Great suggestion for our profession By Dr Ashok Sinha
Dear All, One of the most thought provoking artiocles I read recently is reproduced
below. I hope people like it and discuss and forward it to more people including their MP's!
Great suggestion for our profession By Dr Ashok Sinha
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.
Dr Ashok Sinha could be reached at ashokagt2@yahoo. com
79 Tilla, Kunjavan, Agartala, Tripura.