Immorality of inaction on inequality

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j556 (Published 08 February 2017) Cite this as: BMJ 2017;356:j556

World’s attention is also needed for the frail elderly (geriatric) population as well, who may be stuck with multi-morbidities and with gaps, insufficiencies, and inequities in care.

Dear Editor,

The recent editorial in your journal titled “Immorality of inaction on inequality” is interesting and an eye opener of sorts. While the authors have covered most of the stretch, I will like to add that it’s time that the plight and predicaments of the elderly population also needs to be taken into account as well, and on an urgent and doable basis. Kindly don’t forget the gaps and inequities in the timely care and appropriate management of the morbidities that the frail aged already have, and whose numbers are increasing worldwide. Some of the aged may be turning despondent and losing hopes due to multi-morbidities, poly-pharmacies, inequities in appropriate and readily available geriatric care, which as such is getting more fragmented with either actual or perceived limitations of geriatricians, and the effect of super-specializations. If one cares to search the current literature on elderly care, the gaps, inequities, increasing waiting times, failing expectations, shortfalls in insurance for various reasons, shortcomings in state’s health policies and budgetary allocations, poor infrastructure and insufficient resources to deal with the medical issues of the aged, etc, I am positive about the results being readily available.

It is no secret that at many places around the globe, the available resources and medical facilities for the elderly population are getting overwhelmed. There are such long waiting periods for even helping those elderly who are in need of such simple things like hearing aids. Isn’t t that we all certainly do have choices, and in that either we can keep toeing the line of whatever the current practice, conventional wisdom, and the conventional text tells us, or we once in a while look beyond as well, and try to see things for ourselves with our own current perspectives and experiences. Here I would like to take the example of relying on hearing aids around the world for patients suffering from age-related hearing loss (Presbycusis) that comes with aging.

Quite frankly, although I may be wrong about the usage of hearing aids, but I have always thought differently. When it already is a common knowledge that regular exposure to loud sound is one of the prime factors that destroys ‘hair cells’ within the inner ear, and the hearing loss is consequent to this destruction of hair cells, and that these hair cells are considered most essential for the conduction of sound, then why must we subject the remaining hair cells now to augmented sounds through hearing aids? Wouldn’t this management be putting at risk the remnant population of ‘hair cells’ through a louder and augmented sound from hearing aids? To my mind, this seems like a matter of pure convenience, expediency, and following the established course, which is being followed in the absence of any other genuine and scientifically appropriate modality of remediation for those becoming hard of hearing due to aging. Dr. Arul Rhaj Technique was a consequential development that had been submitted to your journal some years ago as a rapid response.

The question remains, are we interested to improve the present situation? If yes, then perhaps there first of all there is a need for a re-look at all established modalities of managing common morbidities that affect the elderly. It will be appreciated that many elderly may keep wandering in the elusive search of cure for their morbidities as they start weighing down on them, and when adequate respite is not achieved from the current established modalities of management. Many may turn now towards alternative medicine. Therefore, shouldn’t the society, the administrators, law and policy makers, NGOs, philanthropists, researchers and scientists around the world sit down together and decide the way forward, and if the present methods, treatment modalities, etc, is enough and sufficient.

As a way forward, would it be totally unreasonable to think of amalgamating various modalities after thorough understanding, careful planning, and research, and be brought under one umbrella for the sake of patients? Maybe it is also a time to look into some newer possibilities as well, that might have come by accidentally, and as nascent or incomplete any innovative technique may be, the world’s scientists and medical fraternity should be happy taking them on from here, discarding whatever is unsuitable, and improving whatever can be improved and accepted.

Another area for a bit of concern is about the health care getting fragmented due to super specializations, and this possibly becomes a bit difficult for some of the aged population who may have to visit different specialists for their morbidities. At times the consultations are spread out in both time and space, which may put a patient with multi-morbidity or the caregiver into a sort of spin and inconvenience and at times burdened with repetitions and poly-pharmacy, and the results thereof. Simply put, there is a need for the medical fraternity to decide and prepare an exhaustive, practical, and a reasonable curriculum for the geriatricians that can enable and ensure adequate training and matching knowledge and skills to all medical students who undertake the studies of primary care and of geriatrics, so that they are able and also prepared to resolve more by themselves, and refer less. Patients might love this change, with full backup support from specialists whenever needed.

Finally, the world would do well perhaps by not restraining and limiting the roles and scope of primary care physicians, general practice, experts in family medicine, and geriatricians. Remove them from virtual straightjacket that they are presently in, that is limiting their roles and scope. Don’t let their talents be wasted or left unused. They should be able to resolve more and refer less. The subtle interplay and the impact of the corporate, the industry, the insurance sectors, etc, will also have to managed and looked into, if one were to think about bringing about some welcome, effective, and meaningful changes for improving healthcare, while keeping only the best interests of the patients in mind.

Best regards.

Dr (Lieutenant Colonel) Rajesh Chauhan
Honorary National Professor IMA CGP, INDIA.

Competing interests: 1. These are my personal views and have no bearing to any and all the professional affiliations that I have. 2. I have written about many of my innovative medical techniques to your journal as rapid responses as I feel that these should not go with me to my grave. For the same reason I have also penned down two medical books on some of these innovative medical techniques, before my memory faded, and I was still around.

13 February 2017
Dr (Lt Col) Rajesh Chauhan
Consultant Family Medicine & Geriatrics
Family Healthcare Centre, 154 Sector 6-B (HIG), Avas Vikas Colony, Sikandra, AGRA - 282007. INDIA.
154 Sector 6-B (HIG), Avas Vikas Colony, Sikandra, AGRA - 282007. INDIA.