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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 MBBS’.
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 could be reached at ashokagt2@yahoo.com. 79 Tilla,
Kunjavan, Agartala, Tripura.
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