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Redefining delivery of healthcare facilities could help develop new model of low cost treatment

Dr Ashok Seth is chairman of Fortis Escorts Heart Institute, New Delhi and head, cardiology council of Fortis Group of Hospitals. He was named winner of Padma Bhushan, one of India’s highest civilian awards, on the eve of Republic Day this year.

Dr Seth has contributed extensively to the growth of cardiology, especially interventional cardiology in India and across the world. He has pioneered numerous angioplasty techniques for India and Asia Pacific region like directional atherectomy, angioscopy, stents, thrombectomy devices and drug eluting stents, use of Impella heart support device failing heart, bioabsorbable stents and TAVI (Transcatheter Aortic Valve Implantation). He has been a part of the focused Advisory Group and seminal studies for development and clinical applicability of Bioresorbable Scaffold (BRS) Stent, which is well recognized internationally.

For his unique achievements and contributions he was honoured with the Padma Shri award by the President of India in 2003, the National Award of Republic of Spain ‘Officer’s Cross Order of Isabella the Catholic’ in 2010, ‘Mason Sones Award’ from SCAI (Society for Cardiac Angiography and Interventions), USA in 2010 and numerous other awards. He is past president of Cardiological Society of India and vice president of Asian Pacific Society of Cardiology.

Dr Seth has been invited to lecture and demonstrate complex angioplasty techniques to more than 400 international courses and meetings across the globe including live transmissions of complex cases from India to the TCT (Transcatheter Cardiovascular Therapeutics) and EuroPCR meetings. He is on the editorial board of JACC (Journal of the American College of Cardiology) – Cardiovascular Interventions, CCI (Catheterization and Cardiovascular Interventions) Journal, EuroIntervention, and Indian Heart Journal.

He has been honoured with honorary doctorate by four universities in India. He has more than 250 publications to his credit in prestigious Indian and international medical journals, written and edited chapters in 10 text-books of cardiology and medicine and edited two books on cardiology. He has trained more than 350 cardiologists from India and abroad in advance techniques of angioplasty.

Dr Ashok Seth shares his views after being named as a winner of the coveted Padam Bhushan award, in an exclusive interview with India Medical Times:

Dr Ashok Seth
Dr Ashok Seth

How do you feel after being named as the winner of the coveted Padam Bhushan award?

I feel very good about it; it’s an honour. I received a call that the Home Ministry is trying to get in touch with me and I thought somebody known to someone might have had a heart trouble and they are calling me to save somebody’s life then I was told that the government has nominated me for the Padma Bhushan, I was speechless! So, yes it’s a good feeling, it’s a recognition and you feel thankful to everybody who has been with you.

I dedicate this award to my patients who have put so much of faith and trust in me for years and also people who have sacrificed for me because as an individual you cannot achieve even 100th of what you have achieved, had the family not made sacrifices, gave their love and blessings… wishes of people who have worked with me, their level of commitment. I am thankful to everyone and also thankful to god for reaching this position and today getting this prestigious honour.

The expectation would have gone up after this award. How do you plan to cope with it?

I think the responsibilities have increased; my own expectation from myself has always been to the level that I have to give back to the society in the highest possible manner with maximum ethics and compassion. On the other hand the responsibilities have increased because you are an inspirational role model; a lot of doctors in the country, a lot of cardiologists in the country look up to me and I keep on receiving messages that people want to become like me, that puts a bigger responsibility on me and therefore you have to be good to the maximum.

I hope that in the changing world of the medicine I give everybody hope, everybody vision to be passionate, compassionate, ethical and focused and do best for the profession and the society in terms of healthcare delivery and in terms of how you change things for the country.

Dr Ashok Seth
Dr Ashok Seth

What you think were the major contributions of yours for which you were considered for this award?

I was never aiming for an award; it is always that you think of giving back to the society and the award is a back pat that you get from the society. I just continue to work towards the new development of science and technology. I think my biggest contribution in recent times, in terms application of science, was in the development of subcutaneous implantable cardioverter defibrillator, the S-ICD, something in which I was instrumental and part of the core team, its trials and also defining how to use it across the world. And propagating science and technology in a way that the world is recognizing me as a key individual who has taught across the world.

On the other fronts also I think defining how every institution should deliver, leading the Cardiological Society of India into new dimensions of being not just a society of cardiologists but a society that takes care of patients and defines certain guidelines as to how diseases should be treated in this country.

The work has been on multiple fronts like nationally and internationally, not in just treating patients but in new dimensions of research, science and bodies which represent cardiologists and then transferring focus to the patients. I am not just past president of Cardiological Society of India, but I am also the vice president of Asia Pacific Society of Cardiology, which again we are creating, creating uniform policies for cardiology treatment as well as prevention in this country and in the Asia Pacific region.

So, the work has now become much more diverse and is covering various aspects of patient care in both prevention and treatment all across Asia Pacific and there is a long way to go. I think the next step in my life is going to be how do we redefine the delivery of healthcare facilities so that a new model of low cost treatment could emerge.

The whole delivery of healthcare has to be redefined in a manner that the cost of healthcare comes down for everyone, not just for those who visit the hospitals. We want to go more into prevention of heart diseases and awareness is only one aspect of it but improving policies and legislations is important in influencing a new thought process amongst policy makers. Unless people like me start spending more time on how it can change, there is no clear-cut defined model; the treatment model has to be changed.

It doesn’t necessarily mean that there has to be no private hospital and only government hospitals but how government can partner with private hospitals, a model of combined public private partnership where both sides trust each other, not look at each other suspiciously.

Industry is now wanting to be a part of that delivery and if the partnership is correct believe me the patient will be the first one to benefit and yet everybody in that partnership can benefit, there is so much scalability in it.

We just want to do all by ourselves, when the government wants to do it all by itself it fails on that scale, though it has reach but its efficiency goes down. The industry wants to take advantage of that, the scale of what it can do is sitting on a bus wondering when that scalability is going to come but then it has to combine the private and public.

I am very hopeful of the next steps; the new innovative ideas are coming in and entrepreneurship is really the focus and not just on the individual level, it has to be on a large scale.

Please tell us something about some of the technological advancements that Fortis Escorts has adopted?

We are very much into frugal innovation. One of our most innovative models on technology advancement in last two years, which we created, is ‘CritiNext’ or an e-ICU system. Serious patients exist everywhere and in this death defying situation specialists who treat them are not there, there is a shortage of doctors, let alone super-specialists, and we have 600,000 short of doctors as per the WHO standards. Keeping that in mind we said after all these are expertise of super-specialists and if a patient comes to a hospital in a critical condition he is not able to get the right treatment, so we set up these ICUs in smaller cities with simple telephone lines, cameras in the ICU, where we can actually see the patients, we can actually focus on the ventilator parameters, we can actually talk to the doctor and in many instances we have real time charts.

This e-ICU system, CritiNext has super-specialists and we now have 350 ICU beds attached to us, with just a general physician on the other side but monitoring the patient with every aspect what we would have done in a super-specialty hospital, 24 hours. We have saved 75 lives in last one year through just this facility, which costs practically nothing because it is through telephone lines system and a software.

We are gradually increasing the bed strength; at this time we have 18 centres attached to us and it is increasing and the most fascinating thing is that it can be transformed into other models as well, as it was for fatal disorders.

This model helps in appropriate use of antibiotics; it reduces the cost for patients because they do not have to travel; secondly they get highest level of specialty care and thirdly appropriate use of medicine so that no expensive antibiotics are given as first line of treatment.

Telemedicine is a different thing altogether, but if you can guide therapy onsite at the level of your expertise… because healthcare delivery is not just a concept. Telemedicine helps you see more patients, to keep patients away so that they can have treatment right there and that is how you can deliver quality healthcare at patient’s doorstep. If you deliver healthcare at a patient’s doorstep in smaller towns it saves them 60 per cent of the cost of treatment.

Recently, a 16-year-old boy had heart transplant at Fortis. How did it all go?

Yes, that was an achievement and after treatment the boy went home in 15-16 days and this transplant was co-ordinated and a corridor of life was created for the first time between Fortis Memorial Research Institute, Gurgaon and Fortis Escorts (a distance of 32.7 kms) and the heart was brought to us in 29 minutes. It was implanted in less than two hours time since when it was removed. The speed of implantation actually helped the survival.

It also means that more people should donate their organs as one person can help 46 people through various ways and people should actually have a commitment and this is right now missing in our country.

Then we have subcutaneous implantable cardioverter defibrillator, the S-ICD, which is a very new device, it is a life saving device that doesn’t go into the heart but from outside saves patients from sudden cardiac death, so for the first time in India we implanted this device.

I think we will be moving ahead rapidly on many fronts; for me it’s the confidence of the institution that is more important, what this institution, Fortis Escorts Heart Institute, does for the patients and its excellence.

Message for the doctors?

My message for the doctors is that do to your patients what you will do to yourself, advise your patients and do to your patients what you will do to yourself and when you speak to him remember what you are doing and when you do that the world is going to recognize you.

by Vidhi Rathee

One Comment

  1. Royal Bengal Royal Bengal Friday, February 20, 2015

    Each and every doctor in India who are performing angioplasty and using drug eluting stents are taking cash as bribe from the supplier to use their stents. There are USA based companies and Indian companies who manufacture and supply Drug Eluting Stents in India through distributors. Each Doctor decide which company’s stent he or she will use and it depends on who pays them maximum cash as bribe. Big private hospitals in big cities can charge high because they have patients who are financially strong. In big private hospitals, USA based companies stents are sold at Rs 90,000 to Rs 120,000 per stent and doctors get Rs 40,000 to Rs 50,000 from distributor. Cath lab technician gets Rs 2000 to Rs 4000 for using each stent. Distributor buys at Rs 25,000 to Rs 28,000. But they sell at Rs 90,000 to Rs 120,000 as they have to pay half of the price to doctors. Distributor can-not sell any stent without bribing doctors who are using stent.

    In government hospitals since price is fixed by government at near Rs 25,000 per drug eluting stent the USA based companies are not ready to supply there, though they have some type of drug eluting stents which they are supplying to distributors at less than Rs 20,000. In government hospitals Indian companies are strong supplier. Different company sell to distributor at different price and it range from Rs 10,000 or Rs 12,000 or Rs 15,000 per drug eluting stent. In government hospitals distributor pays Rs 4,000 to Rs 7,000 to doctor and pays 1500 to Rs 2,000 to Cath lab technician to sale each stent.

    In smaller cities and big towns, Indian manufacturer are selling Drug Eluting Stents at Rs 50,000 to Rs 75,000. Here the distributors are force to pay Rs 25,000 to Rs 35,000 to doctors and they pay Rs 2,000 to Rs 3000 to Cath Lab Technician for selling each drug eluting stent. There is no doctor in any private hospital or government hospital or army hospital or railway hospital who uses drug eluting stent without taking bribe. Doctors are the chronic terminal cancers of health care system of India.
    Government knows everything but do not do anything. How long we can tolerate this. If government do not take steps public should do something.
    In western countries doctor’s practising licence is cancelled.
    Manufacturing cost for each drug eluting stent is less than Rs 2000 but patient pays more than Rs 100,000 for each stent used.
    Patient and patients party are helpless murgas or bukras.
    Any doctor who is doing angioplasty or cath lab technician you know is highly corrupt person. They are richest people of the society with lot of black money. Huge black money can be recovered if government investigate pan card of these doctors.
    Do you think MCI & Health Minister do-not know what is going on?

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