IAS Gyan

Daily News Analysis

A misguided policy that cuts deep into patient safety

Context: It is impossible for Ayurveda to incorporate surgical techniques while ignoring the other domains of modern medicine

  • The basic requirement of medical practice is the safety of the patient.
  • Surgery is a branch of medicine in which poor training can have dramatic and disastrous results.
  • This is the strongest argument against the ill-advised move of the government of India to allow graduates in Ayurveda to practise surgery.

Apprenticeship is key

  • The well-trained surgeon must have a good knowledge of the structure of the human body in health and disease. T
  • his is one branch of medicine where knowledge can only be acquired through apprenticeship — that is, the learner needs to be guided by an expert.
  • It takes many years and much exposure before a graduate in medicine can safely perform surgery.
  • The surgeon needs to know when not to perform surgery, a skill commonly called clinical judgement. These skills are difficult to teach and difficult to master.

Error can result in devastation

  • In India, the Consumer Protection Act serves as an incentive to modern medical practitioners to provide high quality health care.
  • Even this legal mechanism is not accessible to the poor. One simply cannot get away from it — safe surgery requires years of training.
  • Anecdotes of people not educated, but able to perform complex tasks should be understood in the framework of the psychologist Rasmussen’s Skill, Rule and Knowledge-based Error model.

What constitutes safe surgery

  • Modern medicine is an integrated whole in which specialties have developed from the understanding that the knowledge base is so vast that a single human can only ever hope to master a few of the domains required in order to provide the best possible outcomes to patients.
  • Modern medical training consists of a basic degree during which the fundamentals of the functioning of humans in health and disease, and techniques to diagnose illnesses are taught.
  • Increased knowledge in various domains is obtained through post-graduate training. All these domains work together in order to ensure safe surgery.
  • It is impossible for Ayurveda to incorporate surgical techniques while ignoring all the other domains of modern medicine and still perform surgery safely and effectively.

Is there any sound basis for different scientific systems in the modern world?

  • Important decisions with potential to seriously harm thousands of people should not be casually made without clear answers.
  • Safe and effective health care should not become a casualty of a misguided desire to protect indigenous systems.
  • Traditional knowledge in India has become the victim of self-serving apparatchiks who have fossilised it, preventing its development and growth.
  • Human knowledge is a universal resource, ever growing. The way forward is to incorporate traditional medical systems into modern medicine.

Could deepen inequity

  • The quality of medical care received in India is highly dependent on personal resources.
  • Surgical facilities manned by graduates of Ayurveda will be patronised only by the very poor who do not have the resources to access modern medical care.
  • This will further entrench the existing grossly unequal access to health care. An epidemic of catastrophic complications, disproportionately affecting the poor can be expected if surgical procedures are performed by the poorly trained.

What can be done?

  • There is a shortage of trained medical personnel in rural areas.
  • The only way to address this is to greatly increase the number of government medical colleges.
  • This will take a few years, but it is a safe and effective policy.
  • Safety of patients should not become a victim of misguided policies based on poor understanding of what safe surgery requires.