1. Healthcare

I wanted to be a doctor

Economics Hons., UPES, Dehradun
Jan 1, 1970 12:00 AM 7 min read

For as long as I can remember, I wanted to be a doctor. And whenever people discussed career options for their children, the medical profession has always been one of my top choices. It continues to be one of the most satisfying and inspiring professions - full of challenges, trials and tribulations, with more than its share of defeats and victories.


The Calcutta Medical College set up in 1835 was probably the first medical college in Asia. Recently, it witnessed a strike of OPD and routine clinical services, along with a large majority of government hospitals, private hospitals and nursing homes throughout India.


The Issue - a fight that broke out between the relatives of a patient who died in NRS Medical College, Kolkata with the medical professionals taking care of him. Evidently, a mob of about 200 broke into the hospital hours after the event, and went about thrashing medical residents, seriously injuring two. Both have suffered depressed fractures on their skulls, and only time will tell what sort of long-term consequences these young doctors will face.


The state government was quick to respond. The residents were threatened with harsh action unless they return to work immediately. There was initial escalation - hostel rooms were burnt and female residents were threatened. The assailants claim to have been carried away in the flow of emotions.


In retaliaton, the doctors in West Bengal (except emergency services) went on strike demanding action against these hooligans and better security in hospitals, apart from an apology from the Chief Minister (which appears a bit uncalled for, but doctors claim that the goons were TMC-backed, which is why police did nothing to stop them). Fortunately, there has been a settlement between the state government and the striking doctors, leading to resumption of usual medical services.


But Why Are We Discussing This


Such attacks have been reported several times earlier, both in government and private hospitals, over the last decade or so. However, what is worrisome is the impunity with which these aggressors have managed to beat up doctors, inflicting grievous injuries, damaging hospital equipment, and generally holding healthcare ransom.



What is the Problem, Then?



It cannot be one of lack of service, few other professions have to indulge in such excruciating ordeals. It should not be one of results, over 95% of patients admitted in hospitals are discharged healthy. It should not be one of corruption, India ranked an unimpressive 78 on a list of least corrupt countries when it comes to transparency of administration – Indians apparently prefer people who can get something done for a commission.


Could it be that we expect 100% results once we have paid the cost? But we don’t beat up teachers and vandalise educational institutions when children fail exams. Is it that we beat up those who break promises? But we don’t hit our elected representatives if and when they forget their election manifestos once elected. Is it that feel infuriated when justice is denied. Apparently not, for nobody tries beating up a judge for an unpopular or dubious verdict. So where lies the problem?


The problem doesn’t appear to be one of law. There are adequate provisions to penalise hooliganism and vandalism such as this, with special provisions for protection of hospital staff and equipment. Notably, there are laws protecting hospitals and healthcare providers in at least 13 Indian states (an example is the Punjab Protection of Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, 2008). Inspite of this, we have rarely seen a conviction under any of the Acts providing for the security of healthcare providers even though dozens of such cases have been reported from all parts of the country.


Society expects doctors to be bright, efficient, committed, honest, self-sacrificing, but not ask for anything more than the gratitude of a society not willing to pay them. Medical professionals are always told that the Govt spends lakhs on their education. The same government forgets the lakhs it spends on the IIT graduates who go off to foreign countries for cushy jobs without as much as a by your leave. They also forget to add these lakhs to the bills of patients undergoing treatment in private hospitals: the latter are expected to charge as much or little more than Govt hospitals, regardless of the fact that running hospitals involves investing huge amounts of money on land, construction, equipment, maintenance, electricity, clearances and manpower.


A predictable pattern is seen in hospitals around the country. In government hospitals, people complain about the lack of facilities while in private hospitals they complain about the exorbitant bills. Which could only mean that they expect the services of an international-level private hospital at the price of a government hospital. When this doesn’t happen - or when a patient unfortunately dies despite running up a big bill - there is trouble.


Over time, people have realised that everybody is with them in this fight against healthcare providers - the public, the administration and the media. It doesn’t matter if the victim is someone who had a high-speed crash under the influence of liquor - it’s fine to freely vent one’s emotions and beat up doctors. Or, if there are many sick patients in a ward and only a single doctor to attend to them, again heckling or beating them up is acceptable. And whenever there is a big hospital bill but the patient doesn’t survive, the answer is simple: call a few people, start creating chaos in the hospital reception area, break some computers and a window or two, and hey, presto! The hapless doctor will come out talking about a settlement!


So, what does the doctor do to make up for such losses? He/She jacks up the bills of the other patients. All big private hospitals hire private security agencies to provide round-the-clock guards, while smaller nursing home owners often hire bouncers. And the payment for all these non-medical services must be necessarily factored in the patients’ bills. Everything would be hunky-dory, except for the fact that the doctors’ bodies and minds are being bruised and such arrangements cannot last forever.


Is There a Solution in Sight?


Doctors have to understand that the patients who come to them in pain, need relief and a kind word. Meanwhile, the society needs to recognise and duly appreciate the care-givers who work for their benefit.


MBBS curricula continue to focus chiefly on diseases and their management. Students are never taught how to inform relatives that their dear one is terminally ill and may not recover, nor how to comfort grieving relatives when a life is lost. Regular counselling of relatives does go a long way in preparing them for the loss, if and when it occurs. Furthermore, money cannot and should not buy lives, but without it, high-quality hospitals will be unsustainable. The exorbitant hospital bills of our country are still one-tenth or lower than those in the West, and less than one-fourth of those in Asian countries like Singapore. No wonder, then, that so many hospital chains have been sold due to extensive losses in the last few years.


Violence in hospitals should be totally unacceptable. If society expects doctors to be sympathetic and empathetic, it should empathise with their problems as well. We as a society need to understand and accept that humans are mortal beings. While treatments and procedures save lives and provide relief, they cannot be uniformly successful. Just as nothing can be said to be certain (except death and taxes, as per Benjamin Franklin), medical procedures have certain defined failure and complication rates. Hence, picking up cudgels each time a patient is lost will not improve healthcare; rather, it alienates the very people working to save our lives.


Senior doctors, especially surgeons and interventional physicians like cardiologists and gastroenterologists, should display their competence and results on websites. The law should be particularly strict for those who are practising outside their specialities or levels of competence. A big part of the problem stems from there being no regulation (or rather poor implementation of regulation) over who can practice what. Outcomes of procedures will improve, as will the level of care. This may also result in some increase in the cost incurred, so the penetration of effective insurance must increase, enabling sick patients to get much-needed care.


All medical colleges mention in their prospectus that resident doctors are not expected to do over 12 hours of straight duty except under exceptional circumstances - the only problem being that these instances occur on a daily basis. The government needs to recognise this and correct the anomaly where a doctor in training has to look after dozens of sick patients without rest or food, often getting little or no sleep for 24-36 hours. Consultants need to support their residents more: they must play a bigger role in providing emergency care and not relegate it entirely to senior and junior residents. India also needs more hospitals with good secondary and tertiary care facilities, ideally in the public sector, as a large majority cannot afford private healthcare.


Regardless of the circumstances, no medical professional who has been caring of dozens of sick patients deserves to be beaten up by an angry mob. In case of alleged negligence, people have the right to go to hospital authorities, the government or the courts for an inquiry, but not bash them up this way. All that has been achieved by that incident, and the recurrent violence, is that doctors have just stopped or limited admitting very sick patients or performing complex life-saving procedures. It’s not worthwhile risking one’s neck for another person day-after-day.


Brain drain will continue to increase and brighter kids will stop choosing medicine as a profession, as it is no longer paying in terms of respect or quality of life. The bottom line is, until we as a society can promise basic security to our care-givers, how can we demand it of them to give us their all?


If not, the ultimate loser in this whole affair would be we, the people of India.