Pill goes pop:

April 29/2013: Doctors’ prescriptions have, many a times, been the butt of jokes in patients circle. Forget the uneducated lot even highly educated patients complain that prescriptions handed out by doctors are hardly legible and only trained staff at medicine counters are well equipped to make sense of the scribbles. What goes without saying is the fact that unless one is obsessed with the composition, strength and combinations of various medicines, the prescription in very many ways can baffle the ordinary human being. That probably is the reason why many Indian parents insist that one of their kids should take up the medical profession. After all, a doctor at home is a great blessing, is heard time and again. With the way things stand, this could be a wise perception, much to the pain of the poor child who is chosen to follow the preordained path. 

Interestingly, now it is learnt that the Comptroller and Auditor General (CAG) has asked Auditor Generals of states to start a prescription audit to ascertain whether doctors in the government healthcare sector are prescribing medicines that are available in the hospital or institution’s medicine stores. Primary and community health centres, district and tertiary hospitals and big medical colleges in the state are being scanned for the purpose. The Government it seems has issued strict instructions to doctors to prescribe drugs available at the institution’s store or generic medicines in their place. A report in this regard is expected to be tabled in Parliament soon. At first glance, this seems like a good idea in the sense that it would limit the doctors’ scope of showing favouritism to select pharma companies whose medical representatives are capable of influencing the doctors, through methods unknown, to prescribe particular branded medicines for related ailments. 

It is claimed this kind of audit would help check such prescription aberrations. But one always has to look at both sides of a coin to know the real value. Let’s say doctors decide to stick to medicines available at the ill equipped, under stocked stores at the institution or go for generic versions to keep their jobs safe. What happens then? A patient necessarily goes to a health centre or hospital when home remedies fail and he or she is in dire need of medical assistance. Especially in case of indoor patients who need higher antibiotics and life saving drugs, the patient’s life and fate lies solely in the hands of the doctor and the line of treatment hence followed. If a patient fighting for life needs a certain medicine that is unavailable at the facility’s store, which is very likely considering the state of the dimly lit stores in government centres, then God be with the poor soul. The doctor obviously would not place the patients’ life over his job and perks. He would then choose to opt for an alternative drug, no matter what its effectiveness in the particular case. 

The problem in this country is that no one goes deeper into issues to take a holistic view. Such guidelines and this kind of prescription audit would be perfect in a situation where the government medicine stores are updated and well stocked. But in present circumstances, it could be a fatal move to limit options of drugs to doctors and patients. Everyone is well aware that even generic medicines are not available in all compositions and forms and cannot provide a sure fire alternative to every drug. The audit should first extend to check whether or not government stores are equipped to meet demands for all kinds and types of drugs, whether they maintain a professional computerised stock list, whether they have the required network to immediately source a medicine on unavailability and such details. Their stock list, with expiry dates and other details should be available online. Reputed doctors from all departments should be consulted on which drugs are to be stocked. This effort would prevent doctors from washing their hands off the issue and throw up excuses of unavailability of medicines for loss of lives. 

The government health sector in India is still in a mess. But it is definitely the backbone of the millions who can’t afford private healthcare. There needs to be a complete reorientation and shift of focus to revive the health of this sector. Doctors need to feel motivated to join government ranks and get support to upgrade their skills from time to time to keep up with advances in medicine. Modern equipment and trained technicians are the need of the hour to give backup to the doctors. Research in medical science has not gone much ahead in the recent past, with hardly any new drugs getting introduced into the market even from big pharma companies. Isolated ideas germinating in the minds of some bureaucrats as knee jerk reactions could do more harm than good if the bigger picture and ground reality are not kept in mind. Unfortunately, in India, whenever these momentous executive decisions are being adopted, there is no backup reason stated to the public. This creates a doubt that motivation for these kinds of decisions may not be based only on the premise of ‘public good’. Pressure lobbies and unseen forces are now at work which make all new rules and laws suspect in the eyes of the common man. This is a deviation that will eventually hurt the well being of the nation.