Medicine for 2021: A new normal?

Is the end game of the corona pandemic truly in sight given the vaccine hesitancy, the greed of the developed world in hoarding the vaccines, and thereby adversely affecting its equitable distribution, and lastly the emergence of new contagious strains of the virus, which seem to be driving the pandemic going forwards in 2020. Not quite yet, is my take and we must learn to live with COVID, at least in the imminent future. A new normal thus becomes an imperative, as we can hardly afford to lapse back into the yore.

The most important thing, I would like to see is social life returning to the institutions sans the fear, trepidation and the uncertainty which was associated with the corona pandemic. Vibrant, ebullient, and zestful workforce with a smiling confidence on their faces of having the wherewithal to deal with the future is the single most important asset that must return to any institution.

Just as I plead for the return of joie de vivre in the hospitals, I would also like to see certain degree of discipline and self-application of COVID-appropriate behavior of social distancing, masking, and hand washing to continue. Certain learnt salutary behaviors of a holistic life style should become a habit and not just aberrations of passing. They should be reinforced for perpetuity and should be incentivized by the government and the insurance companies.

Clearly, the need of the hour, as also as it is cost and time efficient, is tele-health. Medical fraternity must transgress the mental barrier and learn to adapt and adopt technology.

Regulations should be made simple and legal protection given against frivolous litigations, which are likely to come up if tele-health takes off. It should be made safe, efficacious, affordable, and free from exploitations from any of the stake-holders, so that a burgeoning new modality is not nipped in the bud. Just as we exhort the virtues of tele-medicine, digitization, and automation, we must not lose the personal touch, empathy, and compassion that are integral to healing and caring – attributes pithy to medicine.

My wish list also includes:

• Tertiary care institutions should be decongested and the first port of call for all ailments should be the good old ‘friend, philosopher and guide’ – our neighborhood family physician. There should be a chain of referral from less specialized to the more specialized tertiary care.
• Increased traction for National Digital Health mission and Ayushman Bharat, which have flattered only to deceive, especially in the arena of tertiary healthcare.
• Private participation in the primary healthcare delivery system of the country to make it more efficient and efficacious and the government should play a proactive role in this.
• Return of specialized workforce to the hospitals.
• New hospitals with collapsing walls concept.
• Greater use of Artificial Intelligence and Big Data analytics for better diagnostics and point-of-care testing.
• Increased spending and attention to, translational research as opposed to core or basic research.
• Robust and single window information delivery mechanism.
• Indigenization of medical equipment, devices, and consumables.

Lastly, even though I belong to a tertiary care specialty, I will still like to see my fraternity stepping back on the gas for invasive investigations and interventions. We learnt the hard way, but pleasantly, that the ICU and the hospital admission rates for emergency procedures went down dramatically during the pandemic, without a pari-pasu increase in mortality or morbidity, suggesting that probably, to some extent, we have been over-doing medicine. A return to domiciliary care for a lot of ailments, and specially for terminal end-of-life events is a new normal, which we must adopt so that the over-burdened facilities, both in the government and private sectors, are available for the more deserving patients.…….and that’s the zeitgeist of the times!