Feedback is an indespensible part of any system especially so in healthcare. But such feedback is almost nonexistant in societies such as India. A medical intern has no way of getting his experiences and ideas reach the head of the department. A nurse has no way of conveying her concerns to the hospital management.
While I working as a resident at a hospital in India, an intern narrated an interesting experience from his rotation in the Gynaecology Ward. He was posted in the Family Planning Division which provides contaceptive counselling and care, and one of the services it provides is insertion of Intra Uterine Contaceptive Devices (IUD’s). These are small – usually copper containing devices which are inserted into the uterus and prevent pregnancy from occuring. This method of contraception is promoted by the government and they offer a small financial incentive to eligible women who come in for this method of contraception.
Sometimes during a womans menstural cycle this small copper peice can get dislodged from the uterus and can be expelled through the vagina alongwith the menstrual flow, women are advised to keep track of this and to come in for a new insertion in case they feel it has been expelled. Now this intern noticed that some women kept coming repeatedly saying that the device had come out. It turned out that they come and have it insterted at one clinic then have it removed at another saying that they are either having discomfort because of it or that they desire to get pregnant. And then they return to have it insterted again, cause they keep getting the monetary incentive every time they get it done.
This not only leads to waste of resources but also medical manpower. India does not have an information/registry system in place to keep track of patients so there is no way of determining whether a certain person has received the monetary incentive or not.
What this scenario demonstrates is the need for a common platform where everyone in healthcare – from medical students to nurses to lab workers and professors can present their experiences and raise issues of concern and discuss possible solutions. Even patients should have a forum where they can discuss their concerns in a collaborative and communicative manner with the healthcare body.
The functioning of any system – even the human body, or for that matter any living organism is dependent on a multitude of positive and negative feedback mechanisms. Even the earth and climate depend on feedback. Financial and political systems depend on cycles of feedback. Healthcare cannot even be called a system if feedback mechanisms do not exist.
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