Like doctors, patients too have rights

His abdomen ripped open, rescue workers pulled out Ishfaq from under the debris left behind by Kashmir's deadliest earthquake but hardly any one expected him to survive. A surgery by doctors who cut the red tape and stitched his abdomen ensured the 10-year-old figures in the list of survivors.

Many count Ishfaq's survival nothing short of a miracle. And yet, it is something that doctors do, day in and day out. Pull people out of the jaws of death.

But giving lives is not all that they end up doing. Like everyone else, they do make mistakes. In their case, it costs lives. A.1999 study by the US-based Institute of Medicine estimated anything between 44,000-98,000 people died annually due to medical errors. That made doctors and the health system the third largest cause of deaths; more people than road accidents, breast cancer or AIDS. And many believed it was an under-statement.

The dynamics of our health system certainly are different. That a large proportion of rural India practically have no access to formal healthcare would indicate many people die due to the absence of doctors than because of them. But their absence in one part is no reason not to seek improvements elsewhere to ensure fewer people die, despite and because of doctors.

In India, this is also important because the health care system has never been designed to talk, or listen to the patients. At medical schools, for instance, doctors are not even taught the importance of communicating with patients. Governments too have never bothered to spell out, if not legislate, patient rights. Or for that matter, worry about the ineffectiveness of existing regulations and the regulators.

Actually, there is only one at the national level; the Medical Council of India which has its hands full monitoring medical colleges to find time to analyse ethical issues . It is also one of MCI least known role. Not surprisingly, the council received just about 479 "matters of ethical nature". This, when cases of malpractice - right from doctors running abortion shops to using patients as guinea pigs for untested drugs — or violations of MCI's ethical guidelines are abound.

One way to get the regulator listen more is to get people to complain more. But this is something that will happen only when people know what they can complain about and who. But for that, patients first have to be told that they do have the rights.

The MCI too would need a simultaneous overhaul aimed at not just strengthening the part that is expected to keep an eye on the professionals but also change the profile of people responsible. Getting civil society organisations on board could be one way to improve accountability, transparency and some argue, its efficiency.

But it is important that the regulator — in its new form or old — does not get bogged down with individual cases. The US learnt the hard way that redressing individual grievances do not promote better health care but defensive diagnosis and treatment.

There is something else India can learn from the US. A new law enacted this year seeks to encourage members of the health care system to report medical errors without fear of reprisal. The idea is to use this information to analyse systemic and regulatory responses to deal with the origin of problem, not its symptom. There may be a case for penalising individuals but it will not save lives. Learning from the mistakes would.