Above: Junior doctors attending a class in a medical college/Photo: mciindia.org
The assaults on doctors in India is due to a lack of understanding of their role and functions and the pressures they work under
By Dr Kamal Kumar Mahawar
Medicine is still referred to as a noble profession. Ever since I started this journey some 28 years ago, these words have been drilled into me. Yes, we also need to be remunerated for our efforts, but that is not the main reason why we do it. We make a difference, we were told, and we get respect like no other profession and that was supposed to make it worth our while. And we believed it.
Our graduation took longer than other disciplines and if one included the period spent doing “internship”, six years would go to obtain an MBBS degree with a licence to practice. Those doing other disciplines would graduate in four, three, even two years. When others our age were constantly partying and having fun, we were studying. The medical syllabus is vast and there is no room for error. Days merged into nights and months into years. We worked hard and believed we were training for a very important role in society and were told our contribution would be valued.
We were paid approximately Rs 1,800 a month as interns and were told that we were lucky as batches before us got only Rs 900. But this was not the end of it. It soon became clear that though we would get a licence to practise, we would not be fit to do so. For that, we would need many more years of training. Preparations began again, this time for postgraduate entrance exams.
I was among the lucky few to be selected for further training in my chosen specialty—general surgery. More than half of the medical graduates in the country do not get this opportunity. They will not only have to train themselves, but also earn a livelihood for themselves and their families. Many of us were now around 23-24 years of age and our families expected us to look after them and not the other way around. But their hopes, as well as ours, were soon going to be dashed.
Those of us who qualified for postgraduate training then spent another two-three years learning the craft and the science while working over 80-90 hours a week and getting paid between Rs 5,000 and Rs 15,000 a month. Even then, finding adequate training opportunities proved elusive. Our professors were under no obligation to train us and we were in no condition to demand anything. For many, it was too much back-breaking work and some even thought of taking their lives.
We saw our friends in other walks of life getting married, settled, and earning many times over. Some left for foreign countries and would send us pictures of posh cars and foreign holidays. We, on the other hand, didn’t even have time to breathe and barely enough money to live by. Yet, we persevered in the hope that one day it would all be worth it. Sadly, that day never came for many of us.
All we wanted was a decent set-up where we could practise modern medicine and get a fair remuneration. We did not seek to be rich. Seeing the dismal state of public healthcare infrastructure in most parts of the country, many did not want to work there. Even renowned central government establishments are pathetic by modern standards and the less said about state government-run clinics and hospitals, the better. Even if one decided to work there, the remuneration did not match the hard work and talent. Plus, there were the erratic and arduous hours to contend with.
You could work for the private sector, but the wages there were not much different either. They too would exploit the market forces, make you work long hours and not even pretend to train you. Many went abroad. Those who stayed back, served either as public sector doctors with pitiable salaries and practising Third World medicine or opened their own establishments (with money borrowed from family and friends) while competing with quacks and faith healers. Contrary to what the public thinks, fewer than one percent of doctors work for or own corporate hospitals; most just get by.
It is against this backdrop that one has to view the violence against doctors in India. Doctors most prone and vulnerable to this are junior doctors working in government hospitals. They have just begun their professional journey and work for long hours without enough rest and basic equipment. They deal with the sickest and the poorest.
Passions run high in such an environment. Elsewhere in the world, doctors and nurses can do their job away from the eyes of worried relatives. Not in India. Here everyone can go anywhere in the hospital, irrespective of the time of day or night. All it takes is a perception on the part of the patients’ relatives or the patients that not enough is being done for them to beat the doctor up. The doctor may have just phoned his superior and is awaiting instructions. But if the patient dies, all hell breaks loose as the relatives think he is negligent. In case any relative has political or underworld connections, then nobody can save the doctor. They come back in hundreds and do whatever they wish. Elsewhere in the world, and even in the private sector in India, hospitals have their own security. But this is not so in government hospitals. Even if there are one or two security personnel, they prefer not to intervene because in our lawless society, they will be the first target in case of any attack and nobody will even bother. The goons usually have political patronage and know they cannot be touched. I am not an expert in security matters, but it is surely not beyond the will of the government to protect its own property and people working in its establishments.
There is more to it. Indians live in one of the unhealthiest environments in the world. The air is so polluted, you can’t breathe. In most parts of the country, there is no access to clean water and even in big cities, water is frequently contaminated. There are piles of garbage every hundred metres but no one is bothered till ill-health strikes. And then the doctor is blamed for failing to save them.
There is another angle to it. With the increasing corporatisation of healthcare, the patient thinks he is a consumer who has the right to demand health. Just like any other service or product, if you pay for it, you want good results. Many patients have difficulty understanding how they can’t be cured or how an operation can have complications when they have paid for it. They do not understand that they are paying for the service and that in healthcare you will have to know God or be God to guarantee outcomes.
Mental, verbal and physical assault of doctors is also on the rise elsewhere in the world and that is because the medical profession and the healthcare industry have become victims of their own success. We have new medicines, sophisticated equipment and modern scanners and the finest micro-surgeries can be done on the tiniest blood vessels. People can be kept alive for months when not one but several organs have failed. We are able to treat a large number of patients and send them home. But when we can’t, when there is a complication, it hits the patients and their families. They cannot understand what happened and why. They look for answers and somebody to blame. Even the most sophisticated patient grievance mechanisms cannot satisfy them. Justice has to be instantaneous and direct. They can tell the doctor anything, even beat him up and he won’t be able to do anything.
We are after all bound by the Hippocratic Oath. We have to behave in the noblest ways or we will lose our licence to practise forever. Patients and their relatives lose nothing in the process. There is no mechanism in large parts of the world for a doctor to report a patient. The best you can do is walk away and that is what most of us do. But age has made many of us a bit more mature. It has taught us how to keep a lid on our emotions. Yes, we have moments when we regret joining this profession, most of the time, it is an honour to do the job we do.
However, fending off attacks is not something that young doctors manning emergency departments are trained to do. They also struggle with the death of a patient or an adverse outcome as much as the patients’ families. Often, these doctors don’t have the requisite training to handle precarious situations without the supervision of senior doctors. They are being asked to work for twice as long as normal human beings for wages that are a tenth of what their friends elsewhere are earning. They are told, this is your duty. Are we then treating these young doctors fairly? I leave it to you to decide.
—The writer is consultant general and bariatric surgeon, Sunderland Royal Hospital, and author of The Ethical Doctor
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