Friday, April 26, 2019

Think about your patient first



First thought this morning
Voting for the election of 17th Lok Sabha is complete in more than 300 (of 543) seats. Voters in more than 20 states have exercised their franchise. From the voting pattern so far and anecdotal evidence collected by me, the following four trends are noteworthy:
(a)   The overall voting percentage this time is similar to 2014, however there are significant differences at regional level.
In 2014 elections the voter participation was amongst the highest since independence. Analysts attributed the high voting percentage to the Modi wave and peoples' longing for change. This time apparently there is no wave, or material anti incumbency for that matter. The still high voter participation therefore is bewildering for both analysts and political parties. Everyone is therefore trying to see it from their own prism. The incumbent and their supporter are seeing this as a vote for stability, while the others are terming it as a vote for change. Higher number of first time voters who are not as droopy as their elders could be another reason for higher participation rate.
(b)   Usually wherever a stronger regional party is present, Congress is not doing well. Haryana though could be an exception. The general feeling is that the contest this time is primarily between BJP and Congress, and the regional party INLD (and its factions) is in total disarray. RLD in Bihar has held together well under the same circumstances (patriarch in jail).
(c)    The campaign so far appears as if we are voting in a referendum on the Prime Minister and not in a general election for Lok Sabha.
(d)   Given the penetration level of electronic, digital and social media, the ban on campaigning upto 48 hrs prior to voting, has become totally redundant.
Chart of the day
Think about your patient first
Once a patient was admitted to an upscale private hospital (XYZ) with a serious cardiovascular ailment. The cardiology team at the hospital was headed by an experienced old surgeon, who was lately rendered incapable of performing complicated surgeries due to his blurred vision and trembling hands.
The team he headed was however not harmonious. Many doctors were either incompetent or had allegiance to their vested pecuniary interests. They would often indulge in unethical practices and conduct unbecoming of a reputable medical practitioner.
The management of the hospital was fully aware of the state of affairs at the hospital, but did little to put the house in order. The popular belief is that the management itself encouraged the disharmony amongst the team members and incongruence of the objectives to stay in control of the institution and maximize the profitability.
The head of the team diagnosed the patient's condition accurately and proposed a line of treatment, which would treat the patient promptly with minimum pain and cost. The team members however disagreed. They wanted the patient to spend more time in hospital and undertake a variety of experimental tests and procedures. This would cost the patient much more and cause more pain. The management concurred with the unethical lot of doctors.
After spending some time in the hospital, paying huge costs, and suffering tremendous pain, when the relatives of the patient saw condition of the patient worsening, they moved him to another hospital (PQR).
The doctors at PQR studied the case history and discovered that the patient's condition was accurately diagnosed at XYZ and correct line of treatment was proposed by the head of the department. The doctors there decided that once the condition of the patient is stabilized they would follow the same line of treatment as suggested by the old surgeon at XYZ.
In few days, the condition of the patient stabilized and he was moved out of the intensive care to normal ward. The doctors at PQR hospital then started the treatment as suggested by the head of the department at XYZ.
However, considering the slow recovery and frequent relapse, the head of the department at the PQR decided to try some unconventional treatment. The patient did not respond to these unconventional methods and his condition worsened materially.
He was again moved to intensive care. The doctors then followed the line of treatment prescribed at XYZ. The patient stabilized and his vital signs showed some improvement. But the patient is far from being cured and remains hospitalized, suffering pain and expenses.
The relatives of the patient are now in a quandary.
Fully aware that doctors at XYZ correctly diagnosed the disease and advised the right line of treatment, they still do not want to reconsider XYZ for its lack of ethics and unfair practices.
They are not too pleased with PQR either, as the unconventional experiments done by doctors there cost them significant amount of money besides inflicted tremendous pain to the patient. But they are willing to forgive PQR since it is now following the same line of treatment which XYZ would have followed.
There is a third hospital (LMN), but it is new, untried, untested and lacks adequate infrastructure. The doctors there have good track record of minor surgeries and treating minor ailments. But trusting them with a serious case and major surgery could be a big risk.
In the meanwhile—
(a)   Doctors and management of XYZ are accusing the management and doctors at PQR of unethical practice and incompetence, charging them with appropriating their diagnosis and following the same line of treatment as they had suggested.
(b)   Doctors and Management at PQR are trying hard to convince the relatives of the patient that if they consider shifting from their hospital, the life of the patient could be at serious risk.
(c)    The doctors and management of LMN are trying to lure the relatives of the patient with a promise that they would engage the good doctors from XYZ and continue with the same treatment at somewhat lesser cost.
PS:
If it is not clear enough, I may disclose identity of the characters in this story:
The patient - Indian economy
Relatives - Indian voters
XYZ - Dr. Manmohan Singh and Sonia Gandhi managed UPA
PQR - Narendra Modi led and managed NDA
LMN - The coalition of regional parties

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