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2009

Depersonalization & its

implication on health system
An Assignment under Comparative Health
system studies
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summary of the contents of the document. Type the abstract of the document
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Dr Joy K Banerjee
MHA-HO Final yr (2008HO017)
9/11/2009
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Depersonalization & its implication on health system

"Education is a progressive discovery of our own ignorance."

- Will Durant

The above quote by Sir Will Durant stands fitting to begin the insight into the above topic.
The health as a system has undergone enormous change from its very inception. And the very
inception of the measure of health taken by man, can be dated back to the pre historic
civilization when the man went to gather food to curb his hunger. Thus from the wilderness
of the forest to the concrete jungles of the 21st century the man has seen a great ordeal and
has happened to transform not only himself but also the surrounding. And what is the driving
factor? its nothing but a self generated need, an instinct to survival and wellbeing that has
guided the man all through and has helped put his intelligence controlled by his common
sense to achieve satisfy this innate desire in the most fashionable and comfortable ways
possible.

Therefore a measure to upkeep ones health to an apparent optimum and that of the fellow
human beings is not an externally forced fancy but a primarily internally driven necessity, a
basic need for all man kind.

As per the WHO definition, “health is not merely absence of the disease but also a mental,
spiritual and social wellbeing.” And thus it is an interwoven matrix of the different systems
and segments of the ever growing society which man has built around itself. Therefore to
look into the health system we need to grossly understand what do we mean by a system.

System is defined as a set of elements arranged in an orderly manner to accomplish an

objective. The system provides a meaningful framework for describing and understanding the
features and functions of the subject. If a system in any field is analysed it will be observed
that it has 3 basic parts :
Input ------------------------------ Process ----------------------------------- Output
All the systems operate in an in environment and the environment in turn influences what
comprises a system and develops a boundary around it. Health system as such is no different
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from the above basic point, but added to the fact that at all the levels and step it is by the
human, to the human and for the human and that’s what makes it complicated !!

Human and humanity have both seen the technology rise and especially in the health system.
From the age old somewhat organised system to the new age ultra modern technology loaded
with the super speciality status where each part of a human being can be categorised into a
speciality subject, humanity has seen it all.

"It has become appallingly obvious that our technology has exceeded our humanity."
- Albert Einstein (1879-1955)

The above quote further explains my point. But in this mad rush for excellence we have lost
at many humanitarian grounds which by far were the corner stone of the health system. One
of the major changes which the technology has brought in is the depersonalization of the
treatment. Now no longer the time is conveniently spent by the doctors in doctor patient one
to one interaction. The entire system has seen a sea change and their has been a cropping of
multiple subsystem within the healthcare system. In the present scenario there are multiple
stake holders involved other than just the doctor.

The reason behind is that the multiple role which the doctor use to play has been
unshouldered from him and each of it has developed into a specialised branch, together
comprising of the present health system. It is a matter of amazement that initially the doctor
not only uses to do multitasking but also had a holistic and comparatively cost effective and
humane way of treatment unlike that of today. The diversification of his role has but done
little benefit if we see from the humanitarian perspective. The diseases have increased in the
statistics, the cost is sky rocketing and the treatment is restricted to those who can afford it.
Thus if this is what the outcome of the real age technology is then good were the days gone
by.
"The significant problems we face cannot be solved at the same level of thinking we were at
when we created them."
- Albert Einstein (1879-1955)
Quoting again the great scientist I want to also mention that every coin has two sides and so
has the depersonalization of health system.
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“Humanity is acquiring all the right technology for all the wrong reasons. “

On the flip side of the over technology usage is the vast reach that it has lead the healthcare to
the humanity. Like nerve command the movements so does the technology commands our
everyday life and health system too is not untouched of it. The technology though has
depersonalised the doctor patient interaction it has set open the vast possibilities of treatment
at various level. And never before in the history of the mankind did the evolving humanity
stand so close to know in depth the human body – health – and disease than it does today.
The import few of the laurels are as follows
• The human genome project
• The designer babies
• The artificial insemination
• The control, inhibition and extinction of many diseases
• The vaccinization concept and the shield to diseases.
• The inhibitor and depressor DNA to disease concept.
• The infinite technology in diagnostics and imaging
• The freezing of the embryo and the surrogacy issues
• telemedicine
You name it and the technology has given a shape to it which was initially beyond
imagination. Even the depersonalization is an issue of past with the appropriate use of
the technology. Telemedicine is one such are where it negates the point that
technology has lead to depersonalization when it is seen in the light that how many
thousands of people in far of rural land can now access to medical care through
technology.

Giving a brief of the telemedicine and its impact on the evolving system of medicine:
"He who has a 'why' to live, can bear with almost any 'how'."
- Friedrich Nietzsche (1844-1900)

Economic evaluation of telemedicine has been comparing the costs of telemedicine to the avoided
costs of conventional methods. Telemedicine has in most cases assumed to have no effect on the
patient’s health outcome, but is just a method of providing the same service in a different manner.
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Key considerations that are visible are following

Improvement in…
• Quality of care.
• Patient safety
• Patient satisfaction
• Practitioner productivity
• Practitioner satisfaction
• Financial return
• Process

The stakeholders of this new usage are as follows. It is to be understood here that we can only delay
the technological intervention and not stop it by any means! The next big revolution in the health care
is the telemedicine which has the bulk and the muscle to change the way health care system was ever
looked and the possibilities are endless.

Telemedicine is not only about reaching the unreached it is about a lot more right from the pre
primary care to the tertiary care and ICE i.e. Information Communication and Education. Though it is
at its inception and evolving at different pace in the different parts of the world, the day is not far
when like the entire world which is connected to GOOGLE for KNOWLEDGE, the world will be
connected to TELEMEDICINE for HEALTH!
The present stakeholders are as:
Stake holders
• Policy Makers
• Service Providers
• Academicians
• Suppliers Of Information / Communication Technology
• User Agency

But telemedicine has to bring together many other things for its success because it is a complete
system which has to ardently follow the basic concept of INPUT ----- PROCESS ---- OUTPUT and
especially when it will be double sided and also as matrix and present in vertical, horizontal and also
in diagonal aspects ! Thus the success lies in Bringing together:
• Education of the Masses.
• Budget
• Technology
• Infrastructure
• Deliverables
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Organizational perspective / expectations : the organizational perspective of telemedicine has to be

developed in a BOTTOM TOP approach because by all possibilities it is the patient who should have
a simple and hassle free usage. And their lies the real challenge to the telemedicine technology. For
the equipments the connectivity, the input output device should not only be simple to use but they
should also be:
• durable,
• affordable
• multitasking
• easily upgradeable
• shock proof
• uninterrupted connectivity
• repeatedly usable
• portable
• compatible
• comprehensive
• eco friendly
• sought
• socially acceptable
• safe usage
• data security
• low cost of maintenance
• data storage facility
• And last but not the least PROFITABLE VENTURE.

It is by far an accepted truth that the health system is facing obstacles at various ends because though
it is well expanded to meet the ends and user it has not sufficiently been able to work on a self
sustainable business model and needs an uninterrupted input of huge resources! Thus the success of
the telemedicine which is bound to change the face of evolving the health system lies in it being a self
sustainable business model appealing the masses and serving rightfully its purpose.
The structure required for this mass appeal should have telemedicine placed at the following
destinations:

• Telemedicine setup in a clinic / corporate hospitals

• Telemedicine setup in Govt. run hospitals
• Telemedicine setup between cities / states / countries
• Right kind of mix of equipments / infrastructure
• Network / connectivity
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• Level of people / professionals operating the telemedicine setup

• Growth perspective
• Scaling up between hospitals / cities / states / countries
• Tying up with centers of excellence
• Excellent opportunity for host of services like tale education, training, digital library, web
portal, etc…
• Mobile telemedicine
• Intranet services

Implementation : A novel idea borrowed from the infrastructure industry to be applied here is the
BOR strategy.
BOR – BUILD, OPERATE, RUN
• Most successful Business Model in IT/ HEALTHCARE all over the world
• Professionals build, operate, transfers to investors
• Professionals build, operate, run to user
• BOT/BOR brings together professionals of Industry/investors/policy makers/suppliers of
information/communication technology/users
• Projects work on mile stones keeping investors/funding agencies/professionals/
Clients and also employees, vendors in mind for the project to become successful

"When you do the common things in life in an uncommon way, you will command the
attention of the world."
- George Washington Carver (1864-1943)

Thus using the quote above, I would like to say that the day is not far when the pain of
depersonalization will be long forgotten because by that time the entire health industry will
like any other industry, will be completely brought under STANDARD OPERATING
PROCEDURE from the ENTRY TO EXIT level. The doctor’s role will be defined as that of
reasercher’s to look into the better, more comprehensive and simple way of health care
maintenance and the role of the doctor’s will be replaced by the mere technicians and skill
full people who will render treatment to the sick by just acting as operators of the machines
with preloaded information and protocol to tackle the ever dynamic health and diseases.
That’s what will be the new face of technology interface and human robotics and artificial
intelligence.
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