MANAGEMENT OF THE SICK HEALTHCARE SYSTEM
( By Dr.S.V.Nadkarni, M.S. )

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Introduction

There is a well known story in mythology of Bali Raja and Batu Waman. Bali Raja was a noble king but Asur-a lower castruling part of the country which is now known as ‘Kerala’. He was a great, wise king and with his strength and intelligence not only conquered the earth round his kingdom but even invaded the kingdom of god. The king of gods, Lord Indra, was frightened that one day Bali Raja will conquer the entire kingdom of gods i.e. ‘swarga’. Therefore, he went to Lord Vishnu with an appeal to protect the gods from the might of Bali Raja. Lord Vishnu agreeing to protect the gods, took the form of a Batu Waman. i.e. small brahmin priest and went to Bali Raja. Bali Raja asked him what he wanted and Batu Waman requested him to give him merely three steps worth of land. Even though Bali Raja knew the trap, he readily agreed and Batu Waman grew into a huge giant figure and with his one step conquered the whole earth and swarga. The next step he kept on ‘narak’ and asked Bali Raja where to keep his third step. Bali Raja promptly asked him to step on his head and thus Batu waman pushed Bali Raja into the ‘narak’. But because he was a really benevolent king. he was allowed to revisit his Praja once a year. To this date the people of Kerala celebrate ‘Onam’ to welcome their king and show him that they are happy.

I do not particularly like the philosophy underlying this story because Bali Raja was not an evil king. His only fault, if it can be called so, was that he was not from higher caste or from among gods. Today we cannot easily accept this philosophy of protecting the haves, even if the have nots are capable of rising above the ‘haves’. But I have been narrating this story for another reason to many of my students, to compare the three steps of Batu Waman to the three questions in clinical practice which encompass the entire field of medicine. The practicing doctor needs to answer only three questions.

1) what is the diagnosis?
2) what is the management? (includes investigations and treatment) and
3) what is the prognosis? Prognosis means the ability to predict what may happen in future if the disease is allowed to progress without treatment or even if it is treated as per his advice what are the consequences that the patient may face in future. In short, he should be able to clarify all the doubts and questions that a patient has in mind about the course of disease. This prediction is not based on conjecture or astrology but has to be based on sound knowledge about the course of disease and the effectiveness of the treatment. The entire medical practice thus depends on the ability of the doctor to answer these three simple questions – simple questions which assume gigantic proportions, like the gigantic steps of Batu Waman. In the same way when I look at any social problem, I like to know what is the diagnosis i.e. what exactly is the society suffering from? Therefore, what will be the steps required to improve the condition of the society and actually whether it will have any long lasting positive effects or will it prove to be a short term remedy and the sufferings will return in the same form or in some other form to trouble the society? Before we look at the problems in health-care system and how to solve them, it is necessary to know the present situation in this system. Therefore let us first look at structure and functions of the medical system as is prevalent at present. I am not a historian nor a great scholar to go through the system of medical practice through the ages. Dr. Udwadia has written a beautiful book on how the medical practice as evolved in every part of the word from about 5000 years back reaching to the present–day–system of medical practice. I have only observed and given thought to the medical system as I saw it from the first day of my entry in the medical college in 1951 till today for the last 60 years and I propose to restrict myself to these years and propose to suggest some remedial measures which I think are necessary to improve the medical practice in the country, so that every one from the poorest to the richest can get the treatment he or she deserves.

 
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