Wednesday, March 22, 2017

We need to protect our resident junior doctors

Resident doctors occupy a unique place in the medical profession. On one hand, they are still students, who are learning the art of practising medicine . They have to keep their professors happy, and also master the content in their textbooks , in order to pass their examinations. However, they are also responsible for delivering care to patients. Theoretically, this is supposed to be done under the supervision of their seniors, but because there is a shortage of qualified professors, they are often forced to fend for themselves. They are paid a pittance, because this is treated as a stipend, and not a salary. They form the heart and soul of a teaching hospital, and are responsible for powering the medical care the teaching government hospitals provide to their patients in real life. Because they know that medicine is a hard task-master, they uncomplainingly work long hours in order to master the nuances of medicine. Sadly, the working conditions they are forced to labour in are pathetic. Hostels are dirty and poorly maintained; the mess which feeds them is a mess; and they remain over-worked and sleep-deprived , in order to make sure their patients are well looked after. 
They are forced to make life-and-death decisions, often without adequate supervision, in the middle of the night, because their seniors are sleeping comfortably in their beds. However, they put up with all this, because they respect their professors; and are willing to work like dogs , because they want to become good doctors when they graduate.
The working conditions for doctors in government hospitals have remained deplorable since I graduated 30 years ago. However, what's changed is that the residents are now scared to take care of seriously ill patients during emergency situations. They are worried that they will get beaten up by the family members in case the patient dies, and no one will protect them. There have been so many incidents of unjustified violence against resident doctors in the past week, that the junior doctors have finally had the courage to get together, take mass leave, and approach the High Court , to pray for protection during the performance of their duties. The healthcare system has reached a breaking point , because we have let our young doctors down.
One would expect the High Court to be empathetic, and stand up for these vulnerable young junior doctors , who are our future doctors of tomorrow. All they are asking for is that the administration provide them with adequate security cover, so that they don't get bashed up by irate relatives; and that the government implement the Maharashtra Medical Services Persons and Medical Institutions (Prevention of Violence & Damages or Loss of Property) Law, to ensure that people who beat up doctors are given the punishment they deserve .This law specifies that an assault on doctors is a cognisable and non-bailable offence , but the police have been very lax in implementing this . The junior doctors simply want confidence that they can work without the threat of being at the receiving end of violence from the patient's family members. Is this too much to ask for ? They deal with life and death issues on a daily basis, and it's the duty of the government and the administration to provide them with safe and secure working conditions.
Instead of ordering the government to implement the law, the High Court has actually threatened these doctors that they may lose their jobs if they don't go back to work. This is so short sighted ! Ordering doctors " to be compassionate to their patients" when we show such little compassion to them is hardly a just or fair solution. All these young doctors want to do is to be able to provide the right care to their patients, without feeling vulnerable and exposed. They want to graduate with their limbs intact, so they can start practising medicine , and serve society as respected doctors. 
It's ironic, but I remember that when I was a resident doctor over 30 years ago, we had gone on strike for 3 weeks, requesting that we be provided with decent working conditions ( clean quarters and healthy food) so that we could take better care of our patients. The government made a lot of promises, but nothing was done at the ground level. The tragedy is that there is very little unity amongst resident doctors. They have limited funds because they are students, which means they cannot afford to hire senior counsels to argue their case; they are dispersed across many hospitals; and they are a floating population, in the sense that they remain resident doctors only for a few years. Once they graduate and start practise, they are no longer resident doctors, and can no longer fight for their cause . The tragedy is that not only have they been hung out to dry by the government and the judiciary, they have also been abandoned by their seniors - their professors, and the entire medical profession itself. Most practising doctors are just making anguished noises on social media about the ill-treatment being meted out to residents, but we have done precious little to actually ensure that these residents get their basic right to work under safe conditions. The administration has failed them - and so has everyone else !
If they are forced to continue running scared while performing their duty of trying to snatch critically ill patients from the jaws of death, then what kind of doctors are we creating for our future ? Why would they want to become doctors at all ? Imagine if you got beaten up, or you saw your friend getting thrashed, just because he was trying to save a seriously ill patient in an emergency . Would you be willing to stick your neck out and try to save the next moribund patient who came to the hospital ? Or would you worry more about saving your own skin ? The tragedy is that well-trained doctors can make a world of a difference to ill patients in the ICU and the ER - but they will now no longer be willing to work in these high- risk settings any more, because they don' t want to risk their own life and limb. Soon doctors will all prefer becoming skin specialists, so that don't have to worry about being bashed up by the relatives of critically ill patients !
Just like factory workers need protection from hazardous machines and unsafe working conditions, doctors need protection too ! As it is, they are stressed, overworked, tired, underpaid and under-supervised. It's not fair to expose them to the risk of violence because the administration has not take adequate security measures. Junior doctors also have a constitutional right to safe working conditions, and it's the job of the legal system to ensure than the administration and the government provides them with the safety and security they need to be able to provide proper care to their patients. The present conditions are deplorable , but if the judiciary and the government continue to browbeat and bully these vulnerable and scared junior doctors, whose careers are at stake, then the future of the entire medical profession is at risk.

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