What does ail the medical profession?
This week we receive the familiar news, attacks on doctors in a medical institute. Incidences of these attacks occur with alarming regularity and seem to be rising. This follows with the regular strike, candle light marches and social media outrage. Then the wide spread condemnation follows with assurances by the government of “looking into the matter” until it occurs again. This brings us back to the question, what ails the medical profession?
Firstly, medical practitioners are almost always under tremendous pressure to deliver top quality medical care to the patients irrespective of the facilities available. At the frontlines, especially in the rural health centers, the lone doctor is responsible to treat patients ranging from a malaria to a cancer and is expected to produce best results irrespective of the diagnostic or treatment infrastructure that may be available at his disposal.
There is also pressure from the bureaucracy to treat all kinds of patients at the PHC level so that they can meet their targets and the promises made. Refusing a patient is not an option irrespective of the resources or the work load, that can invite destruction of the premises to the least and killing of the doctor at worst. The lone medical provider in the hinterland lives under constant fear of harassment by the local politicians or the media in case of slightest perception of noncooperation, the doctor becomes the easy soft target and that becomes a good story for the local press.
Second, the government hospitals are almost always understaffed, the premier ones such as AIIMS see nearly a lakh patients every day. The doctor is supposed to be at the top of his game at all times 24/7. The brunt of delivering frontline medical care falls on trainee doctors or residents, who are graduate doctors who slog through most difficult exams in the country and work for a measly stipend, often living hundreds of kilometers from their home town serving the local populace to get brutally beaten up, often even murdered for no fault of theirs!
Unfortunately, doctors are not a vote bank. They are perceived to have all made a fortune fleecing poor patients, and therefore beating them up somehow appears to be justice served.
Under-representation of medical practitioners in the legislature is also a part of the problem. It is somehow not on the priority list of the political players of the country to create laws that protect the doctors and the rights of the paramedical staff.
The medical associations, though very old, seem to have an insignificant impact on policymaking. They through judicial activism, the media or political lobbying must push for the creation of policy which ensures the protection of the doctors. Clear categorization of medical centers with respect to their capacity and infrastructure and a better doctor-patient ratio will help mitigate this problem. Medico-social workers can help patients avail correct medical treatment at the right time so that there is no flare up and the patient doesn’t reach the medical center when it’s too late. Informing the patients and relatives about the prognosis of the treatment in advance and consent recording procedures can also reduce the stress on the system.
However, in the wake of these attacks, it, therefore, falls on the doctors to create awareness of the prevailing situation in the country. Local medical associations must lobby with their local public representatives to create relevant laws and ensure their implementation. It is sacrosanct for the doctor to heal the wounds of the patients, but equally important for the fraternity to stand up for itself. Let for once, the doctor be in the wards treating patients, not being one!
Dr Aniruddh Bhaidkar is an Asst Professor of Healthcare Management at the DPU Pune and practices in Mumbai