As an Anesthesiologist with 30 years of practice behind me, I am deeply anguished at the recent attacks on doctors and the reaction of the authorities. Today, resident doctors in Maharashtra and Delhi are on strike. More might join to express solidarity.
One wonders when and how and why has the situation deteriorated to such an extent that doctors, once respected, are now brutally assaulted. While condemning such violence, I feel some soul searching is required on the part of the medical fraternity, as well as the Govt, to find some answers.
Let us start with Medical education or the making of a doctor. I was fortunate to train in the best Medical college in Mumbai, the G S Medical college; there were no private colleges in Maharashtra then. Now, a large number of the seats are in private colleges owned mostly by politicians. Permission/recognition is granted by the MCI supposedly after the Institute complies with stringent requirements related to infrastructure, equipment, faculty and the number of patients treated both as inpatients and on an OPD basis.
The MCI is a humungously corrupt body and every new college is potential for making crores of rupees. ( It has very recently been replaced by the National Medical Commission). Colleges which apply for recognition pay agencies which, like wedding planners, arrange everything on the day of the inspection. This includes Faculty, equipment, patients and records, all of which are hired/fake/fudged. Clerks in the MCI office are bribed to divulge travel arrangements made in order to alert colleges in that city.
Everything is in place, like a film set when the inspection team arrives for the ‘surprise’ inspection. The MCI inspectors are in the know: they go through the motions. And make crores by giving recognition. The college is allowed to sell 50% of its seats – the so called management seats – which it does for about a crore each, at the MBBS level and a couple of crores at the MD/MS level.
Because of this flawed system, we have students whose merit lies in being able to afford a crore of rupees to buy a seat, being trained in an Institute which has minimal faculty, and very few patients. This is a terrible situation because unlike Engineering or any other stream, Medicine cannot be taught only in Lecture halls and with PPT presentations. We need to see hundreds and thousands of patients to develop that clinical sense which is so essential to a Physician and operate on hundreds of patients to acquire surgical skills.
Now, this ill trained doctor enters practice having spent up to 3 crores for a 3rd rate education – can you blame him/ her for first wanting to recover his investment? Govt service is out of question as doctors are the most poorly paid despite spending 8-10 years in getting a degree. Enter the Corporate hospital, which is a whole different can of worms. Run as a business in which doctors often have little or no say, the only goal is profit and NOT healing the patient. Unnecessary investigations/surgeries are the rule rather than the exception. Grossly inflating the costs, which patients are in no position to question, is the norm, especially if the patient has Insurance.
Several horror stories of patients being kept on Life support for a couple of days after death to collect hefty ICU charges of Rs. 40,000 to 50,000 per day are sadly true. Govt hospitals fare no better and present a dismal scene. Money spent doesn’t translate into equipment/ state of the art facilities.
Even after being acquired, it is not maintained – crores worth of CT scan or MRI machines lie in disrepair while govt employees make money by referring the patient to private hospitals for a cut. Huge amounts change hands in tendering for substandard drugs. Every one is on the take from the watchman at the gate to the ward boy, ayah, nurse and doctor. The doctors are so grossly ill paid that the job doesn’t attract the best talent. Those who do join are so resentful and feel so exploited that they do not wish to do any work – just clock in their attendance and then disappear to attend to their private practice. Those who attend to patients are over burdened and frustrated – hence often rude and insensitive to the anxious relatives – they have no empathy or time to communicate, which is so essential to avoid a backlash.
Even in private practice, doctors often indulge in malpractices. Paying commission/cuts for referrals is now so common that it doesn’t even raise eyebrows. But doctors earn huge amounts from referrals- Rs.2000 for every CT scan, Rs.6000 if you refer a patient for an entry level hearing aid even! As for the incestuous relationship between Pharma companies and doctors- the tragedy is that it is not even seen as a criminal thing!
Pharma companies sponsor doctors’ conferences, their travel and stay in 5 star comfort and even foot their mobile bills on a regular basis. This is apart from lavish Birthday/Anniversary/New year/Diwali/ Doctor’s day gifts which can range from high end appliances to jewelry.
All this in return for prescribing drugs which are 10 times cheaper if bought in the generic form, or combination drugs with no scientific rationale. Rampant and unnecessary abuse of antibiotics has led to dangerous resistance in the population and sometimes useless drugs like multivitamins which also have side effects and are not benign as assumed, are freely prescribed. Is it any surprise, then, that patients’ faith in doctors has been severely eroded?
While the safety of the doctors is an immediate concern, I would like to urge every one to introspect – providing better security can only be part of the solution. More long term measures are required. For the authorities, I would recommend a complete overhaul of the entire Medical education sector.
Ideally it should not be a for-profit business venture; colleges should admit only the best students, not the ones with the fattest purse. Education should stress on preventive medicine- most of the present day infectious/lifestyle diseases can be easily minimized. Special emphasis should be placed on teaching Ethics and communication skills. Helping patients and near and dear ones to recognize/accept a terminal condition and to walk with them during that difficult journey is never taught- only how to prolong life with ventilators etc. The old family physician tradition is worth reviving – the family doctor was there for you through birth, death, marriage and every thing in between – a true friend, philosopher and guide.
Conditions in govt hospitals need a drastic overhaul – and huge investment. We really need something like the NHS in the UK not this Hobson’s choice between pathetic govt hospitals and greedy corporate ones.
We should make it compulsory for our ‘netas’ to be treated in govt hospitals only, instead of flying abroad. Then and only then can we hope to see some positive change. For my colleagues, I’d like to suggest that there can be nothing better than to revisit our oath to ‘first, do no harm’.
And to remind ourselves why we chose to be in this profession.