Disgruntled doctors, distrustful patients

MANJU GUPTA

Thirty two years ago I just needed an excuse to proudly count all 32 of them, the doctors in my extended family. Three decades later only one of my nieces has wandered into a prestigious medical college and is already regretting it. For those who think that this data size is too small to be statistically significant I offer another example indicative of the present turmoil in the medical fraternity. This year the cutoff for NEET, the entrance exam for medical colleges across the country, showed a significant drop. While some of it can be attributed to complex questions, the wariness of the brightest brains to pursue medicine can't be ignored.

The reasons for this downtrend for what was once a coveted career choice are many. Vis-a-vis any other professions, medical education takes more years out of one's life and more life out of one's years. With a basic graduate degree rapidly becoming worthless, it takes eight to 10 years of relentless slogging to qualify. After the prohibitive cost of education, comes the expenditure of setting up a practice. Adding to the woes is a whole list of draconian laws and ill-conceived regulations. Further the growing distrust and unrealistic expectations of patients has undermined any job satisfaction. Unruly public behaviour and blatant lawlessness, often provoked for political gain, is the last straw that will break the back of medical services in our country.

The state may not fully acknowledge their role but small nursing homes form the backbone of healthcare in India. Typically run by doctor couples, they are responsible for providing affordable treatment in a country where shabby government hospitals are too uncaring and swanky corporate hospitals are too expensive. These 'doctor couple'-run hospitals are on the verge of extinction as their children look for less taxing and more fulfilling careers. Adequate rest and sleep is something doctors prescribe but can't practise. I realised this when due to various reasons I stopped conducting deliveries and taking in emergencies five years ago. The first fortnight felt strange. I was not used to a full night of undisturbed sleep, something that most people take for granted. Not surprisingly, my children did not follow in my footsteps.

Doctors today feel misunderstood and unfairly maligned. Introspection on all fronts is the need of the hour. Public has to understand that if the cost of medical care has increased, its standard has improved too.  Newer investigations, better treatment modalities and expensive equipment have played a role in improving the longevity and quality of life. Instead of going hard on private practitioners, the government has to try harder to provide affordable healthcare to the masses. It also needs to regulate drug pricing, control lawlessness and ensure that court directives are followed and doctors are not unduly harassed. Doctors can't escape their role in this mess. They need to weed the black sheep and break the nexus with drug companies and labs. Peer review and audits to discourage unnecessary procedures is a good way to restore faith.

Lastly, we doctors need to work on our soft skills. In the 30 years of my rural practice, one thing has constantly intrigued me. Despite suffering blatant negligence at the hands of quacks patients are very forgiving to them. The most common adjective used for the erring 'doctor' is "bechara seedha sada". This opposed to any negligence, perceived or otherwise, on the part of a qualified doctor, is dealt with anger and the need to seek redress. I have often wondered why the quack is seen as a well meaning ally whereas we are seen as uncaring robbers out to fleece them.  Does a shiny exterior intimidate patients? Does our 'medicalese' filled with facts and figures alienate them?  Does being forthright and truthful take precedence over being kind and compassionate? Does knowing the course of a disease leave no room to offer comfort and hope? These are questions worth pondering because disgruntled doctors, distrustful patients and demeaning authorities are a recipe for disaster in which everyone will lose. 

(The writer is a gynaecologist based at Gharaunda)