Let me start by saying that if there was one thing I was
clear of since I was a child, it was that I wanted to become a doctor. That may
come from my parents being doctors and lot of extended family members in the
same profession too. I thought it was glamorous, rewarding, humbling and deeply
soul satisfying. I revered in being called a doctor’s child, felt like I was
the chosen one and saw my parents help a lot of people selflessly.
So precisely 18years ago, I was sitting in a big auditorium,
all in awe to be there on the 1st day of our medical school. The
Dean addressed us and attested to the same sentiments that I had had since
childhood. I never cared about the laborious long days, the night shifts, the
long hours of studying, the lateral thinking required to solve difficult
patient issues, the memorizing and rememorizing required before exams. Almost
the next 11years I would spend, memorizing, practicing, learning new skills,
brushing up old skills, mentored by one passionate teacher after the other. The
dead bodies in the dissecting hall in anatomy, the lab experiments on
animals(allowed then!) in physiology, the visits to slums and old age homes in
preventive and social medicine, the patients with the smelliest ulcers in
surgery, the throat cancer patients in oncology, the first death certificate in
emergency medicine, the first vaginal birth in Obstetrics and Gynaecology, the
visual image of the child with ulcers all over the body and mouth with Stevens
Johnsons Syndrome in pediatrics, the learning of surgical techniques and
challenges in ophthalmology, the long duties in the OR, the weekends sacrificed
in stay camps to screen underprivileged communities with eye problems, the
never ending list of questions and books read for clearing the exams year after
year…all of these I enjoyed, revered and glided with glee. Medical Education
gave a humane, humbling, satisfying and soul wrenching experience that I had
never experienced before. I matured with age and learnt to be more patient with
patients and peers.
So here I was 12years after the first day of joining my
medical school. In the process I had graduated, Postgraduated and super
specialized for an extra 2 years too. Also personally had fallen in love,
married and had a child too. When I hunted for the first job, I thought it will
all be too easy. I had done my schooling from one of the best places in the
speciality in the country. But getting work equal to my caliber was not easy. I
was ridiculed for being a young mother and ambitious to think about working so
soon, ridiculed for being too unexperienced and the worst was when I was asked
how much will I generate??
Now this ‘generate’ term was nowhere taught, discussed or
quizzed in the 12 years of exams and oral vivas and essays. So I did not
understand. The so called MBA grad sitting on the interview table explained to
me that we ‘invest’ in a doctor if he/she ‘generates’ atleast 3 times the
salary given. This was shocking to my soul. Where were the real world problems
that I had read my country was facing with poor doctor:patient ratio, not
enough highly qualified doctors to treat a very ‘ in need ’population? Where
was that saying that one of my teachers said that’ Doctors are healers, and you
must not always treat but you must always heal.’ One can argue that there are
government hospitals, rural setups and charity hospitals that I may have worked
in, but the long working hours or the fear of transferrable job does not
support the work life balance that I was seeking for as a working mom.
All throughout the training I had never envisioned how much
I would earn out of my work. I had never been talked about salary package or
incentives which is a common talk in engineering courses or banking sectors. I
was naïve to think that the corporate set up in medical practice was being
built for serving needy people and they treasured having qualified doctors with
them. But the management of these hospital often have the audacity to boast
that all doctors are replaceable, they can run the hospital without doctors(who
could have thought that) and that the doctor has to earn for every square inch
of space that he occupies in the hospital. So I saw post my training, complete
anti of what the books taught. I have witnessed a lot of unethical work
happening in my field and others in many corporate hospitals. It was almost
like witnessing riots where the politicians use goons for causing chaos and
killing people while they sat in their plush bungalows and directed them. In
the name of targets, numbers, generation there were unnecessary meetings
conducted in a lot of hospitals that I know of, to make the doctor the underdog
of the system.
So here you are swimming against the tide, wanting to be
ethical to not over investigate, over prescribe or over operate because you are
just being as right as you have been taught to be. You are chided for being the
under performer, for not generating enough, for not operating enough. The
satisfactory smile on the patient’s face is usually never taken into the
assessment of your ‘performance’ each year. One manager also said that ‘ I
think you talk too much. Don’t talk to these people, just send them to the
counseller who would talk about the package of the surgery!!’
I would have loved to welcome him into the room, when I have
to counsel a parent of a child who is battling a blinding condition, what is
enough talk when the parent is depressed, ostracized from the child’s school
and society as a whole for what the child has. These are real life issues which
as a healer, I have to give solutions and strengths towards.
I have had the pleasure and privilege to work closely with
many doctors, male and female in various specialities. We attend conferences to
brush up knowledge and keep abreast to the new technologies and discoveries, we
leave family and train abroad to understand and practice our craft better, and
we pay through our nose to get access to international journals and literature
to help in the best healing practices. But the harsh realities of the work
atmosphere have taken a toll on my generation of doctors. From poor lifestyles,
underpayment, stresses of ‘ generating’ enough, lack of child care support,
lack of maternity benefits(leave aside paternity rights!), the constant
discussion about the junior doctors in a callous and harsh language have seen a
lot of friends and colleagues who undergo the completely dehumanizing attitudes
that this profession has started posing. Also, medical practice in the country
is becoming more sophisticated and more machine based. Each hospital wants to boast
about the latest laser machine, or latest robotic surgery or the latest high
end MRI machine. The cost of these high end machines run in crores which makes
a doctor completely dependent on corporate hospitals to practice the best care
possible without being crores in debt. So many a times, we find even senior
doctors heading the departments in corporate hospitals, fully aware of the
harsh realities of the management, but shutting the eye to the issue due to no
more practice options.
Every patient coming for healing has also been influenced by
negative media coverage. Many patients and their relatives insult doctors. They
threaten with dire consequences in case of failed treatments. I had my husband
go on a night duty, once where the relative of the patient was carrying a gun
in the pocket and I was praying that the patient should not succumb to the
illness while he was alone on duty. With
constant news of friends beaten up by patients, doctors arrested by the police,
court judgments biased towards the
patients, the stress of being not investigative to save the patient’s money but
not too ‘non investigative’ to miss a rare diagnosis is a real dilemma a lot of
us face in the clinics.
I have seen 50% of colleagues, associates, friends go
through depression. Many silently bear it, many are on medications and many can
just never heal and have become apathetic to the system.
If we have depressed doctors, we cannot expect healing touch
from them. As I strive to never lose hope and stand up for what all I had
dreamt from this profession, I hope some of you reading this realize that
Time’s up and the time is not away where will go back to the quackery system of
healing for the dearth of a new generation of doctors!
The solution has to come from the system, by the system and
for the system. Till then, miles to go before I sleep!
