While the government has brought about reforms that have changed the medical systems; the underlying rot remains and certain problems remain unanswered much to the chagrin of both students and parents. The changes include, a single umbrella system of exams, establishment of centres of excellence at various cities and establishment of a new medical body.
While protests against a single exam have happened in the past from certain states one can see clearly why there is resentment in terms of a single exam system. One of the biggest problem is the presence of different curriculum in different states and that is just to begin with. While it is the responsibility of the state to bring its students to a level playing field, the states have not only been lethargic and morose, they have opposed to the level of being blunt and shaking off their responsibilities and blaming the centre. One needs to understand why the centre has to take a radical step to shake the state government to understand the failures of their healthcare system: the need arises from data of widely fluctuant rates of Neonatal mortality and maternal mortality, which are vastly different in various states.
Now we can contest the facts on basis of terrain and the overall reach to the population, the blame remains on top honchos of planning who have failed to analyse what is wrong. The wrong lies with the system of education that prepares a student for a single umbrella exam. An utter dismal failure at all levels, centre and state alike. The educational system prepared them for one thing and judges them on the basis of what has not been taught. The uninitiated may ask how is that possible? Well it is possible and guess what it is happening. The problem lies in acknowledgement because unless there is acknowledgement, there can be no action. Now, coming to the crux of the protests in recent past which underlines the agenda: let’s not do anything for our students, let’s blame the centre and of course as usual an added angle like caste always works.
While number of students entering the medical field continue to decline and with states introducing legislations to help decrease it further like in Maharashtra, there is a need of re-imagination and the need is urgent.
The government seems oblivious to students problems of the prolonged duration and late economic independence where most are still dependent on parents till almost 30 years of age. The legislation in various states believes in arm-twisting students to work for the community at various “check points”. These check points include the end of basic medical training i.e. MBBS and Post graduation. While one can may find it funny that a student with training in Administration (a relatively new branch offered only at select institutions) can be posted at a Primary Health Care (PHC). Or a student with super specialist training in interventional radiology can be posted in a PHC which lacks even basic facilities for X-rays after which follows a prolonged duration of meetings and hand “warmings” following which, the “student” (already trained) gets a posting of his/her choice which frequently forces them to beg, cry and wail at the door steps of public “rulers”.
While the stories of the outburst of public “rulers” against Doctors frequently makes headlines, we must also know what is expected of the Doctors posted: getting the PHC painted, construction, reporting to each beck and call of the public “ruler”, beg for transfer or to avoid transfer, cosying with the head of Panchayat, pray for safety, sit in dark when lights go out and if they have children; wonder about choice of Schools to ensure good education. All this must be carried out at a measly salary as compared to peers of the same age-experience groups in other fields. While, there has been a remarkable change with the government allowing bidding for placement of medical professionals; what about those who have just finished their training? There needs to be a central transparent system to allow for transfers on request (including mutual agreements) and also jobs like painting, construction and arranging oxygen cylinders etc. must be delegated to somebody else. I’m quite sure that Doctors have no training in that area.
Doctor “demonization” has been a common trend where everyone feels free to take pot shots at doctors, and the list includes General Public, actors, politicians and media alike.
Some have suggested that doctors should not charge money, some have subtly suggested beating the doctors for expensive treatments, some have suggested writing generic medicines including writing the drug name/constituents. While everyone has a freedom to charge what one deems appropriate, a doctor is in a unique position of moral responsibility: to treat at a subsidised price to help the community (that being said, the doctor is supposed to pay taxes like: land, water, biomedical waste, pollution control board, fire safety and a file-full of licenses which involves a lot of “hand warming” including the insurance companies to run the practice- this pertains only to practice while daily life expenses like education of children, care of elderly, EMI for car and apartment etc.) continues without any subsidy offered.
The public seems to be unaware of the fact that the price of a drug is not in the hands of a doctor and while government has taken the initiative to cap drug prices, they seem to have missed a core value “quality” which should be the responsibility of the Central/State government and in a case of proven low quality, the company AND state should be charged as per law.
A Doctor has no way of testing the drug quality so while one laments that writing the drug name will bring down the price, the “pricing” “free hit” just lays out in front of the pharmacist who would be now responsible for the increasing expenses or for that matter even quality. The cost of treatment in corporate hospitals is another issue that brings a lot of hate. While corporate hospital owners play golf and relax, it’s the Doctors who are the workers, it’s them who have to reply to courts, and it’s them who get hit and abused for expenses. The system is modified by Corporate hospital owners to prove that it is the Doctor who is responsible for expensive charges where as in reality it is the hospital which is responsible for the expensive charges. But, it is the Doctor who is the first to lose a share when say a discount is announced. The corporate system has evolved in such a way that the discount is on the Doctor charges and not the hospital i.e. it is a discount by care provider and not the care institute (the corporate company) while the reverse is being projected. As a matter of fact, a Doctor gets only a percentage of what is charged in the bill in their name so the blame should actually be on the corporate set up. So why blame the Doctor? Puzzles me. And last but not the least, if the government is so concerned then, why allow private players in the “health”care at all?
A recent diktat was about not allowing Government doctors to do private practice. Let’s get this straight: why would somebody want to work after getting free from work? Money. They are overworked-underpaid and hence the beeline to go abroad. The latest addition is the new suggestion of capping consultation prices in Karnataka. This is an admittance of the failure of government “health” system where they can not provide quality facilities to the sick in hospitals run by them and hence to prove their dedication and lack of insight, they have come up with the idea to cap consultation. The move is already facing a lot of flak from the Doctor community culminating to a state wide strike in Karnataka on Nov. 3. The questions that remain are:
1.) if the government is so sensitive about treatment cost then why the plethora of licenses to run a private hospital?
2.) What seems to be the need of another grievance redressal system, do they feel that putting an additional legal pressure will decrease the prices further?
Now the most important point: health is the responsibility of the state and tending to a patient is a responsibility the treating Doctor. Most people miss the fact and we frequently see leaders taking pot shots on Doctors for incidence of Dengue, Flu and Malaria; it is not their responsibility. The state is responsible for maintaining a clean environment, food, sanitation and water supply. The Doctor is responsible for treatment and not overlooking the cleanliness of toilets, broken doors of bathroom, wiping of corridors etc. these are pictures which are frequently seen in newspapers where a senior Doctor is seen standing with folded hands while being told about toilets and muck by the public “ruler”.
Doctors in training spend their break time in duty rooms which are neither furnished nor properly ventilated. A lot of students studying medical courses get infected with Tuberculosis and other communicable diseases which they acquire from hospital. The government turns a blind eye to not only the physical maintenance of their hospitals and colleges but also does not pay attention to the inhuman duty hours which affects the mental health of the young doctors. The government needs to employ more people to work and share the burden faced by medical students in order to provide quality care.
Will a new medical body solve all the problems? One can wonder whether those at the top can even see the problems at bottom? In all earnest, they realized the corrupt system and sought to revamp it. I for one hope that they aim to do that. I hope they succeed.
