24 Quality or quantity?

The Lioness and the Vixen: A lioness and a vixen were talking about their wonderful offsprings. Each gloated about how well they behaved and how cute they looked. The vixen wanted toscore a point over the lioness and said, "My litter of cubs in such a beautiful sight. But I notice that you never have more than one cub.” "No," agreed the lioness with a smile, "but my cub is a Lion."

Two professors of medicine met at a conference. One was from a prestigious national Institute and the other from one of the mushroom colleges. After a while, the conversation dwelt on the students and their training. The second professor exclaimed, "What! Your Institute trains only 60 students per year! We produce 300 graduates every year.” "I agree," said the first professor, "but every one of our graduate is an Institute product!"

Comments

During every summer, new medical colleges spring up like mushrooms. The promoters rake in huge capitation fees, as much as Rupees twenty to thirty lakhs per candidate. The candidates are happy to get a medical seat that they would not have got otherwise. Their parents are relived to get rid of much of the 'black money' and delighted that their children would be doctors. Every year, India produce about 17,000 medical graduates with MBBS degree from about 165 medical colleges. About 7,000 go for higher studies. The rest join the pool of about 5,00,000 allopathic doctors. An equal number of doctors of other systems compete with them. The unhealthy competition leads

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to distortions in practice. With some notable exceptions, the quality of the practitioners and of medical practice are quite deplorable.

There is another aspect of the number-game in health care. To impress others with the quantum of practice, many practitioners like to keep a long line of waiting patients. Some have patients waiting up to midnight for a consultation. By then, the doctor is so tired and sleepy that some prescriptions are simply hilarious at best or atrocious at worst. A hilarious example: One tablet of a liquid tonic three times daily! A dangerous one: a penicillin-like drug for a penicillin allergic patient.

The ultimate sufferer in this number game is the health care seeker. In most of the overcrowded clinics, the quality of care is from mediocre to abysmal. That most care seekers do recover and go home speaks for the resilience of the human body.

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A similar number game is also played in medical research. Many researchers rehash the same article up to ten times and quote their own papers repeatedly. Others falsify data and publish them. Only those who overdo it get caught and are exposed. Until researchers are rated by the quality of their work, the 'publish or perish' syndrome will thrive.

The stakeholders must realise that there is always a trade-off between quality and quantity. We should strive to find the right balance to maintain quality in training, research and patient care. The regulatory and professional bodies should suggest national norms. It is long overdue.

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