Saturday, August 22, 2020

Medical profession at cross roads?

 For some years now, the medical profession's esteem has taken a nose dive in the eyes of the general public. There have been many instances of abuse both verbal and physical against doctors. There is a perception with some justification that the profession is not living up to the expected ethical standards. Once much loved profession has now become a service which the public perceives as one which exploits the sick. Perception and truth are two different entities. As one doctor involved working in a corporate hospital told me some time back, that only 10% of the total bill amount actually goes to the treating doctors, but as they are the visible arm of the institution, the patients ire, if there is real or perceived mishap, falls on the hapless doctors. Adding insult to injury the craze for specialisation and super specialisation has resulted in a surfeit of these and they are concentrated mostly in urban areas where most of the tertiary care institutions are located. Now, if you consider that only 2 to 5% of the ill need their attention and that these doctors in the corporate health care vie for the upper middle class and the wealthy sick, it comes to even smaller numbers. The corporate honchos are in a position to dictate terms as there are too many of these super specialists vying for the few available posts. Naturally ethical medicine takes a back seat and revenue generation takes the front.Thus most doctors really work under duress and often forced to compromise ethics and there fore many are an unhappy lot.

The same is true in the public sector. Here too the doctors are unhappy as they are under the thumb of beurocracy that is often very ignorant of matters related to health. Working under often appalling conditions, with no hope of improvement in the working and living conditions, these doctors too are an unhappy lot.

Now arrives the Covid virus pandemic and the societal response to wards doctors and other front line workers is far from encouraging. Instead of whole hearted moral and material support, the citizenry seem to consider them as carriers and spreaders of the illness. Except a few among the politicians and beurocrats, most others think that doctors are like dogs who can be whipped to perform. Given the magnitude of the problem and the many decades of neglect of public health and primary care, the battle against the virus is fought by primary care and public health doctors who are not adequate in numbers and receive little support unlike the situation in the hospitals where the conditions are somewhat better.

Given this generally prevailing melancholy, will medicine attract youngsters as a career choice in future? Earlier days there were two classes of young who wanted to become doctors. One is the motivated who would want to become doctors with the aim of service and money was secondary [not always true], the other was the young progeny of the wealthy or who are going to inherit established medical institutions after their graduation [also not always true]. The latter gravitated mostly towards fee and donation run private medical colleges. what will happen now? With no social support and respect, stigmatised, under intense pressure from all quarters, will not an youngster and his family think twice before venturing to take medicine as a career choice?

My impression is that the clamour for medicine will drastically come down in both public and private medical colleges and am afraid quite a few will be forced to close down, more in private and less in public. In a way it may be good as only motivated young will take up medicine as a career and hopefully service in our government run primary health and speciality health care will improve.

 Interesting times ahead.

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