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Experts Talk
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 | | Dr HG Desai | | Consultant Gastroenterologist, Jaslok, Bhatia and Jagjivan Ram Hospital, Mumbai |
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| DoctorNDTV: Does the Indian Healthcare industry have any problems? If yes, how would you tackle this? | | Dr HG Desai: Indian healthcare industry has several serious problems:
1. Those who need the healthcare attention most, do not receive it, as they cannot afford it. The vast majority of this population is treated by so called 'doctors' who are inadequately qualified.
2. It is unfortunate but true that those who can afford the costly medical treatment in five star hospitals are likely to be treated by a few doctors whose judgment may be affected by monetary gains.
3. In any country the most important aspect of any healthcare system is prevention. This receives inadequate attention from Government agencies, private hospitals and practicing doctors.
4. Admission in medical colleges, by reservation (SC/ST) and by rich paying capitation fees in private medical colleges has caused great deterioration in quality of doctors.
To improve healthcare in our country:
- The importance of providing pure water and to improve sanitation – personal hygiene in the population, cannot be over emphasised.
- Consumption of alcohol, tobacco to be drastically curtailed by education, advertisement, increasing taxes.
- In the population, awareness of proper life style – diet, exercise, safe – sex, recreation should be intensified.
- Vaccination, breast-feeding should be encouraged.
- Antenatal care – (including checking blood for HbsAg, HIV antibody in the last trimester) should be improved to reduce maternal and infant mortality. Home delivery should be discouraged.
- Blood banks should be improved by accepting only voluntary donors and encouraging autologous blood transfusion for non-emergency surgery.
- Emergency trauma care services to be established
- A serious attempt should be made to encourage more people to take health insurance.
- The difference in (lowest) marks should not be more than 20 among students of reserved and unreserved seats. Merit should be the only criteria for all seats in private medical colleges.
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| DoctorNDTV: What are the attributes of a good doctor? | | Dr HG Desai: A good doctor knows that the interests of his patient should always precede his own personal interest. His judgment will never be affected by anything, except the good of his patient. He is not proud of his knowledge but conscious about his ignorance. He knows his limitations: cures a few, comforts many and consoles all. | | |
| DoctorNDTV: What has been your most recent professional milestones? | | Dr HG Desai: To complete and release a book on 'Gastritis: Indian Perspective', providing Indian data on gastritis, to encourage young gastroenterologists, to do further research on the areas of ignorance. | | |
| DoctorNDTV: What do you think are your greatest achievements? | | Dr HG Desai: 1. Starting DM (Gastroenterology) at T N Medical College, Mumbai in 1986. 2. Receiving Shakuntala Amirchand Prize (by a doctor under the age of 40 years) for research work published. Immunological classification of chronic gastritis was published first time in the world (March 1973). 3. To obtain a "Certificate of Integrity" – Rashtriya Samman from Ministry of Finance, New Delhi (2003). 4. To receive Honorary FRCP (London), (2003). 5. Nine publications in the journal Gastroenterology (USA). | | |
| DoctorNDTV: Do you think the medical healthcare in Mumbai is too commercialised? | | Dr HG Desai: Medical health care is too commercialised not only in Mumbai but in all major cities of India (? of the world). In Mumbai, there is a sufficient control by administrators of five star hospitals that patients are charged within a fixed range. When some seats in private medical colleges are sold at exorbitant rates, such commercialisation is inevitable in private individual practice. | | |
| DoctorNDTV: Would you like to tell us about any recent developments in your specialty? | | Dr HG Desai: 1. During the last three decades, an 'epidemic' of lower oesophageal adenocarcinoma in adult white population of developed countries has been observed. This is attributed to the rarity of Helicobacter pylori exposure of the gastric mucosa, with excellent sanitation – hygiene. This observation has raised serious doubts about the wisdom of eradicating H. pylori in all subjects in whom H. pylori is detected.
2. The vast majority of patients of cryptogenic cirrhosis are due to steatohepatitis causing cirrhosis; 14% of patients with steatohepatitis progress to cirrhosis. This has provided another new way for preventing cirrhosis by controlling overweight in the population.
3. In young subjects with dysphagia, absence of common causes on OGD scopy, should raise the suspicion of eosinophilic oesophagitis on observing whitish rings, furrows, or plaques (or even normal mucosa); oesophageal biopsy from mid-oesophagus showing more than 20 eosinophils per high power field, confirms the diagnosis. | | |
| DoctorNDTV: Do you think Indian health websites are useful? Your views about NDTV. | | Dr HG Desai: Indian websites have improved the standard of medical care as consultants are aware that the patient and his/her relatives have probably gathered information from the website. Much more needs to be done by NDTV to make any serious impact on healthcare in India (see answer 1). | | |
| DoctorNDTV: What do you think has been extraordinary development in the field of gastroenterology in the last 20 years? | | Dr HG Desai: 1. Duodenal ulcer results from H. pylori infection and its annual recurrence decreased from 80% (after cure with acid suppression only) to less than 10% (after cure with H. pylori eradication).
2. The ever-increasing improvement in results of orthotopic liver transplant and the frequent living donor transplant operations for adult patients are highly impressive. Whether more vigorous salt restriction to control ascites and prevent its recurrence in Child C patients (who cannot afford liver transplant) improves longevity, should be an area of interest in hepatology units (personal observation).
3. Therapeutic endoscopy – band ligation for oesophageal varices, common bile duct stone extraction, endoscopic mucosal resection for early gastric cancer, pseudocyst drainage including necrosectomy etc. have revolutionized treatment of these diseases. | | |
| DoctorNDTV: What would you have been if not a doctor? | | Dr HG Desai: A lawyer, as my girlfriend’s father was a renowned Supreme Court lawyer! My Hero (MKG) was also a lawyer (see 10). | | |
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