Medicine is an applied science and benefits from advances in basic and other applied sciences. In today’s world, technology itself is an applied science benefiting from basic scientific advances, defining our world and determining our world view of the present and future. The need for a healthy relationship between technology and medicine is paramount, and so we need to look at the current status of this relationship in India. This relationship is determined by the interaction between tech companies and the medical profession. For instance, the oft-quoted WHO statistic regarding the relative lack of medical professionals to cover India’s large population is frequently used to justify the entry of technology to help close this gap. The logic that e-health and phone advice can address this lacuna appears to be persuasive. But on deeper reflection, we can see it is flawed.
The problem is this statistic overlooks the fact that the number of medical professionals for the able-to-pay populace (as against the total population) is far too many as it is, far more than in developed nations. So the majority of Indians, who cannot pay, are unable to access the level of medical care available to the favored few. Tech companies, being corporate bodies and profit-seeking, are driven to focus on the patients who can pay, the same favored few served by medical professionals. The logic they want to serve the unattended many is hence contrived. The unattended majority serve as a vote bank for the politicians, and their dissatisfaction impacts on this group. The dissatisfaction is made more acute, as the media and internet make them aware of the availability of better options. Instead of working to elevate the earning capacity or improving the health standards of the people or improving the quality of public hospitals, politicians find it easier to blame the medical community for the lack of facilities. Witness the recent diatribes claiming medical conferences are acts of collective sin in the sun and sands of foreign climes. (This would be a better description of the fact-finding committees of Legislative Assemblies in India that visit foreign shores. But I digress.)
So politicians and tech companies have a common interest, a common enemy. Having named and shamed the professionals, the politicians have to continue doing so, especially when they recognize this makes good sense at the hustings. Many people are only too willing to follow the logic: “Somebody has to be blamed for this mess (it can’t be us). Here is somebody … so he is to blame.” For the tech companies, it is an imperative to somehow break the monopoly which medical professionals have on their paying patients. Their strategy is predictable. Since humans are flawed, anecdotal errors of medical judgement abound. This can be used as justification for introducing devices using machine learning, artificial intelligence and other awe-inspiring advances. Never mind there is no evidence of benefit from these technologies, even if one ignores the humongous costs involved in acquiring them. The attempts to play up human error are unfair. For instance, anybody in the field of education will tell you that the human brain does not work like a binary computer, but reaches conclusions by a complicated process of inference and logic. Yet it usually outperforms computers.
One may make many individual errors of calculation but get the overall answer correct, more often than the computer that would never make an individual error but can get the overall picture really wrong. But it is not my intention to cast a slur upon the advances of technology to which we owe so much these days (though not all to the good). I only wish to point to the misuse of tech to enable corporate greed to disrupt a profession. The medical profession used to be a part of the solution to the problem of ill health, but now, almost overnight, it is being derided as a part of the problem. This is solely because tech companies smell profits and big profits at that, the legal system smells profit from any mishap real or imagined, and the politicians smell votes. If I may add, the medical professionals also are guilty of the cardinal sin of not paying a regular contribution to political campaign chests. In fact India’s medical community has made a good name for itself globally, both in the developing and the developed world—witness the acceptance of articles of scientific studies from India in international forums, the increasing number of live surgical broadcasts beamed from India, the growing number of exchange visitors, and the vast numbers of patients from abroad seeking high quality, value-for-money treatment here.
The denigration of the profession creates many real problems, such as that of needless defensive medicine, lack of risk-taking on behalf of the patient, impediments to healthy doctor-patient relationship, and an increasing number of good intelligent students opting to choose less risky, more highly paying and less arduous professions. Even within the profession, the number of people contributing actively to patient care is outnumbered by those who manage and control this group. This cannot be good for any society and it is my duty as an academic and medical professional with over 30 years of experience to sound a warning. The aim of technology should be to help the underserved receive the same quality of care available to the fortunate few, and to improve the ability of professionals to do their assigned tasks. Anything else is a travesty.
The author is Dr Ravi Nayar – Consultant otolaryngologist and Dean, Center for Academic Research, HCG Hospitals, Bengaluru. – New Indian Express