GLADSTONE D’COSTA
In my last column, I dis cussed the dwindling applications for both un dergraduate as well as post graduate medical studies. The government solution was to keep lowering the NEET cut-off score to zero or even negative marks. This is hardly a practical solution as society runs the risk of being saddled with doctors and specialists who deliver substandard care. Extensive research, most recently the Lancet Commission Report, have established that the problem in India today is not access to healthcare but rath er access to quality health care. The available health care is substandard and creates more problems than it solves. Rather than address the elephant in the room, the government solution, of re ducing the NEET cut-off to fill seats in the private med ical colleges, is merely going to make the problem worse, with applicants entering the profession for all the wrong reasons. The problem is not re stricted to this country. An alysts predict that by 2036, the US will be short of 86000 doctors and have already initiated measures to deal with this. The solution is to “poach” on foreign trained medical graduates and make it easier for them to enter the country to practice medicine.
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This is only going to exacer bate the situation in coun tries like India. On the one hand, there is a tremendous increase in training capac ity but this is saddled with stark variations in quality of education; coupled with an inequitable distribution of healthcare personnel, with rural areas badly neglected. The vital question that no body is asking is, why is the medical profession no longer attracting the brightest and the best. The profession was tra ditionally on a pedestal be cause of the social status, commitment required and the inherent job satisfaction of seeing patients recover. There was complete trust in the professionals. A common plea was “doctor please do your best to save him/her”. Today, this plea has an add ed rider “and God help you if you don’t”. Stress levels have soared into the strato sphere. Surveys have shown that more than 75% of prac titioners have faced verbal or physical abuse.
A cardiol ogist shot dead in Mexico, a paediatrician stabbed in Chi na are all par for the course. In the US, emergency physi cians now wear panic but tons because assaults have tripled in the last decade. In the UK, doctors now demand better protection along with better pay. The trust that ex isted between gratitude and grief has collapsed. Is it any wonder that 91% of doctors in India are against their chil dren entering the medical profession. In no other profession do the constituents function in such fear of failure. A pipe leaks even after a plumber has attended to it, he just rectifies it, sometimes for additional cost. A CA gets his maths wrong and either the client pays for it or if he is lucky, the error is rectified before it causes any loss. A lawyer messes up a clients’ defence, and the client meek ly submits. If treatment fails a patient for whatever reason, the doctor is questioned by the courts, crucified by head lines and his reputation sav aged by the media. Unless, of course, he falls to fatal assault before that. The reality is that biology sometimes fails in spite of the best measures; and it is simply unrealistic for every patient to survive. Doc tors are then expected to ab sorb the grief, guilt and rage that belong to disease, not the doctor. Medicine is not math ematics and even perfection sometimes fails when fate intervenes.
The fallout is felt in many countries; the first thing a young doctor learns is not empathy but self-defence. He learns to examine patients and write notes always bear ing in mind the possibility that one day his actions may be dissected in a courtroom. This is not what medicine was meant to be. The decade of studies was to save lives, not fear for our own. Doctors do not need worship; they need respect; the right to treat patients; and the right to fail without fear. When it comes to choos ing a speciality, there is a defi nite trend to steer away from those areas where the pos sibility of litigation is high. Surgical specialities, emer gency medicine and trauma are no longer sought after specialities. The priorities are peace of mind and work life balance with more time for family. This change did not occur suddenly. India’s health system has witnessed a dramatic rise of corporate hospitals reducing the op portunities for independent practice. These corporates out of financial practicality, tend to be located in urban areas, neglecting rural areas. Doctors are now employees, with revenue targets, and not professionals shaping their careers. Opening a clin ic, equipping it with loans taken, building trust through entrepreneurship and grow ing within the community has given way to the relative safety of the umbrella of a corporate appointment. The hassles of administrative burdens, income uncertain ty, drowning in government regulations are set against reducing individuality and dulling ambition.
It is not that that young doctors lack am bition. That is too simplistic. They are merely substituting it for sanity. It is a rational response to a system that of fers little reward for sacrifice. Mental health issues are re flected in a suicide rate that is much higher than in the general population. Young doctors see their seniors struggle 48 hrs on the job, creating strains within their families, and they ask them selves “is it worth it”? They determine not to take on too much, and avoid specialities that consume their entire lives. They step back asking why take risks in the face of the ever-present possibility of being hung out to dry for complications that were in no way connected to their treatment. The gradual but certain scarcity of special ists will undoubtedly place further stress on healthcare that is barely surviving the already stressed-out system. If our people are to get the healthcare they need and de serve, society needs to take a long hard look at these and other realities. (The author is the Past IMA Goa State President, founder member and Past President of VHAG, and a past member of the Central Executive Committee of VHAI)
