Poorly Trained Doctors in India make Wrong Diagnosis by Mahboob ali khan MHA,CPHQ,HQM Harvard.
Poorly trained doctors are making wrong diagnoses and dishing out outdated or even incorrect treatment in large parts of India, according to a study.The article in Health Affairs journal detailing the results of a scientific study performed recently in India (The Hindu,December 6, 2012 ) serves to underline what has long been suspected but rarely articulated or discussed on meaningful fora — Just how much do our doctors know? How accurate are they in making a diagnosis and how appropriate is the treatment they recommend?
Published on: Mar 4, 2016
Transcripts - Poorly Trained Doctors in India make Wrong Diagnosis by Mahboob ali khan MHA,CPHQ,HQM Harvard.
Poorly Trained Doctors in India make Wrong
Diagnosis by Mahboob ali khan MHA,CPHQ,HQM
Poorly trained doctors are making wrong diagnoses and dishing out outdated or
even incorrect treatment in large parts of India, according to a study.The article in
Health Affairs journal detailing the results of a scientific study performed recently
in India (The Hindu,December 6, 2012 ) serves to underline what has long been
suspected but rarely articulated or discussed on meaningful fora — Just how much
do our doctors know? How accurate are they in making a diagnosis and how
appropriate is the treatment they recommend?
If the study is any indication, the answer should be alarming. In Delhi, the rate of
correct diagnosis was as low as 22 per cent and the rate of correct treatment was
less than 50 per cent. This meant that patients in this study had only a one-fifth
chance of having their disease diagnosed correctly and less than half got the correct
treatment. The study focussed on primary care providers and in rural Madhya
Pradesh it has found that in 42 per cent of the cases, unnecessary or even harmful
treatment was prescribed.
There may be limitations with the study (it covered medical and non-medical
providers, qualified and unqualified) and undoubtedly there are centres of
excellence where the rates of correct diagnosis and treatment would be higher. But
the study has drawn attention to the massive problem of poorly trained doctors
making wrong diagnoses and dishing out outdated or even incorrect treatment in
large parts of India.
It is widely acknowledged that the quality of the emerging doctors in India is not
uniformly what it used to be. There are many new colleges, especially private,
where the standards are not up to the mark as they just do not have enough clinical
material or patients to teach the students, and there are far too many students who
possibly should not be in a medical school (disinterest, parental pressure, poor
academic capability, etc.) in the first place. The quality of the faculty is patchy at
All this means the doctor who emerges from the medical school is often a health
risk to the patient. Doctors in India have no legal compulsion to keep re-training
themselves. They are not audited on any quality of care measures and it is pretty
much a case of being free to do whatever one wants after the basic qualification is
In a government set-up in most parts of India, the average patient encounter time
with the primary care physician is three minutes or less and this includes the time
taken for writing out the prescription. This means the doctor is effectively making
a decision on the diagnosis and treatment option in two minutes. Clearly, it is
unlikely that in two minutes the doctor would get all inputs (symptom taking,
history, physical examination, etc.,) to make a persistently accurate diagnosis.
Sometimes, the doctors have pre-defined prescriptions that are written out and then
handed over to the patients based on the symptom complex.
All this means that millions of patients could be getting the wrong treatment and
incorrect diagnoses, leading to disability or death. Since we are not even measuring
the accuracy of diagnosis and appropriateness of treatment, we simply do not know
how big the problem is. There has been a strong reluctance to address the issue and
take corrective measures. It does appear that no one really wants to rake up this
matter for fear of what may emerge from a Pandora’s box. As this study has shown
(despite its small sample size and limited scope), there could be a huge problem
and it needs to be addressed now.
The first step would be for the government to commission more such studies on a
larger scale to continually assess the quality measures. This will at least give us
scientific evidence of the size and scale of the problem. The second is to institute
and fully integrate protocol-based diagnoses and treatment systems into the
teaching programme for medical students. The third step would be to make doctors
take a test every five years to assess if they have updated their skills. Doctors who
fail could be given a grace time of a year or two (and multiple attempts) to pass the
test, failing which, their licence could be suspended. The fourth step could be to
use technology with applications like clinical decision support systems to improve
the quality of care delivery. All these are vitally important patient safety measures.
The tragedy is that our society seems indifferent to the fact that visiting a doctor
may actually be injurious to health. Perhaps, it is our belief in destiny or karma that
makes us reluctant to fight for this cause. There are very few strong patient bodies
or consumer groups that take these issues up with the state or medical associations.
A society that does not fight even for something as basic as quality health care,
perhaps, deserves the health care it gets. The next time you visit your doctor,
remember that your odds of getting the right diagnosis and treatment may be even
less than that from the toss of a coin.
The rate of misdiagnosis is very high and doctors are missing diagnosis and
treating with wrong drugs due to lack of more quality training and also due to lack
of time to talk to patient and correctly obtain complete history and exam. The issue
is not about private vs. govt. medical colleges. It is the medical system’s fault at
large. Medical education in India has allowed more students go to med schools and
to become doctors, so that they can help the increasing population with increasing
new medical problems. But the question is , does the increase in medical seats
translate to more qualified doctors or improvement in quality of medical education
and health care delivery? I say, not.
The medical education curriculum in India has not been really changed for the last
several years even though there is lot of research in medicine and lot of new
diagnostic techniques, and better treatment options. Medical students are still
reading the same old text books which were not revised since 7-10 years. The same
old traditional class room teaching, poor bed side teaching, lack of evidence based
teaching or learning, lack of investigative minds in medical schools due to lack of
interest from professors and lack of resources to do so if anyone is interested, poor
testing strategies where medical students will be asked about some cramming
material rather than relevant clinical and thought provoking questions, all these
factors are playing a role in producing new generation doctors with outdated and
obsolete thoughts and treatment strategies.