Re: Ashok Sinha: Doctor in the village

December 20, 2007

Dr. Sinha,

A wonderful write up! It sums up all the aspects well and the system is

workable...anything would be after the mess it is in today!!

Ashish

ashokagt wrote:

this is the article published in tripurainfo.com, anyone interested

can go through.

Ashok Sinha

GET A DOCTOR IN THE VILLAGE, HOW!

By Dr Ashok Sinha

The recent controversy regarding the village posting of doctors has

put the medical community on one side and the whole world on the

other side. I remember, 35 years ago, when I was selected for

medical college I went to one of my elderly aunts to seek her

blessing. She was not very happy about the issue, no, she was not

jealous, but she expressed her anxiety very eloquently. " You are

such a nice boy, but now you'll become a bad man " . That, I think,

sums up the attitude of the society towards the doctors.

The problem possibly lies with the doctors. They work for money,

they do not bother about the society, they can kill female fetuses

for a few bucks more, and they can refuse treatment for want of

money; they are not up-to-date with knowledge, they do unnecessary

tests to get a share of the booty. Most of the complaints are

probably true. I have seen ultra-sonologists giving shamelessly

false report to assist another shameless gynecologist in going for

an unnecessary surgery, and I have seen many more un-parliamentary

linen that I should not wash in public. All are true and more.

My worry is about the ways the society is trying to go about solving

the problem. The society is trying to find a solution without

assistance from doctors. It was the same when the consumer

protection act came. Most of the sane doctors protested, some insane

ones also did. No one listened to us. I remember having told one

gathering of legal experts, that they were putting the patients from

the frying pan to fire; from doctors clutches to lawyers. I asked

them, why did they want consumer protection act for the medical

community, to improve services or getting compensation, or did they

want just to teach a lesson! I assured them none of these would be

possible. People refuse to learn from history. Has the road accident

compensation policy improved the quality of drivers? It has only

raised the insurance rates and probably helped the family of the

dead. If consumer protection act implementation for medical

community was intended for compensation, it was good, but if it was

meant to improve services, it was useless. People gave us funny

looks, thought we were `so bad'.

Now the great thinkers of the nation are again at it. They want

doctors to go to villages, and because the anti-social doctors do

not want to go to villages, they'll have to be forced. I am

surprised at the cerebral quality of the people who rake up such

ideas. Has any one tried to find out why doctors are not interested

in going to the villages! Is it only money! By the way, one of the

lowest paid employees in India is a junior doctor. As a junior

doctor I was paid a princely sum of Rs. 225/- PM, while the ward

boys were paid Rs 400/-. Their duty was 8 hrs, mine 24 hrs; they had

one weekly holiday, I had none. They had time for lunch; I did not.

I survived because the `sisters' were real sisters; I shared their

food. If the barber failed to turn up, I had to `prepare' the

patient for surgery; the ward boy would not even have a nightmare of

doing it. If the ward boy were absent I had to `ensure' that the

patient reached the OT on time, riding on the trolley, guess who

pushed it through the corridors of the hospital! But I tell you; I

enjoyed my stay as a house surgeon. I am still proud of what I did.

Because that was when I learned. That was what prepared me for the

future. That is where I learnt how to give a painless suture, how to

tackle a violent patient, how to tackle grief. I do not think a Lal

Bahadur Institute trained babu will ever understand that, they do

not have the training.

Look at the position of medical education today. MBBS is a five and

a half years course. Already the longest course in the country. But

an MBBS degree is truly nothing today. At one time an MBBS degree

was equivalent to an M Sc degree. One could become a lecturer after

MBBS, could do a Ph D, or D Sc after MBBS. But no more, now MBBS is

equivalent to B Sc. MD was a doctoral degree, Doctor of Medicine,

now a postgraduate degree, a three years postgraduate degree. A two

years postgraduate diploma is not equivalent to M Sc. Even the MCI

is trying its best to degrade the status of medical degrees.

I invite the society to understand the problem first. Force should

come as the last option, not the first. Today an MBBS degree holder

is a pariah in society, to be accepted by the people he has to have

a postgraduate qualification. `Only MBBS', or `simple MBBS', or

worse `plain MBBS' are terms we hear often, but do not understand

the agony of it all. MBBS entrance is one of the toughest in the

country, but let me introduce you to a tougher entrance, the PG

entrance. The number of seats for PG is one third of the total MBBS

seats, so in any case two thirds of the MBBS shall remain `plain and

simple'. This cutthroat competition has prompted the students to

treat MBBS degree as a qualifying benchmark for PG entrance tests.

They prepare for the test rather than trying to become doctors. This

one entrance test would make or break their career. It is better to

be a simple B Sc then to remain a simple MBBS. There are instances

where MBBS students are paying smaller hospitals to get internship

certificate without going to the hospital so that they can utilize

the time studying. What is the result? They do not become a `doctor'

after MBBS; they remain students. One third of them get into PG, two-

thirds fail. No, not because they are stupid, because the know-all

government has put a rationing in the number of seats for PG.

Imagine the fate of these students, they are plain MBBS, did not

spend time learning during internship, now they are out in the open,

no respect, no knowledge, official quacks. This is the most serious

wastage of trained manpower the country is facing today, all because

of our policy makers.

Who is responsible? There was one know-all TV talk show, which said

if you cannot become a doctor in five years, you could never be. So

cerebral! These are the people who control the society, God help us.

One does not become a `doctor' immediately after passing MBBS; it

takes at least 2-3 yrs of fulltime work under supervision to be able

to work independently. That was what house jobs were. Earlier house

jobs were compulsory before MD entrance. After 2 house jobs if one

did not get in to PG one could still practice. Now house job has no

PG entrance value. Practicing medicine without a House job does not

prepare a doctor well.

Is there a solution to the problems in villages? It is there, if our

great parliamentarians bother to listen to us. By the way I have a

few more proposals. I want to make it compulsory for the

parliamentarians to stay in a village for one year as MP and fulfill

all promises made during election campaign otherwise their

Membership would be cancelled. Make it compulsory for IIM graduates

to stay in a village for one year to work for betterment of rural

finances, before they get their degree. I want High Court judges to

stay in villages at least 2 months a year to help solve the pending

cases in the villages to be eligible for promotion to Supreme Court.

I want the IAS officer to be posted in a village for one year before

they are confirmed in their jobs.They can all stay in the excellent

accomodation provided in the villages for the doctors. Sounds funny?

Who started the jokes!

Here is what I suggest.

The entire medical course needs to be revamped. Instead of hundreds

of confusing degrees there should be one degree, MD. It should be a

nine years integrated course, equivalent in status to a Ph D. All

students, after four years, would get a provisional registration to

work as doctors under supervision. They would select their specialty

at this juncture, depending on the merit and other government

policies of the time. Even a surgeon would be MD. All the diploma

courses would be abolished. There would be specialties in family

practice, clinical medicine, hospital based internists, surgeons,

ophthalmologists, and all other specialties that we have today.

One year out of this course will be a village posting where they can

learn the problems of the villages and unlearn some hi-tech

solutions to simple problems. There would never be a shortfall of

doctors in villages, happy doctors and not frustrated ones. I do not

think there would even be a murmur of protest from anywhere. No

forcible " Cultural Revolutionary " tactics would be needed. The GPs

that we get would be trained ones, not untrained ones as we get now.

How does a patient differentiate between a physician MD and a

general practitioner MD. The same way they do now, between MDs in

Medicine, pharmacology, biochemistry and pathology. In any case,

government can recognize certain associations, memberships of which

can be made compulsory. (For example, MD, Member of Indian College

of Pharmacology, or MD Indian College of Surgeons.). This way every

doctor that comes out of the college would have some special skills,

and have worked independently for at the least 4 years before being

released to the society. There is no wastage of doctors as `simple

MBBS'.

The super-specialties should be limited to a few, the brightest

ones. There should be no further confusing degree like M Ch, DM. The

super-specialists would be offered fellowships of the college, e.g.

MD, Fellow of the Indian College of Cardiac Surgeons, equivalent to

postdoctoral degree, D Sc.

By the way this does not solve the problem of the bad guys in the

profession as mentioned in paragraph two of this article. I'll share

a bitter truth with you. The patients are as much responsible for

this situation as the doctors. The ratio of good doctors and bad

doctors is exactly the same as the ratio of good guys and bad guys

in the society, not more, not less. There is something very wrong in

the way patients select their doctors. Name and fame does not depend

on skill, knowledge and sincerity. Sound business tactics, sometimes

not so ethical, makes one doctor more popular than the other.

This article is aimed at sensible people who want a solution, not

revenge. The next doctor could be your son; the next patient could

be your son.

Dr Ashok Sinha could be reached at ashokagt2@.... 79 Tilla,

Kunjavan, Agartala, Tripura.

---------------------------------

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December 21, 2007

That was a nice thought provoking article, Ashok Sinha.

Kishore Shah 1974

December 21, 2007

Wonderful article.........great have sent it to all my know all friends and foes

alike and awaiting some cerebral responses as ashok sir would say..........

aasawari91

standing ovation