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Doctor’s Dilemma: To be or not to be?

Doctor’s Dilemma: To be or not to be?
When William Shakespeare coined the verse, “to be or not to be” in Hamlet more than 400 years ago, thoughts about the plight of doctors in India would surely have not crossed his mind. Yet this question remains pertinent as they brood over their profession and its manifold challenges.        

The question is <g data-gr-id="105" style="display: inline; color: inherit !important; font-size: inherit !important; -webkit-background-size: 0px 2px, 100% 2px; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: transparent; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAA+gAAAACCAYAAADLlPadAAAABmJLR0QA/wD/AP+gvaeTAAAAK0lEQVRYhe3OMQEAIAwDsA6DHPh/ZoTJ2JMoSPW7PwAAAMCqsx0AAAAAkgHerQKHq3BtYQAAAABJRU5ErkJggg==), url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAACCAYAAACZgbYnAAAABmJLR0QA/wD/AP+gvaeTAAAAEklEQVQImWP4vGvnfyYGBgYGABl4A2hm/SKhAAAAAElFTkSuQmCC); background-size: 0px 2px, 100% 2px; background-position: 200% 100%, 0px 100%; background-repeat: no-repeat, no-repeat;">more-apt</g> today on July 1, which marks Doctor’s Day. A day meant to pay tributes to the medical profession, July 1 happens to be the birth and death anniversary of the eminent physician and second Chief Minister of West Bengal Dr. Bidhan Chandra Roy. The day is celebrated in his memory. While messages of gratitude and encouragement pour in for doctors from various corners on this special day, they must be wondering what has gone wrong with their profession during the past several years.

Gripes – though often misplaced- about doctors in the country are all pervasive. They are perceived to be greedy: seeking steep patient targets, overcharging wantonly, taking commissions and operating even when it’s not needed. These are usually touted as their monetary sins. <g data-gr-id="87" style="display: inline; color: inherit !important; font-size: inherit !important; -webkit-background-size: 0px 2px, 100% 2px; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: transparent; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAA+gAAAACCAYAAADLlPadAAAABmJLR0QA/wD/AP+gvaeTAAAAK0lEQVRYhe3OMQEAIAwDsA6DHPh/ZoTJ2JMoSPW7PwAAAMCqsx0AAAAAkgHerQKHq3BtYQAAAABJRU5ErkJggg==), url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAACCAYAAACZgbYnAAAABmJLR0QA/wD/AP+gvaeTAAAAEklEQVQImWP4vGvnfyYGBgYGABl4A2hm/SKhAAAAAElFTkSuQmCC); background-size: 0px 2px, 100% 2px; background-position: 200% 100%, 0px 100%; background-repeat: no-repeat, no-repeat;">Behaviourally</g> speaking, they are often seen as being rude, impatient or plain grumpy. Is any of this true? Partially yes, and both doctors and we as members of the society have to take the blame for this sorry state of affairs. The government is a culprit too, but more about that later.

What does it take to become a doctor in today’s India? Five or more years of rigorous training in the form of a MBBS degree, then three years of backbreaking MD or MS - equivalent to a post-graduate degree - and two to three more years to do a super specialisation course before one can be called a “fully qualified/complete” doctor. Add in a few years of rural service or work in a hospital to get some hands-on experience, and you could be looking at approximately 13 to 15 years of education coupled with basic experience. Clearly such a gestation period is way too long and demanding. By the time a doctor is ready to start making money, he/she realises that peers in other professions are already far ahead in the earnings game. Medical remuneration has simply not kept up with the strenuous demands and qualifications needed to complete medical education. This leads to discontent and uncertainty about their choice of profession, an attitude that sets in quite early.    

The medical profession is also beset with adequately severe ailments. The symptoms are clear, but the medication seems inadequate and ineffective. The condition of the profession itself has deteriorated over the course of time. Respect for the medical profession has dipped over the years as well. Doctors do not see medicine as a calling anymore. Doctors are also demotivated due to the recurrent violence and slander perpetrated against their ilk. This is an alarming and growing trend. Irrespective of any flaws that they may possess, no doctor in his or her senses would want a patient to suffer any more than what he or she is already going through, let alone die due to their negligence. 

Yet newspapers are full of daily reports from different parts of the country reporting about shouting, screaming and often violent relatives, who go on a rampage in the event of so-called non-availability of services or the death of the patient. Is the doctor the only one that is responsible? Could the death have been avoided at all? Why make the doctor a scapegoat?  

A recent strike by 20,000 odd government doctors in Delhi is a classic case in point. One of the major demands of the striking Federation of Resident Doctors Association (<g data-gr-id="75" style="display: inline; color: inherit !important; font-size: inherit !important; -webkit-background-size: 0px 2px, 100% 2px; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: transparent; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAA+gAAAACCAYAAADLlPadAAAABmJLR0QA/wD/AP+gvaeTAAAAK0lEQVRYhe3OMQEAIAwDsA6DHPh/ZoTJ2JMoSPW7PwAAAMCqsx0AAAAAkgHerQKHq3BtYQAAAABJRU5ErkJggg==), url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAACCAYAAACZgbYnAAAABmJLR0QA/wD/AP+gvaeTAAAAEklEQVQImWP4vGvnfyYGBgYGABl4A2hm/SKhAAAAAElFTkSuQmCC); background-size: 0px 2px, 100% 2px; background-position: 200% 100%, 0px 100%; background-repeat: no-repeat, no-repeat;">FORDA</g>) was increased security for doctors in hospitals. As cases of physical assaults continue with impunity and petty thieves roam in hospitals frequently, all sorts of lumpen elements are coming together to create mayhem and mischief at the smallest of provocations. This situation is not unique to Delhi but is widely prevalent in almost all parts of the country.

There are other issues too. The doctor to patient ratio in the country is less than one is to a thousand. This is massively low compared to globally acceptable standards. There is an acute shortage of health workers like nurses and others in the health sector. Working hours are long with salaries and working conditions often being very poor. Given this it’s alarming that government spending on healthcare is gradually declining. Public health is crying for greater allocations, not lesser ones. Thousands of positions in government hospitals lie vacant. Critical medical facilities in government hospitals in the peripheries – away from the gleaming metropolitan landscape - are largely non-existent. Very few want to go and work in the rural, hilly and tribal areas. In many such cases, there are buildings and doctors but no medical equipment. Morale is bound to <g data-gr-id="86" style="display: inline; color: inherit !important; font-size: inherit !important; -webkit-background-size: 0px 2px, 100% 2px; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: transparent; background-image: url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAA+gAAAACCAYAAADLlPadAAAABmJLR0QA/wD/AP+gvaeTAAAAK0lEQVRYhe3OMQEAIAwDsA6DHPh/ZoTJ2JMoSPW7PwAAAMCqsx0AAAAAkgHerQKHq3BtYQAAAABJRU5ErkJggg==), url(data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAACCAYAAACZgbYnAAAABmJLR0QA/wD/AP+gvaeTAAAAEklEQVQImWP4vGvnfyYGBgYGABl4A2hm/SKhAAAAAElFTkSuQmCC); background-size: 0px 2px, 100% 2px; background-position: 200% 100%, 0px 100%; background-repeat: no-repeat, no-repeat;">be low</g> with medical systems being highly politicised.

Though India has made advancements and few key health indicators have improved substantially over the past decades, a lot more needs to be done. Malnutrition, stunted growth and lifestyle diseases are all on the rise. Diabetes, cancer, respiratory diseases all show alarming and increasing numbers, pointing towards a disconcerting upward trend. India, meanwhile, is still fighting the battle of hunger and anemia. There are other immediate challenges and the to-do list is a fairly long one. To make steady improvements, we require a robust and well-developed health system with all parts in sync and symmetry. The doctor is the centrifugal point, the link around which this change has to happen. One of the first foundations for this is a bit of empathy, sensitivity and appreciation for the doctor. Let us then leave our grudges aside to pay our respects and tributes to the medical community, at least for one day!

Anoop Nautiyal is the former Chief Operating Officer for the 108 government health-care emergency services in Uttarakhand. Views expressed are personal.
Anoop Nautiyal

Anoop Nautiyal

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