The wounded healers - I

Dr S Pahel Meitei *

The other day, it was rather amusing to know that many of the young toppers of HSLCE still continued to profess their desire to become doctors and serve the humanity. Young kids with naive unadulterated minds enamoured with the prospect of being in the "noblest profession"! They actually do not know what they are talking about and are in for. More often than not, they will unfortunately come to repent their decision when they actually become doctors.

Such is the state of affairs vis-a-vis the medical profession that increasingly a sense of despair and disillusionment is becoming the rule with doctors across specialities and generations. Even as they endeavour to bring a smile on the faces of their patients, they are constantly fighting the danger of their patients turning their enemies on one hand, and the regret for their parents' or their own choice of profession on the other.

MBBS course has been voted the toughest course of all. Entry to MBBS is equally tough and life during and after the traditionally 5 and half year MBBS much tougher. At a time when your colleagues in Engineering have already started earning, you are still dependent on your parents for room rents and expenses. You are busy with the rural internship and with the books studying for the PG Medical Entrance Exams! All this while, you are aware of the fact that the cut throat competition means that it may take an "average" you 2 to 3 years to crack the exam and get a seat, and even more if you have to take the branch and college of your choice.

If you have non-doctor parents, chances are high that they will start doubting your intelligence and ability. They will keep pestering you to take up a "permanent Govt. Job" and study later. They will compare you with the sons and daughters of their colleagues who have been making big bucks and travelling around the world. God forbid, there will be a few of you who will not be able to bear the pressures of all sorts and who decide to leave the world for good.

PG specialization will make you crazy if you have not become so as yet. By the time you are toiling day and night during the PG course, your school classmates who had the wisdom to go for Engineering are already earning handsome salaries as mid-level professionals: most are married and already glob-trotters. The other classmates who had gone for Civil Services are already in the big bureaucrats' league making big fast bucks of all hues. Your non-doctor parents will compare you with them, and will expect you not only to be financially independent but also to regularly send money to them for familial expenses.

Those of you who chose to get married while doing PG will be in for bigger shocks. Like in my case, your non-doctor parents will accuse your wives of stashing money in their parental homes! Little will they ever try to understand the difficulty of trying to make both ends meet with a monthly stipend ranging from 8000 to 50000, the places with higher stipend meaning higher cost of living. All the frustrations will keep haunting you even in your stop-and-start dreams, with your body and brain continuously beaten black and blue by 36 hour long sleepless duties, seminars, case presentations, seniors' scolding, the pressure to study and the pressure to finish the thesis.

It is anti-sense to make someone do 100 hours a week duty in a physically and mentally taxing profession like medical profession and then expecting him to study and prepare for endless numbers of seminars, clinical case presentations, thesis completion, theoretical and practical examinations. But, it is the norm with Medical profession. A person who is not a doctor cannot even think even in his wildest imaginations that medical profession entails so much physical and mental hardship.

No One Actually Gives a Damn about the "Nobility" of the Doctors' Profession.

Not even your non-doctor parents! You are damn lucky if you have doctor parents. Doctors are the only people who can understand the ambitions, pains, rigors, frustrations and exhilarations that are part and parcel of a doctor's life. Your doctor parents are more likely to support you through thick and thin of the most arduous journeys of your profession.

Many of you, like me, are not going to be lucky enough to have such understanding parents. Your non-doctor parents, just like mine, are more often than not going to be the biggest obstacles in your professional journeys simply because they can never understand the harsh realities of your profession. My parents who know absolutely nothing about medical profession keep claiming that they know everything about the profession and that their perceptions are absolutely correct: that is when they want to criticize me!

The same parents who throw up their hands when I need to make an important professional decision: they say they do not have much idea about our field, and hence cannot offer any advice! Who will understand your frustrations in such a scenario? No one! Blame your hard luck. Your parents are the last people who should understand your problems even if the rest of the world does not. But when you are a doctor, and they are non-doctors, the odds are heavily stacked against you. Hence, you can never expect anybody else in the world, but the fellow doctors, to understand your profession. You will constantly be misunderstood by the non-medicos.

The so called Government run by politicians and bureaucrats has ensured that priorities have always been misplaced in India. The country spends about 1 percent of its gross domestic product (GDP) on public health, compared to 3 percent in China and 8.3 percent in the United States. Sadly, the budget allotted to health care was cut by nearly 20 percent for the year 2014-2015. Key sectors like HIV/AIDS lost funding rather than having it increased.

What is the consequence? The dilapidated public health infrastructure that cannot cater to the ever growing burden of population, poverty and diseases in the country! Hence, the private sector has to make up the deficit and/or cash in on it, whether you like it or not. People will complain that private health services are very costly: they suck the poor people's blood! The fact however remains that healthcare services are very costly.

Public health services are cheaper because the Government is funding for subsidized services. Private healthcare service providers are not funded by the Government, and hence cannot make the services as cheap as the public healthcare services. And, for any venture that is not exactly charitable, the element of profit making naturally creeps in. Otherwise, how can any healthcare organization sustain and progress? Moreover, the owners of corporate hospitals are more often than not businessmen and doctors are merely the employees. However, it is the doctors who are always targeted for being money minded!

Dr. Roshan Radhakrishnan, an anaesthesiologist blogger from Kerala has the following to say. "It is a sacrifice that will take away your twenties and eat away at your thirties. You may enter the field bright-eyed at 18, but I must ask you – what happens if the dream to become, for example, a heart surgeon does not reach fruition? If for some reason, you find yourself unable to get the coveted seat or devote the fifteen odd years I assume it will take to become the junior most in your department, would you be happy with your life? Would you be able to live with losing the dream or would the disappointment eat you up from within?"

Dr. Radhakrishnan takes the example of a young surgeon working in one of the premier institutes in India where one of my own classmates is also undergoing DM course. "This was a doctor who was so passionate a year ago about becoming even better, working hard to get into a super specialty course. 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, now she has lost that drive altogether.

Walking out of her shared one room accommodation 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 50,000/- 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."

No wonder the incidence of suicide is 10 times higher and prevalence of drug dependence is also 6 times higher among the doctors than among the general population. They keep explaining to their patients the value of healthy lifestyle with regular physical exercise and regular time outs for self and family. However, the doctors themselves do not have time for physical exercise or for self or family. They spend their lifetime serving their patients, many of whom still view them as villains!