What ails our doctors?

Healthcare has been in news for all the wrong reasons: rampant commercialisation, medical malpractice, organ trafficking (recent reports on a kidney transplant racket masterminded from Delhi-NCR, for instance). And while the Bharatiya Nyaya Sanhita’s provision of jail terms for doctors found guilty of negligence may seem like the right prescription, the rot is at the root.

Since 1991, India has been celebrating National Doctors' Day on 1 July, the birth (and death) anniversary of the legendary Dr Bidhan Chandra Roy (1882-1962), who was also the chief minister of West Bengal (1948-62) and played a key role in the establishment of medical institutions in Kolkata.

While the idea of a day dedicated to the ‘selfless service of the medical profession’ is a laudable one, what about nurturing new generations of dedicated doctors? The NEET (National Eligibility-cum-Entrance Test) fiasco and the postponement of post-graduate entrance exams have made the country wake up to the state of medical education in India. Even as we revisit and rebuild examination processes, it is pertinent to see what more needs to be done so that our doctors can get on with the real business of healing.

In our decade-long experience of providing primary healthcare in rural tribal Rajasthan, we have worked with a large number of young doctors and interacted with many more working across government primary health centres (PHCs) and community health centres (CHCs). We have also conducted several workshops for doctors to sensitise them to realities of rural India. Based on these, we share a few priorities that need to be addressed. 

Quality of education and personal connect

There is a popular lament that the MBBS of yesteryear knew a lot more about medicine than today’s. Many of us will remember doctors visiting our homes with a briefcase, attending to our sick with the proverbial bedside manner, and providing treatment there and then. This breed of ‘family doctors’ has all but disappeared.

Teachers were fully (and personally) invested in their students, classes were held on schedule and rigour was de rigueur. This rigour is weakening. In our rural sensitisation workshops, many doctors spoke of how little their presence in college mattered. They studied at home, and stayed away for weeks together. It made no difference, as their teachers had little time for them anyway. “People are all mouths, not ears,” is something we hear frequently.

“Your business is to treat patients, not to be empathetic”, a senior gynaecologist had once chided one of them.

We also hear the other side of the story, from private medical colleges. These doctors-in-the-making come from very wealthy families, drive around in fancy cars, and have little interest in classes. Many of them (with a little help from their families) have established nursing homes/ hospitals waiting for them once they finish ‘studying’. At times, the management pressures teachers into clearing them, to make way for the next batch.

A third group that is growing fast comprises students who complete their medical education in China, Russia, east Europe. Even with the poor quality of teaching in Indian medical colleges, there is a marked difference between local- and foreign-educated doctors, who lack knowledge of many of the basics of medicine and are unable to communicate with patients.

This cannot go on. We need to make sure our doctors learn both knowledge, skill, and empathy.

Post MBBS/ MD support Some months ago, one of our doctors received a call from a friend, a doctor working at a PHC. He had just diagnosed a patient with malaria and was calling to inquire what treatment to give. For doctors working on a standalone basis, this need for guidance is to be expected. On any working day, they would see many infections (TB, malaria, others), non-communicable diseases, pregnant women with complications, while also suturing victims of road traffic accidents, and delivering babies.

To meet this need, we set up a group of us doctors working in different parts of India. We post our questions in the group, or call an expert for guidance. Questions range from: ‘How do you manage fluctuating blood sugar in a young woman with diabetes?’ to ‘How do you treat malaria in a pregnant woman’?

We meet online once a week, to share new knowledge, case studies, ask and answer questions. Interacting with doctors working across PHCs in rural areas and also in city hospitals, we see they have few peers/seniors to turn to, when in doubt.

We need systems for doctors to get answers to their questions, and to make sure they stay up to date with new knowledge. This should not necessarily come from the pharma companies. There is talk of introducing examinations for renewing registration. This will help, but it is not enough.

What do we celebrate?

If we look at our news channels and social media, most of it is about India winning the World Cup, or a celebrity marriage. Stories of likely medical misconduct get attention, but what about the ones where lives are saved?

A week ago, a woman with eclampsia was referred from one of our clinic areas to Udaipur, 120 km away. When she reached the hospital, she had been having seizures for over three hours and was barely conscious. That she lived owes a lot to the prompt treatment she received from gynaecologists and nurses.

Such stories need to be featured. These will have a significant impact, both on how doctors view themselves and their profession, as well as how society views them.

Creating a fairer world

When was the last time we talked about the appalling conditions in which our young doctors-in-the-making study — the kind of hostels they live in, the food they eat, their abnormally long duty rosters? When was the last time we shared stories about the lives they save? During the Covid pandemic, yes, but that was an exception.

We need to keep telling such stories. The absence of such stories creates a dangerous disquiet. A few years ago, in a hospital in central Rajasthan, a woman died during a complicated delivery. The immediate backlash from the media and the pressure from the family was expected. But the tragedy that followed was as unexpected as it was heartbreaking: the doctor concerned could not take the strain and ended her life.

The situation in our country today is a wakeup call. As we start rebuilding our healthcare, it would be worthwhile to not pick up fragments but to see it as a whole.

The writer is a doctor and co-founder of Basic Healthcare Services, a Rajasthan-based non-profit that runs primary healthcare centres. Courtesy: The Billion Press

Image courtesy: Freepik.com