What ails our doctors?

There is a growing voice on the “commercialisation” of healthcare, with stories surfacing time and again - the recent reports around kidney transplantation being a case in point. Partly in response to the situation it seems, the Bharatiya Nyaya Sanhita came into force this Doctors Day, with a provision of jail terms for doctors if found guilty of negligence. The many errors in the NEET examination and postponement of the PG entrance exams have brought the country’s attention to medical education in India. As we start rebuilding the examination processes it will be pertinent to see what more needs to be done so that our doctors are on top of their work.

In our decade long work 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 the realities of rural India. Based on these we share a few priorities that need to be addressed.

Quality of education and “connection”

There is a popular lament that MBBS doctors of yesteryear knew a lot more about medicine than the present-day ones, and could “see” patients independently. Many of us will remember doctors visiting our homes with a briefcase, seeing the sick, and providing treatment there and then. They have all but disappeared. There was a lot of rigour in medical college teaching with teachers fully invested in their students, and knowing each one personally. Classes were held as per schedule.

This rigour is weakening. In the rural sensitisation workshops, many doctors spoke of their presence at the college not mattering, of “studying at home” and staying away for weeks together. They lamented that their teachers have little time for them- “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. The doctors-in-the-making come from very rich families, go around in fancy cars, with little interest in their classes. Many of them have established nursing homes/ hospitals to go back to on completion. At times the Management also pressures teachers, to clear (and not detain) them.

A third group that is growing fast, are students who complete their medical education in China/ Russia/ other east European countries. Even with the poor quality of teaching in the Indian medical colleges, there is a wide disconnect between the foreign-educated doctors and the local ones. There is no clear flow of information when talking to patients, also a lack of knowledge of many of the basics/ ABCs of medicine.

This cannot go on. We need to make sure that all those becoming doctors have both the knowledge and skills, and the empathy that a doctor requires.

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: in a day they could be seeing many infections (TB, malaria, others), non-communicable diseases, pregnant women with complications, while also suturing people with road traffic accidents, and conducting deliveries.

This need got a number of us doctors working in different parts of India, to come together as a group. We post our questions in the group, or call up an expert for guidance: how do you manage fluctuating blood sugar in a young woman with diabetes? How do you treat malaria in a pregnant woman? We meet online once a week - to share new knowledge, case studies, and also ask questions. Interacting with doctors working across PHCs in rural areas and also in hospitals in the cities, 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 - not necessarily coming from the drug companies. There is talk of introducing examinations for renewing registration. This will help, but we need to do more.

What do we celebrate?

What are the kinds of news that keep feeding our news channels and social media? At present it is a lot about India winning the World Cup, and a celebrity marriage. Stories of likely misconduct, such as the kidney transplant stories get attention, but what about ones where lives are saved?

A week ago a woman with eclampsia was referred from one of our clinic areas to Udaipur, a distance of 120 kms. When she reached the hospital, she had been having seizures for over 3 hours and was barely conscious. That she was saved owes a lot to the prompt treatment she received from the gynaecologists and nurses.

In the different news media, such stories do 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

Two stories doing the rounds at present are around the Bharatiya Nyaya Sanhita, and the kidney transplant racket. Let us go back - when was the last time we talked about the appalling conditions in which our young doctors/ doctors-in-the-making study - the hostels they live in, food they eat, their abnormally long duty rosters? When did we celebrate stories of the lives they save day after day? We remember well the stellar roles our doctors played during the COVID pandemic.

We need to keep telling such stories. The absence of such stories and constant presence of not so positive ones creates a disquiet which can be dangerous. A few years ago in a hospital in central Rajasthan, in a complicated delivery the woman died. The immediate backlash from the media and the (expected) pressure from the family was not unexpected. But the tragedy that followed was not expected, and heartbreaking: the doctor under the spotlight 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. Views are personal) (Syndicate: The Billion Press)