Control of quacks

Dishonesty unlimited

Reports of medical mistreatment by barefoot medical practitioners appear frequently in the media. Sometimes this even leads to death of the patient. But similar mistreatment is often done by registered medical practitioners (RMPs) as well.

One teacher suffered a minor fall in the school. The doctor told her that there was a hairline fracture and terrorised her by saying that she would become lame if she did not have a full cast done. The poor lady paid Rs 2,000 to put the cast. Back home her husband showed the x-ray to another RMP friend, who said there was no fracture at all. There was only an injury to the vein.

He removed the cast and told them to do regular hot fermentation. Soon the pain was gone. It is clear that mistreatment is done both by barefoot — and registered doctors. But mistreatment by a barefoot doctor is considered a crime, while the same mistreatment by an RMP is passed off as a mishappening.

It is also well known among medical circles that RMPs prescribe unnecessary tests because they get commissions from the labs. A lab owner in Delhi told this writer that Rs 20 out of every x-ray costing Rs 100 goes to the doctor. Doctors get commissions of Rs 500 to Rs 2,500 on every CT and MRI scan.

It is clear that both barefoot and registered doctors are equally dishonest. The solution, therefore, is not to put a lid on barefoot doctors and give oxygen to RMPs. The need is to regulate all doctors strictly. Regulation cannot be truly done by the government doctors who invariably come from the RMP stream. It is necessary to establish an independent regulator for all medical practitioners along the lines of Lokayukta.

Barefoot doctors are providing cure in distant rural areas. Government doctors are unavailable because they prefer postings in metros, where they can earn big commissions by writing CT and MRI scans. Putting an end to the services provided by barefoot doctors will deprive these areas of all medical cure. Worse, reduced competition from barefoot doctors will enable RMPs to increase their charges.

But we also need to make barefoot doctors accountable. Solution is to increase the supply of RMPs. This will lead to increased competition and bring down their consultation charges as well as commissions from labs.

There is a need to establish a parallel stream of examination and registration for barefoot doctors. One aspiring to become chartered accountant has to pass certain examinations and do apprenticeship with an established CA. There is no need for him to attend four years of college. A similar examination system can be set up for barefoot doctors. Registration of barefoot doctors will increase their accountability.

Private examination

Another way to increase supply is to introduce a private examination system for RMPs. Many compounders, pharmacists and nurses have more experience than RMPs. They do not at present have the authority to write out medicines. These may be registered as doctors if they are able to pass an exam just as ‘private’ candidates are allowed to sit in exams of BA. These measures will lead to an increase in the supply of RMPs; they will set up their clinics in distant rural areas and also lead to a reduction in the fees and commissions charged by them.

The subject also has bearing on our tradition medicine system. There was no system of registration of vaidyas, astrologers and pundits. Young men became apprentices of a practicing vaidya and, in due course, became vaidyas themselves. This system automatically led to decentralisation.

Vaidyas were free to evolve different methods of treatment. They also experimented with locally available herbs and made new formulations that were suitable to local climate, culture and eating habits. This research was not done in air-conditioned labs. It was done by the vaidya prescribing different medicines and observing the results. This system was economically efficient.

The cost of treatment was less because of reliance on locally available herbs. It does not cost much to eat two leaves of Tulsi everyday. The same treatment would cost more if a RMP prescribes Tulsi extract.

This traditional system of medicine is now dying. One reason is that an experienced vaidya is treated as a unregistered doctor and his knowledge is declared illegal. Another reason is that vaidyas have started prescribing medicines produced in big companies. These are expensive. They do not now discover or prescribe locally available remedies. Thus ayurvedic treatment often turns out more expensive than allopathic treatment. We have, therefore, become dependent upon the modern, centralised and expensive medical system.

Centralisation is harmful for research. The RMP is like a clerk. He reads the rule book and prescribes the medicines. His own contribution is limited to deciding which page in the rule book to read. The RMP is not oriented to undertake innovation and research.

It becomes very difficult to mainstream his findings should he make some invention because the procedure of clinical trials, etc is expensive and cumbersome and requires a pharmaceutical company to sponsor his research. All this is a consequence of us denigrating our traditional system of medicine. We should not blindly adopt the expensive centralised modern medicine system to the detriment of our inexpensive decentralised system.