In India the National Doctors’ Day is celebrated on July 1 all across India to honour the legendary physician and the second CM of West Bengal, Dr B.C. Roy. According to Wiki it is an attempt to emphasize on the value of doctors in our lives and to offer them our respects.
So, on 1st July I received the usual slew of text messages and emails from random sources like banks, pharma, share bazaar etc wishing me for the day. None of whom had raised a word of protest when resident doctors in India were being lynched some months ago. No campaigns called #not in my name, no candlelight marches, no ‘we are the 99%’. Nothing. http://www.rediff.com/getahead/report/but-who-do-we-blame-who-do-we-beat-up-doctors/20170324.htm
Doctors were an easy target, the face of a health system that is increasingly being neglected by the government in the public sector https://thewire.in/24924/health-budget-figures-tell-a-sick-story/ and is increasingly indifferent as well as commercial ( and exploitative) in the private sector.
Who is responsible for this state of affairs? In India over 80% of all health services are sought in the private sector. Why? Because no one wants to deal with an inefficient and deadly public sector. http://www.thehindu.com/data/Indians-spend-8-times-more-on-private-hospitals-than-on-govt.-ones/article14593186.ece, http://www.hindustantimes.com/india/most-indians-prefer-private-healthcare-services-over-govt-hospitals/story-KSgqT0rqLIebKzq34wRbJJ.html
The doctors who do private practise are in it because they do care about patients and curing people but they also want to be free to do it their own way and to earn money. Because they want to be able to afford a house, send their children to good schools, own a car, travel abroad. Same as their friends who go to engineering colleges, do MBAs, law, work in finance sector etc. It’s a job like any other. And why not? India may have had a socialist heart but our hands are capitalist now. https://www.quora.com/Why-do-doctors-make-so-much-money
Most doctors work extremely hard, often losing the work-life balance, neglecting their own health, struggling to stay updated with their knowledge in a rapidly changing world while attending CMEs which do not always contribute to any education. Yes, some doctors did start unhealthy and unethical practises such as the cut practise and some doctors will do un- indicated diagnostics, or even un-indicated surgeries just like every profession has its black sheep. But once the market forces come into play, this is inevitable. Check out this wonderful book where the author explains how even blood donation when not voluntary can become a racket. https://www.theguardian.com/books/2012/may/17/what-money-cant-buy-michael-sandel-review
And here is a video where the author, who is the Professor of Justice at Harvard, talks eloquently about these ideas.
Yes there are some doctors who are extremely successful and many do fairly well. But like in every field there will be many more at the lower base of the pyramid, earning no more than a mid- range corporate job. After all for every SRK or Priyanka Chopra there are 10 Abhisheks. And the odd Dhinchak Pooja also J
In some places an Estate Agent could be earning more per hour than a doctor ! http://www.thisismoney.co.uk/money/mortgageshome/article-2562253/Where-sell-home-without-high-estate-agent-fees.html
Since one can be self –employed it is difficult to be really jobless as a doctor, unless of course, you are a woman, in which case you may have to compromise and go part time, or ‘no time’ or work only as administrators of clinics or in day jobs. https://www.nytimes.com/2014/04/24/upshot/the-pay-gap-is-because-of-gender-not-jobs.html
But far greater are the system issues that no one seems willing to address. http://www.theweek.in/content/archival/news/india/doctors-break-silence-on-rot-in-india-medical-sector.html
What is the medical education like? Is it uniform across the country in the government colleges? Who allowed so many private medical colleges to spring up? What is their accountability? What do we teach medical students? https://www.washingtonpost.com/news/worldviews/wp/2016/04/21/how-bad-are-most-of-indias-medical-schools-very-according-to-new-reports/?utm_term=.57c8bb93deea
What is the process of admission like? It could be a real killer as the Vyapam scam would suggest where after 25 deaths and a hundred conspiracy theories, no one was ever convicted. http://www.hindustantimes.com/bhopal/25-mystery-deaths-and-2-000-arrests-all-about-mp-s-vyapam-scam/story-Y3dLEQdkEsVyCwuPQXxaXI.html
What is the life of a resident doctor like? http://www.dnaindia.com/mumbai/report-mumbai-s-doctors-live-subhuman-lives-in-filthy-shacks-1944469
Who cares that they spend years and years struggling with studies and ward work in an indifferent and often hostile environment, work through sleep deprivation during 36 hour shifts, doing blood collection with no gloves, often no regular food if you work a surgical residency, with cramped and dirty living quarters with limited facilities while managing to also run OPDs, look after the admitted patients, carry out surgeries and other life- saving interventions? Who is there to see when they run like crazy through the long corridors between labour ward and blood bank, after midnight, the last meal eaten hours ago, to get hold of blood bags when the ward staff go missing or would simply not move fast enough? http://www.dnaindia.com/health/report-a-doctor-s-life-Overworked-and-disillusioned-resident-doctors-are-fast-losing-hope-2378284
But no one, literally NO ONE cares if resident doctors are tired, ill, depressed, upset, dealing with any personal issues, suicidal, being bullied by colleagues, unsupported by seniors or anything at all. As long as they turn up for work, all is well. http://indianexpress.com/article/explained/how-inhumanlylong-work-hoursare-killing-youngdoctors-literally-2/
How do we self-regulate the medical profession when the Medical Council of India President is in the news for all the wrong reasons? http://punemirror.indiatimes.com/pune/civic/mci-a-den-of-corruption-says-symbiosis-founder/articleshow/58539993.cms
The current curriculum has a focus almost entirely on a biomedical curative model and the preventive and social medicine is the least liked subject. The wards are the temples of learning. We learn to diagnose typhoid, hepatitis, worm infestations, amoebic cysts through fever patterns, blood tests, palpating spleens, livers. And if no one solved the problems of potable water, toilets, hand washing, (besides of course the overarching issues of poverty, caste discrimination, malnutrition and gender inequality) well, then we have more patients to examine and treat!
Such medical students will emerge from the chrysalis of medical colleges as brilliant butterflies who can make Indian medical ‘industry’ among the best in the world with our health tourism attracting thousands every year. But how does the public health system benefit? How does the public benefit? And if the government does not solve these system issues who else is supposed to? What is the use of blaming individual doctors alone? http://www.bmj.com/content/350/bmj.h237/rr-3
We are always told that doctors should go to the villages because the need is the greatest and India lives in the villages etc etc. But I want to know that by that logic why doesn’t everyone go to the villages?? Why don’t civil engineers, architects, lawyers also go the villages? Why don’t ministers and politicians go to the hospitals in their own constituencies rather than jetting off to USA? Equally, one would want to know why so many people leave these villages and come to cities in their tens of thousands every single day to escape the poverty and caste politics and to improve the life of their families? Looks like no one wants to be in the villages right now, not even the villagers……
So, it seems to me that the only people who are really happy on Doctors’ Day is probably the pharma industry, corporate hospitals and politicians nexus who are working together like a vast satanic web with medical students, residents and private doctors and private patients all trapped in it, putting money and blood sweat and tears into keeping it going, while the ‘government’ turns a blind eye, the public system crumbles and the hostile public unable to see who is running the machine, wreck violence against those who are as much a victim of it as they are. http://www.thehindu.com/news/cities/Kochi/doctors-continue-to-be-fed-and-bred-by-pharma-firms/article4760424.ece
The next post will explore the origins of the medical system. Wait for it !