Rakesh Saraf
What is the present day mantra of improving health care in a particular region? Set up a medical college in that region. But this does not work because the aim and purpose of a medical college is different from the aim and purpose of a hospital. The amount of money and resources required for setting up and more importantly, sustaining a single medical college in a particular region can be used instead, to set up state of art 10 to 15 district and sub district hospitals, throughout the length and breadth of that region, thus bringing health services near the door steps of the public.
Believing medical colleges to be equivalent to hospitals is the root cause of many problems in health service. This two in one approach is harming both teaching and patient care. Culture and working of a medical college is different from that of a hospital. Teaching, training and research is the primary aim of a medical college. Prompt patient treatment is the primary of a hospital
The hospital attached to a medical college is meant for this primary purpose of teaching, training and research. Only a limited number of patients can be catered to in such a hospital; measured patient treatment is an accompanying offshoot of this approach. Measured patient treatment means that the patient is first examined by the medical student, then by the resident doctor, thereafter the patient condition is discussed with the consultant and finally treatment plan outlined and executed. It takes some time before the treatment is started. This way teaching and treatment is conducted sequentially. This approach also benefits the patient since multiple level examinations and discussions enable comprehensive diagnosis and management. It becomes obvious that this measured approach cannot be followed if the medical college hospital is converted into a general hospital. Then the sheer number of patients precludes this measured approach. On the other hand, a district/sub district hospital is not bound by this teaching protocol because the need for it does not arise and so the patient can be immediately assessed and treated by the qualified doctor in the hospital. This way large number of patients can be handled in the stipulated time in a district/sub district hospital. By converting a medical college into a primary patient treatment hospital the very purpose of establishing a medical college is defeated. Compounding the problem is the allowance for private practice in the medical college which further curtails time for teaching and training and research. When doctors get sucked into the nectar of private practice where will there be aptitude and physical and mental energy left for undivided, uninterrupted, quality teaching, training and research. No private practice policy in a medical college will discourage those without academic aptitude from entering and corrupting it.
Teaching, training and research in a medical college requires dedicated protected time and a different kind of work culture and approach from that of a hospital. It is either quality teaching/training/research, or neither quality teaching nor quality patient care. Neither quality teaching/training/research nor quality patient care is the norm in most of the medical colleges in our country. It is a folly to mix the working of these two establishments; it is a folly to allow private practice in the medical college; to do so reflect ignorance and short sightedness.
So before establishing a medical college in a region that lacks health resources, build and put into operation, state of art district and sub district hospitals in that very region, fully equipped with men and material. Then and thereafter, consider the need for a medical college. The need for a medical college may not even arise. If, on the other hand, the need for a medical college is felt then go ahead and built it. This requires long term planning and execution. There is no short cut to establishing a medical college. Otherwise what happens that as soon as a medical college comes up in a particular region, it has to take up the responsibility and burden of providing all types of patient care to the general public, in absence of suitably equipped district and sub-district hospitals in that very region. Quality teaching, training and research in the medical college get undermined due to pressure of time and resources. In due course there is neither quality teaching/training/research nor quality patient care in the medical college.
Famous medical institutions attained excellence because they were set up after establishing general purpose/ speciality quality hospitals in the region and so they were able to focus their energies and time to medical care advancement in the form of teaching, training and research and this subsequently percolated to district/sub district hospitals and impacted patient care. Properly trained staff from medical college when they start working in district and sub-district hospitals can then further enhance quality care to patients in these hospitals. Politicians, bureaucrats and the general public need to become aware of this fact.
Real problem in our country is lack of quality teaching and training of doctors, nurses and technicians in so called medical and nursing colleges. Two in one approach ultimately imparts compromised health care delivery to the general public.
( The author is Professor and HOD Surgery, Institute of Dental Sciences, Jammu.)
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