03/09/2017
The way forward...
Dr.Cyril Jacob Kurian (Senior Resident , Department of Nephrology ,GMC Kottayam)
(Published in the Convocation Special Supplement)
Congratulations !!!
You have done it ...
Welcome to the most rewarding career in the world and I am not talking about the money or the status , it is the sheer variety of this job. It is variety of the people you come across- the poorest of the poor , the rich , saints and villains, priests, atheists, politicians, film stars, manual labourers, soldiers, craftsmen - people from all walks of life. All of them teach you something new. Something that make you a better person each day.
You must be up to your gills with well meaning advice by now telling you how you always have to keep up the dignity of the profession, epitomise high ideals and simple living and be the new Mother Teresa's and Father Damien's of the 21st centuary. I will not add my voice to the clamour.
Ladies and gentlemen , look out for yourselves. Take of the rose- tinted glasses and look about you all the hard work you put into your MBBS degree. Gone are the days when it could guarantee you a good life. Gone are days when you could win hearts and minds with your idealism and good intentions. It is a cold, hard world out there. "Winter has come"
We are the future. It is past time we fought to reclaim our respect and freedom from the forces that erode it from all directions. Miracles are expected of us. But we are sadly, only human. Unreasonable expectations build up in the minds of a fickle public have been fanned to such an extent that the slightest mishap or lapse is treated as an unpardonable sin. We are not Gods , we are not infallible. We are merely professionals striving to keep up with latest advancements, that are coming up at a bewildering rate.
The challenges facing the medical profession are many. The government is slowly stepping back from the health sector. Poor pay, red tape, outdated facilities, sparse recruitments and the unrealistic demands placed upon them drive talented doctors out of public sector.
70 years have passed since independence.. Where are our premiere medical research institutions? Where are the new drugs, monoclonal antibodies, antibiotics, developed in our country? Where are our mega clinical trials? Where are our disease registers? Is it a lack of talent? The country that build Mangalyaan, Chandrayaan, Arihant and Tejas is certainly not lacking in inventivesness. The country that made 'Buddha smile' is not lacking in will power. What is lacking is 'vision'. Active encouragement and resources are needed to attract gifted youngters and institutions into research that may take decades to achieve frutition. An open mind , a willingness to accept failure and learn from it has to be promoted .
In this, the goverment needs our advice. People who are currently active in research, academia and practice - those in touch with the ground realities of the day should work with the government and responsible bodies to bring about this change.
The medical curriculum needs to be streamlined and revamped . We dont need more and more entrance and exit exams. Thanks, but no thanks. Our heads are grey enough to begin with. Isn’t it time for an amalgamated seven or eight year course that would fully trained post graduated doctor? And shouldn’ we redesign our internship to fit in this time frame?
The doctor was once independent and the master of his destiny. Now, with the evolution of corporate health care, he is soon becoming an employee- subject to the whims and fancies of the administrators. His job security, a fable. He is being assessed in terms of profitability, productivity, ' targets' ,' conversion rates' and ' bed turn over rates' . If targets are not met, he is threatened with pay acts or dismissals. If he succumbs to these demands he is castigated by the keepers of ' social consciousness' a a , blood sucking businessmen withougreedyt an iota of social responsibility. We are the victims here, people if corporatisation is inevitable, it is the time we developed a class of doctor - administrators and a whole new set of yardsticks to measure doctor performance. Afterall, it is not a conveyer belt or an investment bank that we are operating.
Another field doctors are being victimised is by the law . Western standards, western algorithms, western protocols and expectations are being used to judge doctors practising, often in a resource and personal limited setting. They cannot be applied in indiscriminately in our setting. Where we are trained to go systematically from history, clinical examination, differential diagnosis and targeted investigations to reach a diagnosis; the current expectations is to perform a battery of test per protocol with no room for experience, interpretations, judgement or personalisation. You are 'damned' if you do and damned if don't investigate. The courts are bound to follow the letter of the law. The existing laws need to be adapted to realities of working in a resource limited, economically constrained setting like ours, with adequate consideration for the socioeconomic and cultural factors. This should be taken to mean that a dilution of the standards of care is to be advocated. This happy balance of the ideal and the practical can only be achieved of we give intensive, continuous education to the legislators, the intelligentsia and the legal fraternity. We have to push this agenda in the media, to reach this message out to the public. Only by building an atmosphere of trust and clear communication with the different stake holders shall we be able to bring about this change.
The first step towards bringing about a change should start with ourselves. We are an intensly competitive bunch eager to criticise our fellow practitioners. Often seen as superior, condescending and argumentative. This is how we have alienated other. This is why everyone so love to criticise a doctor.
Almost every medicolegal case, assault or complaint against a doctor has another medical professional - knowingly or unknowingly at its nucleus. We need to learn to function as a team. Working together, as a part of a hierarchy has to be - know, not taught - but drilled into our very souls to step those unseenly backbiting. If you think a fellow practitioner needs to be pulled up, go the appropriate bodies to sort it out. Your consulting room or wrd should never be the place fo that. Soft skill training should be made mandatory part of medical education. We have in our institution, teachers who are legends at man - and - materials management. Good news is - these skills can be learned.
How good a student will you be?
That is enough with the gloom and the doom. Take time to smell the roses and fell breeze. Spend time with your family. Invest in your health. Laugh. Dance. Have a hobby. Learn a martial art. Keep a pet.
Break new paths. Study. Research. Teach. Mentor your juniors. Inspire your students. Discover new things. Strive for authenticity. Push the boundaries back as far as you can. Care your names into the stone.
Best of luck on your new journey. It is a hard, cold world out there. Lets fight back together...
"Valar Dohaeris "
