Major General Madhuri Kanitkar, recalled that she was the sole doctor trained in the field of paediatric nephrology in the 1990s. but now there is a fellowship programme in paediatric nephrology. (File)
Then, a chronic low backache meant suspending the patient in a traction for three weeks till the spine was stretched and space was created between the discs and vertebrae. After some exercise, the patient was considered fit to go back to work.
“Today, if a patient asked for an X-ray for a nagging backache, he/she will ask for an MRI and a quick fix to get rid of the pain,” says 82-year-old Dr K H Sancheti, a pioneer in the field of orthopaedics. Patients are in a hurry to get cured and with newer modes of investigations and treatments, hospitals today are catering to sub-divisions of one main branch. Instead of a general orthopaedic surgeon, hospitals have spine specialists, shoulder surgeons, foot and ankle surgeons, among others. “There are over 16 branches under the umbrella of orthopaedics,” says Dr Sancheti, the founder-director of the Sancheti Institute of Orthopaedics and Rehabilitation.
Major General Madhuri Kanitkar, dean of the Armed Forces Medical College, recalled that she was the sole doctor trained in the field of paediatric nephrology in the 1990s. “Today, there is a fellowship programme in paediatric nephrology. With a wide spectrum of diseases, the number of specialities have also increased, “ said Major General Kanitkar.
Number of hospitals increase, but some nursing homes face closure
About 20 years ago, there were individual, doctor-run medical establishments in Pune and almost all cities. Usually, they were dedicated to one or two specialities like Gynec-Obstetrics, Pediatrics, Orthopedics, said Dr Jayant Navrange, in-charge of the medico-legal cell of the Indian Medical Association’s Pune branch.
Bomi Bhote, chairman of the Association of Hospitals in Pune, pointed out that from four to five large hospitals in the 1990s, there are 78 hospitals in the city today, of which 10-15 are large.
“For instance, in the 1990s, Ruby Hall Clinic had only 150 beds but today, the hospital has expanded to 850 beds,” Bhote said. However, stringent rules has made it difficult for smaller nursing homes to survive, said Dr Sharad Agarkhedkar, former president of IMA, Pune branch.
What’s that disease? Ask ‘Dr’ Google
Today, most patients are well-informed, they do a Google search, ‘shop’ for more doctors online and then consult them. “Back then, it was the good old general physician (GP) who was sought by patients. If the GP was sympathetic to the patient’s problems, then they got attached to him for life, and the entire family consulted him. Qualifications like BAMS, BHMS didn’t matter. Today, with the internet boom, patients are more aware about medical issues. On a positive note, at least patients are consulting doctors within a day or two of the onset of the problem,” said Dr Arvind Chopra, rheumatologist.
Heart, womb transplants; newer diagnostics, better investigations
Bloodless, safe and speedy surgeries are possible today, said Dr Sunita Tandulwadkar, gynaecologist and IVF specialist.
“From three chip camera, high-definition system to robotic surgery, there has been tremendous advancement in the treatment modality in almost all disciplines… Newer technology also helps magnify the image of the sperm 7,200 times and select better quality ones to treat male infertility…,” said Tandulwadkar. Aarti Gokhale, central coordinator at Zonal Transplant Coordination Committee, western zone, said organ donation was not widely prevalent in the 1990s. Over the years, there has been increasing awareness and this year, seven heart transplants have been performed. In a first, two womb transplants were also performed at Galaxy Hospital in Pune.
Deteriorating doctor patient ties, rising costs, increasing litigations
Earlier, the doctor-patient relationship used to be cordial and patient-centric, said Navrange. In 1995, the Consumer Protection Act was made applicable to the medical profession; soon, there was a considerable rise in the number of litigations. The treatment cost increased, and the percentage of patients covered under medical insurance went up. The procedure to hospitalise was simple. In case of emergencies, a patient would be taken in and the treatment would be started without asking for payment or insurance. Over the years, the trust between a patient and doctor has eroded, leading to more and more procedural and documentation factors, said Navrange. Bhote pointed out that the health sector also faces problems like patients who can’t avail of cashless insurance facility for three months.
Private health care unaffordable, public health system needs upgradation
A majority of large and corporate hospitals today boast of international-standard health care and an increasing patient load from other countries, placing Pune among the leading cities involved in medical tourism. What ails the private health care system is the high cost and unnecessary investigations, said Dr Anant Phadke, coordinator at Jan Arogya Abhiyan. Earlier, at least 30 per cent of Puneites were dependent on the public health system. Now, 15 per cent avail treatment from corporation-run hospitals, said Dr Dilip Sarda, former president of IMA’s Pune branch.
Dr Ramesh Bhosale, head of the Department of Gynaecology at Sassoon General Hospital, said efforts are increasing to attract the upper middle-class income group to seek treatment at government hospitals. At Sassoon, it is the lower income group that avails of treatment. However, the patient load is high, with as many as seven lakh availing of OPD treatment every year, said Bhosale.
Dr S T Pardeshi, former chief of medical services at PMC, admits that most middle-class income groups prefer treatment at private hospitals. “However, there are 17 hospitals and 905 dispensaries run by the PMC today. Dialysis machines, CATH Lab and other diagnostics are being set up in corporation-run hospitals,” he said.
Stress levels high; dengue, chikungunya, swine flu prevalent
While some people have become health conscious, a majority have been sucked into unhealthy lifestyles, said Dr Phadke. Factors like pollution and others have led to increasing stress levels and there are rising cases of diabetes and hypertension, said Dr Bhushan Patwardhan, professor at the Inter-Disciplinary School of Health Sciences, Pune University.
Communicable diseases like swine flu, dengue and chikungunya pose a massive challenge to doctors, said Dr Sarda.