'Do not turn hippocratic oath into hypocritical oath: Shashi Tharoor to graduating doctors

At the 56th Annual Convocation of St. John’s Medical College, Bengaluru, held on Saturday, Shashi Tharoor, Member of Parliament and former Union Minister, chose to highlight the yawning gap between the need for skilled doctors and the actual number that India produces in various clinical specialities.

"Medicine should be calling not a profession. If you're motivated by money, you may as well be a banker. As healthcare professionals, you are here to pursue the highest calling of saving human lives. In everything you do, you must not lose sight of that ultimate human endeavor," Tharoor said, after the 163 odd health professionals were awarded their degrees and they administered their Hippocratic Oath that they will do no harm with their medical knowledge. He asked them not to turn it into a 'hypocritical oath'.

The graduating batch included 59 MBBS students, 71 PG degree students, 14 PG diploma students, 18 Super Specialty students, and one PhD scholar. He also pointed out to the fact that 34 out of 46 medical students who received prizes at the Convocation were women, which is 75%.

He said increasingly doctors have to acquire new skills that the previous generation might not have had to like certain computer and IT skills that are necessary to operate, and use sophisticated equipment without which the advanced practice of medicine is not possible.

"So new technologies involving artificial intelligence will help you make a better diagnosis. Robotics will help you conduct surgical procedures. Our advances will provide you with options to use non invasive methods of treatment. The process of learning does not end today," he said.

Demand for doctors in rural areas

The demand for medical professionals for treatment is ever increasing both in India and abroad and yet at the same time, the acute shortage of medical professionals in rural areas persists in our country. "That's why I'm always disappointed to find medical doctors in other professions like the civil services. I hope those of you contemplating a career that does not require medical training would reconsider your goals in knowing what a precious gift you have as a trained doctor, one that should not be wasted for pushing files instead," Tharoor said.

"Experts tell me that most graduates are academically sound but are often found deficient in the performance of clinical skills and problems which form the core of clinical competence," he said, adding that 'we have a shameful record of having one of the lowest proportions of GDP dedicated to healthcare even among developing countries". "Our proportion of GDP dedicated to healthcare is roughly around 1% at a time when the WHO recommends 5%. At the same time, we have the highest out of pocket expenditure in the world. A 2017 Lancet survey points out that amongst 184 counties studied, India and Bangladesh jointly had the sixth largest out of pocket expenditures," he said.

According to the World Bank, out of pocket expenditure is 86% in India, 56.8% in the UK, 32% in France, and just 20% in the US with insurance companies covering the rest. 65.5% of all healthcare expenditure in India is private but the global average is only 28%. The National Sample Surveys have established that healthcare expenditure between 2004 and 2014 has pushed 50.6 million citizens back into poverty.

Some numbers cited by Tharoor:

• According to the World Bank, India has just seven doctors for 10,000 people while China has 19, USA has 25, and Australia has 33.
• India needs four lakh more doctors
• India has a doctor-patient ratio of 1:2000 (that includes every practitioner in the field) double the WHO minimum standard of 1:1000
• Allopathic doctor to patient ratio is 1:11,082 which is ten times what the WHO recommends
• Psychologist to patient ratio is 1:1.25 lakh
• In the previous budget, the allocation of mental health was 0.06% of the overall healthcare budget
• 47% and 31% of hospital admissions in rural and urban India respectively are financed by the sale of homes and assets