Wednesday, June 25, 2008

Why I don't want my daughter to become a doctor

I am in the prime of my professional career as an IVF specialist and have been very pleased with the way life has treated me. However, I have major misgivings about what the next generation of Indian doctors are going to have to deal with.

Here’s a sampling of some of the woes medical students and residents in India have to battle with today.

There’s an apparently never-ending series of examinations to clear before you can get a license to practice . For some specialties, it can take upto 10 years before you get a degree which means that doctors are over 30 years old by the time they start seeing patients independently.

The government changes the medical college rules when it so fancies. When some politician decides that doctors need to do more for the poor, medical colleges make new rules and decide that rural service is compulsory , so that hapless medical students are stuck for another year in a village, in a hopeless job where they learn nothing, and have no facilities or supplies to be able to do any good to anyone.

There are limited seats and openings for certain specialties which means that many young doctors never get a chance to practice the specialty they want to. Not only are there very few seats, but most of these are blocked as a result of the pernicious reservation policy. Imagine the heartburn a bright young doctor who has set his mind on becoming a heart surgeon goes through when the only seat available for MCh cardiothoracic surgery goes to a candidate who has only 50% of his marks, just because he belongs to a backward class.

Doctors are a soft target and easy to beat up on. The Indian press enjoys doctor-bashing and does it with predictable regularity. A few black sheep tar the image of the entire profession so that hard working upright doctors who have devoted their lives to taking care of patients are treated with disrespect. Doctors are considered to be dishonest money-hungry professionals – and the law ( PNDT Act) now forces ultrasound clinics to put up signs which effectively
say – “ We will not perform illegal activities” ! Society no longer trusts doctors - it's that simple !

The government has failed miserably at providing primary health care to citizens , but does its best to interfere with the running of efficient corporate hospitals , just because they make a profit.

Individually, we all respect our personal doctor and go running to him when we fall ill . However, we tend to view the medical profession as a whole with a jaundiced eye ! Why is there such a major discrepancy in the way most of view the medical profession vis-a-vis our own doctor ?

Doctors are usually excellent in the clinic. They are very good at helping their patients, one at a time, because this is what they have been trained to do , and they do this very well. Ironically, this is what hurts them ! They are not very good as a group because they have poor political skills and cannot band together . They often end up fighting with each other because of petty personal rivalry and compete with each other for patients and prestige. They are so focussed on trying to get more of the slice of the patient population for themselves that they don't realise that their cake is fast shrinking ! There is strength in unity, but the Medical Associations do not stand up for individual doctors who are helpless and vulnerable. The profession has lost its autonomy, and is regulated by bureaucrats and outsiders, who have little understanding of the realities of providing medical care.

The role which doctors used to play in guiding society to provide health care for the community has been usurped by health activists , who are supposed to represent the interests of patients. Unfortunately, many of these live in ivory towers and have never taken care of a patient in their lives. They provide excellent solutions on paper which never get implemented because they are unrealistic and impractical.

What can we do to redress the problem ?

Doctors have a lot of individual clout and they should learn to use it for the sake of the profession. This is difficult to do in the hurly-burly of daily medical practice, but senior doctors who have retired can perform this role very efficiently. Doctors are meant to be patient advocates – and senior retired doctors should be invited to represent the interests of patients and doctors . They have spent a lifetime studying medicine and healthcare and are aware of ground realities.

It’s a fact that the medical profession has lost its charm and the future looks even gloomier. Doctors have lost their moral authority and their professional prestige. We seem to be headed the US route, where the doctor-patient relationship has been tarnished because of commercialism.

If this negative vicious cycle continues, not only is it going be sad for the next generation of doctors but it’s going to be even worse for the next generation of patients ! Angry, unhappy and frustrated doctors provide poor quality care – and it is their patients who will suffer !











1 comment:

  1. Thoughtful posts- some very good points. I enjoy your blog :)

    ReplyDelete

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