“Not only our tertiary health care system has been affected but the quality of our teaching has also gone down,” said Dr Shahida Mir, principal Government Medial College Srinagar. “And in this entire scenario nobody is satisfied neither the patient nor the doctors.”
Mir wants an immediate end of the trend before its effects become too much to bear for the tertiary health care infrastructure.
“The doctors at the rural hospitals have all the good facilities for treating the patients, but they say why will we bother to treat when we can refer them to Srinagar,” said a doctor in SMHS.
“Last time an emergency case was referred to me from Islamabad, who only needed glucose drip to get well and another needed just a pain killer injection” he said. “Such examples are in thousands.”
Doctors say that they can’t even refuse admission to a patient who visits them and anybody visiting the hospitals in Srinagar has to be looked after or admitted if the need arises.
With no referral policy doctors in rural hospitals remain unaccountable even if they go on referring each and every patient to Srinagar.
“The doctors at districts or other centres simply write refer to Srinagar on the prescription slip of a patient. Beyond that there is no reason written as to why he or she can’t treat the patient,” said Dr Mir.
There is a growing call among the doctors in Srinagar’s premier hospitals to do something in this regard and all of them agree on the need of a Referral policy or other such rules.
“The referral policy will make such doctors accountable for each and every patient visiting them in the hospital” said Dr Tabish. “The doctor will have to disclose the reasons why he is referring the patient to other hospital, what are the complications, what treatment he tried and why does he think patient has not responded and other such reasons.”
Suggestions for a health and referral policy have been forwarded to government as well, but till date there has been no forward movement.
“Like in UK, a patient cannot be admitted in any other hospital unless he or she is accompanied by a reference letter issued by a doctor” said Dr Tabish. “A patient is examined by a general practitioner and when he gives the required letter, then only the patient can be referred to any other hospital with the exceptions being emergency cases.”
Doctors say that such a system could help improve the tertiary health care.
Experts also suggest introduction of back referral system in Kashmir, which is also similar to referral policy, wherein a patient can be referred to tertiary health care hospital only as a last resort.
Dr Mir also agrees that if the steps are taken in this regard it will give a major boost to quality of health care system in Kashmir. “In rural areas people will be satisfied as doctors fearing accountability will treat each and every case carefully at their respective places and rarely will they refer any patient to Srinagar,” said Dr Mir. “Our super speciality health care will progress as it will be relieved of tremendous pressure.”
“If we somehow get to implement the required laws, our SKIMS will be able to provide healthcare facilities at par with AIIMS, USA or London,” said Dr Tabish. “But only we need a manoeuvring space so that we can focus on quality specialised healthcare and provide best to the patients visiting our hospital.”
J&K is one of the unhealthy states. In Kashmir valley alone the health department and tertiary care hospitals sell more than 50 lakh OPD tickets every year. Many others go unregistered as patients prefer private nursing homes or clinics. Quite a good number of dis-satisfied patients visit outside states for the treatment. On an average Kashmiris purchase drugs worth 1000 crore rupees every year. And all the figures have been increasing with every passing day. Experts fear that the health care system of Kashmir will crumble under its own weight if government doesn’t come out with a proper health policy to plug all the loopholes and provide quality health care to people.
