The doctor's pain

Doctors in general have come under public condemnation recently. Nobody disputes that a significant percentage of medical practitioners are doing things that are unethical and violating the Hippocratic Oath they have taken while getting their degree. However, there is also a need to examine all the facets of the issue dispassionately.

A medical intern once made a comment: “If the best batsman in the country fails to score for four matches consistently or if a top actor flops, it does not do a great harm to anybody. Imagine if a routine surgical operation for cataract or for tonsil removal goes wrong just once!” That comment spoke volumes about the nature of the medical profession. It is blamed quickly, is venerated very rarely for the responsibility its members shoulder and contrary to public perception its practitioners are compensated belatedly in their professional careers.

Take the case of the medical interns or house surgeons. People do not want to recognise even once that these people work extremely hard - mentally, physically and emotionally - harder than any graduate in most other disciplines of study would; they work long hours, are on call duty almost 24/7, earn a pittance, and take the flak from patient’s relatives when they slip – sometimes their own fault but many a time a limitation beyond them.
The expectations of the Indian society are huge when it comes to the medics. A doctor should not make any error – either of omission, commission or even of judgment. A doctor will live like a holy man – the smaller the fee he takes the better he is. Stories abound about doctors of yore who took five rupees for their fee. Holy men and monks, the experience has been, are maintained in good comfort by their followers. There are no such ‘devotees’ for the medics.

The demands on the student of medicine are quite heavy. Medical degree is hard four-and-a-half years of intensive study with clinicals and then one full year’s work as an intern. For courses half as demanding, the pay packets are several times more than what a budding doctor would get. The story does not stop there. An MBBS is not seen as sufficient by anybody in the society. Getting a seat for MD or MS or even a post-graduate diploma is not easy either. When one does get lucky to obtain a seat, post-graduation is even more hard work for the next three years with, again, a pittance for the pay with all the work in the out patient departments in the hospitals of the medical college.

Long arduous journey

For a person who has done hard and focused study, so critical to mankind, Indian society does not provide adequate monetary rewards. An MD/MS qualified doctor has to struggle to find a job – even one that offers meager payment. After a few yew years when he tries setting up his independent practice, it is some more effort to make two ends meet. It is, indeed, a long arduous journey towards financial comfort. Unethical behaviour has no excuse; it must be punished where necessary; when it concerns health, it is serious indeed. Nevertheless, the reasons for the same need to be understood for any corrective steps.

Our society is hypocritical when it expects certain segment of it to be a blemish-free shining stone in the midst of mucky sand everywhere. A medic, practicing unethically or otherwise, cannot be seen apart from the society at large. He has the same good and bad motivations - same desire for good living, same greed, same penchant for flouting rules and looking for short-cuts, and the same urge to ‘get rich quick’ – as many other citizens in Indian society.

We expect onerous ‘life and death’ responsibility thrown on certain individuals without giving a thought as to how such heavy responsibility should be legitimately compensated. For our individual benefit we want a doctor to be like a ‘god’ – healing, giving good health, but not expecting anything from us. However we do not really give the doctor that respect; we drag him down to the gutter level the moment something goes wrong – by the doctor’s doing or not doing, willful or otherwise.

There is another question that goes unanswered in all the debates. Who made the doctors, whichever way they are? We, in our zeal to get our son and daughter to become a professional, have created the demand for the mushrooming growth of the medical colleges. It is the same citizen who pays the capitation fee – in any form that it may be asked – to get his son/daughter admitted. There are 335 medical colleges in India, a large fraction of them are private colleges. It is said that some ask for as much as Rs 50 lakh per seat. It is said that seats in post-graduate degree courses such as MD/MS are sold for a crore of rupees or more for some specialties. The least demanded speciality too is sold for not less than 50 lakh. Commercialisation on this scale has created a warped educational system. This should be a topic for a really intense national debate.
We, the citizens whose aspirational levels far exceed the means available, have created this problem. It is the government – made by us and made of us – that has allowed this cancerous growth of ‘higher educational institutions’. Yes; the disease is bad. It hurts. But, we cannot blame the disease. We have to introspect and locate the root causes. We need to break the shell of hypocrisy and get real.

 (The writer is a former professor at IIM, Bangalore)