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
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
79 Tilla,Kunjavan, Agartala, Tripura.
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