We paid for our lunch

At last this old fool is showing signs of growing senile; you may feel when you read this caption. Who else will pay you may think, I don’t blame you if you do so. But we doctors are special. We allow others to pay and that is why I thought it is worth writing about this lunch when doctors attending the meeting [actually the association of ours] paid for the lunch before the CME [continuing medical education] programme.

It was in 1980, more than thirty years ago, That I along with a few of my friends started an organization which later came to be known as family physicians association[FPA], entirely devoted to the CME needs of family physicians then called general practitioners [I still like that name]. Was there no such body to look after the learning needs? There was the local branch of the Indian Medical Association. But they never were able to understand that GP is funny kind of specimen who needs special education and this is spread across all specialties. He is not interested in the intricacies of how an MRI machine works but only wants to know how to differentiate a cyst from a solid tumor. If the learned speaker teacher spends an hour explaining how the MRI works, he can be rest assured to hear loud snores from the audience. Mine and other’s attempts at getting the august body of the IMA see reason failed and that made us after nearly five years of struggle, to go ahead and start a new organization with a small number of twenty doctors. This steadily grew and now it has on its roll six hundred!

Initially we met at the local medical association’s premises where we didn’t have to pay rent and managed the expenses of a cup of tea and biscuits from our own pockets. Soon the association asked us to pay rent. This meant our expenditure went up and also the expectations of our members who by now had begun feeling that a tea meeting left hem hungry and wanted to have something more substantial to eat. They came from different parts of the town and some went straight to their clinics from the CME and naturally a lunch was preferable to tea and biscuits. But who will pay for this?

By now, the original manageable, like minded twenty had grown and the members felt there is no harm in getting sponsorship. My advice then that it is better we pay for our lunches and for hiring the meeting place fell on deaf years. Sponsorship meant approaching Pharma companies and at that time FPA was not well known and did not have the clout which it has now. This meant us [office bearers] going with a begging bowl requesting sponsorship. What was difficult became increasingly easy and members got used to eating free lunch. Then why is this sudden desire to pay and learn?

Let me tell you a real life story which will make you appreciate why. I had a medical school friend who came up the very hard way. His initial years were very difficult and he had no money to pay for his daily needs and his education. He had to entirely depend upon the goodwill of his donors for this. Some paid his school fee, some his lodging and some for his food. The last named was according to him was most demeaning. He would go a house each day for his mid day meal. Some households received him with courtesy and tried to make him feel at home. Some would feed him only after the entire household was fed and some would give him previous days left overs. Very few thought he had a right to self respect. Beggars are no choosers and my friend was a kind of beggar. Receiver of help is always at a disadvantage and in most cases your self respect is at stake. Though my friend became very successful later in life he never would forget the indignity of this free meal.

Then am I right in comparing this with the four course lunch that Pharma companies give us in the sponsored CMEs? I see no difference. At least those who fed Satya [my friend’s name] did it without expecting anything in return. They were thus more altruistic. Whereas Pharma companies expect us doctors to help them to sell their products. Even if one does not do that they know when their sales person meets the doctor he will be received well. This is a perfect example of you scratch my back and I yours. As they are interested in product promotion it was often difficult o have the CME unrelated to product promotion. So the sponsored education remained lopsided. Nevertheless I like many others felt lopsided education is better than no education but the desire to free us from this dependence on Pharma companies was always at the back of our minds [though not all of us!].

Five years ago we took a decision to make the participants of our CME programme to pay a small sum of Rupees fifty [less than a dollar] as a registration fee. There was a mountain of protest. Many came to me and castigated me for having forced them to pay what was earlier free. Their argument was that the sponsor who pays for the programme and lunch does so because he benefits from this either directly or indirectly and who are you [I] to spoil this perfect I scratch your back and you scratch mine arrangement.

Logic almost always defeats reason. It never occurs to us that there is dignity in paying for our learning especially when we can afford to do so. But the logic that when there is someone else who is paying why go and upset the apple cart is still quite strong.

So a beginning has been made and a compromise has been arrived at. We will not go and ask for sponsorship. If someone comes along and sponsors on our terms [speaker and subject of our choice] don’t say no. If none comes forward then pay from your pocket. This is what we did.

We paid for our lunch!