“Voice of the Doctor” and points to ponder
My take on #VIOLENCE_AGAINST_THE_DOCTORS
#Make_in_India #Made_in_India #Save_the_doctor #Braindrain #Justice #is_doctor_next_to_God #Bharat_Swabhiman #Morality #SaveTheSaviour
Over the last few years, there has been increasing violence against the medical community. This has made me to think again and again about this issue and also other matters related to health scenario in the nation. I am therefore speaking my mind regarding the savior.
After completing MBBS and joining as a resident in medical institutions in the country, the resident doctors and junior faculty members especially clinical specialties and super-specialties work ranging from 12 to 36 hours continuously (at a stretch), day and night. Sometimes not getting sleep even for few minutes, missing their meals and not taking even a deep breath under the sun. The question of asking for a leave /holiday is next to impossible. These resident doctors particularly in clinical specialties dealing with emergency services are handling critical patients single-handedly like a soldier at a war-front in the middle of the night. Author himself has seen and carried patient’s trolley with his senior and junior colleagues at midnight when even ward-boy is not available and security personals are taking their deep sleep. This is a story of hundreds of saviors working selflessly for saving precious lives of fellow Indians, and they are doing this duty for a patient who is not even a distant relative, without the “SIFARISH”of any Mantri or MLA. For doing such tremendous work, skipping food and skipping even urinals pays a heavy price and in-turn damages their health.
Doctors are indeed humans and this takes its toll and they suffer from Tuberculosis, hepatitis, various type of infections, psychological trauma, weight loss, etc., etc. etc. The author and also his colleagues are witness to seeing their juniors and seniors who were on anti-tubercular treatment and anti-viral medications working in casualty and operation theatres endlessly without proper dietary facilities unavailable in most govt. run institutions.
Clinicians are treating HIV, hepatitis patients upfront at the time of admissions. As most of the patients and their relatives have the extremely bad habit of not divulging their patient’s medical history at the onset. Compounded by the shortage of resources and non-availability of Universal health precaution facilities in govt. institutions, this is an extremely risky scenario for health staff and also the fourth class employees too. The psychological trauma to any such infections during residency is tremendous on the life of budding specialists. Moreover because of the pressure of peers and department, pressure of resuming duty early takes further toll.
In middle of this routine, incident of abuse and manhandling and sometimes grievous attacks being beaten by rods and sticks, kicked by mobs is heart breaking vis-à-vis the passion for service. Recent incidents of violence against medical fraternity, and murders of senior medical officers in some state few years back for taking a stand against the corruption leaves a scar on the impressionable minds on young professionals. In spite of all this resident doctors work with sincerity and commitment.
Although author does not support the idea of junior doctors going on strike for any reasons, but most of the media houses are involved in bashing of the doctors and insult them out of proportion during the strike. No reporter would ever visit and enquire the living condition of residents, the duration of work, etc. and reporting is biased most of the times. These channels would show all deaths in the hospitals at the time of strike and label them to be due to strike by resident doctors, in spite of the fact that faculty of the departments are managing the patients in the absence of residents. The concept of resident doctor has come from west, where the all facilities of resident (living in the same place) are there, whereas in Indian govt. hospitals sometimes even the toilet facilities and quality canteen is not available. Many among them feel the pain and because of apathy of the system and other reasons including financial / monetary and better quality of life choose to move out of the nation to work in foreign nations. The pay scales there could be 300% to 5,000% higher than what is being earned here in India, and of course with lesser work hours and work environment. Author believes that temporary, contract based, urgent temporary appointments must be regularized after 6months. As success in the present society is quantified by how much you earn, the medical professional being part of the society is bound to be affected psychologically and this would affect its future decision making.
There is amplification by the media propaganda by serials and that hosted by “Intolerant Actor” showing the medical fraternity in bad shape and causes distrust between the pious relationship between the doctor and patient. While the truth may be obscured, this “Mala fide” intention against the community is nail in the coffin. There are some practitioners who may be earning in an unjust manner and self-introspection is important for the community also, but showing whole of the fraternity in bad shape is harmful for the nation as it would make the patient cynical.
India spends less than 1%on health and medical education and stands at 112 in WHO ratings. The nation at present is lagging far behind the WHO norm of 1:1000, compounded by the practitioners leaving the country leaves the situation /ratio to undesired state. The ratio is lower than that of Pakistan, Algeria and Vietnam. India has 1doctor for every 1681 persons according to MCI. This is not a live database as some may have gone outside the nation, some may have ceased to work, death, etc. This figure is applicable if 80% of these doctors are available on a particular day. There are 9.5 Lakh doctors (938,861 doctors as per recently published report.) registered with MCI state councils and 7.4 Lakh available for active services. From April 2013 and March 2016, at least 4,701 doctors who graduated from India chose to go abroad. When govt. spends lakhs of Indian currency on making the professional, this brain drain is also a financial loss to the country. It is extremely worse scenario for govt. sector as India has 1 govt. doctor for 11,528 people and one nurse for 483 people. Most of the people cannot afford private medical facilities due to low income, the burden of work falls on the govt. institutions and particularly on govt. medical colleges.
Causes of failure of health care delivery system reported by parliamentary committee were:
1. Illegal capitation fees in private colleges,
2. Health service inequality in rural and urban India,
3. Disconnect between the public-health and medical education systems.
MCI is 82 year old organization responsible for medical education standard, but with lack of man-power the delivery at the grass-root level is bound to fail. Thus MCI or any other national body should address this issue as well because India is short of 5,00,000 doctors.
As Dr J K Bhutani explained that there are three ‘cardinal sins’ which have done harm to the medical profession and I believe that this is absolutely true in the present scenario:
1. Inclusion of Art of Medical Science in Consumer Protection Act -1986
2. Capitation Medical Education -1990
3. Corporatization of medical treatment and ruthless target oriented business model 1990’s
Privatization of Medical education institutes which are directly or controlled by politicians and big business groups. As their focus is only on the monetary benefits and earning a business of 250 billion Indian currencies, ethical issues are side-lined and opportunity for those deserving the education is reduced to ebb. Author believes that NEET for MBBS and MD AND THE DENTAL branch/specialty is a right way forward and should prove a deterrent.
My suggestion would be to create a scenario for promising young professionals that they do not leave the nation due to lack of support or want of money. The govt. and institutions should take the responsibilities of guiding, pursuing and mentoring the young minds to take the courses which require more dedication and commitment. More opportunities must be created along with better infrastructure, security at work place, timely job placements; time bound promotions and everything in total transparency. As medical profession is equally important if not more (any action to save is bigger than any achievement) for a nation as is armed forces guarding the borders and protecting us, professionals leaving the nation is not just an economic loss, but a great loss for society. Preventing professionals from leaving the job must never be by forceful, but with positive initiatives by the institutions. Any govt. medical officer resigning from the services should be properly and appropriately investigated in a cordial manner and the reasons accordingly corrected for preventing such incidents in future.
Institutions across the nation should have some basic courses /initiatives during the internship program.
1. Course on public dealing.
2. Management course on handling the attendants of patients with critical illness.
3. Teaching /course on declaring demise of the patient.
4. Counseling sessions for their further professional Endeavour.
5. Recognition of the aptitude of the graduates, so as to place the right man at the right place.
6. Session on work ethics, morality build-up.
7. Written / oral examination for all graduates before giving certificate of medical practice, and 10 yearly examinations thereafter.
8. Creation of better work environment where there is more student teacher interaction.
9. It is the job of all institution heads to remove the bias in the minds of graduates for certain specialties so as to decrease the vacancies in certain specialties and justice to all specialties.
There should be a proper dress code establishment for all health professionals starting from the junior level (interns) and faculty and finally to the health ministry. The dress code should be like the armed forces. With change in the status/promotion of the resident, star must be added to the shoulder of the medical profession. The dress code for pharmacist should be different from nursing staff and dress code for nursing should be different from medical doctors. Author suggests that proper dress would boost the self-confidence of the practitioner, help in approaching the doctor by the attendants of the patient and its positive impact on work culture.
All medical institutions need to be connected with central agency online for real time data collection, statistics and also any other incidents which are affecting the functioning. All institutions must have real time connectivity through internet by means of which important decision making and opinions could be shared for various academic and administrative decisions. This would help in revolutionizing the sharing of information. Better interactions between state level medical fraternity and also at national level. Interactive groups between all the medical colleges throughout the nation. Media cell is important for sharing the information.
Regarding the medical community being on the receiving end of attendants bashing and assault, it is a thing which is seen and heard from north to south, east to west of the nation. And it is really annoying. So what can be done is the larger question? 1. Change in people’s perception, 2.Strict law enforcement, 3. There should be effective handling of people who are creating nuisance and 4. Security in the work place. If we deal with all these issues, incidents would come done. Recent decision of the court on those causing grievous hurt on the doctors is a welcome step.
I suggest a medical channel dedicated to the medical community of the nation on the likes of Rajya Sabha Channel and Lok Sabha Channel which deals in various aspects of work done by medical community.
Dr. Rahul Gupta
Professor, Department of Paediatric Surgery,
SMS Medical College Jaipur, Rajasthan, India
meetsurgeon007@gmail.com