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Doctor, Heal Thyself!

June 4, 2012

By Dr Surinder Kumar Joshi
A former Soldier, Doctor, Health Administrator

Dr Surinder Kumar Joshi

While watching the fourth episode of Satyamev Jayate, I was getting a feeling that Aamir Khan is touching a hornet’s nest. Sure enough. The protests started the same day. But it is not as I had expected. It is a much muted reaction from a few doctors, may be because the others are too busy in their practice. There have been some sane and mature voices also from some senior professionals who had the courage to accept the fact based criticism.

What Mr Khan had shown, discussed and brought to the public notice wasn’t anything new, not to the doctors at least. No doctor in India can claim to be so naive as not to know what’s happening out there. In fact, I would honestly admit that the presentation was very touching and stirring.

In film line Aamir has created new benchmarks of excellence not only as an actor, director and producer but also as a humanitarian thinker. Now he has entered the arena of social activism/reform. By taking on the evils affecting our medical profession head on and handling the issues with exemplary sensitivity he has done a commendable job.

Why the Protests?

The protests are mostly because:

1.      The criticism is coming from an outsider, a non-medical who himself is rolling in money.

2.      Medical profession is being singled out. What about other professions? Which profession is clean, politicians, bureaucrats, police, engineers, judiciary, lawyers, accountants… who is clean and not corrupt?

3.      Entire profession is being painted black because of some black sheep. A large majority are good doctors doing a good job considering the amount of workload they are handling.

4.      The poor salaries that the doctors are paid. Mr Khan should know the princely salary (about Rs 20000/-) that an average doctor draws in India after getting his degree and even after PG (Rs 30 to 40 thousand). Impressive returns after investing 10 years of their life and almost a crore of their hard earned (or borrowed) money on their MBBS degree and further more on post-graduation!

5.      The adverse conditions under which the doctors have to work, in terms of lack of equipment, trained manpower, and poor facilities.

These are some of the points they feel that Mr Aamir should have taken cognizance of. Although some of the grievances of doctors are well justified, they cannot serve as an effective defence against the charges.

Their objection to singling out the medical profession, for instance, has no validity. This is the only profession, which affects the human lives so critically and so directly. No other profession can have such crucial impact on human lives as the medical profession. And therefore, any dereliction, negligence, carelessness or corruption gets magnified a hundred times instantaneously. Aamir has taken up the subject because corruption and unprofessionalism in medical profession has reached such proportions that it is seriously affecting the lives and safety of people.

There is no denying that medical profession has been doing a great job for relieving the pain and suffering of mankind for centuries and the society has generously appreciated that by elevating the doctor to the level of demigod. But unfortunately the creed of those devoted and honest doctors is gradually dwindling so much that they are in danger of becoming an extinct species. The number of cases of corruption, carelessness, negligence and even criminal offences among medical professionals, in the present day, is alarming and they are on the increase. Every day we hear the news of doctors arrested in some or the other place for some or the other offence. The problem is further increasing because other doctors (who are clean) do not do their duty of reporting these corrupt doctors to the Medical Councils as required vide MCI Regulations 2002.

Traditionally, medical profession has been allowed to self regulate. But now because of the irresponsible (even criminal) behaviour of many unscrupulous and greedy doctors, and non-effectiveness of the Medical Councils in regulating their conduct, the society is feeling increasingly restless. They do not trust the doctors any more as much as they did in the past. But the genesis of this malady needs to be understood in the correct perspective.

Health — a Low Priority: The problem starts with the political system. Health Ministry has generally been among the lowest priority in terms of the budget allocation as well as the appointment of health ministers. Most of the health ministers have been the individuals who had no clue about the subject of Health Planning and Administration. Many of the appointees are such as have already proved their incompetence elsewhere or those who have to be adjusted under pressure from Mamtas, Lalitas, Mayas or other coalition partners. They neither have the acumen nor any interest in the job. The MCI and its State Councils have been a big disappointment, ruining whatever reputation the profession had. Still, it is not that there is a dearth of competent and honest doctors in the country. The problem is that our system does not want them.

Quality of Medical Education: As regards the doctors, there is certainly a decline in the quality of medical education. The young boys and girls who enter the profession are still innocent, honest and untouched by corruption. They can be moulded any way. But our worthy teachers do not have the time from their private practice or other activities. The example most of them set (to be emulated by the students) falls far short of the image of a teacher in terms of honesty, integrity, commitment and concern for teaching for which they are hired and paid. The tradition of administration of Hippocratic Oath to students in medical colleges is no more in practice. The Code of Professional Ethics and Conduct prescribed by the MCI is not known to an overwhelming majority of the fresh graduates because medical ethics is not a subject included in the curriculum. The only time the subject crops up is when the doctor has to apply for registration with the State Medical Council which requires the doctor to submit an affidavit that he has read the MCI (Code of Conduct, Ethics and Etiquette) Regulations, 2002, doesn’t matter whether he has actually read it or not.

Quality of doctors also depends on the quality of students entering the profession. Mr Aamir mentioned that most of the students entering the medical profession must be very intelligent. Well, one cannot be too sure — certainly not about the students who get the admission after paying huge capitation fees and enter the medical colleges licensed through bribes. Many of these students belong to very rich families and all they are interested in is getting a degree to decorate their names rather than learning the profession. Why are so many young dentists and medical graduates running after MBA these days rather than practicing their profession and honing their skills? The fact is that many of them did poorly because of poor training facilities in the colleges or due to lack of aptitude and find themselves a ‘misfit’ as a clinician. The same seats could have been utilized by students who were really interested in the profession. These are some of the factors affecting the quality of students entering the profession. If some of them still remain dedicated even after graduation, the conduct of senior professionals under whom they work, serves as a good detergent to wash off the stain.

Money Matters: Let’s look at the problem from economic angle. The society and the government expects that after having invested so many years and so much of money, the doctor should remain satisfied and happy and work like a ‘good boy’ (or ‘good girl’) in rural areas without adequate facilities/amenities and continue working like a dedicated robot without any care for his own and his family’s needs, necessities and aspirations. When people around him from ‘Mantri’ to ‘Santri’ are blatantly eating into the portals of the nation, a doctor must have a Teflon coating to keep him protected from the evils afflicting our entire society. Let’s not forget that the doctors, too, are from, and live in, the same society. If the society around them has become corrupt and is getting away with it, how can the doctors remain unaffected?

I am an optimist and do believe that the malady is not incurable. The solution will come up once the doctors seriously get down to diagnosing the ailment. They will find the cure also. Starting with working for a less corrupt society we also start indoctrinating the next generation doctors who are still free from the germs of this malady. As far as the senior doctors are concerned they are as much open to scrutiny by the IT department as any other citizen of the country. But the first step would be to put the corrupt politicians on the mat (Who will bell the cat!). Once that is started and implemented in the police and IT departments, doctors will automatically fall in line. They are, by and large, amenable to reasoning because a large majority of them are good professionals not yet corrupted, but forced to compromise, may be to avoid being odd men.

Going by the news of doctors being caught/arrested for various acts of omission or commission every day, it does appear to be a case of ‘Res Ipsa loquitur’ (Latin for “the thing speaks for itself”). The explaining has to be done by the medical profession and not by Mr Aamir Khan who is only showing us the mirror. He is only helping us medicos heal our ailing system. My medical brethren will do well to do some honest introspection. It’s time to clean up the house rather than shooting the messenger.

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