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doctor in India
creature since time immemorial now knew to hate... because that was what it
received for no fault of its own. For the crimes of others, it had paid with its body and
soul.
That, in a nutshell, is the reason why I will never allow you, my child, to
become a doctor in India.
Still confused, I guess? It is okay. Take a chair and sit down... this is going to
take awhile.
Increasingly, I find myself watching and talking to doctors across two
generations and various specialties these days. And increasingly, that sense
of despair and disillusionment is writ large in their words. They find
themselves wondering where things went wrong even as they struggle to
bring a smile on their faces. With 0.7 doctors per 1000 Indians, the
doctor:patient ratio is far below that of other comparable countries like
China (1.9), United Kingdom (2.8) and United States (2.5). Spain's 4.9
seems like an absolute luxury in comparison, I must admit. What this
means in layman's terms is simply this - that you are always going to be
swamped with patients beyond the logical human capacity in India.
Thou shalt sacrifice your time, parents, spouse and child.
Getting a 63 hour a week schedule (7 days x 9 hours) is a blessing and
most of the young guns who join in fresh after post graduation know fully
well that a 100 hour a week schedule is par for the course once you begin
working. And sadly, this is advocated and in fact encouraged by most
hospitals too - who wouldn't want to have workers in a contract which
states 8 hours a day and then get them to work 14, stating that 'this is how
it is for all doctors and besides, we are in the business of selfless
service.' You would never allow a taxi driver to drive you for 24 hours
continuously but asking surgeons to do that every third day is fair game in
India, apparently.
Wanting to do the alloted number of hours in your contract and then come
home to your family is now frowned upon in our field... it implies weakness.
Nay, it implies a a lack of professionalism.
Thou shalt sacrifice thy life dream.
For a field like ours in a country like ours which is overpopulated and has a
major portion of that hovering below or around the poverty line, having the
support of the government to ensure the benefits of health care reach
everyone is vital to our success. They needed to make medicines more
affordable at the very least. Sadly, rather than increase the amount, they
decided to cut the budget allotted to health care by nearly 20 percent. Key
sectors like HIV/AIDS lost funding rather than having it increased. This at a
time when we spend a mere 1% as it is on public health care in India as
opposed to 3% in China and 8% in United States. What can I say, my child?
I guess India is healthier than those other poor nations, are we not?
Defensive medicine
I wish it were JUST about losing your family life, working twice
the allotted hours and taking home the pitiably disproportionate salary
though. But sadly, it isn't even that anymore. Now, it is about getting home
in one piece. From stopping patients from dying, the medical field is now
being forced to worry about not being killed by the patients bystanders.
You are then the monster that the public reads in the papers - the one who killed
their loved one because of your greed to steal their money/harvest their organs/molest
their ailing mother or child. Then the very same people who demanded that doctors
take home a salary in 5 digits will have no problems in demanding compensation in six
or seven digits. It does not matter if they are wrong... what is important is that by
spoiling the doctor's reputation, you succeed in blackmailing him or the hospital into a
compromise. If every death inside a hospital were to be called a case of medical
negligence, why would doctors admit the patient at all?
Are you willing to die for your profession?
The Indian Medical Association confirmed in May 2015 that over 75% of the
doctors in India have faced some form of violence at the patient's hands in
India.
75%. This is after admitting that not all cases of violence get reported to
them. There are even instances of doctors being actually killed for following
the law. How do you explain that to his widowed wife? When was the last
time you saw a software techie being killed off for not making an app
properly? Still feel like using the 'Selfless service' card again? That's a
pretty thin card to keep playing while beating every 3 out of 4 doctors,
don't you think?
The recent verdict in the Joseph Eye Hospital case brought the reality of the Indian
mindset home to many doctors. Handing down verdicts of imprisonment to 3 doctors
for the loss of vision of 66 patients following an eye surgery camp, the judicial system
showed an amazing lack of comprehension about what was going on. It does not need
a rocket scientist to realize that a single trained doctor cannot make the same mistake
66 times in 66 different eyes on the same day. The obvious answer to such incidence of
mass endophthalmitis is in the use of unsterile solutions used - the unsterile part being
a fault of the pharmaceutical company that manufactures the solution.
8. When things go bad, the crowd will calmly ignore the government and
pharmacy that cut corners for a profit and be at the doctor's doorstep with stakes
and pitchforks. And celebrities will be there to tut-tut on national television
about how doctors are corrupt and cutting off organs for their own profits.
population) need to make a profit to continue. If they shut down, the healthcare of the
country would collapse in months simply because government hospitals would never
be able to manage the volume. Again, the arrow of your moral compass will tremble as
you grapple between the inner desire to treat people in pain and the requirement of
forcing them away to a less safer center because they (like you!) cannot afford this
hospital.
Know that you are not God. 'Feeling like a God' when you see a patient open his eyes
after a successful surgery is different from believing you are a God. It only need one
mishap for such Gods to fall... and fall hard.
Professional competition exists too, as though you didn't have enough on your plate.
Being competitive probably exists in every field but here the game is played with
people's lives. But when someone discredits you to sway the patient to leave you, you
wonder what the point really is. Was it not supposed to be about healing people?
The imbecilic outsiders.
Case in point: When one state was unable to deal with the number of patients in the
rural areas who needed health care, doctors from the neighbouring state stepped in
and conducted camps there, helping the poor get the treatment they needed. How did
the former state respond? By banning all the doctors from the other hospital for THE
CRIME of providing health care to people in need. They could not provide it
themselves but they would not allow the other state to lend a helping hand. This was
the stand of the elected ministers in the end - we would rather our folk suffer than
allow you to take credit for helping them when we cannot do it ourselves.
You have ministers running tobacco empires who head committees on health and
undo all the work of doctors by claiming that tobacco is good for health.
You have self-proclaimed fakirs and saints telling to raise the population manifold at a
time when we are stretched at the seams due to overpopulation.
You as a doctor are caught in the moral ineptitude of such politicians and
film stars who never attend government hospitals themselves and yet
decide how hospitals must be run.
This is what every young doctor in India today is struggling with - the
disillusionment of it all.
We want to heal... we want that satisfaction of being able to save lives and
see a cheerful smile on the face of someone who came to us in anguish. But
not like this. Not dictated by the whims of businessmen who demand
profits, not by the fear of being beaten up by relatives of patients who
cannot accept death as an eventuality, not while worrying about how to pay
the next electricity bill and not by losing our touch with everyone who
matters to us just because a nation chooses not to strengthen its own
healthcare system. The fear you feel as a doctor should be because you
think you have missed a differential diagnosis when a patient comes to you,
not that you will be beaten up if the patient's condition worsens.
Depending on where you work, you will face some permutation or combination of
the above ills of being a doctor in India.
And it will eat you from the inside. You will wonder how to strike the balance
between being there for those you love personally and those who need you
professionally. You will ask yourself how everyone demands you have a
dozen degrees beyond your name and yet does not seem to think it
necessary that you be paid equivalent to the effort you put in to reach here.
You will see your peers do everything by the book and get beaten down by
hospital politics or physically by patients and you will wonder - should I save
the next critical patient who comes into the hospital or refer him elsewhere
to save myself, knowing that the law has failed me.
And in that moment, you stop being the doctor you set out to be.
'Selfless service' does not require you to give up your soul and
life.
Authors note:
I have been conversing with a lot of doctors recently and the sound of disillusionment
about the field has never been as loud as it is today. Even doctors of generations past
and heads of departments acknowledge the shift, stating that they are happy that
they are not starting off their careers in today's India. One line which many of them
said and one which I also agree with entirely is the basis of this article - "I will never
allow my children to join this field."
There is also an email sitting in my inbox asking me to sign and share a petition
demanding that applications for licensed guns be fast tracked for doctors. I have
read it and placed a 'star' across the mail. I do not intend to sign it because I don't
advocate guns as a rule... I see children cry everyday when I bring an intravenous
cannula near their tiny arms. I do not wish to have them worry about the gun in the
doctor's pocket too. But I empathize with the sorrow of the doctors who made the
petition. And I know one day, I too may find myself revisiting this petition should a
calamity befall me. As its is, hospitals have started employing bouncers now.
I would love to hear from doctors here as well. Even if you disagree with my
thoughts entirely, I do not mind. I just want to see how far the disillusionment lies
and whether the "Hippocrates Oath" and "selfless service" tag are still as strong in
your hearts today as it was the day you joined your medical college. Where do you
think it is all going wrong in India?
Update (16 May 2015): I would like to thank Dailyrounds.org (for
republishing my article) and all the others who shared this across social
media on their timelines for helping get the word across.
Update (18 May 2015): Thanks to Scroll.In, Scoopwhoop, Ndtv and Quartz
too now, I guess. As for a popular news media site which shared the
blogpost, I guess I should specify here - This is a letter to my future kids. I
DONT have a child yet. :)
Update (19 May 2015): Okay, I have lost track now of who all have shared.
HuffingtonPost, Deccan Chronicle, Navbharat, Asianet... Thank you all.
Some people have asked me to comment on the fun headlines of the media
sites which published this post, focusing on the 'pole dancer' bit. Frankly, I
realize that it is a bit much to use that as a headline but if it serves the
purpose and gets doctors engaging in a discussion, I will gladly take the hit
for it :)
P.S. I am also a little amused by a site claiming I am fed up of my
profession. It is precisely the converse - it is because I (and my fellow
brethren in the medical fraternity) love the profession that we are raising
our voices against the decay we note in the system. We accept it is
derailed and this - getting people to talk on what is now an international
forum - is hopefully the first step to bringing it back on track and fixing the
image that is tarnished so badly.
Posted by Thavam