Doctor's Dilemma

An email from Dr. Ashok Sinha of Agartala, Tripura is doing rounds among Medical Fraternity. I feel that this particular mail requires wider public exposure than read by only Doctors.

' The recent controversy regarding the village posting of doctors has put the medical community on one side and the whole world on the other side. I remember, 35 years ago, when I was selected for medical college I went to one of my elderly aunts to seek her blessing. She was not very happy about the issue, no, she was not jealous, but she expressed her anxiety very eloquently. "You are such a nice boy, but now you'll become a bad man". That, I think, sums up the attitude of the society towards the doctors. The problem possibly lies with the doctors. They work for money, they do not bother about the society, they can kill female fetuses for a few bucks more, and they can refuse treatment for want of money; they are not up-to-date with knowledge, they do unnecessary tests to get a share of the booty. Most of the complaints are probably true. I have seen ultra-sonologists giving shamelessly false report to assist another shameless gynecologist in going for an unnecessary surgery, and I have seen many more un-parliamentary linen that I should not wash in public. All are true and more. My worry is about the ways the society is trying to go about solving the problem. The society is trying to find a solution without assistance from doctors. It was the same when the consumer protection act came. Most of the sane doctors protested, some insane ones also did. No one listened to us. I remember having told one gathering of legal experts, that they were putting the patients from the frying pan to fire; from doctors clutches to lawyers. I asked them, why did they want consumer protection act for the medical community, to improve services or getting compensation, or did they want just to teach a lesson! I assured them none of these would be possible. People refuse to learn from history. Has the road accident compensation policy improved the quality of drivers? It has only raised the insurance rates and probably helped the family of the dead. If consumer protection act implementation for medical community was intended for compensation, it was good, but if it was meant to improve services, it was useless. People gave us funny looks, thought we were `so bad'. Now the great thinkers of the nation are again at it. They want doctors to go to villages, and because the anti-social doctors do not want to go to villages, they'll have to be forced. I am surprised at the cerebral quality of the people who rake up such ideas. Has any one tried to find out why doctors are not interested in going to the villages! Is it only money! By the way, one of the lowest paid employees in India is a junior doctor. As a junior doctor I was paid a princely sum of Rs. 225/- PM, while the ward boys were paid Rs 400/-. Their duty was 8 hrs, mine 24 hrs; they had one weekly holiday, I had none. They had time for lunch; I did not. I survived because the `sisters' were real sisters; I shared their food. If the barber failed to turn up, I had to `prepare' the patient for surgery; the ward boy would not even have a nightmare of doing it. If the ward boy were absent I had to `ensure' that the patient reached the OT on time, riding on the trolley, guess who pushed it through the corridors of the hospital! But I tell you; I enjoyed my stay as a house surgeon. I am still proud of what I did. Because that was when I learned. That was what prepared me for the future. That is where I learnt how to give a painless suture, how to tackle a violent patient, how to tackle grief. I do not think a Lal Bahadur Institute trained babu will ever understand that, they do not have the training. Look at the position of medical education today. MBBS is a five and a half years course. Already the longest course in the country. But an MBBS degree is truly nothing today. At one time an MBBS degree was equivalent to an M Sc degree. One could become a lecturer after MBBS, could do a Ph D, or D Sc after MBBS. But no more, now MBBS is equivalent to B Sc. MD was a doctoral degree, Doctor of Medicine, now a postgraduate degree, a three years postgraduate degree. A two years postgraduate diploma is not equivalent to M Sc. Even the MCI is trying its best to degrade the status of medical degrees. I invite the society to understand the problem first. Force should come as the last option, not the first. Today an MBBS degree holder is a pariah in society, to be accepted by the people he has to have a postgraduate qualification. `Only MBBS', or `simple MBBS', or worse `plain MBBS' are terms we hear often, but do not understand the agony of it all. MBBS entrance is one of the toughest in the country, but let me introduce you to a tougher entrance, the PG entrance. The number of seats for PG is one third of the total MBBS seats, so in any case two thirds of the MBBS shall remain `plain and simple'. This cutthroat competition has prompted the students to treat MBBS degree as a qualifying benchmark for PG entrance tests. They prepare for the test rather than trying to become doctors. This one entrance test would make or break their career. It is better to be a simple B Sc then to remain a simple MBBS. There are instances where MBBS students are paying smaller hospitals to get internship certificate without going to the hospital so that they can utilize the time studying. What is the result? They do not become a `doctor' after MBBS; they remain students. One third of them get into PG, two- thirds fail. No, not because they are stupid, because the know-all government has put a rationing in the number of seats for PG. Imagine the fate of these students, they are plain MBBS, did not spend time learning during internship, now they are out in the open, no respect, no knowledge, official quacks. This is the most serious wastage of trained manpower the country is facing today, all because of our policy makers. Who is responsible? There was one know-all TV talk show, which said if you cannot become a doctor in five years, you could never be. So cerebral! These are the people who control the society, God help us. One does not become a `doctor' immediately after passing MBBS; it takes at least 2-3 yrs of fulltime work under supervision to be able to work independently. That was what house jobs were. Earlier house jobs were compulsory before MD entrance. After 2 house jobs if one did not get in to PG one could still practice. Now house job has no PG entrance value. Practicing medicine without a House job does not prepare a doctor well. Is there a solution to the problems in villages? It is there, if our great parliamentarians bother to listen to us. By the way I have a few more proposals. I want to make it compulsory for the parliamentarians to stay in a village for one year as MP and fulfill all promises made during election campaign otherwise their Membership would be cancelled. Make it compulsory for IIM graduates to stay in a village for one year to work for betterment of rural finances, before they get their degree. I want High Court judges to stay in villages at least 2 months a year to help solve the pending cases in the villages to be eligible for promotion to Supreme Court. I want the IAS officer to be posted in a village for one year before they are confirmed in their jobs.They can all stay in the excellent accomodation provided in the villages for the doctors. Sounds funny? Who started the jokes! Here is what I suggest. The entire medical course needs to be revamped. Instead of hundreds of confusing degrees there should be one degree, MD. It should be a nine years integrated course, equivalent in status to a Ph D. All students, after four years, would get a provisional registration to work as doctors under supervision. They would select their specialty at this juncture, depending on the merit and other government policies of the time. Even a surgeon would be MD. All the diploma courses would be abolished. There would be specialties in family practice, clinical medicine, hospital based internists, surgeons, ophthalmologists, and all other specialties that we have today. One year out of this course will be a village posting where they can learn the problems of the villages and unlearn some hi-tech solutions to simple problems. There would never be a shortfall of doctors in villages, happy doctors and not frustrated ones. I do not think there would even be a murmur of protest from anywhere. No forcible "Cultural Revolutionary" tactics would be needed. The GPs that we get would be trained ones, not untrained ones as we get now. How does a patient differentiate between a physician MD and a general practitioner MD. The same way they do now, between MDs in Medicine, pharmacology, biochemistry and pathology. In any case, government can recognize certain associations, memberships of which can be made compulsory. (For example, MD, Member of Indian College of Pharmacology, or MD Indian College of Surgeons.). This way every doctor that comes out of the college would have some special skills, and have worked independently for at the least 4 years before being released to the society. There is no wastage of doctors as `simple MBBS'. The super-specialties should be limited to a few, the brightest ones. There should be no further confusing degree like M Ch, DM. The super-specialists would be offered fellowships of the college, e.g. MD, Fellow of the Indian College of Cardiac Surgeons, equivalent to postdoctoral degree, D Sc. By the way this does not solve the problem of the bad guys in the profession as mentioned in paragraph two of this article. I'll share a bitter truth with you. The patients are as much responsible for this situation as the doctors. The ratio of good doctors and bad doctors is exactly the same as the ratio of good guys and bad guys in the society, not more, not less. There is something very wrong in the way patients select their doctors. Name and fame does not depend on skill, knowledge and sincerity. Sound business tactics, sometimes not so ethical, makes one doctor more popular than the other. This article is aimed at sensible people who want a solution, not revenge. The next doctor could be your son; the next patient could be your son. '