I rarely write on this blog about topical issues because, well, they are like clouds.. they rain a lot, but they always leave just as they came - in a short time.
However, this news piece is something that touches a long term raw nerve and probably, i do have something new to say.
Some days ago, an 85 year old stroke patient was brought to the hospital in Kolkata. The doctors could not save him. The 'relatives' of the old man - only 200 of them,
beat the doctor up mercilessly, and also cracked his skull while they were at it.
Right after that, doctors all over the country were up in arms.
OPDs were shut down and surgeries were cancelled. Emergency services were not stopped, but they were not adequate. All this was happening while
100 children were dying in the state of Bihar, from an illness that comes every time the Litchis (a particularly sweet fruit that is considered a delicacy in most parts of the world) are harvested.
Over the next week, memes making doctors look like wronged angels appeared. Doctors wondered why ordinary people are not taking up cudgels for them.
Let's try and understand this. Because this one incident, and what it has triggered, should force us to think about a few things. I've been a mute spectator to this circus for many years now, and this really has got to stop. Or at least, get better.
The life of a doctor
What life? A medical student has no life. When the rest of us are busy playing, these kids, sometimes as young as 15 (Grade 10 onwards) are slogging to prepare for the entrance exams - which are really hard to crack.
Question One: If it is about aptitude, WHY do students need to prepare for the exams? What are you testing, specifically? If the knowledge is expected to be at grade level, why is the test designed such that a child needs to prepare over and above their grade books?
After they clear this entrance, they enter the 5 year basic program. This program requires them to study by rote, appear for duty in the wards. Do you know how long a medical student is officially expected to remain on duty? Wait for it - 36 hours.
A person who is responsible for saving the lives of others, who is supposed to take split second decisions in emergencies, is supposed to keep his/her brain alert for 36 hours without sleep, rest, or even washing facilities. In most cases, they serve the poorest of the poor and have little access to the specialists. Which means they are forced to take these decisions on a tired brain, without access to expert knowledge, and they still save lives.
Many times, even the seniors force their resident duties upon the juniors. One time, my friend was on duty for 36 hours, went to the hostel for 8 hours and was back for a senior's 36 hour duty. She told me this was the norm. If you go against your seniors, they just make life miserable for you. The same for teachers.
Question Two: What is the pedagogical need for 36 hour duties. Is it to toughen the mind? Why is a relentless mind needed to be a doctor? I truly do not understand this, and am sure there is a purpose to it. Because we do end up creating the world's best doctors.
After the medical degree, starts the PG scramble. Will they get into MD, or will they go abroad, or will they do a PG diploma in their own field? That is another 2-3 years of their lives invested.
After that, most doctors take up salaried roles in the corporate hospitals. After a few years, private practice maybe.
Most of them work for many hours a day. Most of them see patients on Sundays and Saturdays.
Quite a few of them get paid very well. Some try to go abroad. But the best doctors, imho, come from the public health system of India. They see, on average, 200-300 patients a day. They treat patients using minimal resources and inexpensive medicines. When i really need medical advice, i go to a government hospital.
The other side of the story:
A child of 6 months of age has a skin condition. Instead of telling the parents to understand the underlying cause of the allergy, the dermatologist prescribes steroids. The child is kept on topical steroids for almost 6 months, until the parents notice that there is permanent damage to the skin of the child. By then, it is too late.
A child of 3 years comes to the doctor with proteinuria. Instead of checking the salt intake of the child and telling the parents that they really need to keep it below 1.5 grams a day and wait, the doctor follows "medical protocol" and advises them to put the child on steroids immediately. For the rest of their life, that child is not likely to have a normal life for more than a few months at a time. S/he will be in and out of hospitals his/her whole life.
A child has an autoimmune disorder. Any autoimmune disorder. Instead of reading research on what causes these autoimmune disorders, or even guiding parents to support groups where they can find out more, the doctors follow "protocol" and start the child on steroid based therapy, which quickly progresses to other, more drastic interventions.
A child of 2 years of age is not growing. The doctor prescribes "Pediasure" as a "growth nutrition supplement". One year later, the child has developed an auto-immune disorder. No one makes the connection. Why? Because auto-immune disorders are idiopathic - No cause known.
A girl of 15 years of age has hirsutism. Her parents take her to a doctor, who puts her on PCOS medication instead of telling her that her body and system is evolving, and to give it time. Do you know how PCOS medication works? Most of them work by supressing ovulation, and just inducing bleeding at the right time. So in effect, you are suppressing the ovaries at a time when you should be giving them the time to develop on their own and probably adjust her diet.
This girl then goes on to gain weight, and at the right time, is very likely to need fertility treatment.
A stroke patient comes into the hospital. The doctor convinces the family that they should get a surgery done. After the surgery, the patient is on ventilator, and in coma. The family, which is poor and got the father to the best medical care, is now 3 lakhs poorer and has a father who is responding even less than he was before the surgery. No fault is taken by the hospital or the doctor. The doctor tried his best and stroke cases are tricky as it is.
A stroke patient is brought to the hospital and is kept on the ventilator. During this time, everyone except the family of the person knows that the patient is dead. But the family is charged a cool 50,000 per day for being on life support that is effectively violating his dead body.
All of these are permanent, life changing medications. In each case, the doctor has followed medical protocol and is therefore not at fault at all. And not one of them is rare. Ask anyone about any of these instances and you will hear at least 3-4 examples that they know of personally.
But, these are also lives ruined.
My dear doctors, my only question to you is - Why did you not ask, "What is leading to the PCOS epidemic among young girls? Why are so many children coming to us with MCNS and other autoimmune disorders? Why is cancer among women in their 40s so prevalent? Why do most men today have prostrate issues?"
The pharma companies will not pay for the Why research. But the IMA and other professional bodies of doctors have enough money and know-how to design and conduct such researches on Indian patients and arrive at the causes. Today, one hears those causes anecdotally. But once there is a research telling us that these are the things not working for our Indian constitution, will we all not move towards a healthier society? When I tried to find out what was the effect of a particular immunisation on children of Indian genetic stock, I realised that the pharma companies are not required to even test on Indian genes and check if the immunisation is required, effective, or harmful.
We are all taking immunisation as per the Caucasian subject studies. No Indian medical body or government has asked pharma companies to conduct such research on Indian subjects and publish results.
In short, dear doctors, here is my view:
What you have to go through, just to become a doctor, is A LOT. It deserves respect of the highest order. What you do after that, day after day, being patient with each patient, treating people, especially in some pretty harsh conditions - that deserves respect too.
But collectively, you sold us out. So while we may root for one doctor individually because he has been good to me and my family, I will not root for doctors as a group. We cannot.
I am, of course, aware that the doctors who deal with thousands of patients in a day and face patient violence, have very little in common with the doctors who sold us out. And it is not fair. But then, the ones who are making the memes on social media on behalf of all doctors are the ones who have the time and the connectivity.
And in that ONE incident, the fact that the victim was a doctor makes no difference. Any bunch of goons who come and beat up another person, deserves to be put in jail and be tried for it.
