle and so develops heart failure. This condition will be with him for life and will need many medications, and probably a number of hospitalizations with a stay in the intensive care unit (ICU). This major shift enormously impacts how we should (but mostly do not) organize the treatment of the patient and his or her disease, how we should (but mostly do not) organize the payment system for that care, how we should (but mostly do not) use technologies wisely for care, and how we should (but mostly do not) ensure quality and safety in patient care. Medical college’s curricula should emphasize homeostasis and health, rather than disease and diagnosis, and provide training in the science and practice of cost-effective health promotion. In turn, payers will need to reimburse for health maintenance and prevention activities, primary care physicians will have to act as health coaches.

Eighty percent of what affects health outcomes is associated with factors outside the traditional boundaries of healthcare delivery—health behaviors (Alcohol, tobacco, drugs use, sexual adventures), social and economic factors (employment, education, income), and physical environment (air quality, water quality, food quality and quantity). When healthcare delivery systems expand their interactions to these territories, outcomes will improve. New models must also reward innovation and excellence.

The most important lifestyle is good food i e a diet high in healthful fats , moderate amounts of high quality protein, low amounts of carbs, with the bulk of carbohydrates coming from fruits/vegetables and very little  from grains and sugars. Unfortunately most Indians thrive on calories from sweets,grains and potatoes. Other important components in healthcare include: Comprehensive exercise program, Stress Reduction and Positive Thinking, Optimize Vitamin D with Proper Sun Exposure, High Quality Animal-Based Omega-3 Fats, and avoidance of medicines, Chemicals, Toxins, and Pollutants. Stress free life and positive thinking will be icing over the cake.

May 4, 2017

From Sick care to healthy care

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Doctor’s Criminal Liability

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