Sunday, March 26, 2017

How can we prevent doctor bashing ?

Now that the doctors have gone back to work, everyone is breathing a sigh of relief. The government is very pleased that they have averted a crisis, and that patients are being looked after once again; and the junior doctors are pleased that they can go back to completing their education and getting their degrees. One more storm has been weathered successfully.

However, what's very disappointing is that no one is stepping back to look at the big picture. No one has bothered to do a root cause analysis as to the reason for this simmering anger against doctors; and there has been practically no public support for these young residents, who have been hung out to dry for having the courage to demand protection for themselves - something which is their basic right, and which they should be able to take for granted.
The tragedy is that strikes and agitations by junior doctors have become recurrent events . I remember that when I was a resident 30 years ago, we had also gone on strike , and the government broke us by wearing us out and threatening us . They are playing exactly the same game again - it's just the names of the players who have changed.
All the junior doctors asked for is that the administration provide them with enough security , so that their personal safety is not endangered during the performance of their duty. Is this too much ask for ?

To add insult to injury, even the High Court Chief Justice threatens the doctors when they sought protection ! She  said - Public will hit you': Resume work or face termination, Bombay HC tells striking resident doctors. It's very sad that a judge is suggesting that it's OK for citizens to break the law and beat up doctors!

Things have gone from bad to worse in the last 30 years . The living conditions the government hospitals provide for these junior doctors remains deplorable. The support infrastructure is completely lacking ; junior doctors are chronically overworked and sleep deprived; and they are made to do a lot of useless scut work , because the hospitals refuse to spend money on the ancillary staff required to provide good patient care. It is the poor junior doctors who are saddled with this additional burden - something which is not part of their curriculum or job description, because it doesn't involve delivering clinical care to the patient. The tragedy is that because these young doctors are conscientious and responsible , they are willing to take on these additional duties, even though they shouldn't have to, simply because they want to make sure that their patients get better.

Thus, they waste hours carrying blood samples from the ward to the laboratory ; or collecting reports from the x-ray department , rather than learning at the patient's bedside . This is stuff that should actually be done by ward boys, assistants and clerks, but because the hospital doesn't have the budget to employ them, it's the junior doctors who are treated as beasts of burden, and forced to do these mundane administrative tasks. What's really appreciable is that they do this unquestioningly and uncomplainingly, because they respect their seniors and professors, and will do whatever they ask them to.

No junior doctors ever says, "No, this is not my job , and I refuse to do it " - though they would be well within their rights to do so. This is also partly because of inertia - this is what their seniors did, and this is the way things have always been. However, the truth is that this is a broken system, and we cannot continue like this.

The underlying reason for this sad state of affairs is that the government loves to make populist declarations as regards medical care. Thus, they promise to provide free health care to everyone, even though they don't have enough hospital beds and doctors to be able to do so . This sounds great on paper , and gives the ministers a lot of press coverage. However, the problem is they don't put their money where their mouth is. They don't back up their promises by spending money on employing additional staff in the hospitals; or providing the hospital dean with a budget which is sufficient for him to be able to ensure that the aging medical equipment in these hospitals continues to work properly. Even basic medicines are not available in the pharmacy, and patients are made to run around from pillar to post. It's easy to see why patients in these government hospitals lose their temper - the system is so badly designed, that anyone is bound to get agitated, upset, and frustrated trying to navigate it. However, patients can't vent their anger on the people who deserve their ire - the politicians and administrators, because they are inaccessible.

This is why it is the junior doctors who end up serving as punching bags whenever anything goes wrong. It's high time that we accept that these problems do not arise because junior doctors are careless ; lazy ; or don't want to work. Let's not forget that medical students are our academic creme de la creme - they are the best and the brightest our educational system produces, and they have worked hard to get into medical college. They continue to be willing to slog hard, and do so no matter how adverse their working conditions are.

The reason for the doctor bashing is because the system is dysfunctional and broken ; and unless we are willing to spend enough money to make sure that the citizens of this country get good quality health care at an affordable cost, things are just going to progressively become worse. The reality is that the administration continues to ill-treat them with impunity, just because they can do so easily. They are a floating population, who are very vulnerable, because they know that their careers are at stake, and they don't want to risk this.

My big worry is that the government doesn't seem to understand the long-term consequence of ignoring the legitimate claims of doctors. Bright students will no longer want to join medical college after seeing how badly doctors are treated by the administration, the media , and by angry relatives. A medical college seat used to be highly coveted. It will now go to the B-graders, because the A-graders will look for greener pastures and opt for other careers. Most parents will also discourage their students from taking up medicine - a very far cry from the past, when parents would be exceptionally proud if their children secured admission in medical college because this was so highly competitive.

Please stop and think. The message are we conveying to these young doctors is that we don't care about your personal safety - you have to go back to taking care of patients, no matter the risk to your life and limb . If we treat them so inhumanly, how can we expect them to become humane doctors and care for their patients when they graduate.

Instead of allowing the poor doctors to remain convenient scapegoats, we need to speak up and make sure the government authorities are held answerable for improving medical infrastructure . The government has more than enough money - it's just that corrupt officials and bureaucrats pocket it , as result of which patients are deprived of basic medical facilities. This is what we should really be agitating against - but because affluent citizens like you and me get our care from private medical facilities, we don't care if the government allows the public hospitals go to the dogs.

Today, tempers have cooled, and the medical associations and the government have come to an understanding. We've weathered the crisis for now, but I think it's just a matter of time when it will blow up again. The next time another doctor gets beaten up by angry relatives , we will have a sense of deja vu, but whether this incident will occur in the next week, or the next year, I cannot predict.

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