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Monday, December 09, 2013

Response to Dr. Kiran's and Dr. Varun's Articles!

Hi Dr. Kiran,

This was a wonderfully written and thought out article.

However, it seems to me that it was thought of only in the context of Dr. Varun's post.

Let me offer you a background of where and what I have done before I continue.

I did my MBBS in a very small village town called Loni, Pravaranagar. I did my internship through there with the first 3 months at Shirdi wherein I contracted a disease that paralysed me for a year and I then continued my internship on a walker and crutches at Sir J.J. Hospital and its various posts. I did a one year stint at the PHC at Palghar.

I worked as a surgical resident at Rajawadi General Hospital (BMC run) for three years

There is so much truth in both your articles that it's easy to miss the bigger picture.

I have seen 'batting' and unfortunately or fortunately been at the receiving end of it as well. I've admitted patients who were clearly required to be admitted in the medical ward only because they wouldn't just to have them transferred to another unit the next day. 

We've had patients admitted in our ward who came to the casualty the night before but were not admitted because the other unit was exceptional at batting them away just to come another day

I've taken transfers to my ward till my fellow residents and interns begged me to stop saying our ward is always full.

There was just one answer to them all. The more you see the more you will learn and the more you will earn! For some strange reason, this chant seemed to calm them down everytime.

For the part about patients sitting out of the casualty I've seen that too. Maggots, Diabetic Foot, Gangrene...I've seen them all turned away by the CMO when I wasn't on duty only to be told to mind my unit's business on my non call days.

I've seen people come from across the country to meet and talk to my Unit Head just for 5 minutes because he was open to alternative medicine. I've seen that 67 year old Unit Head ready to come to the hospital from half way across town just to consult on a patient that we weren't sure about.

I've seen patient's relatives beating up my colleagues when the patient died. TWICE in my unit with different colleagues. Over a period of 3 years. With nothing done about it both times in spite of police complaints and strikes.

I've participated in parallel OPD's when the strike was on with almost all residents in attendance.

When you talk about corruption, I know people taking kick backs even now, after being established private practitioners, and I know people who flat out refused when we were doing our internship for free!

I have been made to stay up 56 hours caring for a patient as an Intern when my resident and registrar had to study for their exams. They were extremely good seniors and I did it because I wanted to not because I had to. But, there was a question in my mind, was this what I bargained for? Is this what I want to do?

Climbing up the ladder. In our day and age, working hard at PHC's and government posts to try and reach the level of the Superintendent is not only a far fetched dream, but is also much like the elections of today. There is no separating politics and climbing the organizational ladder. I say this from past experience wherein my Associate Professor stayed and A.P. for seven years because he was told the only way to get promoted to Professor was to leave his city and go work someplace else. 

The other issue is money and I hear many morale battles saying medicine is not about money. I would ask you to come back to this post about 8-10 years down to road when you are married and have kids and still have to depend on your family to cover expenses. People in the developed world take up positions in their respective government institutions because they are well provided for. 

Not matter how much this stings, it is about the money.
Would you not give up an opportunity at private practice if you are well compensated for your time at a government hospital.

Lastly lets agree that there are always two sides to a coin and there are enough good doctors to overshadow the bad but all Dr. Varun's post has done is highlight a side. At this stage of his life, it will look all bad. We tend to glorify the ugly because that's what gets people's attention and I suspect that's all he intended.

Only if someone highlights the issues will there even be a discussion for improvement. I'm glad that you have provided the flip side to show that there are indeed good things about the profession. But let's not kid ourselves. There's just too much to go and it will take immense efforts from all of us to improve this.

A simple thing that I have started in my private practice is to prescribe drugs with their generic names written alongside brand names. The choice is then on the patient!

Let's work together to change the system.

P.S. Why go abroad to get a degree in MPH. Stay on in India and change the system from here!

P.P.S. For those who haven't read the preceding articles, here are the links 

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