Change The Medical Scene, India: Article One. Healthcare Failure In India: Problems And Solutions

1: Etiopathogenesis
(c) Dr. Rajas Deshpande

This is my heartfelt attempt towards initiating a change in the Indian healthcare system. We all, even the government, wants it to improve but nobody seems to know where to start.

I appeal the younger generation of doctors to please think deeply about this article in terms of your future, unless you want to face the same humiliation, insecurity, inhuman attitudes, suppression and threats all your life, just because you are divided. I intend to offend no one, my non-Utopian aim is that every patient as well as every doctor should be happy, healthy and satisfied. There indeed are more good than bad doctors in India, but guess who dominates the scene.

In this series of articles I have tried to first identify the basic problems, and will propose probable answers in my later articles. Before we analyse outsiders, let us first take an honest look at ourselves.

Problems Within Medical Community:

  1. We have many class differences between doctors. This is the most prominent cause of non-unity of doctors. These class differences may be summarised as (a): Intellectual: some doctors are far more intelligent and skilful than others. (b): Cultural: some doctors know the best ways to behave and speak with patients, others have an arrogant, ill-mannered, abusive and sometimes filthy, inviting a bad reputation. (c): Academic/ Clinical: some doctors are trained at extremely good institutes, some put in gigantic self-study efforts, and therefore are academically and / or clinically better even if their medical degree is the same. (d): Financial: some need financial support and critical effort to survive through medical courses, fighting till in their thirties to settle down, while for some others, financially it’s a cakewalk.
  2. Shameful tendency amongst doctors, of discrimination based upon State, Caste, Region, Religion, Academic Institute, City, Financial Status or Political party, generating an “Insider-Outsider” culture. This has also resulted in many hospitals employing doctors from a particular religion or socio-cultural/ financial status even if better candidates are available. Few honourable exceptions.
  3. Jealousy, Insecurity and Envy: There are successful and struggling doctors in every branch. The shameful tendency of some established doctors to suppress and disallow juniors in their institutes is well known. Most wise institutes now employ two or more competing masters in every branch and fire up their egos against each other, to have them fight tooth and nails. Guess who profits and who bleeds. The comic tragedy is that even very brilliant doctors fall prey to such tactics. © Dr. Rajas Deshpande.
  4. Financial desperation: Juniors who come from poorer backgrounds, in spite of better abilities, have no money to invest, make their own hospitals, and must work at bigger hospitals under such competing seniors, and the only way they are allowed to survive is by getting better numbers. This results in a very hostile, bitter work culture.
  5. Killing Humanity: The entire medical community is guilty of perpetually ignoring, intimidating, suppressing and blackmailing medical students, especially postgraduate resident doctors. India has probably the worst inhuman treatment for its budding and junior doctors, with no one interested in addressing their problems. They live in most pathetic conditions, often six in a single room. They are inhumanly overworked, with a shameless answer “We did it, now you do it” from their seniors. “No food and No sleep” is nothing to be proud of, it is Torture. Post graduate students and resident doctors are not only FORCED to work far beyond human capacity, they are overtasked with mindless curriculums. The “Slaves” in our history were far better off compared to how the resident doctors are treated today in India.
  6. Extremely low quality medical institutes: Guess who owns and runs these, still churning out valid degree holders.
  7. Nepotism: Where “Premium” students, often children of the powerful, politicians, administrators, doctors, socially prominent are treated differently, groomed specially and airlifted to success while others, however meritorious and efficient, are humiliated and suppressed. © Dr. Rajas Deshpande.
  8. Master-Slave Culture: In every private or Corporate owned hospital, there is an unwritten rule: never cross the Master-Slave boundaries, never ask questions, you are here because we allow you to be. Should you dare to correct someone about policies, ethics, financial irregularities, excess profiteering, you are unceremoniously thrown out, given the title of a rebel, a troublemaker, and your reputation as a doctor is torn beyond redemption. This is the worst for surgeons than physicians, as ‘badmouthing’ / deliberate ill-reputing of a surgeon can ruin their entire career. Unfortunately, it is not only the hospitals, but different classes of doctors mentioned above participate in this mudslinging too. No institute in India has an honest troubleshooting department for doctors. There is no respite, there is no organisation, doctor’s body, government department that protects a doctor thrown out, defamed or harassed by corporates or big hospitals. Very few hospitals are doctor- friendly.
  9. Even in government service, sycophancy is the strictest tradition.
  10. The SP Syndrome: Shoelicking-Postholders are the worst tragedy in healthcare. Even after being qualified doctors, these ‘doctors’ have learnt the quick-ladder culture to sit in a medical administrative chair. They know which side to please, and are seldom seen working in the interest of either the doctors or the profession. They have but one agenda: strengthening their chair-bum glue. They are found almost everywhere in healthcare, and many enjoy the administrative superiority and control over better qualified and even senior doctors. There are rare honourable exceptions who try and balance the hospital and doctor’s sides. However, those involved in policy making are rarely in direct contact with the patients, have rarely had a reputation / experience of good medical practice, and are happy with hypothetical speeches sweetened for their powerful masters. Senior doctors have never stood up for an unfairly fired or colleague, and often our own community disowns a doctor harassed by healthcare giants or government. Thousands of excellent doctors have either left the country or live in dark anonymity just because there was no Godfather for them. This is a major cause of policy failures and pathetic research in Indian healthcare, inspite of having some of the best medical brains upon earth.
  11. The only thing that helps a good doctor is long-term goodwill generated over years, where patients spread a good word about their relief from that doctor. Against this is pitched the permission to hospitals for self-advertising, which often misleads the society.
  12. Once a doctor starts a hospital, there are so many taxes / overheads that he / she must shoulder, so much paperwork, that it is difficult to concentrate upon patients alone. Add innumerable laws, restrictions, rules that make it impossible to sustain over long term. Bribes are a stark reality wherever rules, restrictions are involved. This is why many doctors have closed down smaller hospitals.
  13. While doctors are only allowed to charge their (mostly) limited fees, almost everyone else in the profession earns a lot more profit, often unjust. From rooms, service, nursing, gloves, catheters, to procedures, from canteen to labs to radiology to pharmacy, the hospital and pharmas earn profits everywhere (this is acceptable in proportion of the investment). The one paid least in the final bill is the doctor / surgeon, who usually earns a piddly sum in spite of being the most important factor in the chain. The doctor is also primarily responsible medico-legally for every case. Patients are upset with the doctor even after saving their lives because the bill is fat, not knowing that most doctors have no say in hospital billings. © Dr. Rajas Deshpande.
  14. The Corruption: There is no denying the fact that some doctors participate in various “unethical” means of earning via “commissions”. While all corruption is wrong, this is an extremely hot and debatable issue, where many questions are unanswered. For example, if a doctor owns a hospital and a lab and a pharmacy, he can profit under all three headings, but if a doctor working with him is also paid from this profit, it is presumed unethical. Our society is too financially biased, and it will never accept the necessity of profits in healthcare. However, the same society or its government has no answers to what a good ethical doctor should do if there are financial emergencies like this pandemic where his / her income is near nil. Hence the doctor is left to ensure his / her own income, with or without patients. Our society will preach doctors a lot of pompous lessons of ethics and compassion, but won’t feed the doctors family if he is in financial trouble due to all the good and free work he does. To completely eliminate “backdoor incomes”, the only way is that the doctor’s fees will shoot up.
  15. Over-smart Attention seekers: This community of doctors will do anything to garner attention. They will make news for being cheapest, they will construct new theories of individual, private research and blabber about them on national / state channels, massage the egos of power, speak against their own colleagues just to get praise from society and media and so much more. They hunt celebrities and powerful to be seen with, always speak the language of “Sweet, Beautiful, Positive” and imply from their wisely framed speech that only they can understand compassion and patient’s feelings while other doctors don’t. These are the usual early birds on TV, who criticise their own professional colleagues whenever there is violence against doctors, preaching about communication, making the society feel that ‘bashing up of junior doctors’ is justified, just because they could not communicate well. They will go to any unscientific extent to fool the public to be in good books of the government and administration, and completely vanish when their profession is suffering. This attention-seeking community has done the worst harm to medicos and the reputation of our noble profession.
  16. Doctor’s Organisations: “………………………………………………………………………………………………………………………………………………………” .

To Be Continued
© Dr. Rajas Deshpande

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1 thought on “Change The Medical Scene, India: Article One. Healthcare Failure In India: Problems And Solutions

  1. So well written sir.
    I am also annoyed by how doctors enable the ‘entitled’ health seeker by being passive to their outrageous behavior just to retain their clientele. We as juniors are expected to tolerate every misbehavior because if we stand against it, the senior consultant is annoyed and insecure of losing the follow up.
    And it’s surprising when our senior consultants indulge in superficial, small talks with them and ignore their direct or indirect insults. Being understanding and empathetic is good, but there are some who surprisingly wont mind accepting or even flattering those who disrespect them. And then they take us all for granted.

    Like

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