Doctor, Heal Thyself!
Author - Anil Chawla
Earlier this month, two junior doctors were beaten up at a hospital in Kolkata by relatives of a patient. The attack deserves to be condemned in the strongest possible words. Incidentally, the patient belonged to Muslim community and the doctors were Hindus. So, additional angle of Muslim bullying was also added to the incident and sure enough political parties looked at it from a communal perspective adding fuel to fire. Almost two weeks have passed since the incidence occurred. Agitating doctors across the country are back to work. Media is no longer interested in the story since it has more hot stuff on its hands. Political parties are also back to their usual game playing. Now, it is high time to do some serious thinking on the subject.
Doctors seem to believe that legal protection in the form of Doctors Protection Act will give them protection from all types of attacks. Medical profession of the modern type has been in existence in India for more than a century. It was not too long ago that doctors were considered a form of God and attacking or even insulting a doctor was an unimaginable act for almost everyone in the population. Surely, something has changed leading to the present situation when doctors do not feel safe in the society anymore and they ask for protection of the strong arm of law.
In the past two weeks, I have seen doctors acting as cry babies and blaming all and sundry for their present plight. Doctors have been forwarding memes, videos and quotes on social media highlighting that their profession is a noble one and they need to be protected. No one disputes that. But, one wishes that there was some genuine introspection on the part of doctors about what has led to the fall in their position. The only introspection or critical comment I noticed was from Dr. Devi Shetty (the great man) who talked of liberating medical education. He talked of medical education becoming elitist and creating doctors who have no intention to serve. Dr. Devi Shetty is a lone voice of compassion and empathy in the hard-nosed community of Indian doctors. One surely wishes that there were more like Dr. Devi Shetty.
In the past four decades I have interacted with doctors at various levels and observed them from close quarters. There have been many instances when I thought in my heart that given the way the doctor(s) has / have behaved, the day is not far when doctors in the country will be beaten on the streets. Sorry to say that! Let me narrate just three instances when I thought that the day is not far when …:
- A close relative was suffering from prostate enlargement. A famous urologist of Bhopal prescribed him chemotherapy tablets even though he did not have any indications of cancer. The urologist was giving chemotherapy to induce cancer so that he could make more money with a complicated case. When I posted the matter on Facebook with pictures of prescription etc. none of my doctor friends on Facebook cared to even comment about the criminal behavior of the urologist. Their tacit support to the dastardly criminal urologist made me comment that the day is not far when …
- It is not unheard of in India for a surgeon to come out from the operation theater in the middle of a surgery and demand money from relatives of the patient undergoing surgery citing some complication. The surgeon threatens that if the demanded money is not brought immediately, the patient will surely die. Helpless relatives run here and there to arrange the ransom money. I have never heard of any doctor raising his / her voice against this extortion. Sometimes, the ransom so arranged is shared among the full team and at other times, it is a matter of professional courtesy on the part of juniors to keep their mouth shut. Irrespective of the underlying reasons, every time I hear it I say that the day is not far when …
- A few years back I went to the clinic of a doctor friend. He was using a pad with nice printing and with a carbonless copy being created for every prescription. I was impressed. I complimented him for the advancement. He laughed and said that the pad was given by a pharmaceutical company who used the copy of prescription to pay him his commission. I was aghast and said to myself that the day is not far when …
The above three instances are merely illustrative. I am sure that there must be occasions in your life when you felt the same way. Doctors have lost respect and they know it. Unfortunately, the doctors are neither willing to understand the causes nor mindful of the need to undo the damage.
Professional associations of doctors in the country are not seized of the problem. With the limited information available to me, it seems that all conferences, symposiums and such professional gatherings of doctors are opportunities for doctors to collect large bounty of free gifts and imbibe copious quantities of liquor - all provided free by pharmaceutical and medical equipment companies. Any talk of ethics at such events will surely be drowned in the festive celebratory mood.
The unholy alliance of doctors and pharma companies is not limited only to grand events. It extends to every small event. Even if there is a reunion of a class of a medical college, one can be sure that there will be some company footing the bill for alcohol. Sure enough, a few doctors benefit more from this unholy alliance while the majority feels jealous of the lucky few. But, the majority raises no voice and is thus a tacit partner in the crime.
Can we blame these doctors who do not understand the basics of ethics, morality and righteousness? Medical education in the country is caught in a rut. Doctors do not learn anything whatsoever about subjects like philosophy or ethics that may enable them to question about right and wrong. They are trained to be prescription writing machines. They are not even taught to be human. Exposure to their star faculty members (whose singular focus is on making the maximum money by hook or by crook and flaunting it) teaches them that all talk of ethics, philosophy, empathy, righteousness etc. is plain bullshit and purpose of life is to make maximum money at all costs. The desensitization and criminalization of young boys and girls who join medical education is fast. A few decades back, I learnt that in medical college hostels of Bhopal it was routine for male students to beat mess workers. As someone who has lived for six years in a hostel, I found it shocking. At our hostels at IIT Bombay, we could not even imagine insulting the hands that fed us. But apparently, medical students are taught differently.
What starts off with bad behavior towards mess workers grows to domestic violence later in life. I know a doctor whose family knows very well that he beats his wife (also a doctor) now and then. As I understand, domestic violence does not attract any adverse action from Medical Council of India (MCI). So, a doctor can beat his wife, misbehave with all and sundry, and yet claim to be engaged in a noble profession.
MCI sets the bar very high when it comes to initiating actions against a doctor. Regulations relating to Professional Conduct, Etiquette and Ethics issued by MCI state that, “A physician shall uphold the dignity and honour of his profession”, but these are empty words. A doctor can be a wife-basher, convicted of criminal offences, an alcoholic or a drug-addict and yet he will continue to have the right to practice as a doctor. None of these will probably amount to not upholding the "dignity and honour of the profession". A doctor can report for duty in a hospital drunk without any fear of disciplinary action by the professional body that is supposed to keep a check on him / her. In fact, sadly, I know more than one doctor who died in the past few years due to alcoholism. Though there are no statistics available, I believe that more doctors die every year due to alcoholism, drug abuse and psychiatric diseases than due to attacks by patients and their relatives. Considering that many of my close friends and relatives are doctors, my sympathies are with them. I know that they are helpless since they are products of a horrible, outdated, inhuman and inadequate education system which desensitized them and kept them away from knowledge that looks as a human being as an integral whole and not as sum of digestive system + nervous system + ...
Medical education in the country is one of the few streams of education that are controlled by trade unions and not by academicians. Of course, it may also be mentioned that, exceptions aside, most medical colleges have no academicians. They have teaching machines who do teaching in the spare time that they can find after rigorous hospital practice and after-duty-hours money spinning. A teacher becomes an academician when he / she undertakes research and becomes a knowledge seeker. Notable exceptions like AIIMS or PGRI aside, no medical college in India does any research whatsoever. Orientation of research or knowledge seeking is conspicuous by its absence in most medical colleges of the country. It should come as no surprise that medical education in the country is exactly what it was five or six or seven decades ago.
The agency responsible for medical education in the country, MCI, does not even think of promoting academic culture in the institutions controlled by it. It may surprise some that the focus of MCI, like any other trade union, is primarily to restrict the supply of doctors in the country so that their members can charge hefty fees. India faces an acute shortage of doctors. One would think that MCI would consider it their solemn national duty to ensure that the shortage is mitigated with higher intake in medical education. No, MCI cannot be bothered with such national problems. They keep making it more difficult to set up medical colleges by modifying the regulations. One must not mention the rampant corruption in the process for the fear of inviting legal action. Not surprisingly, number of active allopathic doctors in India is barely keeping pace with the population growth and the problem of shortage of doctors continues while MCI bosses enjoy wealth, position and power. Are there any voices against this from the doctor community? With a few notable exceptions, there are none.
Trade union controlled mindless dehumanized medical education of India suffers from another malaise. Medical institutions of every other country in the world work at reconciling the traditional medicine systems and practices with the modern allopathic medicine. For example, in China it is compulsory for every allopathic medical student to learn the basics of traditional Chinese medicine. Not so in India which has a well-developed ancient system of traditional medicine known as ayurved. Medical college professors of India have a closed mind. Most of them stopped learning the day they got their last degree. Understanding ayurved will need a concerted effort on their part to get out of their comfort zone and do something that will not add to the roaring evening practice. So, what is their reaction? They bury their heads in sand and declare that ayurved is quackery. Do they undertake any research before announcing so? No, never! They have no qualms about prescribing ayurvedic drugs which have western sounding names (Liv 52, Septilin) but ridicule ayurved even in instances when they know very well that allopathic medicines cannot cure. Net result of this stupidity and arrogance is that public health of the country suffers. India, with her large population and limited resources, needs a consolidated approach where diseases that are incurable in allopathic system are referred to ayurvedic doctors if the diseases are curable by ayurved. This will need allopathic doctors to get down from their egoistic perches and interact academically and humbly with ayurved.
Before I close, let me assert that the purpose of this article is not to insult or deprecate doctors in any way. Doctors play an extremely important role in the society. Purpose of this article is only to motivate the community of doctors to introspect and think about the reasons for their fall from grace in the eyes of the people of India.
Also, it must be mentioned that health is too important a subject to be left to doctors alone. We, as responsible members of the society must press for ensuring that our doctors are truly human and abide by the ideal contained in the MCI Regulations related to Professional Conduct, Etiquette and Ethics – "The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. Who-so-ever chooses his profession, assumes the obligation to conduct himself in accordance with its ideals". Yes, these two sentences are from MCI regulations. You can look around and check how many doctors you know follow this ideal.
Lastly, let me assure the doctors that if they indeed cure themselves and medical education system of India; and act in accordance with the ideals of their profession they shall need no legal protection whatsoever. People of this country have valued and respected doctors for centuries. O doctor, heal thyself and we shall love to hold you in highest possible esteem.
Anil Chawla
27 June 2019