IS ALL REALLY WELL?? (PART I)

People are a big fan of a film star’s work, trying to emulate their life and principles. They are an icon for the general population. They should think well and do their homework before endorsing some product, movie or a T.V. show. When they become biased towards a particular story, or show its one sided version, it tarnishes their image in the minds of a lot of people. Speaking against medical practitioners on a commercial T.V. show is appalling, that too after taking a huge amount of money. It is supposedly just a doctor’s duty to do all the charity and social work.

As told by these “icons” of the society, private medical colleges charge a capitation fee of 40-50 lakhs for MBBS. No such story has ever been reported for engineering, architecture, law and management colleges, however tainted they may be. A trend has been started to target the medical fraternity.

It has been cited in one of the shows that since 2001, 31 government medical colleges have been opened as compared to 106 private institutions. Till date, there are a total of 152 government medical colleges in the country and 181 private institutions. The situation is not as grim as it is made to project. Only the time period which “suited” the show had been taken in to consideration. It is better to give no picture than to give an incomplete, incorrect picture. Almost 95% of all the private medical colleges in India are owned and run by politicians, there being a nexus between politicians and the Medical Council of India (MCI). The corruption by this nexus is to be blamed for the mess, and not the medical practitioners.

There was also a reference that doctors ask for 30% commission from pharmaceutical companies to prescribe their drugs. This is a baseless and unjustified statement, just to sensationalize the matter. This is as true as “All leading actors and directors compel struggling actors to spend a night with them” or “All lawyers taking money from both the parties in a legal battle” or “All chartered accountants teaching their clients methods to evade tax, and then passing on the information to taxmen for rewards”. There are a few “black sheep” in every profession, but labeling the whole fraternity is also not justifiable.

There has been a comparison on the numbers of licenses cancelled in England and in India. If the show’s research team is so resourceful, some more information ought to be compared too, viz. number of doctors being beaten up on duty by ruffians in England and India, and also the number of people convicted for such crimes; the stipend or salary, and accommodation facilities provided to the doctors of the two countries; the duty hours and working conditions of the doctors of the two countries; and the academic and research infrastructure being provided to the medical students.

It was quoted that the most brilliant students who take up medicine, should take it only for service to mankind, they should go to other fields if they want to earn. This is not an age of imperialism. Doctors are also authorized to earn and spend a good life. A doctor does not get any special discount on MRP of consumer goods, any school does not waive off its fees for a doctor's kid, a doctor does not get any special tax rebate, the people who attack doctors on duty are seldom convicted, a doctor does not get any discount on railway or airplane tickets, or petrol. The film stars do no good by promoting detrimental products and earning millions, and then expect a doctor to sacrifice his life and happiness.

A few “distinguished” personalities of the medical fraternity were targeted and asked whether they could do humanitarian work and earn at same time. This is just like asking the big shots of the film industry their income and generalizing it for every actor in the industry (even the junior artists). Just as there are only a few big names in the film industry, there are even fewer notable doctors who run their chain of Multi-specialty hospitals spread all over the country.

A doctor has spent five years of his life in graduating from a medical college. A person in any other field would have become a postgraduate in this much time and start earning. This is followed by three more years of post graduation, again to be followed by three more years of super-specialization. All these seats are so few with so tough competition, there tends to be a gap of a year or two in preparing for various entrance exams.

There is a talk of doctors to be working in rural and government hospitals after their study. The rural / government sector also needs help of engineers, lawyers and chartered accountants. Engineers are nowhere seen being sent to rural areas to design and monitor roads and industrial development. Lawyers are never compelled to work as public prosecutors before they can join some big corporate firm. Chartered accountants are not asked to work in CAG office and various other government financial sectors before joining some multinational giants. Government also wants that doctors should not immigrate to other countries without asking them. IIT/IIM students are never stopped before they flee to foreign countries for big fat salaries. There has almost nothing been done by the governments for doctors that can be considered special. It cannot even protect them from goons while on duty.

If only some research had been done to locate some real cases of medical malpractice or negligence and ferreted out the real incriminating evidence behind them, before presenting them before the people, there would have been done some real service to society. Moreover, instead of just presenting one version of what happened, it would have been most appropriate and fair to all concerned if there was, simultaneously or immediately after, given a chance to the medical fraternity to present their defense. This would have made it more interesting and lent the utmost credibility not only to the show but also to the “star’s” image and intentions. It is not too late even now for this to be arranged in one of the forthcoming episodes.

ROAD TO SUCCESS OR A BLIND TUNNEL??

Dentistry is no longer just the pulling out of teeth, but an emerging branch of medicine with the emphasis on conservation of tooth, replacement of teeth with life-like appearance, relieving a person’s pain and improving his smile. In ancient history of Indian medicine and ayurveda, dentistry was having its existence as a part and parcel of medicine for good health. Despite the pace at which dentistry is moving forward the biggest fact still remains that the new brigade of budding dentists is in a dilemma.

Dentists are amongst the 5% highest paid professionals in the western world, whereas in India they are struggling to earn a decent livelihood, baring a few. Although, there is a high burden of oral diseases in the country but there are few job opportunities in India, amounting to stress amongst the dental students.

Dental education has been regarded as a complex, demanding and often stressful instructive exposure, involving an acquisition of required academic, clinical and interpersonal skills during the course of learning, with a dental college known to be a highly demanding and stressful learning environment.

Common sources of the stress to the students include meeting the requirements of the curriculum, achieving good grades, fear of failing, approachability to the staff and patients being late or not showing up for their appointments. Other causes include change in sleeping and eating habits, an increased work load and new responsibilities and stress about finding a good job after graduating.

The duration of Bachelor of Dental Surgery programme is of five years, governed by the Dental Council of India. The fee for studying dentistry is the highest for any undergraduate programme next only to medicine and as compared to medicine, although there is a high burden of dental disease in the country, there are currently hardly any job opportunities for dentists in India. A main reason for this is that there is no oral health policy in India at the national level, and in many states there are no dental services provided under the public health sector. Consequently, job opportunities for fresh undergraduates are solely concentrated in the private sector, leading to an increased competition, thus limiting the earnings.

High levels of stress may result in mental and/or physical ill health, substance misuse, absenteeism and diminished efficiency at work or learning, quite evident among dental students, which is higher even when compared with other students of health professions.

With increasing awareness amongst the urban population and the stiff competition that dental graduates face, there has been an increase in the number of aspirants for postgraduate courses. A heavy competition exists to achieve admission for postgraduate studies, leading to an increase in the number of unemployed dental graduates. The number of seats available for M.D.S. is only around 3,000 compared to 25,000 B.D.S. students graduating every year. Dentistry is regarded as a flourishing industry in the western world, and the budding Indian dentists are in stress.

Majority of the dental graduates, given a chance, would like to migrate to other countries. The reason for migration is the monetary benefits that the dentists get in most of the developed countries. The facilities in the developed countries are more advanced, easily accessible, and promising as compared to those available in India. Those aspiring to rise in research and academics also prefer to go abroad.

Increased awareness of Indian patients has also raised their expectations from the dental practitioners. Awareness about the dental education among Indian population has also decreased the charm of B.D.S. degree alone and more number of patients tries to consult a specialist for their problems. But the disappointing ratio of number of post graduation seats to the number of fresh graduates passing out is a bottleneck in the career prospects of a dentist. A large number of candidates also want to go for government jobs, but are disappointed due to very limited vacancies.

The National Urban and Rural Health mission programmes provide effective health care to the rural as well as poor urban population, especially the disadvantaged groups including women and children, by improving access, enabling community ownership and demand for services, strengthening public health systems for efficient service delivery, enhancing equity and accountability and promoting decentralization. These programs are not only beneficial for the people but also provide employment to healthcare professionals. Unfortunately, there are no such programmes for oral and dental healthcare. In a country where 60% have never visited a dentist and 75% of people clean their teeth only once or less than once a day, such programs are a must.

A number of changes need to be considered in the curriculum of dentistry. Students wishing to study dentistry should be exposed to the nature of the profession and the study environment prior to applying to this program. There should also be a provision of an entrance interview to evaluate the candidate’s interest and suitability for the course. Dental colleges should collaborate with educational experts in designing and developing a curriculum structure which is more student-orientated, aimed at enhancing the students’ psychological well-being whilst maintaining a focus on academic and clinical performance and producing graduates with a positive professional attitude. A stress reduction program could be implemented. Such programs for dental students as including specific courses, stress-reduction sessions, introduction to behavioural sciences and faculty incorporated advising systems foster coping behaviours that are useful on a daily basis, as well as preventative measures to reduce chronic stress effects.

It is now time that the policy makers of Indian health system like the government of India, various state governments and the dental council of India look into the matter to increase the number of M.D.S. seats in government as well as private colleges under government quota; create jobs in the government, private and semi-government sectors; conduct orientation courses regarding future prospects in various dental colleges of India, create counseling cells in each and every dental college to combat stress amongst dental students, and launch programmes similar to National Urban and Rural Health missions for dental and oral healthcare.

WE TOO HAVE A LIFE!!!

The position of a doctor, not everybody knows clear;

We live in this society, in terror, horror, fear…

You want us to prepare for you, bills that are phony;

Bogus reports, fake postmortems, and everything that fetches you money…

You want us to give your unborn daughters death;

Not letting them come into the world, going away without a breath…

You take junk food, drugs and things, making your body waste;

Then expect us to cure you, our treatment to be all chaste…

You know not a thing about, our science so tall;

Read a bit from somewhere, think you know it all…

You know not that all these years, we have toiled so much;

Not knowing hunger, night or day, or things like such…

Not taking one to hospital, who’s injured on the way;

And tall claims about humanity, is that what you’ve got to say???

Leaving your ailing parents with us, and then starting to avoid;

Expecting us to be there round the clock, to fill up the void…

You treat us like a God, when the need is there by you;

Then why do you create a scene, when we demand our due??

A tip of hundreds in a hotel, you find paying it correct;

A doctor’s fee on the other hand, you always seem to dissect…

O people, wake up, look in the mirror;

Is that how you treat, your delightful server??

We people are silent, by choice and not by chance;

If we go away for one day, your life would just lance…

We just urge you to treat us, in a way that is right;

We want to serve you all, do not want to fight…

Pay  no heed to people who want to cause strife;

After all we are also humans, and WE TOO HAVE A LIFE!!!

DOCTORS OR CALL CENTRE EXECUTIVES??

The practice of sharing their phone numbers in compassion for a patient, coupled with utter lack of tele-etiquettes in the Indian society has given many doctors the worst nightmares of their lives. There are calls to enquire about diet, medicine doses, appointments, and, of course, whenever the patient "wants to cry" in the middle of the night.

Surprisingly, the illiterate and poor never disturb unless an emergency, it's the uber rich, and “hyper-educated” who think of even so much as a sneeze is a medical emergency. There are some very respectable exceptions, very well mannered patients who message and await answer. But then, there are those who email and message, all at the same time, and then keep on asking for reply. Or worse, they keep on calling till one replies.

All this is more pronounced especially on weekends. A doctor gets this precious little time with family and for self, and this time must not be claimed, unless an emergency. There are regular Sunday e-mailers, and also those who keep on sending incessant messages on internet messengers every day, starting 6 a.m., right from greetings to jokes to anything. Just because it does not cost anything, except the privacy of someone who rarely gets time for self or family. There are many who do not know that phone calls are supposed to be short, and do not replace a full-fledged consultation. And many times, this may be followed by, “Could you please message me because I might not remember.”

The tendency to avoid "consultation / visiting fee" by simply making a phone call has become a very common practice. The biggest joke is that the patients tell doctors that they are so busy that they CAN NOT come for their own check-up, and then ask the doctor to go through their 4 page emails, reports and “get back” to them. Patients in the western world wait for months to see a specialist, the Indian rich make the specialist wait for follow up. They are busy till they drop and then want the doctor IMMEDIATELY THERE. In contrast, poor and illiterate patients do follow up and get on with their life at the earliest.

No patient who calls, messages or e-mails for consultations has the courtesy to ask upon meeting about the charges for tele-consultation / e-consultation. It is a presumed-free service added to the list of a doctor's duties, as expected by the society.

Doctors give numbers to patient as a "help" in case of any emergency, and NO doctor in the world is afraid of receiving a call for true emergency, whatever the time may be. But it is seldom in cases of emergency that this “facility” is used. Also, there are those whose kids / parents are sick for days, and they only remember to consult a doctor on weekends, when a doctor “tries” to spare some time for himself / family.

The attitude is that what difference one phone call can make. Most of the people don't know that such "one phone call or message" not only disturbs the routine of the doctor and creates a negative impression of the patient in the mind of the doctor, but also breaks the thought process the doctor is supposed to be having while examining a patient, which is crucial for a correct diagnosis. This phone thing is one major reason why the doctor-patient bond is disturbed. To add to this, there are patients whose phone keeps on ringing while getting examined by the doctor, and they MUST pick it up and talk.

Few people know that the calls and messages of an average doctor exceed a hundred per day. Even trivial enquiries such as whereabouts of the doctor, taking an appointment time, bargaining the fee, enquiring about the address, continuous commentary about a patients activity ("He didn’t sleep well" or "He is not talking much today") to a running commentary of patient’s whereabouts ("We have started from our home’, " We have reached your clinic" and "We have been waiting for 15 minutes" etc.) are made on phones. Above all, people are not happy to talk to anyone else except the doctor. They have to speak to the doctor himself, even if there are receptionists, assistants etc.

For doctors, it is like a crime to spend some time to connect with friends on social media even on weekends or nights. Just as one opens a social networking site, there are a few more consultations in waiting. Being stalked by patients ultimately results in never being able to get connected on these sites. Very little number of patients respect a doctor’s privacy.

Every near and dear one of the patient, in order to show his care and affection, tries to have a word with the doctor. After all, it is, and would always remain……. FREE.