( By Dr.S.V.Nadkarni, M.S. )

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There are some other aspects of health-care system which remain uncovered, the main being the need and inadequacy of paramedical services, transport of serious patients and ambulance services and disaster managemet or critical care management in the peripheral parts (not cities, where it is overemphasized as usual) The need for nurses is supposed to be double that of doctors, presently they are less than half the total number of doctors – the deficit is 4 times the actual need. Physiotherapiests are clustered in big cities, technicians are scanty, but strangely the need is only half-felt because the ‘basic’ doctors manage to do half of these jobs, while some other functions can be conveniently neglected. It is a pity to see doctors doing clerical or semi clerical, purely administrative work or paramedical work – Not so much a problem of dignity but of wasteful expenditure of creating a doctor at a formidable cost and giving him a job which could easily be done by people who are being trained at a much lesser cost.

Sometimes, I feel that we have too many ambulances but indiscipline and total apathy to coordinate gives us a paradoxical picture of inordinate delay in getting an ambulance while plenty of them are parked idly, all over the city. We lack administration and management.

I have decided to refrain from entering into these aspects in greater detail because 1) I myself have very scanty data and experience in this field and 2) because what I have written so far appears to be too complex and ‘head-breaking’ if I may coin such a word. Will this one Man Committee report – self appointed – work? Will it serve any purpose ? I do not know. If it falls in the hands of high level medical administrators, or bodies or persons in high places in any social field, who are concerned about our health-care system, it would atleast ferment discussion, and something would come out of it. Otherwise, it will achieve only one thing – satisfaction for myself that I have expressed my views. I wish best luck to myself.

I have added two of my earlier articles. The first one, written nearly 35 years ago, advocated a bill to be given to every patient in teaching hospitals - even if he does not pay a paise. The idea was to create "cost canciousness" among students and teachers, which may lead to a concept of "Cost Effective Health Care Management".

The second article is a word of caution to the poor and middle class patients. It explains why high tech modern hospitals become ivory towers and how the management therein would invariably become too expensive and often impersonal. It is advisible to go to middle ranged hospitals for simple or moderate illnesses and reserve these hospitals, only for serious or previously untreatable diseases.

I hope, readers will benifit by absorbing these thoughts.

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