Surviving India: Dawa Daru aur Doctor
Since a few months now, I am being forced to come into (involuntary) contact with a lot of people from the medical fraternity. Not that I have anything against the fraternity, mind you. In fact, come to think of it, a significant percentage of my friends and relations are Doctors. But since some time now, I have been in contact with medical folks more from the point of view of treatment of near and dear ones, than in a social setting. It helps that I know so many people who are doctors. One gets an inside perspective of who's good, who's so so and who's really bad, plus the advantage of added attention and some times hefty discounts to get quality treatment.Generally speaking, my experience is that we have quality and relatively cheap medical treatment available in our cities of the mainstream variety, especially the bigger ones and provided the place is well known and its credentials checked in advance. I have found patients being looked after well by the staff, doctors well trained,the facilities are adequate, if not cutting edge and at the price you pay for both the treatment, and the medicines compares very favorably with similar facilities with many other countries in the world. Consider the fact that an Angioplasty to remove one arterial block in your heart costs around Rs.1 lakh or $2000, whereas I am told that the same procedure costs 10 times, or more in a developed western country. Of course, the swankier your hospital, the fatter the bill and it is true that some hospitals (Apollo, Escorts etc) are now run more like corporate entities than a 'traditional' hospital. I have heard my share of horror stories about corporate hospitals but having never experienced one, it would be unfair to comment on them.
Medicine is the most prized professions in our country. But whenever I speak to my friends and relatives who are doctors though, I have found them to be very pessimistic of their profession. My sister and my brother-in-law, both of whom are doctors and run a successful hospital in Mumbai, agreed quite readily to their son's wish that he join Engineering rather than medicine, which would have been a much easier option for him, considering that he would have a readymade medium sized hospital to fall back on, at the start of is career. I was surprised but not for long, when they reeled to me the same reasons, which some of my Doctor friends had already told me of.
Consider the fact that the medical course (M.B.B.S) runs for four and a half years, after which there is a one year internship period. In many states and almost all cities, being an M.B.B.S means being ''kis jhad ki patti' (dime a dozen).Unless you are a post-graduate you are dead meat (pun not intended). So if you have done your medicine from a private institute and have shelled twenty lakh donation (in Maharashtra) and two lakh rupee per year fee for five years, tough luck buddy- go ahead and shell 30-40 lakhs more for a post grad seat plus annual fees and expenses- and spend two more years in college chewing books, doing night shifts and such like. My sister informs me that sons of doctors with established practice who could not get through merit in Govt. colleges are the ones who pay up these mind boggling sums. People who have got through merit in Govt. or private colleges, study like mad and try to get in a post doctoral course on merit. If they succeed, you have another two years post-doctoral course ahead of you, and you are also about 27 yrs of age and haven't even started your career yet. If your parents are not doctors with a ready made practice, a largish investment to buy/lease space for a clinic awaits you. If you are a surgeon, the costs of establishing a hospital in any city today would run into crores.
But the vicious circle doesn't end here. As of today, the situation in Maharashtra is that there is an abundance of even post doctoral medical practitioners in the urban areas of states like Maharashtra, at least. Unless you complete a super specialization, you are not ensured of the gravy train, you have worked out for. So off you go, study again like a madman and IF you get through (the pyramid gets really steep here), you - study for another 3 years or so. Hush ! So in other words, you end up starting your career at 27 or 30-31!No wonder you are sapped of most of your life force by then.
Doctors also exhibit curiously conservative behavior when it comes to marriage, much to my amusement. Firstly, no doctor worth his salt, generally speaking, would marry a non-doctor, for practical reasons. This means that there is a rash of love marriages during your average medical course, as both girls and boys try to think of the future and plan ahead. Since our society is so caste and religion conscious, these affairs are also perforce conducted between two students of the same caste. There are exceptions of course, but they only prove the rule. Many student doctors also marry the right degree, along with the caste and religion. Many doctors for instance would not usually like to marry girls who have specialized in courses which require the girl to be out on night shifts, which mean a hectic schedule or those which are not complementary to their own field. The minutiae to these calculations are endless and most amusing to a third person.
In states like Maharastra and Karnataka who have allowed private colleges, the number of seats available has ensured that the number of M.B.B.S and post doctoral students has spiraled. A significant percentage of these are students from outside these states. Every year, today, Maharashtra churns out tens of thousands of doctors. This is still inadequate for a country like India where the doctor to citizen ratio is an abysmal 0.6% compared to a country like U.S. where it stands at 2.6%. Given this you would expect that Doctors would not be facing too much competition, right? But ask any doctor you know and he will groan that the competition is totally out of control and there are too many doctors around. Why this paradox? For the simple reason that all the doctors who are churned out, want to settle in urban areas. Of the 20-25 doctors I know, only one (my cousin) practices in a rural area, out of choice, because he wanted to give something back to his birth place. This means that they all end up in the same place and then compete with one another. This over abundance has resulted in patients seeking doctors who are specialists, since he is no longer content with consulting a plain vanilla M.B.B.S who are more abundant than the neighborhood pan wallah. The over emphasis on niche specialists though has destroyed a very important institution- the family doctor. Patients neglect the fact that 99 % of the illnesses they face are routine and can be treated by an M.B.B.S doctor. Sticking to one doctor you trust, helps you and you family, since he would be the repository of all you family medical history and is intimately aware of what suits you and what not, your lifestyle is and then treat you per this information. More importantly, this doctor would (or should) know when NOT to blindly prescribe medicines and let nature take its own course. Half of the medical problems faced by many are due to over medication and lack of this personal touch, according to a doctor friend of mine. I would tend to agree since I have experienced the advantages of having a family doctor since my childhood and so has my wife. Clinical treatment in our big cities has become a mass production factory of prescribing stronger than necessary antibiotics, in large doses, unnecessary surgical procedures and lab tests, the vicious merry go round of referrals to a round of specialists, all of whom are part of a referral ring to even criminal negligence, gross ethical violations and such like, at the extreme.
However,there are the stray rays of hope, after all- charitable/ semi-charitable institutions (also, often the most well run of institutions with ultra modern facilities and the best of medical talent) like Vellore's CMC , Shankar Netralaya, just to name two. Then there are doctors like Dr. Abhay Bang of SEARCH, who not only have succeeded in propounding a new model for health for our Indian conditions by bringing down the infant mortality rate of some of the most backward areas in Maharastra by as much as 75%, according to TIME magazine but who have also managed to write one of the most inspiring of books for a patient with heart disease - Majha Sakshatkari Hridayroga (My heart disease - a revelation). How did he this John Hopkins alumni achieve this insurmountable feat? " We decided to listen to our patients," says Abhay. Now that's difficult for anyone, and not just our mainstream medical fraternity, isn't it?
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Doctors also exhibit curiously conservative behavior when it comes to marriage, much to my amusement. Firstly, no doctor worth his salt, generally speaking, would marry a non-doctor, for practical reasons. This means that there is a rash of love marriages during your average medical course, as both girls and boys try to think of the future and plan ahead. Since our society is so caste and religion conscious, these affairs are also perforce conducted between two students of the same caste. There are exceptions of course, but they only prove the rule. Many student doctors also marry the right degree, along with the caste and religion. Many doctors for instance would not usually like to marry girls who have specialized in courses which require the girl to be out on night shifts, which mean a hectic schedule or those which are not complementary to their own field. The minutiae to these calculations are endless and most amusing to a third person.
In states like Maharastra and Karnataka who have allowed private colleges, the number of seats available has ensured that the number of M.B.B.S and post doctoral students has spiraled. A significant percentage of these are students from outside these states. Every year, today, Maharashtra churns out tens of thousands of doctors. This is still inadequate for a country like India where the doctor to citizen ratio is an abysmal 0.6% compared to a country like U.S. where it stands at 2.6%. Given this you would expect that Doctors would not be facing too much competition, right? But ask any doctor you know and he will groan that the competition is totally out of control and there are too many doctors around. Why this paradox? For the simple reason that all the doctors who are churned out, want to settle in urban areas. Of the 20-25 doctors I know, only one (my cousin) practices in a rural area, out of choice, because he wanted to give something back to his birth place. This means that they all end up in the same place and then compete with one another. This over abundance has resulted in patients seeking doctors who are specialists, since he is no longer content with consulting a plain vanilla M.B.B.S who are more abundant than the neighborhood pan wallah. The over emphasis on niche specialists though has destroyed a very important institution- the family doctor. Patients neglect the fact that 99 % of the illnesses they face are routine and can be treated by an M.B.B.S doctor. Sticking to one doctor you trust, helps you and you family, since he would be the repository of all you family medical history and is intimately aware of what suits you and what not, your lifestyle is and then treat you per this information. More importantly, this doctor would (or should) know when NOT to blindly prescribe medicines and let nature take its own course. Half of the medical problems faced by many are due to over medication and lack of this personal touch, according to a doctor friend of mine. I would tend to agree since I have experienced the advantages of having a family doctor since my childhood and so has my wife. Clinical treatment in our big cities has become a mass production factory of prescribing stronger than necessary antibiotics, in large doses, unnecessary surgical procedures and lab tests, the vicious merry go round of referrals to a round of specialists, all of whom are part of a referral ring to even criminal negligence, gross ethical violations and such like, at the extreme.
However,there are the stray rays of hope, after all- charitable/ semi-charitable institutions (also, often the most well run of institutions with ultra modern facilities and the best of medical talent) like Vellore's CMC , Shankar Netralaya, just to name two. Then there are doctors like Dr. Abhay Bang of SEARCH, who not only have succeeded in propounding a new model for health for our Indian conditions by bringing down the infant mortality rate of some of the most backward areas in Maharastra by as much as 75%, according to TIME magazine but who have also managed to write one of the most inspiring of books for a patient with heart disease - Majha Sakshatkari Hridayroga (My heart disease - a revelation). How did he this John Hopkins alumni achieve this insurmountable feat? " We decided to listen to our patients," says Abhay. Now that's difficult for anyone, and not just our mainstream medical fraternity, isn't it?
