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Doctor: Guess who is watching? – Innovative internet platforms and their impact on accountability

By Vikash Ranjan Keshri
on August 5, 2016

Over a year ago, I suffered from an unusual fever with severe weight loss. Fifteen days into the fever, desperately despondent and confused about the cause of my ailment, being a medical doctor myself I realised that this was not just any ordinary infection. I consulted a general physician in town and was recommended a thyroid profile test based on a provisional diagnosis of a possible thyroid infection. The test results clinched the diagnosis of a rare thyroid gland infection resulting in severe thyrotoxicosis, so I decided to consult an endocrinologist. Even though I live in a city with enough medical doctors, some of whom I know, I decided to use the internet to find an endocrinologist. In bed with a fever, I Googled “Endocrinologist in Patna” on my smartphone and found thousands of results pop-up in seconds. After due consideration I picked one. Next morning, I visited a small but very organised clinic, attended by possibly one of the best doctors I could have come across. His diagnosis of thyrotoxicosis was accurate and substantiated by a thyroid scan as well. Following his advice and medication, I started recovering over the next few days.

This experience made me think of technology and its uses, especially in low resource settings. I wonder if it would have been possible for me to find an endocrinologist while in bed, if I hadn’t had access to online resources. Online I was able to locate a practitioner, view his credentials and read reviews – of course, one has to exercise reasonable caution while accessing information online. Not everything on the internet is true! Still, this experience made me wonder if this information sharing might, in some way, encourage a better standard of services and quality of care.

Another example along the same lines is that of Ryan, a young student whose mother had a severe headache for days. He looked online for a doctor; results threw up multiple suggestions in seconds – all apt – and selection was made based on filters based on public ratings to sort out the most popular one. He could also review qualifications and public reviews, and pick what he considered the best option.

Where am I coming from? Doctors in India traditionally command high respect in society; hence one would expect a certain responsibility to self-regulate. Yet, in recent years, this country witnessed a noticeable surge in the number of incidences of private medical practices held liable for misconduct, etc. as a result of increased public scrutiny.

The Medical Council of India is responsible for issuing a code of ethics of practice but not for its regulation. Medical services in India come under the purview of the Consumer Protection Act. Recently The Clinical Establishments (Registration and Regulation) Act, 2010 was enacted by the Government of India, making provisions for the registration and regulation of all clinical establishments in the country. The Act prescribes minimum standards for health facilities and services provided. The Act has taken effect in the four states – Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim, and all Union Territories except the NCT of DELHI since March, 2012. The states of Uttar Pradesh, Uttarakhand, Rajasthan, Bihar and Jharkhand have adopted the Act under clause (1) of article 252 of the Constitution.  However, the implementation of such efforts of regulation has been met with resistance by the medical fraternity and relevant professional bodies.

I am afraid such continued denial of the fraternity, as to issues of quality of services delivered and accountability, as well as their inability to see the issues in a strictly dispassionate manner may have serious bearing on the delivery of quality healthcare services in general. It may even result in a feeling of indifference and apathy among people towards the medical professional.

Technological platforms and the resulting access to information have made the social audit of health services easier. The increase in cases of medical negligence and malpractice could be a result of increased civil society vigilance, or even the role of the media. Whatever the reason, today the medical profession in India is being increasingly looked upon with doubt and contempt; or so I feel. And as someone from the fraternity, I see opportunities embedded in technology for the medical community to respond to the need of times. To disregard the growing power of technology as a potential equaliser only threatens the profession and its leaders. Given that people today use the internet to find and locate shops or gyms, there is no reason why people won’t use the internet to shop around for medical services suitable to them, as in my case. I know there are certain dangers, but it’s a trend that can’t be stopped, so it’s better to embrace it and try to channel it, rather than wish it just goes away.

Today, technological innovations and public networking through technology can considerably improve social accountability of the medical profession and also act as a crucial element of extrinsic motivation. They can also, hopefully, motivate clinical establishments to comply with quality parameters and attract more patients. Mobile apps providing easy search and filter functions to select the best medical practitioners or clinics can dramatically change the way people decide about choosing a medical professional when in need.

As mentioned, everything, including technology (and certainly the internet) must be approached and viewed with caution. Access to such tools, particularly in poorer countries is (still) restricted to the better-off and the educated. Technology may also be manipulated and misused. But overall, technology offers us the potential to effect a change which has long been a distant dream for many, to achieve quality of care and address the health inequities through competition, social accountability and reduced information asymmetry. So, my dear doctor friends, be mindful of “who’s watching”!

 Note: The author acknowledges the contributions by his colleague, Mr. Rajesh Narayan Singh.

About Vikash Ranjan Keshri

A medical doctor with public health specialization and practising Health Policy and System Researcher, Vikash is currently working for an International Organization in Patna, Bihar, India. He has over seven years of experience of working with the health system in different capacities. Currently he is working as Maternal Health Specialist in a technical support programme, where he is actively working on many policy level issues. Vikash is also an alumnus of Institute of Tropical Medicine, where he attended “Short Course on Health Policy” in 2016.