Delegating Specialized Clinical Work To ‘Technically Qualified’ Is A Terrible Idea

Rajiv Kumar, Vice Chairman of Niti Aayog, in an online conference on Thursday stated that there is a need to dramatically reduce the cost of medical education. “We must not over-professionalize the system. We don’t always need a qualified MBBS to give us anesthesia or read scans. We can have a whole set of technically qualified yet not-so-expensive experts,” said Kumar, as per a TOI report.

My mother is an anesthetist. She was amused to hear Kumar's remarks. She didn’t feel slighted in the least because anesthetists have lived with bruised egos all their lives. Even fellow doctors from other branches sometimes refer to them as ‘behoshi wale’ (unconsciousness inducers). The remarks could be in jest but never is an element of truth absent from humour.

The notion of ‘all you do is drop a little ether, what’s the big deal?’ is as old as anesthesia itself. And it has only appropriated new equivalents with time. The lack of recognition has been so real that it has pushed a few anesthesiology pioneers – to whom all of mankind owes a great moral debt – to suicide. So when the anesthetists have endured sneering attitude of their own colleagues, the dismissive words of an economist can only amuse them.

Kumar’s remarks are way too careless. Let's understand this first: just because it looks simple, does not mean it is simple. An architect might draw the rough sketch of a building in five minutes and it might seem very simple to draw a few lines. But in those five minutes, the architect dives deep into the pool of knowledge and skill, harvested over years of training and work, comes out with the most useful bits, and gives you a sketch that carries value and meaning.

The same way, seemingly simple jobs of giving anesthesia or reading scans are tasks requiring a very high degree of skill and knowledge. Anesthesiologists and radiologists have learnt to do it over the years and years of painstaking, almost cruel, training.

Anesthesia means taking care of a patient before, during, and after surgery. Now, a slightly lesser dose can result in the patient feeling pain during surgery. A higher dose can lead to low pulse, drop in blood pressure, and if it prolongs for a few minutes, even death. The change in levels of oxygen and carbon dioxide in the body during operation can only be interpreted and treated by a doctor, equipped with deep knowledge of the human body’s physiology, anatomy, and medicine. One does not learn these things in a crash course.

Even an MBBS doctor is not competent enough to give anesthesia. It requires a two/three-year specialization course after MBBS. To suggest that ‘technically qualified’ persons can give anesthesia is to dismiss a whole, specialized branch of study as useless. It’s a terrible idea, dangerous in fact, and reeks of dire ignorance. Technicians, of course, are enormously important in the operation theatre but one can’t jumble the roles of anesthetists, technicians, nursing staff and surgeons.

Furthermore, the Coronavirus outbreak crisis has only served to underline the importance of anesthetists. The virus can lead to severe respiratory issues and critical patients might need to be intubated. Intubation involves inserting a tube through the mouth and airway of the patient so that they could be placed on a ventilator. The procedure is done by anesthetists, and among Coronavirus patients, the risk of the doctor getting exposed to the virus during the procedure is extremely high.

At such a time, irresponsible remarks about professionals, who are at the frontline in the fight against Coronavirus, will only invite ridicule and disdain. Just as something like this would: we don’t always need an economics graduate to write national policy; we can have a whole set of clerically qualified yet not-so-expensive experts.

(Views expressed are personal)