Where do these Superspecialists fit in ?
The health structure of India and for that matter the world over, is hierarchical . In other words, it starts with primary care
centres (which are actually defunct here in Manipur for quite sometime!) where doctors with basic medical qualification (MBBS) deals with mundane ailments and carry out the state health policy and programs.
In the next tier comes the secondary care centres (equivalent of our JN Hospital, Porompat or RIMS at the moment where most of the bulk of common medical/surgical problems are handled.
Last comes the tertiary care centres where the most complex and difficult health problems are handled as well the rarest of the rare ailments are seen.
Doctors here can not refer the patient to anywhere else except outside the country. RIMS is reportedly poised to take on this last responsibility. The DM/MCh superspecialists are supposed to function in a tertiary care centre.
What are the requirements for starting a Department of Gastrointestinal Surgery in India?
According to the MCI (Medical Council of India), a doctor with a minimum of MCh (GI Surgery) from a recognized college/institute or MS with at least 2 years special training in a recognized Department of Gastrointestinal Surgery and the degree should find a place in the schedules to Indian Medical Council Act 1956.
There seems to have been quite a great deal of confusion in the minds of doctors and patients alike as to what is Minimally Invasive Surgery/ Minimal Access Surgery/ Laparoscopic Surgery. It is not a medical subspecialty or subject.
It rather means a new technique of doing the conventional operations. For example, there is Gynaecologic laparoscopist, cardiothoracic laparoscoic surgeon, urologic laparoscopist, general surgical laparoscopist, GI surgical laparoscopist, and even neurosurgical laparoscopist.
Similarly, Gynaecologist with laparoscopic training becomes a laparoscopic Gynaecologist, a general surgeon a laparoscopic general surgeon, and a GI surgeon a laparoscopic GI surgeon and so on and so forth.
To give a better example, a laparoscopic general surgeon would routinely do laparoscopic appendectomy while a laparoscopic GI surgeon would routinely do laparoscopic colectomy or esophagectomy.
In order to start a superspecialty department, there are certain pre-conditions which are mandatory. The ancilliary departments need to be developed too.
For example, a Department of Gastrointestinal Surgery depends largely on Medical Gastroenterology, GI Interventional Radiology, GI pathology, Nuclear Medicine, GI Physiology, Immunology, Basic Science Laboratory and an Anaesthetist specially trained in Anaesthesia for Liver Surgery and Organ Transplantation.
Last but not the least, the public mindset have to change as the present concept of no mortality, no morbidity is incompatible with most of superspecialist surgical subjects.
For example, out of every 100 esophagectomies, 10-15 can be expected to succumb within 30 days of operation while 30-40 out of every 100 patients will have a complications( inherent) while for every 10,000 appendectomy operations ( done by a General Surgeon), 1 patient can succumb and less than 5 every 100 will have a complication.
Also read - "Why I chose to stay in Manipur" by the same writer.
To be continued...
* Dr. Aribam Devadutta Sharma, MBBS, MS, MCh, is a Gastrointestinal Surgeon at RIMS, Imphal and the first MCh–GI Surgeon of the North–East India. He contributes regularly to e-pao.net and can be contacted at aribam(dot)sharma(at)jipmer(dot)net or d_aribam(at)yahoo(dot)co(dot)in . This article was webcasted on 10th January 2007
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