Saturday, March 10, 2012

A noble profession . . . ? ? A Myth . . .

Well, this post is in response to a strike by medical students including post-graduate and superpeciality students and interns in the Government Medical Colleges in my home state, Kerala. There has been couple of documents in one of the facebook sites regarding this. Unfortunately, the two documents are in Malayalam. The reason for the strike is this - the Kerala Government has brought in compulsory rural bond of one year for medical students after each course. Therefore, if a student ultimately ends up doing a superspeciality course of DM/MCh, he would have given one year of bond each after his MBBS, MS/MD and lastly DM/MCh totalling 3 years in addition to his studies.

Well, the place I can compare to is CMC, Vellore or CMC, Ludhiana where you can end up doing more of 'bonded labour' after each of your courses. I understand that after MBBS, it is 2 years of bond after which it is another 3 years after your MC/MS and another 2 years after your MS/MCh. However, one can argue that these are private medical colleges and students get admission after signing up an informed consent about all the long periods of service that they have to go through.

Now, the question is why we are so agitated. The first thing we all do is that we compare ourselves with our friends who had done maybe their BTech or even graduation in other subjects. I remember one of my friends, who had a almost 6 digit salary job waiting for him when he had just turned 22 whereas I was toiling for my final year MBBS. A common scenario we are all familiar with. Becomes quite a difficult situation when you have siblings who are doing something else other than medicine.

It is not a unknown truth - quite a lot of us become doctors for the glamour and opportunities in the form of recognition, fame, job satisfaction that it brings.

Now, the strike has occured because quite a lot of us feels that we have been wronged, rather ignored. Our dreams of soaring high up in the sky has been dashed to the ground.
Well, we all want solutions . . . They are not easy . . . But, I wanted to put down my thoughts. I'm not saying that I'm absolutely correct - but there are some principles by which we need to move forward.

1. To all parents - do not bug your children to become doctors. It's not an easy job. Nobody will give them the same adoring respect that you might have given to the doctors you met in your ‘good old days’. But, do note - your children will never be poor if they are good doctors - but don't expect them to always become those sort of flashy characters that you see on serials like 'House MD'.

I remember a story about an orientation session where one newcomer in MBBS class told a senior professor, who was very famous for his austerity that he planned to become a doctor so that he could own a Mercedes car. The professor looked him straight into him and told him that unless he decides to do some really unethical practice or he decides to take a huge dowry or plan to go abroad, he will not even have enough to buy one tyre of a Mercedes. I’m pretty sure that holds true even today.

2. To the government - give us respect. I am sure that doctors need to be given as much as importance in the scheme of things as is enjoyed by IAS/IPS officers of the administration. To have a glimpse of what facilities our governments give for doctors working in the public health care sector be it medical college or primary health centre, I'm sure that there will be few of my friends who would be ready to take photographs of doctor official living quarters at various places all over the country and post it in some forum. It’s common knowledge about the appalling conditions in which almost all of my colleagues in government health sector serves.

3. To those who are in medical school - once we have taken a decision to become doctors, accept the fact that life is going to be tough. Of course, do fight when we are all convinced that there is gross injustice being perpetuated.

I remember one incident that happened while I was in doing internship. The PG admissions for superspeciality was just over. One of the new admissions was a guy who had done his graduation and post graduation in one of the private colleges which of course did not have much of a rush. And he was initially posted in our unit.

The day after in-patient admission, it was very evident in his mannerisms and posture that he had worked quite hard over the night. Our chief ultimately noticed that this fellow looked like he could fall any moment. Work was quite hard. We could hardly sleep much on admission day and everything had to be ready by the next day morning. The grand rounds was on and the chief called him up and asked him whether he was sick.

Our guy looked quite thrilled that the chief noticed. He proudly told the chief that he got to sleep only couple of hours the previous night. The chief looked at him and exclaimed - 'You got to sleep two hours !!!' I need not tell you what happened over the next ten minutes. It was massacre.

I know many people can disagree with me. There are umpteen incidents when a life was saved because a doctor decided to go and see a patient stat in the dead of the night and not wait till the next day morning, even though he was too tired after a long day in outpatient. I remember one of the senior missionary doctor in Orissa telling about how patients came to hospital and died when he went on vacation.

People with a foreign body stuck in the throat, someone who had a seizure and aspirated, a baby who has aspirated meconium during birth, an accident victim with a tension pneumothorax or a blot clot in his brain . . . You need to act within minutes . . . Otherwise someone loses a loved one . . .

We doctors practice medicine. Practice takes us closer to perfection. When we practice medicine, it’s not like tennis practice, when we know when a ball will be thrown to us. Only when a patient knocks at the emergency do we realise that we have a practice. And from experience, my best teacher patients came without any warning at unearthly hours, at the end of a busy outpatient or when I was really tired at the end of days work. I learnt best when someone who was on duty called me for a second opinion.

Apologies for preaching for long . . .

And for an attempt towards a final solution.

Facts: There are quite a lot of vacancies in government public health care sector. The number of applicants are also quite large. I understand that there is no active part being played by the government to fill up the vacancies. Rather, they try to save resources by recruiting people on a fixed contract or an ad hoc basis with lower benefits and compensation.

Solutions: When a student graduates, give the option of joining government service based on the marks that he gets for his exams over the 5 years of study. Why do you want to hold another examination? The point of entry into government service should be primarily after graduation. Once they are in, it should be the responsibility of the government to send them for post-graduation and superspeciality studies - which can be done along with of the general entrance examinations. If a need arises, one can have selection for post-graduates and super specialities at later times.

One major problem is of people being available for work in Primary Health Centres and Community Health Centres. Students from rural areas and semirural areas should be posted to places which are near to their homes. Post those from cities to PHC/CHC who does not have any medical graduate from the nearby area. This should be done using lots and not on the basis of merit. I know that this would be a bit complex, but can be done without much difficulty if compared to more complex things which we attempt in our lives.

Well, before you do all this and put down all the rules, do get a stay order from the Supreme Court staying all attempts by anyone to scuttle the rules or obtain a stay order when these rules are in the implementation phase . . .

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