THE MISERY OF MEDICAL PROFESSION
On the surface of earth Human beings are the noblest creation of God and Doctors who take care of the physical pain and suffering of human beings are considered next to God. To be a doctor, then, means much more than to dispense pills or to patch up or repair torn flesh and shattered minds. To be a doctor is to be an intermediary between man and GOD. The patient, at the same time is a human being who is worried, hopeful and searching for relief, help and trust. This trust forms a building stone of any successful relationship and the importance of an intimacy between patient and doctor can never be overstated as in most cases an accurate diagnosis or effective treatment relies directly on the quality of this relationship. It has been suggested that the ideal doctor–patient relationship consists of the eight C‟s: Choice, competence, communication, compassion, continuity, cure, care and (no) conflict of interest.
The doctor-patient relationship has always been assumed to be a straight forward association between an expert in medicine and a person in need of medical care. In past, there was no question about this noble service but recently countrywide dissatisfaction on the major pillar (doctors) in India have resulted in considerable strain on this relationship. The doctor patient relationship has seen a drastic change in the last decade or so and an activity- passivity (Paternalistic) model has changed to the model of guidance - cooperation and mutual participation. The mismatch of doctor and patient expectation is very much prevalent these days and when there is a difference between an expectation of the patient’s relative and ground reality, it outbursts in the form of mistrust, anger and violence. This mistrust is so haunting that many doctors have started propagating a concept that treat every patient as potential litigant keeping in mind that even the noblest of thought and action done with the sole intention to save a life is sued in the court of law.
Unfortunately the mistrust has creeped so deep into the minds of people that not only patients but society at large has started devaluing doctors yet expecting nothing short of perfection. People in general have also become more intolerant and resort to violence at the drop of a hat. Be it for protecting their cows or people, anyone can get beaten up these days. The forces of increasing economic aspirations, stress levels, frustration due to urbanization, and high levels of competition, distorted and disturbed religious and cultural values have added to the intolerance among the masses. People are frustrated with the quality of health care in this country, the prime cause being infrastructure lapses. If a patient who needs immediate medical attention is not given a bed or a ventilator, the family is bound to be infuriated, and their anger is let out on the first doctor they find. Nothing comes free in this material world and to give free and cheap treatment during these times is not doctor’s responsibility but the responsibility of government and doctors cannot be held responsible for high cost of medicine and clinical tests.
India does not have any “Health for all‟ policy and the government is also miser about its public health spending, allocating just 1.4 per cent of gross domestic product, much lower than other countries. The health care delivery is either through private sector which appears to be costly and business oriented or perpetually under functioning public sector which is in pathetic state. A sincere and result oriented up gradation of public sector is the need of an hour rather than the hollow and politically motivated statements and enforcements. A major landmark political decision of Consumer protection act 1986 did more harm than good for medical profession. This is a two-edged sword which on one hand, was misused by patients for their benefits and threatening the doctors and hospital owners while on the other hand it made doctors more defensive and forced them to take approach of evidence-based medicine thus tremendously increasing the cost of treatment. Today number of negligence cases against doctors in Consumer protection court are on increase, majority of them are fake with malafide intentions as a result the relationship of understanding is deteriorating.
Similarly, an implementation of Clinical Establishment bill, uploading of videos of senior doctors doing rounds in ICU’s in UP, cutting salaries of doctors and threatening them for their resent will not only demoralise them but present them in a negative way that will have a large dreadful impact for the generations to come. Rather than doing such mimicry, Government should make policy for easy access of good health care facility to everyone irrespective of the caste, colour, religion and status in society. An effective law to prevent violence against doctors should be strictly implemented and the syllabus of medicine should be made more relevant with inclusion of some new subjects like medico legal aspects, ethics in medicine, communication skills, and management etc. so that with changing times the dependency upon legal experts, skilled orators etc becomes less thereby reducing the cost of healthcare. These measures should be taken early before it’s too late.
Every field has black sheep’s and law should deal with those law-avoiding people. Doctors should understand that they are not supreme who cannot be questioned and Society have to come to an understanding that doctors are not God and they are just using their learned skills for the betterment of the patient. In addition, patients have to show greatest regard and honour for doctors so that they can work in threat-free environment which will benefit society at large. The law and policy makers need to formulate a genuine patient - doctor friendly policies that works on a mutual beneficiary system so that it remains more of a symbiotic relationship.
In this changing world, with unique challenges that threaten the health and well-being of the population, it is imperative that all stakeholders –the doctor, patient, community and government collectively rise to the occasion and face these challenges simultaneously, inclusively and sustainably and work for an ultimate goal of great nation --- the nation that would be one where the best of health care is available to all, for all and where the governance is responsive, transparent and corruption free – a healthy nation that is one of the best places to live in.
Dr. Pawan K Suri
MBBS, MD, DM, FESC, FSCAI
Chief Cardiologist, SGL SuperSpeciality Hospital
Jalandhar, Punjab
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