A doctor, dumber than me?

The overwhelming messages from this week’s readings convey that health systems lack funding, coordination, efficiency, skilled labor and good public policy. We have also learned that overemphasizing disease control has resulted in weakening the overall health structure in which services are provided. But what about empowering the patients? Would increasing their knowledge of diseases and symptoms lead to better quality in the system?

Mills et al. suggest that to strengthen health systems we need to focus on three elements: stewardship and regulation, organizational structure and financing, and human capital. Like Mills et al., most authors in this week’s articles pay particular attention to finances. Without financial resources there are no medical supplies, no salaries for doctors and nurses, no equipment to make diagnosis, and no hospitals and medical centers to attend patients. However, none of these would be beneficial with inexperienced and unskilled doctors[1]. This is a common scenario in the developing world, but in the article, Wanted: Smarter Patients published by Foreign Policy Magazine, Charles Kenny brings an interesting perspective.

Kenny’s argument is based on providing better tools to educate patients. Unlike Mills et al., he does not question the doctor’s knowledge and the ability of health centers to provide proper quality care. He rather points out medical negligence ignoring common procedures. In the developing world—where shortage of health centers is common—diagnosis get repetitive. Doctors feel that the symptoms for one case fit them all. In Kenny’s example of Tanzania, many children that present the same symptoms are diagnose with malaria, but skipping simple check-up steps can send a child home with a severe case of pneumonia.[2]

Kenny states that, “there is no simple solution to the problem of getting doctors to do their job better in developing countries. Training and education alone certainly won’t cut it.[3]” This ineffectiveness could probably be corrected with Mills et al.’s method of performance remuneration. If doctors in the developing world knew that they would get more money for the amount of lives they save and the better treatment they give to their patients, then we would avoid simple mistakes. The reality is that the lack of good governance inhibits cohesive health programs, solid institutions, and economic incentives to be distributed to health practitioners. An alternative is educating patients and providing them with simple mechanisms to become aware of their misdiagnosis. In this way, Kenny’s ‘smarter patients’ would be able to go back home and reflect on the doctor’s decisions by using diagnostic kits that test common diseases.[4]

Yet, technologies in the third world need to be simple and cheap if they aim to reach the majority of the population. To do this, NGOs can become supply partners[5]. In Kenny’s article, Diagnostics for All (DFA) illustrates this opportunity. Some of the solutions that DFA created are papers (that turn different colors) to test spoiled milk, crops affected with mold, diabetes, etc.

Overall the articles from this week, present a bickering critique on how the adverse finances in the health systems (of the developing world) leave us with uncoordinated and fragmented frameworks of action. However, after reading Kenny’s article I realized that we neglected the responsibility of the patient to the medical system. A Smarter Patient should care and question the way in which he receives a diagnose and complaint about the quality of the service. A patient should demand education on common diseases to avoid receiving the wrong medications. Kenny also emphasizes that an incorrect application of the available resources can lead to fatal results where usually patients lament their losses. The hidden truth however, is that most of these cases are completely preventable.

The tendencies indicate that while doctors can look for better opportunities somewhere else, some patients do not really have a choice. In the developing world there is no time for analyzing options, presenting complaints, or even choosing a health facility. To this I believe Kenny’s message is clear, as he advocates for patients reactions, we now remember that education is the basis of progress.

 


[1] Mills, Anne, Fawsia Rasheed, and Stephen Tollman. “Strengthening Health Systems.” Disease Control Priorities in Developing Countries. 2nd ed. New York: Oxford UP, 2006. P.94.Print

[2] Kenny, Charles. “Wanted: Smarter Patients.” Foreign Policy Magazine, 3 Oct. 2011. Web. 23 Oct. 2011. <http://www.foreignpolicy.com/articles/2011/10/03/wanted_smarter_patients&gt;.

[3] Ibid.

[4] Ibid.

[5] Reich, MR, Takemi, K, Roberts, MJ, Hsiao, WC. “Global action on health systems: a proposal for the Toyako G8 summit.” The Lancet .Vol.371. 8 March 2008. Print

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