It is a tragedy that the people of India prize and value individual excellence more than system excellence.
All intellectuals (doctors) in India—and, for that matter, in all developing countries and even some developed countries—miss an important point regarding healthcare.
There are two situations:
- Great doctors by virtue of their knowledge, intellectual capability and experience, but working within poor systems.
- Great systems with average doctors, supported by accountability, checks and balances.
The second yields better results.
India should move away from individual greatness towards system greatness. Satya Nadella and Sundar Pichai attained great positions not only because of their individual greatness, but also because of the systems in the USA.
A case in point is that one of my relatives passed away from cholangiocarcinoma. Her gallbladder had been removed two years earlier because she had pain and gallstones. A biopsy was sent, and carcinoma was detected. The pathologist informed neither the patient nor the surgeon. She presented with secondary cancer two years later and subsequently passed away.
Medical care needs systems and accountability. The rest of it is artisanship, like that of goldsmiths, blacksmiths and weavers. We doctors are glorified, high-ticket plumbers; let us not forget it.
Let us not indulge in hyperbole or self-righteousness by claiming that we are the best.
In our minds, the healthcare system is based on a beggar-and-benefactor model. Healthcare is not treated as a sacrosanct fundamental right.
Food, clothing and shelter were the fundamental rights of yesterday. As civilisation progresses, they must become food, clothing, shelter, healthcare and dignity.
If we contextualise the French Revolution and other revolutions, we must remember Rousseau’s Social Contract, which says, in essence, that the individual forgoes his sovereignty in exchange for the provision of security for life and property. It implies that, if the contract is not fulfilled, he or she is within their rights to become a rebel and an outlaw. History is replete with this phenomenon.
Healthcare is security of life. If the government does not provide it, the citizen has every right to become an outlaw and reclaim his sovereignty.
Healthcare is a sacred Dharmic duty. We are privileged to perform that duty. It is not a market commodity and should not be counted as commerce.
2 responses
I think the excellence of a system can only be achieved when the individual(s) responsible for its smooth functioning also possess that excellence. The two are closely interlinked, I think we really can’t have one without the other. In fact, the excellence of the individual responsible for the system ultimately leads to the excellence of the system, and vice versa.
And I’m really sorry to hear about your relative. Believe it or not, something very similar happened to one of my relatives too. The diagnosis was also cholangiocarcinoma. He was only 44 and had two small kids. The diagnosis was made, but unfortunately, it was not reported for further management. A couple years later, the disease eventually progressed with secondaries, it sadly led to his demise.
What made it even more difficult to accept was that this happened in the USA, where you would expect the systems to be excellent. It happened at Duke Medical Center.
Thanks for the comment.