THE UGLY TRUTH ABOUT INDIAN DENTISTRY

Dental education in India was established around a century ago, when the first dental college was started in Calcutta by Dr. Ahmed in 1920. Diseases such as tooth decay, gum problems, poor oral hygiene and oral cancers have always been major public health issues in India. It is well known that poor Socio-economic Status (SES) provides negative impact on favorable dental health awareness, attitude and oral hygiene behavior. Only in the last two decades dental industry has emerged as a field independent from general healthcare. Moreover, efforts of various organizations like World Health Organization (WHO), Indian Dental Association (IDA) and Dental Council of India (DCI) to increase awareness of oral hygiene have provided major contribution in establishing today’s developing dental industry.

The Indian healthcare industry is experiencing quick transformation owing to the increasing demand for quality healthcare. With the ever-increasing standard of living, people in India are becoming health conscious, shaping a new market which is giving increasing importance to healthy teeth and dental cosmetics. The potential size of India’s dental market is vast, and India is slated to become one of the largest single country markets for overseas dental products and materials, with a yearly growth rate of nearly 10%.

This huge market of dental industry in India has also made a remarkable impact on the dental education. The dental colleges providing bachelor’s degree in dentistry (BDS) have grown in number with consequent increase in the number of dental graduates. Currently, 296 DCI recognized Dental colleges exist with total intake capacity of around 24,000 students per year (as per the information provided on the official website of DCI). Among these, only 40 colleges with total intake capacity of 1,500 students are government colleges, rest are in private sector. This scenario demonstrates the impact of commercialization on dental education.

Despite the role of private sector in the growth of Indian dental education, there are certain issues regarding quality of education provided by private dental colleges. Unfortunately, many of the colleges have less than adequate infrastructure. There is evidence that many dental colleges are short of staff. Faculty members in many dental colleges are engaged in private practice with comparatively less time to devote to teaching. This may well result in less than adequate practical training for students. Often, students in private colleges lack the necessary clinical exposure, and hence are not properly trained.

From a student’s perspective, the demand for dental courses is going down with each passing year, while the interest in medical education remains unaffected. This situation shows the lack of interest particularly in dental education rather than overall healthcare system. In spite of such a great promise of growth in dental industry, quite a few dental seats have remained vacant in past few years, showing lack of interest of students in dental education. The entrance examinations are common for all the medical, dental and paramedical education including nursing, physical therapy, pharmacy, and occupational therapy. Typically, the order of preference for students is medical followed closely by dental and paramedical courses. One can say that, students select the dental education by force and not by interest, as they are not getting admission in medical course.

The distribution pattern of the dental colleges across various states of India is also very uneven, leading to unequal distribution of dentists across the states affecting their dentist-population ratio.

An increased level of awareness among patients has raised their expectations from the dental practitioners. Awareness about the dental education among Indian population has also decreased the charm of BDS degree alone and more and more patients try to consult a specialist for their problems. This is the reason why the aim of dental graduate is to get the master’s degree (MDS). But the number of seats available for MDS is only around 3,000 compared to each year pass outs of 24,000 BDS students. This is a big bottleneck in career prospects of a dentist.

Dentistry is one of the highest paid professions in developed countries but the situation is not same in India. Opportunities for dental graduates are limited. Jobs in government sector are few. With each new hospital opening it creates only a handful of jobs for a dentist as compared to many jobs for medical graduates. The salaries in private hospitals are also less, with most Private hospitals and clinics offer a fresh dental graduate a meagre amount of less than Rs. 10,000 per month for a full time job.

Private practice in dentistry is more fruitful than being attached to dental hospitals or clinics. Working at dental hospitals provides fixed income with slower annual growth compared to private practice. Hence, private practice is the dream of every dental graduate. However, the investment for establishing a competent dental clinic is quite high due to expensive equipments.

Due to the above stated reasons many of young graduates after failure to get admission in MDS seats feel confused and try to search other alternatives for career growth. Some look for overseas where after an initial period of struggle, the opportunities and returns are better, with countries like USA, UK and Australia being popular destinations for dental graduates. Most of these countries will require clearing a licensing exam and few years of study.

Courses like Public Health, Healthcare Management, Clinical Research and Administrative services are also becoming popular with dental graduates where better opportunities await them in the corporate health care and pharmaceutical companies. Once absorbed, they need to compete with the people of various non medical undergraduate streams and their dental education becomes unused.

The dentist-population ration in India is 1:15,000 against the 1:7,500 recommended by WHO. The ratio in urban areas is 1:10,000, and is close to 1:2,50,000 in rural areas. The major missing link causing this unfortunate situation in a country is the absence of a primary health care approach in dentistry. It is often difficult for the poor urban and the rural population to get access to emergency care. Community oriented oral health programs are seldom found, with no dentist found in Primary Health Centers (PHCs) and Community Health Centers (CHCs) in most of the states.

All the above mentioned factors cannot be taken care of immediately, but the government, both at the central and the state levels, should take some prompt steps to address the above mentioned problems.

First of all, the dental entrance exam should not be linked to the medical admission exam but should be a separate exam by itself. Having a separate exam will definitely bring students to the dental college who are really interested in the dental profession. Also, the number of post-graduate seats should be increased so that there is enough motivation that students do not become averse to this profession.

More dental units in government hospitals should be established, along with posting dentists at all PHCs and CHCs across the country, along with creating more job opportunities by the government through state public service commissions, under National Rural Health Mission to serve in rural areas, under Rashtriya Bal Swasthya Karyakram (RBSK) for early child disease detection, anti-oral cancer and no-tobacco campaigns and school dental health programmes.

Dental graduates can also be used as a back-up choice in case of non-availability of medical graduates, having gone similar rigorous training. Currently the government is using AYUSH workers as second choice, who are not even allowed to prescribe medicines. Dental graduates and AYUSH workers working together could be of a greater aid in improving rural healthcare. Also, as with Medical Officers (MO) and MO (AYUSH), the government should create posts of MO (Dentistry), along with making dentists eligible for Block Medical Officers (BMOs) and Chief Medical Officers (CMOs) to ensure that there is no disparity between medical and dental graduates, with separate directorates of dentistry should be made for every state so that proper policies can be framed.

Unless some drastic measures are taken, the situation may well go out of hand, and then it would be too late to put things back together.

WHY DO DOCTORS CHARGE WHAT THEY DO??

It is a fact that doctors are willing to work long hours for patients, whom they do not know, for an income that is not bad, but is much less than other professions command. Many people admire the fact that doctors are willing to work for 24 hours at a stretch, sometimes getting up in the middle of the night for emergencies. It can be an arduous lifestyle that can disrupt any person’s personal life, something that one cannot compensate for even with money.

On the other hand, quite a few patients also feel that doctors charge too much. They envy the cars that some doctors drive and the fact that they might take off an occasional week to travel abroad. Many resent the fact that they have to pay thousands of rupees for procedures that take just a few minutes.

Also, it is a well-known fact that the fee charged by doctors can vary considerably, not only from doctor to doctor, but from patient to patient as well. It remains one of the greatest mysteries of medicine for patients that why doctors charge what they do.

People would tend to be much happier if medical costs were transparent. The truth is that the amount that doctors charge can sometimes be a mystery even for doctors themselves. Many doctors are not very good business people, and the inconsistencies in the fees they charge reflect that.

Since doctors are used to working for free or very low wages during their medical training, young doctors often are quite uncomfortable collecting fees for their professional services when they start practicing. Most doctors use market criteria to set their fees and charge what other doctors are charging, which can be a useful rule of thumb.

Many doctors, who are idealistic when they are young, charge enough to make a comfortable living so that they can cover their expenses and still have enough to keep the family happy. This is simple to do in some cases, but extremely difficult in others, where doctors often start their practices often owing lakhs of rupees in debt as loans to pay for their medical colleges.

Even some experienced doctors who are financially quite sound and willing to charge just enough to cover their costs, enough to cover their staff salaries and other costs, but often end up underpaying themselves. Ironically, even though these doctors charges less because they feel that they don’t need much money to be contented, it often mistakenly conveys to patients that the quality of services may not be as good. This is the reason it is quite common to see an escalation of prices.

Once a doctor in a region increases his fee, the others often do so as well. Conversely, if one doctor drops his prices, others will do so as well in order to stay in competition. Doctors who are ably business minded take a practical viewpoint. They conduct a market survey to determine how much patients in their community are willing to pay for their services and set their prices accordingly.

Some doctors deliberately charge higher fees than the competition, especially the senior, more experienced doctors, who often feel that they deserve the additional income because of their experience and expertise. Others do so because they want to create an air of exclusivity about them, because they know that patients often misinterpret high fees as being equal to a better quality of service. This approach is especially prevalent in fields such as cosmetic surgery. However, a higher price is not always better and on the other hand, a lower fee does not always mean a bargain either.

In developed countries such as the United States where third-party payers dominate the market, the ability for doctors to set their own fees is practically zero. They pretty much have to charge what a government-run insurance plan or private payer is willing to offer. As medical insurance becomes more common in India, this trend may become more common here, too, with the insurance companies starting to call the shots.

While many doctors pride themselves on their professional skills and take pride in the fact that they are not bothered about money, the fact remains that medical private practice is also a business, and unless doctors learn how to charge the right amount for their services, they often end up underpaying themselves.

In the long run, undercharging for one’s services may mean that a doctor would not be able to invest in updating his professional skills or buying state-of-the-art equipment, both of which can enhance the medical care that he provides. He could then put himself at a risk of losing his valuable patients to corporate hospitals, which are extremely good at maximizing their profits.

It is important to find the right balance so that one can enjoy his financial income as well as his emotional income. Earning money is not a sin just because a person is a doctor, and if a part of the revenue that one brings in is used to improve patient care, it’s a win-win for both the doctor and his patients.

OPENING A NEW CLINIC: TO BUY OR TO RENT??

In this world, a correct timing is everything, and doctors starting a new medical practice are no exception. Whether one is are opening his first clinic following graduation, launching one’s own practice after working as an employee in a hospital, or relocating to a new area, it pays to look before one leaps.

To decide whether it would be best to buy or rent one’s clinic space, it is important to assess where one is at the particular moment in his career, how long one plans to remain in the area where he is starting his practice, and to review one’s personal and professional debt and financial goals.

If one is planning to purchase property to start a clinic, one should focus on reducing other liabilities such as other personal debt before securing a loan for the clinic. In addition, before committing to a rent agreement, one should review his short-term and long-term financial goals and create a roadmap to achieve them. This is because along with loan repayments, there needs to be a plan in place to meet one’s goals of creating education funds for their children and a retirement fund for themselves. Some younger doctors are able to purchase property early in their careers because they continue to live in their parents’ home when they start practising, allowing them to save more of their income while accumulating less debt.

Doctors who launch a medical practice in a metropolitan city may be shocked by the high cost of both buying as well as getting a property on rent. While many doctors would prefer the investment of buying property to open their clinic, it may not always be feasible, as from a financial point of view, buying property to open a clinic right at the start of one’s career is not very cost effective. A few doctors might also be fortunate enough to have their either or both parents as doctors. So they can also move their practice into the existing facility.

Doctors might also consider an unorthodox option, such as launching their practice in a “polyclinic.” A polyclinic is an office with multiple rooms shared by several doctors, practicing in a particular time slot. One doctor may occupy a consultation room for a few hours. Then another doctor, specializing in some other area would see his patients in the next time slot. This also allows for a doctor to visit a number of places, thus increasing his own practice as well. This is emerging as a trend in most of the metropolitan cities, where acquiring space for oneself is so expensive.

A polyclinic arrangement creates an informal group practice arrangement. Advantages of this structure also include faster and more convenient specialist consultations, which improves patient care. Doctors also share staff and receptionist, which helps reduce operational costs.

Most doctors look for space to buy or rent through friends, patients, and relatives. It is very tempting to cut corners to save money when one is starting his practice. However, this often turns out to be a penny-wise, pound-foolish approach. Whether one decides to buy or rent clinic space, it is always better to find a professional real estate firm to help with the search. The added expense would always be worth the investment.

Landlords are, more often than not, fickle-minded and many times, when they know that the tenant is doing well professionally, are not averse to arbitrarily increasing the rent, with an attitude “accept the new terms or go”. Although there are regulations for lease transactions, addressing a grievance with a property owner still can be a long, drawn out process. If one decides to pursue a leasing arrangement, real estate professionals have relationships with building owners who would tend to honor contract terms.

If one plans to open a clinic in a residential complex, permission of the local residents needs to be obtained. The management committee that governs the housing society may be reluctant to give this permission because the local municipality would then treat the building as a commercial premises and increase the taxes. These taxes are charged directly to the societies, and therefore the cost has to be shared by all of the residents. Moreover, if the management committee changes, the new governing body may reverse the permission that one had received, and one would have to relocate the clinic.

For the long-term, buying property for the clinic, although more expensive, is often in the best interest of one’s clinic. If one is just starting out and has limited funds, he should keep his costs low and save as much of his income as one can to secure an affordable loan from a reputable lender in a few years.

Often, owning one’s own clinic represents an investment in land, which many doctors feel is secure and tangible even though it may not be financially cost effective in the early stages. It also gives them a lot of peace of mind that the clinic is in their own name.

LOVE THY PATIENT: A DOCTOR’S DUTY

A few weeks ago, the author wrote about how to keep one’s doctor happy. The current article now focuses on how it is a doctor’s responsibility to love his patient’s as well. As it is a give and take phenomenon, it might not look like it is very hard to make patients happy. Although, sometimes there can be issues with patient satisfaction, and at times, it can be nearly impossible. It all depends on the doctor’s own inner life as a medical practitioner and a human being. The key to medicine, to be a beloved doctor, is to love one’s patients.

But this often can be a huge task. People can be remarkably difficult to love. They are often angry, uncommunicative, cruel, manipulative and even tend be dishonest with others (not just about the patients, but in general) Humans resist love almost as fiercely as they desire it. They push one another away with profanity. They tend to anger each other with their attitude, until someone lashes out, reminding one of a basic frailty in human beings.

The question which arises in a doctor’s mind is how to do it, to love these people, especially when they come to a doctor in the chaos of his work in the clinic or hospital or to love them when a doctor is weary and a patient has strange complaints in the middle of the night. After all, it is not easy to love somebody who, despite the doctor’s suggestions on all of his previous visits, continues to ignore the advice, not take his prescriptions and not change his lifestyle. Sometimes it feels like it is impossible to love one’s patients.

It all depends on one’s perspective. According to many, loving someone can mean having warm emotions for that person, feeling good about someone or having a satisfying relationship with someone. If that were the case, loving someone would be very difficult, because people in the modern times have reconstructed and deconstructed the word love until it is barely recognizable.

Everybody wants love to be a feeling he has, when in fact, love must be an action to show. When someone’s children are loud and disobedient, when they scream and throw tantrums, it is often difficult to feel good about them. But the person still feeds them, bathes them, sings to them, and puts them to bed with kisses in hope of a better day, one in which the terrible phase has passed.

Whatever a wife feels about her angry drunk husband, a father about his unrestricted college-going son, or people about their manipulative relatives, when they behave with competence, when they do what is right, and seek the best for such people, they show love for them. This is love borne of action, and not emotion. This is the love that is, in some ways, more steady and true.

Similarly, for a doctor, this way, a cycle is born. When a doctor acts towards a patient with competence, it shows the doctor’s love towards the patient. And when the doctor does that, he learns in time to see the patients less as numbers and more as people. An unbelievable thing then happens. Patients start loving the doctor back, making the magic happen.

Doctors talk to their patients, the patients talk to the doctors, and they come together. A Doctor asks patients about their family, and the patients ask him about his. He inquires about the reason of their sadness, and they tell him things that can shake one to the core and reminds of how one can have nothing to complain about when held up to their life story of neglect and loss. And because a doctor listens (sometimes even hug them or pray for them), they know a doctor is human, too. And they come to love the doctor even more.

In time, one can find new, wonderful ways to love. Over the years, one can learn that everyone wants to hear how beautiful one’s baby is, because every baby is, for the parents, the most beautiful one in the world. Children, generally considered afraid of a doctor, can also recognize this love. They also can then look at the doctor, smile, and reach for the doctor to hold them. And the doctor is also the recipient of thousands of blessings.

This way, a doctor also tends to get less and less bothered by little things. A doctor too likes to drink his tea his tea while it is still hot. A doctor still gets annoyed when he is busy. But a doctor is a work in progress. If a doctor can order a cup of tea for his patient while having his own, he should. One tends to have a wonderful time when life moves on smoothly and the doctor sits back and hears an occasional patient’s life story or tell a joke. This way, the love grows. By acting in love, love increases.

Love is not a thing to be taught in the classroom, and there is nothing in the world that can measure it. It is impossible to apply evidence-based evaluations to love. But once a doctor allows it to start and carry forward, it would only grow more and more. And the doctor’s satisfaction scores would probably go up too.

THE LOSING SHEEN OF DENTISTRY

Dental education in India was established around a century ago, when the first dental college was started in Calcutta by Dr. Ahmed in 1920. Diseases such as dental caries, gum problems, poor oral hygiene and oral cancers have always been major public health issues in India. It is well known that poor Socio-economic Status (SES) provides negative impact on favorable dental health awareness, attitude and oral hygiene behavior. Only in the last two decades dental industry has emerged as a field independent from general healthcare. Moreover, efforts of various organizations like World Health Organization (WHO), Indian Dental Association (IDA) and Dental Council of India (DCI) to increase awareness of oral hygiene have provided major contribution in establishing today’s developing dental industry.

The Indian healthcare industry is experiencing quick transformation owing to the increasing demand for quality healthcare. With the ever-increasing standard of living, people in India are becoming health conscious, shaping a new market which is giving increasing importance to healthy teeth and dental cosmetics. The potential size of India’s dental market is vast, and India is slated to become one of the largest single country markets for overseas dental products and materials, with a yearly growth rate of nearly 10%.

This huge market of dental industry in India has also made a remarkable impact on the dental education. The dental colleges providing bachelor’s degree in dentistry (BDS) have grown in number with consequent increase in the number of dental graduates. Currently, 296 DCI recognized Dental colleges exist with total intake capacity of around 24,000 students per year (as per the information provided on the official website of DCI). Among these, only 40 colleges with total intake capacity of 1,500 students are government colleges, rest are in private sector. This scenario demonstrates the impact of commercialization on dental education.

Despite the role of private sector in the growth of Indian dental education, there are certain issues regarding quality of education provided by private dental colleges. Unfortunately, many of the colleges have less than adequate infrastructure. There is evidence that many dental colleges are short of staff. Faculty members in many dental colleges are engaged in private practice with comparatively less time to devote to teaching. This may well result in less than adequate practical training for students. Often, students in private colleges lack the necessary clinical exposure, and hence are not properly trained.

From a student’s perspective, the demand for dental courses is going down with each passing year, while the interest in medical education remains unaffected. This situation shows the lack of interest particularly in dental education rather than overall healthcare system. In spite of such a great promise of growth in dental industry, quite a few dental seats have remained vacant in past few years, showing lack of interest of students in dental education. The entrance examinations are common for all the medical, dental and paramedical education including nursing, physical therapy, pharmacy, and occupational therapy. Typically, the order of preference for students is medical followed closely by dental and paramedical courses. One can say that, students select the dental education by force and not by interest, as they are not getting admission in medical course.

The distribution pattern of the dental colleges across various states of India is also very uneven, leading to unequal distribution of dentists across the states affecting their dentist-population ratio.

An increased level of awareness among patients has raised their expectations from the dental practitioners. Awareness about the dental education among Indian population has also decreased the charm of BDS degree alone and more and more patients try to consult a specialist for their problems. This is the reason why the aim of dental graduate is to get the master’s degree (MDS). But the number of seats available for MDS is only around 3,000 compared to each year pass outs of 24,000 BDS students. This is a big bottleneck in career prospects of a dentist.

Dentistry is one of the highest paid professions in developed countries but the situation is not same in India. Opportunities for dental graduates are limited. Jobs in government sector are few. With each new hospital opening it creates only a handful of jobs for a dentist as compared to many jobs for medical graduates. The salaries in private hospitals are also less, with most Private hospitals and clinics offer a fresh dental graduate a meager amount of less than Rs. 10,000 per month for a full time job.

Private practice in dentistry is more fruitful than being attached to dental hospitals or clinics. Working at dental hospitals provides fixed income with slower annual growth compared to private practice. Hence, private practice is the dream of every dental graduate. However, the investment for establishing a competent dental clinic is quite high due to expensive equipments.

Due to the above stated reasons many of young graduates after failure to get admission in MDS seats feel confused and try to search other alternatives for career growth. Some look for overseas where after an initial period of struggle, the opportunities and returns are better, with countries like USA, UK and Australia being popular destinations for dental graduates. Most of these countries will require clearing a licensing exam and few years of study.

Courses like Public Health, Healthcare Management, Clinical Research and Administrative services are also becoming popular with dental graduates where better opportunities await them in the corporate health care and pharmaceutical companies. Once absorbed, they need to compete with the people of various non medical undergraduate streams and their dental education becomes unused.

The dentist-population ration in India is 1:15,000 against the 1:7,500 recommended by WHO. The ratio in urban areas is 1:10,000, and is close to 1:2,50,000 in rural areas. The major missing link causing this unfortunate situation in a country is the absence of a primary health care approach in dentistry. It is often difficult for the poor urban and the rural population to get access to emergency care. Community oriented oral health programs are seldom found, with no dentist found in Primary Health Centers (PHCs) and Community Health Centers (CHCs) in most of the states.

All the above mentioned factors cannot be taken care of immediately, but the government should take some steps to ensure that these problems do not go out of hand, and the situation is reversed as promptly as possible. A few suggestions are listed as under:

1. The dental entrance exam should not be linked to the medical admission exam but should be an exam by itself. Having a separate exam will definitely bring students to the dental college who are really interested in the dental profession.

2. Number of post-graduate seats should be increased.

3. Establishing more dental units in government hospitals, along with posting dentists at all PHCs and CHCs across the country.

4. More job opportunities can be created by the government through state public service commissions, under National Rural Health Mission to serve in rural areas, under Rashtriya Bal Swasthya Karyakram (RBSK) for early child disease detection, anti-oral cancer and no-tobacco campaigns and school dental health programmes.

5. Dental graduates could be used as a back-up choice in case of non-availability of medical graduates, having gone similar rigorous training. Currently the government is using AYUSH workers as second choice, who are not even allowed to prescribe medicines. Dental graduates and AYUSH workers working together could be of a greater aid in improving rural healthcare.

6. As with Medical Officers (MO) and MO (AYUSH), the government should create posts of MO (Dentistry), along with making dentists eligible for Block Medical Officers (BMOs) and Chief Medical Officers (CMOs) to ensure that there is no disparity between medical and dental graduates.

7. Separate directorates of dentistry should be made for every state so that proper policies can be framed.

SHOULD A DENTIST BE CALLED A DOCTOR??

Whenever someone says, "You are not a real doctor but only a dentist", most of the time these words are spoken in jest. The speaker just means to be facetious, provoking the dentist to show his insecurity and adopt a defensive posture. However in this age of enlightenment, only an unintelligent individual can seriously believe that dentists are not real doctors.

Someone not recognizing a dentist as a doctor probably started back in history with dentistry springing off from barbers. These days, a dentist spends 5 years of formal accredited education learning about the diseases and conditions that are associated with the oral cavity, head and neck. He not only examines and diagnoses, but also performs surgeries if need be. It is not that a dentist does not save lives. Dentists, on numerous occasions, drain space infections which, if left untreated, could even threaten the life of a patient.  Someone has to be well-trained and knowledgeable to do that and cause no long-term ill effects. For that accomplishment, one is worthy of the title doctor.

To become a dentist requires a lot of hand and eye dexterity. After all, it is not easy to drill a precise 5mm x 5mm x 5mm deep hole in a tooth, while looking in a mirror with an object which is constantly moving and making unpleasant sounds.

A dentist may not be a doctor of medicine but has, however, earned the right to be called doctor since his education and training has endowed him with special knowledge and skills worthy of the title. No dentist should ever have to feel inadequate or unworthy of the term doctor. After many years of intensive study and hard work, a dentist has earned the title of doctor.

Dentists in nearly all parts of the world are called doctors. In many situations, the term “doctor” seems to attach most naturally to those who are physicians, surgeons, or otherwise dedicated to care of the human body. Dentists are not considered usually to fall within this group, but the title of doctor gets derived as much as from their training, as their profession.

Although most commonly associated with medicine, the word “doctor” actually derives from the Latin word “doceo”, which means “to teach”. Anyone considered an expert in a specific field, be it science or arts or history, can be called a doctor, provided he or she has undergone the requisite training. In most of the cases, any sort of doctorate-level degree gives rise to the title, with dentists being no exception.

Different countries have different requirements to become a dental practitioner, but most programs involve several years of study culminating in either a Bachelor of Dental Surgery (BDS) or a Doctor of Dental Surgery (DDS). Recipients of these degrees are both personally and professionally known as a doctor.

Perhaps England is one of the only countries in the world to not automatically confer trained dentists with the title of doctor. This primarily owes to the gradation of the British education system. The title of doctor is sometimes used out of respect in England, or as a courtesy. Some dentists in England also like to be called doctors as a means of drawing a parallel to the systems in other parts of the world, though this has caused quite some controversy. Outside of England, a dentist is typically considered a doctor no matter his or her speciality. General dentists are usually the most common. These professionals perform basic oral examinations, helping keep the teeth and gums healthy. Dental graduates are eligible to become general practitioners right away, with specialties like Oral Surgery or Orthodontics typically requiring additional training. As long as the practitioner has the basic degree, he can be called a doctor.

In some cases, dentists carry more than one degree. This is often the case with a dentist who has gone on to earn a PhD (Doctor of Philosophy) degree. This sort of advanced training often helps practitioners to do better work, but it does not impact their titles. A doctor is a doctor after the first degree.

Like most medical doctors, dentists are typically able to write and fill prescriptions, as well as make diagnoses and provide primary care. These powers set them apart from dental assistants and hygienists, professionals who act more as assistants than doctors. In many practices, assistants or hygienists do much of the hands-on work with patients, including preparation of x-rays and basic cleanings. The doctor will examine all findings, however, and is usually responsible for making a final determination when it comes to a patient’s oral health.

Dentists and physicians might be taking care of different aspects of the human body, but both are equally worthy of the title of doctor. If someone does say "You are not a real doctor, but only a dentist", the right thing to do is just walk away smiling, content in the knowledge that one cannot reason with an uneducated person, and nor should one try.

QUACKERY: A DOCTOR’S NIGHTMARE

Quackery is a very common sighting in India, with people claiming to cure everything from infertility to cancer, companies selling mass-produced “natural” products claiming to cure every problem under the sun. Even qualified doctors are known to suggest things that patients do not really need.

Everyone wants to become younger, thinner and to live longer. So it is not surprising that quackery flourishes all over the world. The top characteristic of quackery is the product’s hype and promotion, rather than simply fraud and greed, though these qualities often go concurrently.

Most of the quackery is involved in informing people that something is bad for them (such as allopathic medicines) and selling a substitute (such as “organic” or “natural” supplements). Quackery is also involved in misleading advertising of dietary supplements, homoeopathic products or ayurvedic medicines. Some products can indeed be useful for some purposes, but marketing them for every disease can render them worthless. For example some vitamin supplements can be life-saving in certain anemias, but giving them as “energy tonics” is a form of medical fraud. Similarly, certain ayurvedic herbs can be very useful, but many alleged ayurvedic medicines available in medical stores can be completely useless, as they do not contain what they are supposed to. Similarly, homoeopathic medicines can be helpful, as they are tailor made for a particular person and only a skilled homoeopathic physician can identify the required medicines properly. But taking a standard over-the-counter homoeopathic remedy for certain common illnesses such as headaches and colds flouts the basic principle of homoeopathy.

Quackery can harm individuals in many ways. There is loss of a tremendous amount of money which patients invested in pursuing the treatment. People do not tend to realize the total money spent on quacks, as very little amounts of money is extracted at a time, amounting to huge figures in the end. A dacoit tends to take either a person’s money or his life, whereas a quack takes both money and life, as many of his therapies can cause direct harm.

Quacks tend to thrive as there is no clear machinery to act against them. While the Medical Council of India can initiate steps against qualified doctors indulging in unethical practice, it cannot touch a quack. Even the health department cannot take any direct action, and has to file a complaint with the police, and the police cannot act on its own, without any complaint being filed. As a result, such unscrupulous people are roaming around free.

It is a common misconception that natural medicines have no side-effects. In reality, anything which has an effect has the potential to cause side-effects. The indirect harm caused by these therapies can also be enormous, like patients landing in the hands of “Babas” to get their cancers treated deprive themselves of the opportunity of getting effective, state-of-the-art medical treatment. Faith healing is an integral part of Indian tradition, especially in villages where “educated” priests take advantage of people’s ignorance and blind faith.

Many of the “well-informed” people believe that they are far more sophisticated than the illiterate villager, way above to fall prey to quacks. What they do not understand is that quackery is not just going to unqualified personnel to get oneself treated, but also refers to products widely being advertised over all forms of media, making tall but fake claims of their products. Almost everybody, at some point of time or the other, would have tried at least one product which promises to either make one grow more hair, make a better lover out of a person, remove the wrinkles, make one lose excess weight, or improve the memory. The advertisements for these products being so prevalent mean that they have a ready and gullible audience.

A quack often keeps his methods secret to prevent others from decisively demonstrating that it does not work. No one who actually discovers a cure would keep it secret. If a method works, especially for a serious disease, the person would tend to gain enormous fame and fortune by sharing the discovery.

Quackery often dresses itself in a cloak of pseudo-scientific respectability and its promoters often use scientific terms and quotes from scientific references, like claiming to “detoxify” the body, “balance” its chemistry, release the “negative energy” or “bring it in harmony with nature”. These products use concepts that are impossible to measure or quantify, and the success is claimed even when nothing has actually been accomplished.

Many of such people claim that most diseases are caused by faulty nutrition and can be cured by taking supplements. Most of the diseases are not related to diet at all. In cases where diet actually is a factor in a person’s disease, the solution is not to take supplements but to make necessary alterations in the diet.

One of quackery’s most powerful appeals is the suggestion to “think for oneself” instead of following collective wisdom of scientific community, which is based on years of unremitting studies and research. All humans have the same anatomy and physiology, and scientific rules apply equally to all people. Any claim which sounds “too good to be true” most likely is a sham. The best way one can protect himself from being taken for a ride is to make sure that one is well informed about his own body.

WHEN DOCTORS BECOME PATIENTS

There seems to be a stereotype that doctors do not, or at least are not meant to, get sick. Doctors are supposed to be infallible, unbreakable bastions of health who are not supposed to fall prey to illness like any other average person. When a doctor does become sick, it creates a complicated situation not only for himself, but for the doctor treating him as well.

Doctors, like any other human being, are bound to get sick. It would not be requiring any rocket science to assume that a doctor would be getting the best possible medical care. After all, being an insider, he understands the medical system in and out, and is likely to get VIP care from other doctors, who are his professional colleagues. The sick doctor understands about medicine, and would know what exactly the best medical treatment for his case would be, along with the knowledge of the best specialist to consult for his ailment. A doctor would tend to make the best use of this inside knowledge to get the best treatment when he falls ill.

Ironically, this is not the case to be, with the doctors often getting poor care for their own ailments. One of the reasons that can be attributed to the same is the VIP syndrome. Because the doctor is a professional peer, he is likely to be over tested, as the treating doctor would not like to take any sort of chance in case of his ailing colleague. This often also leads to overtreatment, as the treating doctor goes out of his way to do his best for his colleague. As luck would have it, this also sometimes leads to shortcuts being taken, because the ailing doctor is given preferential treatment, and is allowed to jump the queue, rather than being required to follow the standard protocol.

Also, because it is assumed that a doctor knows what is happening, the treating doctor may often not provide an explanation for what he is doing, or why he is choosing a particular course of action.

Sometimes doctors also tend to suffer from “medical student syndrome”, which means that when a doctor falls ill, he starts thinking that he is suffering from the most complex illnesses of the world. A lot of doctors have the reputation of being difficult patients, with a saying that, when doctors do get sick, they make the worst patients. The ailing doctor does not want to be a bad patient, and passively follows whatever advice is being given by the treating doctor, without bringing into use his own grey matter. This leads to a shift in the balance of the delicate doctor-patient relationship (which is now a doctor-doctor relationship). The ailing doctor is hesitant to speak up because he doesn’t want it to appear that he is challenging the authority of the doctor. He is afraid to ask too many questions, may not even express his personal preferences, and is worried that doing so might damage the chemistry between the two of them. The treating doctor may also wrongly assume that because his patient is a doctor, he knows and understands everything which is being done, so he may not take the time to provide a complete explanation.

The treating doctor going out of his way to make sure everything goes like clockwork also tends to create a problem. As it is an honour to treat a colleague, he wants to make sure there is no mishap or oversight, which means that he often tends to add a lot of unnecessary bells and whistles to his treatment, just to make sure that everything possible which can be done, is done, and that his colleague is getting state of the art, cutting edge treatment. Thus, the treating doctor would tend to recollect even the most uncommon complications, and then go out of their way to make sure the same fate does not befall the person sitting in front of them, sometimes making things worse than they actually are at the moment.

Just because the patient is a doctor does not mean the patient is an expert in the field of his ailment. For the treating doctor, it can be difficult to be in charge of someone who has intimate knowledge of the medical system. The key is to treat a doctor like any other patient, and for the doctor who is sick to behave like they are not a doctor. Doctors who become ill should think of themselves as a patient, making sure they are being fully informed.

Some amount of learning has to be done on both sides. When the patient is a doctor, it is advisable to treat him as any other patient, with empathy, respect, confidentiality, thoroughness, and professional objectivity. No assumptions are to be made, or any responsibility taken for examination, investigation, treatment or the outcome. The ailing doctor has to be in the patient role. Everyone is going to be sick at some point of time or the other, and even doctors need to allow themselves to be a patient.

WAITING AT THE DOCTOR’S: CAN IT BE AVOIDED??

Sitting in the waiting room, waiting for a doctor always seems like a very long time. More than likely, the receptionist always asks to sit and wait for an indefinite amount of time.

Every doctor would term this long wait as a “necessary evil,” a consequence of having to reserve time in his schedule for patients with urgent problems. Doctors are of the view that they can never provide immediate care to the sickest patients if they tried to accommodate the schedules of all patients.

There is some truth to these claims. But they are far from complete explanations of patient delays. People today expect their services to be performed quickly, but a visit to a doctor is frequently an exception.

In many areas, mainly rural and sub-urban areas, there is a shortage of doctors. This is especially true for specialists. In these areas, there is simply not enough supply to meet demand, leading to unavoidable delays. Individuals in rural areas understand this reality. Rather than wait, they frequently choose to travel long distances to major cities for their routine medical care. Those in economically challenged and medically underserved communities often find themselves with no choice but to forgo medical care altogether, or land in the hands of quacks. But this is not the case in most urban areas. If managed efficiently and effectively, there are enough doctors to treat the population’s total needs. In these well-staffed places, every patient should be able to see a doctor in a timely manner for routine care, as well as for urgent problems.

But patients in these communities often experience similar delays. In this case, it’s not an issue of too few doctors but rather a failure of health care system design. Reputed doctors, particularly specialists who work as practitioners, receive a lot of referrals and appointment requests, with likelihood that other doctors of the same speciality having a lower demand. The result is that patients in one doctor’s practice are waiting to be seen while a second doctor is only partially scheduled. The reason that one doctor is busy and one is available has to do with patient preference. It is a matter of choice. And when a doctor has to see a last-minute urgent case, people with more routine needs end up waiting even longer.

When doctors work together as one, they can manage this variation effectively. But when each doctor works independently, then patients inevitably will wait for care even though the specialist expertise is readily available nearby.

To address the variation in demand, a few ideas could be implemented. Doctors could form a single medical group of highly qualified individuals and schedule each patient to see the first available doctor to care for his problem. But this solution would not be deemed feasible in most communities, the reason being economics. Doctors charge a particular consultation fee for each visit. As a result, they would fear the loss of personal revenue every time a patient saw another doctor. Therefore, patients with routine problems end up waiting when they don’t have to.

Delays in hospitals have a different cause. Hospital administrators try to maximize care on weekdays and limit care to medical emergencies on weekends. That is because doctors, nurses and staff are reluctant to work on weekends for personal reasons, and would rather wait until Monday to provide routine treatment.

In most hospitals, only one doctor from each specialty is assigned to deliver care on weekends, with the nurses and technicians providing only emergency diagnostic and interventional services. When the single on-call doctor for a particular specialty is in the operation theatre performing an emergency surgery, all of the other patients whose problems are not as severe are forced to wait.

And if a stable patient admitted on Sunday morning requires some diagnostic test or a non-emergency surgical procedure, the hospital staff may decide not to call in the stand-by team over the weekend, preferring to wait until Monday. And that is why patients admitted over the weekend end up staying longer than patients admitted for the same problem on any weekday.

But what is considered a medically appropriate delay can have negative consequences for patients. Hospital delays increase the risk of a patient experiencing an avoidable complication, such as a hospital-acquired infection. And in some cases, the added time may allow the patient’s condition to worsen. Delays could be minimized without increasing costs if hospitals evened out staffing across all seven days.

Doctors, whenever asked about the weekends, do always assure that they are always available to provide “emergency care.” But providing routine care sooner, and thereby decreasing the risks to patients while lowering total cost, is not their imperative. And the medical culture also supports this view.

Many patients accept delays in health care because they do not realize anything else is possible. Change is possible, although it is never easy. Doctors would need to implement new systems and technologies that allow patients to see the first available doctor. And hospitals would need to confront the weekday model and deal with unhappy doctors, nurses and staff.

But once patients experience this level of control over their health care, they would never accept delays again. The world is entering a new era of consumerism. People want the same level of convenience from health care they experience elsewhere in their lives. And the best part is that with a few changes, they can have it.