Sunday, July 5, 2015

Why I will never allow my child to become a doctor in India


Guest article by Dr. Roshan Radhakrishnan
Increasingly, I find myself watching and talking to doctors across two generations and various specialties these days. And increasingly, a sense of despair and disillusionment is writ large in their words.

With 0.7 doctors per 1,000 Indians, the doctor to patient ratio is far below that of other comparable countries like China (1.9), the UK (2.8) and the US (2.5). Spain’s 4.9 seems like an absolute luxury in comparison.

What this means in layman’s terms is: In India, you are always going to be swamped with patients beyond the logical human capacity.

That, in a nutshell, is the reason why I will never allow you, my child, to become a doctor in India. Let me spell out all the reasons for you here.

You shall sacrifice your time, parents, spouse and child

Getting a 63-hour a week schedule (nine hours daily for seven days) is a blessing, and most of the young guns who join in fresh after post graduation know fully well that a 100-hour a week schedule is par for the course once you begin working.
And sadly, this is advocated, and encouraged by most hospitals, too. You would never allow a taxi driver to drive you for 24 hours continuously, but asking surgeons to do that every third day is fair game in India, apparently.

You might not be able to pay your rent in your 30s

A young surgeon working in one of the premier institutes in India spoke to me the other day. She had joined the hospital because of its awe-inspiring reputation across India, aware that the hard hours she put in would sharpen her skills and broaden her knowledge of the specialty. But a year later, the woman had lost that drive altogether.

Walking out of her home at 7 AM and returning home at 10 PM, just to fall into bed and then wake up again at 5 in the morning to restart the cycle, she wondered what was the point of it all. She was losing touch with her loved ones and had become a zombie, lost between the politics within the hospital and a total lack of social life.

All this for a handsome salary of Rs50,000 ($786) a month in Mumbai, which she knew would not buy her two nights in the ICU of the very hospital she was working in. There would be a pot of gold at the end of the rainbow, I wanted to tell her. She would earn more in her forties than her techie friends earned in their thirties, I could have consoled her. But I did not. Because I know how she feels.
Another doctor spoke out recently on a public forum, talking of his experience of doing six years of rural service for the government. When he finally left it two years ago, the man in his thirties had less than Rs15,000 ($236) in his bank balance with no extravagant purchases or trips to boast off.

He needed his parents’ help at that age to pay for his rent. It all came to a head when a shopkeeper revealed how his monthly takeaway was more than the doctor’s—without any risk whatsoever.

Your country has one of the lowest health budgets

In a country like ours where a major portion of the population hovers below or around the poverty line, having the support of the government is vital to our success. They need to make medicines more affordable at the very least.

Sadly, instead of supporting us, they decided to cut the budget allotted to health care by nearly 20%. This at a time when we spend a mere 1% on public health care in India, as opposed to 3% in China and 8% in the US.

You might have to die for your profession

This month, the Indian Medical Association confirmed that over 75% of doctors in India have faced some form of violence at the patient’s hands in India.

There are even instances of doctors being actually killed for following the law. When was the last time you saw a software techie being killed for not making an app properly?

The recent verdict in the Joseph Eye Hospital case brought the reality of the Indian mindset home to many doctors. Handing down verdicts of imprisonment to three doctors for the loss of vision of 66 patients, following an eye surgery camp, the judicial system showed an amazing lack of comprehension about what was going on. It does not need a rocket scientist to realise that a single trained doctor cannot make the same mistake 66 times in 66 different eyes on the same day.

The obvious answer to such incidence of mass endophthalmitis is in the use of unsterile solutions used—the unsterile part being a fault of the pharmaceutical company that manufactures the solution.
There is no way for a doctor to know (without opening every individual bottle and testing them) if the solution contains microscopic bacteria, just as there is no way for you to know if there are any in your coffee before drinking it. And yet, to please a crowd baying for blood and money, even though it was obvious the fault lay with the tainted solution, the doctors were sent to prison. Sounds familiar, does it not?

Remember the Chhattisgarh sterilisation deaths of 2014? Everyone knows the doctor’s name in that case. It was later proven that the fault was with the tainted medicines that were made in rodent-infested factories. So tell me, what was the name of the pharmaceutical company and what action has been taken against it since then?

You might not be able to deal with the malaise within

There are going to be doctors working beside you who will promote a medicine not necessarily because it is good, but because the pharmaceutical representative gives him a good incentive. And you will see that doctor taking home more than you do for doing the same work as you, and the devil on your shoulder will smile. He will positively grin, in fact, as you stare at the price of the new smartphone that is beyond your financial reach because social service and respect do not pay the bills.

There will be those who need to make back the money spent on getting an education—I hear certain post graduation seats now go for Rs4 crore ($0.6 million).
You will find doctors who are forced to do the extra procedure because, working in a private hospital, they need to answer to the heads above. They need to make a profit for their bosses who shrug as they remind you that if the hospital runs into losses and shuts down, the loser is the patient himself.

And when you think about it, they are right, are they not? Private hospitals (which still cater to a huge percentage of the population) need to make a profit to continue. If they shut down, the health care of the country would collapse in months simply because government hospitals would never be able to manage the volume.

You may not be able to deal with the imbecilic outsiders

You have ministers running tobacco empires who head committees on health and undo all the work of doctors by claiming that tobacco is good for health. You have self-proclaimed fakirs and saints telling you to raise the population manifold at a time when we are stretched at the seams due to overpopulation. You as a doctor are caught in the moral ineptitude of such politicians and film stars who never attend government hospitals themselves and yet decide how hospitals must be run.

As a father, you will find me as broadminded and tolerant as they get. You will have every opportunity to choose whether you want to retain your religion or change it based on what resonates within your mind. You will have every opportunity to choose the love of your life irrespective of caste, creed or even gender.

I will let you have every choice in life and I will be there to support you and guide you along the way. But I will never allow you to become a doctor in India. Because I did not raise my child for two decades just to watch her lose her sense of right and wrong, of humanity or worse, watch her die.