|Year : 2019 | Volume
| Issue : 4 | Page : 263-264
Rheumatology in India: Yesterday, today, and tomorrow?
Robert J Moots
Department of Rheumatology, University of Liverpool; Clinical Sciences Centre, Aintree University Hospital, Longmoor Lane, Liverpool, England, UK
|Date of Web Publication||31-Dec-2019|
Prof. Robert J Moots
Department of Rheumatology, University of Liverpool, Liverpool, England
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Moots RJ. Rheumatology in India: Yesterday, today, and tomorrow?. Indian J Rheumatol 2019;14:263-4
Musculoskeletal diseases have long been recognized to be major issues in developed countries such as the UK where, since the time of William Heberden in the 18th Century, work has been undertaken both to investigate etiology and to improve patient care. In parallel, undergraduate and postgraduate training in rheumatology in the UK has developed to the extent that outcomes for patients suffering from many forms of arthritis in the UK are now close to that, if not the same, of otherwise healthy people.
Don't stop reading…. I can hear you thinking “so what?” The United Kingdom is a rich, developed country. Indeed it is. But what about the rich, but still developing country, India, producer of the largest number of doctors in the world? Who am I to comment? What do I know? Well, India is a country that I have had the pleasure to visit numerous times, for many years, both metropolitan cities and countryside, speaking on rheumatology matters and making many good friends. India is also a country where, at the 2018 meeting of Bengaluru, my rheumatology colleagues were shocked to learn that 70%–75% or more of physicians considered there to be a lack of training in rheumatology, both at under- and postgraduate levels.
What is my impression? A major shock on my first visit to India, many years ago, was the mismatch. A mismatch between the huge raw talent and the ability to harness this on qualification. I met (and happily still meet) so many committed, clever, and ambitious medical students and postgraduates in India, hungry for knowledge and keen to change the world. But, especially in the past, yet still today, I see a lack of provision of appropriately regulated, standardized, and focused training to allow the potential to be fulfilled.
Of course, there are phenomenal differences between India and the UK, aren't there? Well, perhaps not as much as some may think. India has candidates going into medical school at least as good as the kids in the UK, and I have visited Indian medical schools that boast facilities that exceed some in the UK! Furthermore, the great ongoing enhancements in housing and public health, together with success in managing the huge burden of communicable diseases, have led to noncommunicable diseases such as arthritis starting to appear on the agenda in India – for patients, the medical community and, importantly, government. There are now many more rheumatologists in India and IRACON has grown from a small, social get together with a bit of science, that was fun to attend, to the major internationally known congress, with cutting edge presentations and high profile attendees of today, but, thankfully, still a friendly meeting that is fun to attend.
So, what is my experience of rheumatology training in India? Right from the start, I was impressed with the rheumatologists I met in India, who equaled those in the West with respect to knowledge, clinical acumen, and approach. I have seen rheumatology fellowships develop, providing the opportunity to train more rheumatologists and observed the new rheumatology consultants make a nice living on qualification. I have also had the pleasure to host training visits from Indian trainees and newly qualified consultants – and have always been impressed by their attitude and ability. I have also been pleased to employ Indian-trained doctors in the NHS, appointed in open competition with those entirely UK-trained. There is therefore considerable success in rheumatology training in India.
But my glowing report of rheumatology in the UK is only part of the picture. There have been many similarities to the situation in India and I shouldn't throw stones if I live in a glass house. If we are doing better in rheumatology in the UK today, our history has been so good and we still have some way to go. Not too far before my first visit to India, we in the UK were complaining about the lack of rheumatology appearing on the curriculum of medical schools, too few rheumatologists in the country and training schemes that may not be delivering enough rheumatologists compared to all other developed countries.
Thankfully this has changed. Down to many factors that included a combination of lobbying by patients, significant financial support by the major UK arthritis charity (ensuring that chairs in rheumatology were established in most (if not all) UK medical schools) and with a concerted campaign by rheumatologists to get more involved in medical education things are better now. The nationally coordinated and regulated postgraduate program to train rheumatologists that has arisen after much consideration provides a clear pathway to produces excellent consultants in rheumatology.
So I would contend that, in a relatively short time, India has already made great strides in developing effective medical education. The current situation in India sounds surprisingly familiar to that in the UK when I was undertaking my specialist training. India is different to the UK in so many interesting ways. But now in a position that echoes the situation in my home country in recent memory. Should this revelation of perceived poor profile of rheumatology in India generate panic? No. Should the revelation result in action? Yes. What form should this action take? Well, it's not up to me to tell my friends and colleagues in India what to do – but what I can do reassure them that, with vision, this will change. The first and most important step has already been taken: identify the extent of the problem! Asking the right question is key to getting the correct solution. This survey has provided an excellent baseline that can and should be revisited. I will look forward to seeing how, as in the UK some years ago, India will rise to the challenge and many, many more patients will benefit from the huge development in understanding and managing rheumatic diseases in the future that this observation will stimulate.
| References|| |
Misra DP, Ravindran V, Sharma A, Wakhlu A, Negi VS, Chaturvedi V, et al
. Physicians perception of rheumatology practice and training in India. J Assoc Physicians India 2019;67:38-43.
Ledingham JM, Snowden N, Rivett A, Galloway J, Ide Z, Firth J, et al
. Patient-and clinician-reported outcomes forpatients with new presentation of inflammatory arthritis: observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis. Rheumatology 2017;56:231-8.
Kay LJ, Deighton CM, Walker DJ, Hay EM. Undergraduate rheumatology teaching in the UK: A survey of current practice and changes since 1990. Arthritis Research Campaign Undergraduate Working Party of the ARC Education Sub-committee. Rheumatology 2000;39:800-3.