Doctor-specialists the country doesn't need

They were eager to launch into an exciting and impressive career. Chatting with some of them, I found that their professional choices for post graduation ranged from orthopaedics to cardiology to neurosurgery. They were aiming at nothing less than high profile super specialisation after training in one of the country’s best medical schools. One solitary young graduate was interested in public health. There were no takers for general practice (GP).

This is a sad reflection on medical education in India where medical schools train doctors to become tertiary care specialists when the country is crying for primary health care.
They prepare them to treat complex diseases in state-of-the-art hospitals rather than treat common but chronic ailments in community hospitals where patients seek continuing medical care. They groom them to find cures for diseases rather than find preventive measures to avoid them in the first place.

Our medical education creates a system which is disease-oriented rather than health-oriented. No wonder our medical colleges churn out doctors who prefer to use the latest technology to diagnose and treat diseases rather than their own skills. Naturally, they would like to work in hospitals with the most sophisticated equipment rather than a village dispensary where they have to fall back on their own expertise to treat patients. The latest proposal of the health ministry to start a Bachelor of Rural Medicine and Surgery (BRMS) course has therefore come at an appropriate time.

The Centre’s concern that doctors are unwilling to serve in rural India, where more than 75 per cent of the population lives, needs to be examined in all its aspects. First and foremost, this underserved population lacks the bare necessities of life that includes proper health care. Secondly, it is a population that has been denied educational facilities which has added to its below the standard lifestyle. Lastly, while urban India boasts of glitzy hospitals with super specialities and fancy diagnostic centres, its rural counterpart does not even possess properly equipped primary health care centres and clinics to treat the ordinary, day to day ailments of patients who cannot afford to have ‘rich’ diseases.

This sad situation needs to be taken into account by the Medical Council of India (MCI) as well if it has to be corrected. Not only must the medical education curriculum be revamped thoroughly to make future doctors understand the social aspects of diseases, but it must inculcate more humane and ethical values into the profession they have chosen. The science of medical practice is even more important than that of medical theories.

Set priorities

Lastly, it is obvious that any sound health care measure must cater to the most urgent needs of the largest number of people first. In a developing country where the majority lives in utter poverty, the government’s first priority must be to provide affordable medicare to the largest number for the simplest ailments. Before our medical schools churn out more and more specialists in every disease, they must also train an equal number of doctors who can treat an ordinary cold, cough or diarrhoea.

More children die of the last named ailment in India’s villages and urban slums than they do of any other disease. Yet, we find young doctors look down on becoming a GP when the glitter of high profile disciplines are there. The fault then lies in the structure of medical education itself. If medical schools tested a student’s aptitude for social service at the same time as it gauged his academic excellence, they would be training doctors who were interested in public service even as they launched into the medical profession. Such students would then opt for public health and preventive medicine for many patients rather than treat exotic diseases of the few. In order to achieve this, the MCI must work out a suitable curriculum for medical undergraduates with the help of the deans of medical colleges.

Doctors do not need to be highly qualified to treat ordinary ailments. If the centre can revive the Licentiate Medical Practicioner's (LMP) scheme which generated doctors who treated poor patients in small clinics and rural health centres, It would make medical education more meaningful. The concept of the barefoot doctor dispensing his services to the most needy and the most underserved sections of sick people is nowhere more needed than in a country like India where huge disparities exist between large sections of people in medicare and health care facilities.

While our cities boast of corporate giants setting up massive hospitals with mind-boggling diagnostic and treatment facilities at even more mind boggling costs, our small towns and villages are starved of the basic tools for treatment of illnesses. While we boast of medical tourism where wealthy patients from other countries come and get treated for a pittance, we seem to have forgotten our own aging and sick population which needs urgent care and attention. An attitudinal change must come from the medical schools themselves. They are the places where committed doctors and healers are made.