The medical science has seen a sea change over the last century…..more than what has been achieved in the previous 5 centuries put together. The change has been for the better for patients as people are getting cured of diseases which previously had no cures. In this state of change to expect the medical profession not to change is simply naive. I would like to enumerate the good, the bad and the ugly of the medical profession in general and the joys and challenges of doctors in particular. This is in no way a negative or cynical post. It is more of a perspective of how things are and how it is going to be.
Over the years the field has grown leaps and bounds and this being the era of super specialization…..now doctors are moving on to micro specialization. It has become harder for students to keep up to the whole gamut of information which keeps changing every few years so “specialization in minutiae is inevitable” is the new world order for doctors. I agree with this in principle but the path to specialization especially in India is difficult, unrewarding and involves a lot of factors unrelated to your capability to be a good doctor. First on the list comes low pay right from the time a medical graduate passes out. This pay never reaches the amount appropriate to his/her level of expertize all through their career unless he/she indulges in any wrong practices or his/her family owns a hospital. Second is the high cost of medical education not only monetarily but in the quality of life a medical student has to endure throughout his student life. An equally capable professional in another field is pretty much well set by the time a doctor can come out to practice and by which time the doctor has a mountain of debt and an unforgiving society. There is very little incentive for a student in India to join the medical profession unless their family owns a hospital or have unending disposable income to spend. This puts the profession beyond the reach of the middle class since there are no returns for the incredible amount of mental and financial investment required from a doctor. So is it any surprise with the quality and character of the doctors of the new era. The brightest and smartest don’t want to become doctors since it’s simply not reasonable for a middle class family to sustain a medical student. This makes way for corruption and only the people with the insane amounts of money can become doctors in the new era. Are these the kind of doctors you want to trust your lives with? Those fortunate to be bright enough enough to secure a government medical/ residency seats which they can afford are treated so shabbily by the system. They are often put up in slum like living condition in hostels with bug infested rooms, mosquitoes and the works by government colleges. They are often made to work 80-100hrs a week resulting poor nutrition and low morale. A lot of them end up sick and in extreme cases even dead. On top of that, the added danger of flash mobs assaulting the emergency doctors on call. The general feeling is the residents are often disgusted with the system and with their seniors for perpetuating this unfair system. This is how the brightest in the field are treated by the society. Some links below which might give an idea of how big the problem is. https://in.news.yahoo.com/why-indian-doctors-fear-for-their-lives-043955469.html?fb_action_ids=10202670862286429&fb_action_types=og.recommends&fb_ref=facebook_cb http://www.dnaindia.com/mumbai/report-who-takes-care-of-doctors-in-bmc-run-hospitals-2029755
The specialist doctor problem
These days everyone wants to be treated by the specialist. To a lay person it might seem like the most correct thing to do and may feel that a super specialist is very accomplished hence also the most capable to treat his disease. In practice however it is a huge waste of resources. In most patient surveys around India and the world 80% of the sickness can be treated at the primary healthcare point. The consequences of making the cardiologist treat a common cold is that the patient is wasting a cardiologist’s expertise and overpaying his consultation as well. People don’t realize the importance of a general practitioner or general physician in their healthcare. This discourages newly minted medical professionals from taking up general practice. It is just not viable for them. What is the government doing about this problem. They are completely ignoring the issue and like they have treated primary education, they are treating primary healthcare with the same disdain. They aren’t hiring permanent staff for their rural areas and those hired are paid salaries once in 6 months. They are forcibly making new residents serve in rural areas. This again is a huge waste of valuable resources. Orthopedic surgeons are doubling up as midwives and delivering babies in rural areas since there are no other doctors. How will this change our primary healthcare in anyway? GPs are not average doctors as people would like to think. They have a different set of skills than a super specialist. While a super specialist is restricted to a very narrow field of medicine the GP is trained to look at the patient as a whole. More amazing diagnoses is made in a GPs chamber than a neurosurgeon’s. But in the new era this important medical community is dwindling.
Quality of life of a Doctor
I’m not saying it is the toughest job on earth but a doctors life now harder than it has ever been. Very few vacations- no money during student life and no time once you are practicing. Family suffers. My father is a doctor and all through my childhood I resented the fact that we took so few family vacations and that my father was never there for the most important events in school or others. All the while he was working day and night to make ends meet and ensure that we, his children get the right education, amenities and taken care of. This made sure that I was a reluctant doctor for the most part of medical school. I eventually found my calling and was “reformed” but it was a painful journey nonetheless. It is going to get worse for the future generations. There is this underlying myth that doctors make a lot of money during their careers which is really not true. I had a conversation with a friend from the money making tech industries and he had this to say “Doctors can’t contribute enough financially to the nation to command higher salaries. A doctor ONLY saves lives but engineers,financial analysts and CEOs create wealth which they distribute among themselves.” This is how much value saving lives commands. I was angry at what he said at first but later realized this is how the money creating industries think of doctors: overpaid and untrustworthy. Life and death can’t be quantified in stocks and bonds and hence that is not enough. It made me sad as to how this came to pass and this perception is precisely what the next generation of doctors will have to work against. Governments post newly minted doctors into rural areas on compulsory postings but on temporary jobs. It is cheap labor for the exchequer, vote banks are taken care of and they don’t have to bother about a permanent solution for a complex problem like rural health. What these people don’t realize is that by having this attitude they will ultimately increase healthcare costs and then everybody suffers. This inability of the society to acknowledge their altruism will be the reason to discourage the next generation of brilliant students from taking up this unforgiving profession. Doctors are no more demigods or authorities in their field. Their medical decisions will be altered by arm twisting untrusting patients, fear of malpractice suits, defensive medicine, target hounding corporate hospitals, a populist government and an inefficient tlaw system. All this stress while their family still suffers from the lack of their time and money. http://www.kevinmd.com/blog/2014/11/wish-knew-advice-spouses-doctors-residents.html
Doctor and patient relationship
To a doctor who is just starting out I would say this: ‘ Your decisions will be questioned at every step. You cannot dismiss patients like you are doing a favor to them. You will have to get down to the level of the patient and sometimes lower’. It will be a big let down in a doctor’s life that they keep having their motives questioned every day of their professional lives. I think this is for the better as the doctor community has been too arrogant for far too long. They spend so little time with patients giving the excuse of long patient lists and surgeries. I think this is why people are so distrusting of what we do. Doctors of the new era have to respect the “new patient” who is educated, informed and has 1000 questions. There will be unreasonable patients just like other professionals have unreasonable clients. You have to approach it like how other professionals do. Any drug that you prescribe you should know all the side effects. Any surgery that you do you should know all possible complications. Ignorance is never an excuse anymore. Its your jib to know. Never be dogmatic and steadfast about your decisions or opinions. Learn humility, patients appreciate that. State your professional opinion clearly before educating your patient about his/her disease and give them more than one choice when possible. Let patients take ownership of the decisions that need to be taken. All this takes time and you would be well advised to give it to them in the first instance or you’ll be forced to give it in court. This sword of Damocles hanging over your head seems very unfair when all you wanted to do was do your job well. There is no point complaining about it and we have to make peace with our present day realities. If we want to be counted as professionals we have to be accountable. Period. Also you need to connect to every patient you meet. For you will have several patients but for a patient you are the only doctor at that point of time. Learn more about your patients and make them feel like you are their doctor rather than make them feel they are your patients. There is a world of a difference in that. http://mattandjennimurray.blogspot.sg/2014/09/in-defense-of-doctors.html?m=1 http://www.buzzfeed.com/lukelewis/16-doctors-on-the-dumbest-patients-they-have-ever-treated?bffb
Doctors and the media
Doctors in India are the vilified lot and not for small reason due to the unrelenting attitude of the media to slam doctors at every given opportunity. Media misuse their privilege to become just the loudest voice in the room. Most of the popular channels give out gross wrong health advice, unhealthy diet fads and advertisements of dubious cures. If that was not enough we have enough doctor slamming shows like Satyamev Jayate. Shows like these invite doctors and patients to discussion forums and post recording heavily edit the discussion in a very biased fashion to suit only their pre determined point of view and to create sensationalism to increase the TRPs of their shows. Doctors are the favorite punching bags since doctors in India have no voice. They don’t form vote banks since they are an educated community which can’t be swayed by politicians. They don’t have a lobby to fight these instances of injustice since doctors in general don’t make enough money impact the finance of any political entity. The Indian Medical Association and its state counterparts sometimes have token protests against these wrongs which not surprisingly never gets reported in the media. Doctors in hospital emergency rooms get beaten up every other day almost in all instances for no fault of theirs. This almost barbaric treatment of junior doctors in hospitals across the country are never reported in the media and if reported would highlight “some mistake” on the part of the treating doctors and never anything defending the doctors. This is because in most instances these assaults on doctors are perpetuated or encouraged by media persons. And strangely if there is any instance of a doctor strike protesting archaic quota system of medical education, low pay or assault of doctors in hospitals, the same media will come raining down on the doctor community of holding people’s life at ransom. What I’m sad to see is that people don’t realize that doctors are not anarchists.They would be more happy treating patients rather than be in protest rallies and fight lathi charges. If they are forced to do these things one has to realize how desperate and frustrated they are with the system. Nobody else is fighting for them and doctors have no choice but to protest in what little way they can. It is sometimes heart rending to see doctors who are on hunger strikes still running emergency clinics in these protest areas since they don’t want people to suffer.
Doctors and Doctors
Over the years in the medical profession I have seen as a young doctor trying to make a mark that doctors work against doctors. There is too much professional jealousy and Godfather complex in the doctor community. There is a culture of disrespect which is passed on from the senior doctors to the junior ones. A senior doctor would not bat an eyelid before running down his junior colleague or rival in front of the patients. When you can’t respect your own profession how can you expect the patient to respect it. Doctors cannot treat their junior colleagues like slaves at their beck and call. If you don’t respect your colleagues the feeling will be mutual. So the first step in the new era will be respect for everyone from medical student to super specialist. While we are at it there should be respect for everyone concerned with your patients….every person in the health delivery system forms a vital cog in the machinery. The future of healthcare is in creating effective teams rather than hierarchy. Things have to change in the near future in India to prevent hierarchy from setting into a system. Only when you remove nepotism , favoritism and godfathers from the picture will we gain a meritorious medical community. Mentors are the need of the day. Only if the present stalwarts mentor the next generation of doctors will there be continued value of our art. But if these stalwarts are insistent on running their personal fiefdoms then its a bleak future ahead.
Finally the joys of being a doctor
Being an optimist has helped me still enjoy my profession in a positive way despite the injustices that are being done to doctors in India. Its been a very long road from being a reluctant doctor to an empathetic doctor and this journey has taught me a lot of lessons. One of the joys of being a doctor is having the power to change a person’s life and livelihood with one accurate diagnosis and appropriate treatment. A doctor may not move nations or even sometimes not even impress the patient he’s treating but power to positively impact another person’s life is incredible to say the least and I suspect is the reason why doctors still continue to perfect their art and science. Doctors may not make millions of dollars like lawyers, engineers, management consultants and businessmen but the value they give the society with their work is not measure able with any material affluence.