The real purpose of the medical college

Why in the News?

Recently, a surgical instrument left behind in the patient’s stomach was found after her having suffered with pain for almost a year, a case of medical negligence in one of the leading medical colleges in Kerala.

Growing need to examine contribution of medical colleges in a public health perspective:

1. The case of the patient was due to medical negligence even in one of the most advanced health care systems in the country.
2. Growing vacancies in seats to Bachelor of Dental Surgery and Master of Dental Surgery courses in dental colleges across the country.
3. A policy proposal of 2019 by the GoI to convert district hospitals to medical colleges that is being pursued along with a policy of sanctioning an AIIMS- like institution in every State.

Medical colleges:

1. The institution serves two main purposes:
   1. Educational role: To provide education and training of students to become medical professionals through teaching and apprenticeship (internship).
   2. Offering medical care: Patients with serious illnesses can avail services from medical colleges anytime when they have a referral from the lower-level facilities.
2. Myths about medical colleges:
   1. A medical college sanctioned for a district would take care of every health-care needs of the people there
   2. False security and hope that the chances of children living near the vicinity of medical college has increased chance of getting a medical seat.
   3. Increasing the no. of medical professionals is the solution to the issue of inadequate access to health care.

Tertiary care needs:

1. Emphasis on secondary-care facilities is required rather than large state-of-the-art medical colleges, if curative care needs of the people are the priority.
   1. Only 1% of the total population requires advanced tertiary care, annually.
2. District hospitals which have to function and follow referral systems from the lower-level facilities face challenges such as,
   1. Poor infrastructure
   2. Lack of specialists
   3. No referral system, which is partly due to non-functional secondary-level care facilities.
3. Overload of all kinds of patients- requiring primary care to the most advanced care waiting for treatment in higher-level facilities, i.e., district hospitals or medical colleges. 
4. Ideal model for secondary-care facilities:
   1. Referral system
   2. Patient care specialities such as
      1. Cardiac care and surgery
      2. Regular dialysis services
      3. Cancer treatment with a network of regional cancer centres
   3. Best trauma care responses after road traffic accidents.
5. Problems faced by medical colleges:
   1. crowding of patients in need of primary and secondary care
      1. 80% of the cases that are treated in medical colleges do not require treatment under tertiary specialty care.
      2. perennial failure of India’s health services to implement a referral system in tertiary-care facilities is because of failure to strengthen secondary-level care.
   2. Most secondary-care needs do not require hospitalisation and hence are excluded from any health insurance scheme. Therefore, medical colleges are being stormed by the patients for curative care.

Popular versus people-centric policy:

Though popular support rests with establishment and the creation of a medical college as it encompasses an ‘image’ of advanced technology and development, inadequate provisioning of secondary-level health care in the region should be real problem to be addressed.

1. If district hospitals are converted to medical colleges, the priority shifts from a treatment centre to that of an education and research centre, where patient priorities become secondary.
2. Strengthening secondary-level curative care can be the best policy for governments to strengthen their health-care system.
3. It can be a strong regulator for the commercial private sector which survives on the less complex secondary-care needs of people.