XV Annual Meet of medico friend circle - Technology and Healthcare (Issues and Perspectives)
Item
- Title
- XV Annual Meet of medico friend circle - Technology and Healthcare (Issues and Perspectives)
- Date
- 1989
- extracted text
-
HtAVTH CELt
COWW'JK'1V ..-v, Marks Road
nru^
’V'00
BAN J
lU‘c
r/ ANNUAL L33T IF h^jlOC MW ClflCLT
7JJ.ri.LCjf Al-.D -~SaLT£-CaXS (issues end Versoectives)
Questions and issues for discussion
The overall aim of tile discussion is to discuss the potential, the
limitations and trie problem associated with different technologies in
■leal tie-care; the use/misuse underuse of certain heal th-care-technolo gi es
and the desirable, ore.ctice.l alternative (if and when necessary) to the
current use of technology. (jcience and Technology ere net the same. But
these are interchangeably used especially in the field of kedical-care.
This common usage will be followed here.)
This theme can be discussed under three broad sub-topics, Viz
Broader issues in the relationship
between Technology and health-care;
(B)
Diagnostic and tnerapeautic technology;
(c)
Technology in Nations health progrecines,
heal th programmes at mess, cciasunity level.
In what follows, these different issues are nosed sometimes in the
fort, of Questions or sometimes in the form of just points.
(a) B^aD^X 13JQVJ ;
1
s Technology and Bealth-Status -
A. 1.1
: The relationship between advances in health-care technology and
health of the people on longetivity, morbidity, pain and sufferings.
A. l.;2
The'role of preventive ana srouotive health-technologies vis-a-
vis diagnostic toercueautic ones in improving the healtb-stutus of
people, has t.'.e development of the former been neglected ? If so, why ?
A. g. 1
s Absolute li:.its s In the sense that inssite of application of
t e best available technology (artificial respirators etc.), meaningful
life is not possible, (only vegetative existence is possible) in terminal'
illnesses,
currently incurable fatal diseases like s.ost cancers; cases
of irreversible coLt. due to d variety o/ reasons. Beyond a limit, can
problems due to ageing be taC-'l ed medically ?
.... other such situations.
p..A s 3ela.ti.ve limits : There are many situations wherein medical
intervention does not substantially alter the picture, once the
disease occurs. Sor example : coronary artery disease, cerebro vascular
■episodes, psychiatric -problems, occupational health hazards etc., In
these cases, prevention is the real solution. But cun preventive measures
be best
2
J
?
4
:: 2
4o-np.> primcrly
by individuals
under medical advice (a kind of
tech-
nicel intervention) or* is it a work to be done primarily at a social
level by changing the very purpose and dynamics of our society ? Is the
letter primarily a medical intervention or basically a socio-economic,
cultural decision ?
A. 3
s heal th-technology and value system Has heal th-technology
contributed positively to egalitarian values ?
The role of cieaical technology in changing medical ethics, social
values, creating anral challenges for example s technique of safer
abortions, caesarian section, contraceptive devices, amino centesis and
sex determination , new reproductive technologies, genetic engineering...
(The rcral dilemmas raised by artificial respitors and other life
sustaining technologies would be covered in A.2.1).
A systematic discussion about heal th—technology and culture, as
well as about heal th-technology and ethics
may need uaich core extensive
discussion. Hence tn i s discussion would have to be left out of the scope
of this meet.
A, 4
;
Privatization in health-care.
A. 4.1 : That is specific about the current vzave of privatization of
1
health-care in India ?
>
A, 4. 2 s That are the various implications - medical, economic, political
of this privatization ?
(B) ■HA'GMtJTlU & Th3RA23UTJC
T3CH1K LO GY
3.1.1 8 Corazon investigations at 2HC and in general -practice »
In India, cotcon-investigations are underused at the level of PHC
and in general practice, wiiereas they are overused in hospital and
consultant practice.
"'/nite Blood Cell count, Uiythrocyte Sedimentation late, Blood
■Sugar, Urine (albumin, sugar, ..icrosco ?ic), dputum for Acid Fast Bacilli
(i-xr3; ; X-ray chest, Gzin-clip for AF3; Cervical Fan's Gm ear, Peripheral
Blood Smear for male riel parasite*».... these can be called as co: non
investigations needed at the level of PHC and general practise in India.
Can we E&fee somewhat definite statement as to which of these
investigations are under sed in whic situations and the reasons for the
under- tr.’ : •»’ tion ?
B.l. 2 t
. ‘.on in"es tiga t ’
in hospitals and consul tan t p ra c ti c e s
:ese '-.xve investi .yitioas and some other widely available ones
1 iie Complete . e.emo gram, Glucose ‘olerance Curve, Complete Gpectrur. of
3
I
f
Liver Junction Tests, oenir. Electrolytes and Triglycerides, X-ray chest,
ECj, Ultrasonography... etc.’, are being overused in hospital and
consultant practice.
Can we maze somewhat definite statement as to which of these
investigations are overused in which situations and the reasons for this
overuse ? '/not is the role of bed side examine, tion in the diagnosis ?
3.1.3
’’That is the impact of the current trend of privatization of
*
medical care on the overuse of diagnostic technology ?
,
Therapeutic technology ; Drugs form the isost iuuortant aspect
of therapeutic
technology. But since a systematic discussion on the
use of drugs is beyond the scope of this meet and since this question
has been discussed in many forums,
it has
been decided to exclude
overuse of drugs from the discussion of this meet.
3.2.1 : Do we distinguish between clearcut overuse/nisuse of therapeutic
technologies like unnecessary injections, D.& C, tonsill ectomies,
appendicectomies,,. etc., on the one hand and borderline cases of overuse
like overuse of caesarian
section to ’play safe’ or to 'save the
trouble' ?
3.2,2 : 'fetch are the appropriate therapeutic technologies which are
being underused and why ? for example, needle as airation bioosy ;
vasectomy (as compared to tubectony) palliative surgery in terminal
malignant diseases (as compared to radical surgery); Exercises for orth
opaedic and neurological cases,
in pregnancy; respiratory exercises....
which others ?
!
(c) TECHNCLvjZ jUx Cc. bUMTY L?/jL lOTEnVENTIC??
C.1.1 t Choosing a tec-.nology at the mass level, is a demanding job.
In Inaian conditions which are the criteria to be considered before a
rational decision can be r.ade ?
'ith these criteria in mind which of
the following government programmes are scientifically, socially
justifiabl e ? -
u) Almost exclusive reliance on oral Polio vaccine
in absence of any programme for safe disposal
of hui_an excreta;
(2)
jiving Chloroquin tablets and taking peripheral
Slood .Smear in All cases of fever;
| c'
V
Choi era—vaccination in the wake of a cholera-epidemic
4
1
■
-t 4
U}
jiving only one hundred tablets of ferrous sulpha.te
tc pregnant wos^en
(5)
'■
Regular weight record (Growth nonitoring) of
the underfives without appropriate social
intervention to alleviate poverty;
(£)
Clinic based icnunisation facility as a shortcut
tc Dass level immunisation progrades say in relation
to polio and Measles immunisation;
(7)
Compal .wiry warning on Cigerette packets
(that it is injurious to health} without,
any restriction on its production;
(8)
Prorogate prohibition of alcohol in the wake of
free licencing for liouer trade
any other such instances ?
rf;
t:
?
Position: 3641 (2 views)