51 Holding a mirror

The king's order: Once a poet sang praise of the subjects of a kingdom for being so upright and honest. The king and all the subjects were delighted but the court jester told the king, "Sir! I do not agree with the poet. Your subjects behave well because you do not permit them to behave in any other way. Relax your rules and you will see their true nature. The king reflected on this profound statement.

A few weeks later, the king ordered every household to pour one pot of milk into the temple tank before the sunrise. Since it was for performing religious rites, no guard would supervise it. Everyonethought that he/she would pour a pot of water in the dark so that no one would notice it and it can't be detected later. It was a matter of collective shame when the king arrived at dawn to see the tank full of pure water with absolutely no milk in it!

The teachers of pharmacology - the study of medicines - taught only rational treatment to their students. Since irrational drugs were not taught, they expected that all was well with the quality of prescribing by their students who became practising doctors. It was a revelation to them when a survey revealed two-thirds of the medical prescriptions to be irrational. Further unpleasant revelations surfaced when the supreme court said that even modern allopathic doctors indulged in prescribing medicines belonging to other systems and that such cross-practice amounted to nothing more than quackery. Such a practice was declared illegal and a punishable offence.

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Comments

An audit holds a mirror to see ourselves as we are. It helps us to see the true nature of things as they exist in practice, take stock of the situation and plan corrective measures, if needed. A true audit should be like what the king did - the target should have the freedom to behave as they want. Otherwise, the true picture will never emerge. Our health ministers make well-publicised visits to health facilities and never get to see the true picture. Perhaps, they do not wish to face the ugly side of reality.

A medical audit should not be used to conduct witch hunts. Then the stake holders will ensure that results of the audit are as truthful as an income-tax return. The results of the audit should be revealed for introspection, brain-storming and for any corrective action for the future. If any individual is found wanting, he/she may be counselled in private.

The study by Foundation of Research in Community Health on the supply and use of drugs in Satara district of Maharashtra is an example of holistic and broad based drug audit (Phadke A et al, 1995). The current trends in drug use are quite disturbing. For instance, wasteful annual expenditure on unnecessary drugs is estimated to be about Rs 170 million per year in that district.

If the current medical practice has to improve, the medical councils should be proactive, conduct periodic audits and adopt corrective measures to curb any 'unhealthy trends' detected. As the jester told the king, bad habits are curbed by regulations.

On the other hand, good habits are promoted by the professional groups. Every professional body should periodically introspect and promote professional behaviour that is good for the society. The Indian Academy of Paediatrics have shown the way. It is time that others, especially the tertiary specialities, joined in the movement of introspective self-cleansing(see Chapter 26).

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