Diagnostic (t)Error

Side-effects, a term usually associated with prescription drugs, can safely be applied in Kashmir to illness itself, for no sooner does a healthy person here transition into patient-hood than he or she suffers leaden feet – a problem research could show to be universal in the Valley. Far from being a prospect of relief and comfort, the thought of visiting hospitals and private clinics for treatment comes with the sickening foreknowledge of heavy expense beyond the capacity of honest monthly budgets. But then there is no questioning the wisdom of healers who reel off a long series of investigations and a longer one of medication, often, as patients mostly complain, after the most cursory examination and reflection. Clinicians – there are justifiable reservations for using this word for Kashmir’s medical practitioners who have neither the time nor the inclination in their overcrowded waiting-rooms and multiple practices to use clinical skill – bank purely on technology where a scrupulous application of the trained mind’s deductive powers could have sufficed. The need to eliminate ‘diagnostic error,’ an argument often proffered to defend what essentially is professional malpractice, has been turned, for the patient, into ‘diagnostic terror.’ For, what can the poor fellow, with life at stake, do, except cower under the doctor’s learned gaze, and beg, borrow or steal to fund his CAT Scans, MRIs and bronchoscopies – blood chemistry, X-Ray, and even ultra-sonography now being passe in the new era where a doctor advising anything less would not be worth the paper his medical degree is printed on.  

Unbeknown to the government, which has been an enthusiastic advocate of the policy, a public-private partnership in health care is already a reality, perhaps a harder reality that the government could ever hope to achieve. For, the public pays for the sophisticated, and in many cases state-of-the-art, diagnostic equipment in state-run hospitals and for the supposedly trained manpower to operate it, and the profits go to private health care enterprises. It is a mystery how high-end diagnostic facilities in allegedly organised hospitals remain stubbornly out of order, but private clinics with  same or similar machinery run like clockwork – often manned by personnel also on government payroll. Allegations abound. Not just that highly-qualified and highly-paid physicians and surgeons are half-hearted in their official duties with more than half a mind dwelling on their private practices, but also that members of the so-called noble profession do not deem it beneath themselves to be hand-in-glove with private diagnostic clinics and pharmaceutical companies for hefty commissions. This mutually-beneficial arrangement cannot run if diagnostic facilities in state-run hospitals are kept in order and functioning reliably on a regular basis. Flashback to a couple of days ago when an Anantnag patient was advised an MRI at the SKIMS Medical College Hospital in Bemina, and officially informed that she would have to wait for two years before she could get the test conducted at the institution. The medical wisdom that would maintain a three-year-long waiting-list when just days or hours could prove to be a matter of life and death for a patient has probably had the desired effect – the 72-year-old woman from Shangus must certainly have paid obeisance to the system and got her MRI done at some private centre. But what would absolve the SKIMS MCH of blame would be an un-doctored declaration of the number of MRIs it conducts per day, the capacity of its facility, and how often the facility has been out of order since installation. The question is, will the government ask this question.

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