Health Care Ethics Issues

Social Justice Through Health Care

SOCIAL JUSTICE THROUGH HEALTH CARE

We hardly come across a person who may be fully satisfied with the health care delivery system run by either the government or the private sector. This is true not only for developing but for all the developed countries as well. Every law abiding, contributing individual has some legitimate expectations from the state. Disenchantment with present dispensation of health care compels people to seek better options across the borders. Even the present flow rate of patients from developed to developing countries has assumed the proportions of Medical tourism. Medical tourism is not a one-way traffic. Poor from India are known to visit Rashid Hospital at Lahore for kidney transplants. Medical tourism will definitely bring in world class equipment and services in our corporate hospitals. These corporate tertiary care hospitals can act as excellent referral hospitals. Lack of enough clinical material, as the patients are often referred to in medical parleyences is prompting the doctors from developed world into medical adventurism. Very recently two NGO’s headed by renowned plastic surgeons of Indian origin were in India, claiming to their credit hundreds of cleft lip and palate surgeries conducted in one week. During my brief interaction when I asked them one basic question that how do you justify single step surgery by a single specialist for a clinical entity that require 3-5 set up surgeries by 10 specialists over a period of 20 years, there was no answer. On record local doctors conduct all these surgeries. These NGO’s bring in a battery of trainee resident doctors for hands on training. Dumping of questionable services and drugs continues unabated in the absence of stringent regulations. Clear-cut up to date guidelines by health authorities have yet to be issued to safe guard the health interests of this nation. Most of the drugs banned in developed countries are still being dumped in the Indian market. Commerce alone dictates the policies of multinational companies in health sector of developing countries. State and national medical councils, the watch dogs of our national health interests are controlled by elected representatives from among the doctors. Competitive populism for being elected to these high offices takes away the very sting off these regulators. In this ‘market forces’ driven health sector, apart from other factors, size of the population, economic prosperity and literacy levels dictate the out look of key players. Subjective as well as objective assessments of the health care operations leave people confused with huge piles of data and endless interpretations. At the tail end of govt. health care delivery system is the rural dispensary or the slum revamping center, and the end user an illiterate or semi literate villager or a slum dweller. Dispensary is the humane face, the welfare state can present to its people. In yesteryears the service providers were from among the same social class they used to serve. Doctor can be a friend, philosopher and guide to the locals. Unfortunately the economic and social disparity between the service providing doctors and the service user population has grown enormously. Ad-hocism in health care delivery should be done away with immediate effect. Doctors and paramedical staff appointed on yearly contract basis are not showing any interest in the national programmes. Established private health care providers also have not shown any meaningful commitment for national programmes. Middle class itself has fragmented. Now it is fashionable to assign economic values to any issue like gender, but for social responsibility and justice. In this era of fast paced growth, the unorganized, silently suffering millions can not be wished away. Once reading on biodiversity I stumbled upon a very interesting quote, “only the species with economic importance will survive”. In our active pursuit for magnetizing economy, we assigned economic values to any thing except for morals. Commercialization of education has produced a new breed of professionals who have scant regard for professional ethics. Privatization is the buzzword with governments, because it takes away government responsibility. Private sector players are eyeing many ‘viable’ health institutions. There are no takers for commercially non-viable rural institutions. Rural health institutions dispense social medicine. Very recently one of the key players from private sector health care quoted the cost of developing one bed in corporate hospital at Rs. 30-60 lacs. These corporate health services are definitely out of each of the common man. These type of hospitals are definitely required for a nation with the present rate of growth but ‘bharat’ definitely needs different kind of hospitals. There are very strong social under currents against the exploitive private healthcare, inadequate government sector health care resources and the indifferent approach of welfare state. Health for all is a very lofty but expensive proposition. There are ways and means to reduce the pressure from government institutions. Private-public partnership, health insurance, monitoring and regulation of private sector health care can all make the things bit easy. Preventive health care education can go a long way in improving the public health. Community participation in health care has produced few but wonderful examples. Complementary community participation can make up for minor but critical deficiencies in the government run health care system. Setting up of health system corporations with World Bank assistance has already improved the working of govt. sector health care institutions considerably. Community participation through NGO’s can still improve the system, but most of the meaningful NGO’s turn their back on govt. run health care institutions because of their doubts on the integrity of government officers. Government health care institution are increasingly seen not as caring hospitals but like police stations, where medico legal reports are written and postmortems conducted. Most of the government doctors’ time is spent in courts appearing as medico legal experts witnesses. Emergency, post mortem, and then the VIP duties in addition hardly leave the doctors free for any meaningful job at government hospitals. There is an urgent need to have separate curative, preventive, legal, administrate and health intelligence wings. Government hospitals attract the poorest of the poor, mostly people from the unorganized sector. Their contribution to national GDP is by no means small. With the present growth rate, upward social mobility is seen in every strata of society. Many segments of this unorganized sector can be organised so that they also enjoy the patronage of welfare state in the form of health insurance policies. Apart from direct benefit to these segments of society, the state will benefit from the ‘off loading’ of burden from government run health care system and loading it on insurance driven private sector health care institutions. Poorest of the poor will repose faith in welfare state. Sanjivini, health insurance policy with the Punjab Milkmen Cooperative Societies is already a big success. ECHS (Ex servicemen Contributory Health Scheme) is an other success story. These success stories can be replicated with countless groups like, panwallas, dhabewallas, autorikshaw drivers etc. Simply organize the unorganized sector. There is no dearth of role models from among government doctors also. Their inclusion rather than drift after dissent from the present dispensation of health care will immensely improve the system. Stability of tenure is an excellent incentive government can give to its doctors without costing anything to exchequer. Yet tenure beyond decades should be discouraged as it leads to development of vested interests of the old incumbents and denial of chance to the youngsters. Resource mismatching is a major problem in the govt. run health care system. There are dispensaries where specialists are posted and still many more civil hospitals where non-specialist are posted. These mismatching result in defective and inefficient health care. Nodal Hospitals can be created for round the clock emergency services by cannibalizing defunct and sick institutions where equipment worth crores is lying unused and salary bills are bleeding the exchequer white. Most of the medical officers retire in the same administrate rank. This undue stagnation has forced many a brilliant doctors out of service. By simply seeking options for place of posting, honestly implementing with minimum displacement on merit can also revitalize the govt. doctors’ cadres. Private sector health care delivery system is a totally market driven commercial enterprise. So called ‘market forces’ have least respect for ethical and moral value systems. Multi level marketing chains have evolved in the name of referral systems. End result is exploitation of the unsuspecting common man, who still regards his healer a holy person. This ‘incentive’ system is strengthening the hold of unqualified, unscrupulous and unregistered medical practitioners on illiterate masses. Not many qualified doctors are unscrupulous. A large section of private health care providers feel genuinely threatened by blackmailers of all sorts. Consumer protection act is a very convenient beating stick in the hands of their tormentors.

Under the constant threat of being blackmailed, the private health care providers are becoming more defensive in attitude. More patients are being referred to tertiary care institutions for this reason only, thereby flooding the referral institutions. People have a common feeling that sickness is an invitation for exploitation at the hands of private health care providers. Even the charitable hospitals are charging as heavily as fully private hospitals. Medical profession is fully responsible and capable of self-correction. Medical councils and associations can jointly evolve a fail-safe mechanism to keep their black sheep under check even without government help, but the buck stops with the government. Welfare state is duty bound not only in providing health care delivery system but also proper health care administration and social justice through its health care delivery mechanism.

Name : Dr. Pardeep Kumar Sharma

Email-ID : omfspardeep@yahoo.com.

(M) : 0988456296

Date of Birth : 12.02.1962

Education Qualifications : BDS (Bachelor of Dental Surgery)

MDS (Master of Dental Surgery in Oral and Maxillofacial Surgery)

Educational Institutes Attended

Govt. High School Bargari : Matriculation (1969-1977)

Distt. Faridkot, Punjab, India

DAV College Chandigarh : Pre-University (1973-79)

(Punjab University)

Barjindra College Faridkot : Pre-Medical (1980)

Dental Wing, Medical College : BDS (1981-1986)

Patiala

Dental College and Hospital : MDS (2003-2006)

Amritsar

Professional Experience

House Officer, Christian : 1987-1988

Medical College & Hospital,

Ludhiana

Research Officer, All India : Jan. 1989 to June 1989

Institute of Medical Science

AIIIMS, New Delhi

Dental Officer, Indian Armed : July 1989 to August 1994.

Forces in the Rank of Capt.

3

Medical Officer (Dental) : w.e.f. Nov. 1995 till date

in Punjab Civil Medical Service

(PCMS)

Research papers Published

“Role of Programmed cell death in dental anomalies associated with cleft lip and Palate”. “Medical Hypotheses” Churchil Living Stone Publishers London-1991

Post traumatic polatoglossal adhesion, a case report stomatologica India (1990).

Research Project Undertakes

“Malocclusion and associated Factors among Delhi Children” a study sponsored by Indian Council of Medical Research (ICMR).

Areas of Interest : Environment, Health, Defence, International Affairs and Rationalism

About the Author

author is an oral and maxillofacial surgeon working as programme officer with civil surgeon ludhiana,punjab ,india

Legal Issues: Confidentiality, Liability And Ethics

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Pacific Coast¨ Luxury 600tc Duvet Cover (Cappuccino) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Silver Grey) – King $149.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (White) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Moss Green) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Moss Green) – Queen $129.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Moss Green) – King $149.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pet Pals: Animal Doctor PRE-OWNED – Nintendo DS $9.99 SynopsisAnimals need tender loving care to stay happy and healthy, just like people do, and you’re just the compassionate veterinarian needed to bring a variety of animals back to good health. Step into the world of veterinary medicine as an eager young rookie, and do your best to diagnose, treat and heal the many patients who come through your door in order to work your way through the ranks of your chosen profession. With your care and expertise, your patients will be on the road to good health and you’ll be well on your way to becoming a top vet. In Pet Pals: Animal Doctor, you’ll find yourself facing 30 medical cases created by real veterinarians, spanning everything from simple infections to complex broken bones. Tend to 23 different types of animals, including a Yorkshire terrier, a python, a parakeet, a Siamese cat and a hamster, using your DS touch screen to administer more than 40 tests, interact with your patients and their owners and more. Follow up with your patients in the Recovery Room, where you’ll bandage, feed, clean and play with your healing charges, and enhance your veterinary knowledge with a variety of instructive mini games, including Memory, Trivia Quiz and Jigsaw Puzzle.

Animal Planet: Emergency Vets PRE-OWNED – Nintendo DS $12.99 SynopsisAs an up-and-coming veterinarian at the Alameda East Hospital, your job is taking good care of animals. From cleaning teeth and medicating to the intricacies of performing operations, your knowledge and skills help keep a wide variety of animals in good health. Show off your veterinary talents when the pressure’s on as you prove you have what it takes to be a real Emergency Vet. In this interactive game based on the Animal Planet series Emergency Vets, you’ll find yourself charged with taking care of 30 different animal species, ranging from dogs and cats to horses and ferrets. Learn real-life veterinary information from Animal Planet and talent from the TV series. Put your knowledge to work as you perform 15 vet mini games, including memory, puzzle and matching games, each with five levels of difficulty.

Discovery Kids: Pony Paradise PRE-OWNED – Nintendo DS $12.99 SynopsisYour greatest wish has always been for a pony of your very own. Now, with Discovery Kids: Pony Paradise, that dream can become a reality. In this charming simulation, you can adopt an adorable pony and raise it from birth to adulthood. Lavish your tender loving care on your pony pal to ensure its health and happiness for the long haul. A world of equine discovery awaits in Pony Paradise. Adopt a pony from any of four realistic breeds, and give your new best friend the care it needs to grow and flourish. Groom your pony, feed it and take it for rides in a variety of cool 3D environments, ranging from a lovely meadow to the bustle of the circus. You can even accessorize your pony with more than 60 unique collectible items to make sure your pet is the most stylish around.

Discovery Kids: Dolphin Discovery PRE-OWNED – Nintendo DS $12.99 SynopsisThe crowd waits with eager anticipation as you prepare for the next performance. At your signal, your pet dolphin leaps gracefully from the water, its body glistening in the sunlight. You’ve practiced for this moment, and your dolphin executes every aspect of your well-planned routine to perfection. You feel pride welling up in you as the audience bursts into excited applause, and your dolphin lifts its head from the water and seems to be grinning right along with you. In Discovery Kids: Dolphin Discovery, you’ll have the chance to care for and train your very own pet dolphin. Raise and nurture it to ensure its health and happiness, and gain its trust through your thoughtful care. Teach your dolphin a variety of tricks and routines, working together to perfect them. Then go in front of an audience for a performance and reap the rewards of the crowd’s applause.

Animal Planet Vet Life PRE-OWNED – Nintendo Wii $24.99 SynopsisYou’re on your way to becoming a world-renowned veterinary doctor. Under the guidance of Dr. Rogers, you will travel the world, volunteering at local vet clinics and performing numerous procedures to save injured animals. With your help, these wild and domesticated animals will be back to good health in no time. Animal Planet: Vet Life lets you take on the role of Jack or Abani as you journey across the globe, treating a variety of animals in different settings. Help more than 40 animals, including domestic and wild animals, as you perform 60 procedures, from routine check-ups to fixing broken bones. Feed, pet and exercise animals as part of their post-operative care and learn valuable facts about them. These animals will receive the best care possible with you as their veterinarian.

Animal Planet: Vet Life PRE-OWNED – Nintendo DS $19.99 SynopsisYou’re on your way to becoming a world-renowned veterinary doctor. Under the guidance of Dr. Rogers, you will travel the world, volunteering at local vet clinics and performing numerous procedures to save injured animals. With your help, these wild and domesticated animals will be back to good health in no time. Animal Planet: Vet Life lets you take on the role of Jack or Abani as you journey across the globe, treating a variety of animals in different settings. Help more than 40 animals, including farm and wild animals as you perform 60 procedures, from routine check-ups to fixing broken bones. Feed, pet and exercise animals as part of their post-operative care and learn valuable facts about animals. These animals will receive the best care possible with you as their veterinarian.

B-Complex, Ultra (100mg, 100 medium Capsules) $13.49 B Vitamin Complex for Stress Management & Energy. Ultra B-Complex™ is a synergistic combination of essential B vitamins which promote a health nervous system and support brain health. These coenzymes also assist the process of energy production throughout the body. Working together, these nutrients help maintain healthy skin, hair, eyes, liver, mouth, muscle and the gastrointestinal tract.

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