Patient Vs Case
This reference to the patient here triggered a thought whether somebody who is asymptomatic can be called a ‘patient’?. It was felt okay as checking the dictionary meaning revealed that a patient is ‘a person receiving or registered to receive medical treatment.’
Sometime later, this idea propped up again in another article where it is contrasted with a case :
Contrary to the pervasive misconception that PCR alone diagnoses COVID-19, it detects only virus infection, not the disease. Most of the media report PCR positive persons incorrectly as cases. In medical parlance, case is “patient with disease”. PCR positive but asymptomatic subjects during contact tracing are infections, not cases.
It introduces overlapping terms like infection vs disease, person vs. patient vs. case, symptomatic vs. symptomatic (later in the epidemiological heat, asymptomatic got to be viewed as presymptomatic with all the attended implications)
Today came across another article which tries to distinguish the terms
Two terms that are used interchangeably but have distinct
intended usage are “case” and “patient.” A “patient” is an
individual who has a particular condition and undergoes
specific interventions. A “case” refers to the condition with
its attendant circumstances. Consider the example “a case
with tuberculosis presented to our clinic for treatment.”
Unless there is a new strain of tuberculosis that can now
affect cabinets and cases (possibly a mutant fungal-bacterial
lichen), the use of “patient” would be more appropriate in
this “case.”
So here is indicated that the word ‘case’ refers to the condition (depersonalized), while ‘patient’ refers to the person.
Thus these are the nuances in the usage of these words. The Covid pandemic situation thus gives an opportunity to interrogate these terms.
RTI enquiry into two recent orders by the ‘Court of the State Commissioner for Disabilities’
The ‘Court of the State Commissioner for Disabilities’ recently issued two orders :
- one regarding extending exam related benefits to children coming under borderline intelligence category, and
- the other for ensuring exam benefits for Specific Learning Disability.
Both the orders and how they came about (as traced by RTI inquiry) can be seen below
https://online.fliphtml5.com/azkuz/dlik/
In-fact both these categories of children have felt left out from exam related benefits provided by the 10th std exam boards. While children coming in the borderline intelligence level haven’t had received any exam related benefits till date (benefits were only due if children fell in the ID/MR category), SLD children found the benefits that they were enjoying suddenly denied this year. This denial came about due to a series of emergent developments. They are as follows
1. SLD become recognised as a disability under the recent RPWD Act 2016.
2. Thus, SLDisability would now require a medical board certificate like that in the case of other disabilities seeking benefits. This is unlike the situation till now : i.e. for claiming exam related benefits it was enough if SLD got certified (as a disorder) by medical specialists (psychiatrists) sitting in their OPDs.
3. With the RPWD ACT getting implemented the nature of the medical boards itself underwent reconfiguration. Non-medical professionals who are part of disability assessment got formally inducted into the boards in all specialties. Hence, clinical psychologists who were back stage actors till date for mental disability assessment, got formally included into the boards. However when it came to the medical authority in SLD boards , RPWD Act entrusted that role to pediatric doctors and not psychiatrists (ignoring the fact that psychiatrists have been doing the certification in SLD till date). Lately there seems to be measures taken to rectify this by including psychiatrists into SLD boards: see minutes of a central gov level committee below
4. Now, whether it be the pediatricians or the erstwhile psychiatrists who would be sitting in the boards, they were faced with a new problem. They were pressed to give a % score for the disability in SLD as it has been defined as a ‘benchmark disability’ under the RPWD Act. This quantification is alien with respect to SLD as the method to do so has not been delineated yet.
5. Therefore the medical boards started issuing SLDisability certificates without % disability scores (bench-marking). These certificates got rejected for exam related benefits as they were lacking bench-marking. Parents and headmasters of schools got involved , they petitioned the disability commissioner who has sought to resolve the issue of bench-marking by this issuing the order.
Benchmark Disability: The concept of bench-marking is not clear to all. The RPWD acts in one long sentence says how it is to be defined based on the type of disability – ones that are defined in measurable terms and those not defined in measurable terms. I had been grappling with what this defined/ not defined in measurable terms actually means. Tried to clarify it with some experts working in the disability arena but could not get my doubts cleared. Today I stumbled on this lovely document which clarified it and removed my long standing doubts! (a snip of the relevant section is extracted below)
The court for disabilities while looking at the SLD case has weighed in on the fact that SLD is indeed one of the defined ‘benchmark disabilities’ in the RPWD Act. Secondly, as SLD comes under the disabilities not defined in measurable terms, percentage need to be mentioned to benchmark (even if medical boards are not able to do so), hence the court decided that 40% benchmark may be deemed even if not mentioned in the certificate! To note that the same decision was taken independently, three months later, by an expert committee on disabilities under GOI (minutes embedded above). Thus the decision stand ratified!
court orders in this line :
https://indiankanoon.org/doc/89179709/
https://www.livelaw.in/news-updates/provide-children-with-iq-levels-between-70-84-facilities-available-to-disabled-persons-in-sslc-exam-2022-kerala-high-court-grants-interim-relief-196107 https://www.newindianexpress.com/states/kerala/2022/apr/09/low-iq-students-deserve-special-consideration-kerala-hc-2439766.html
added dec 2022. looks like order from disability commissioner for april,2023 sslc exam
Tail Piece:
Some archival materials in this connection: SLD certification forms in use before RPWD Act made it into a board certified disability
2. Form 2 and the order behind it form2 a different version
3. pediatrician based form3 : added in 2022. form4 for borderline based on disability commissioner order of 2020
4. 2014 document showing sld crowding opd in hospitals
5. news piece by an economist on sld issue
6. 2023 situation of paediatrican+ psy letter + supt letter!
7. meeting called in Idukki for sld issue
Post script:
A blue print of project proposal which i had presented to the edu dept at that time to streamline certification.
added on 04.04.2022: borderline issues again pops up this year, yet again resulting another order from the incumbent disability commissioner ( repeat situation from what happened before). order is below
mananorama news on this issue 1st week of april in connection with sslc 2022
supreme court order in connection with scribe
based on this central gov has issued quidelines and now kerala state has adopted appendix 5 from it for sslc scribe!!
added on june 2223
pdf of same
the above part of a series on waynad ..full series below ..a good read
Community Psychiatry in India 
