Five years ago while working at a district hospital in Maharashtra I had my first altercation with a (local) politician. His extreme and violent arrogance, especially while dealing with a doctor in a public hospital, made my then hot-blooded 23-year-old self very furious (if that were to happen today, I would be much calmer and balanced). The unique experience exposed me to an important societal entity, the ‘politician’s complex’: the well-known fact that most Indian politicians feel so entitled that they do not care for any morals, ethics, rules and regulations.
Later over the years however, I was unfortunately a witness to a different type of complex, the ‘doctor’s complex’: a general understanding among medical students and doctors (especially in the MBBS stream) that ‘we are the ultimate “sacrificing” profession’, that ‘nobody has as tough work schedules as us’, etc. Not all of us harbour these notions, but many to most sure do. On my part I maintain safe distance from this doctor’s complex. As Mohan Bhargav sincerely and honestly declared in Swades that ‘main nahin maanta hamara desh duniya ka sabse mahaan desh hai’, I too don’t believe that the medical profession is the ‘greatest’ in the world: it is foolish to regard one profession to be greater or lesser than the other. At any rate, most of the ‘great’ things we attribute to us are not exclusive at all (something which my non-medical friends frequently make me aware of): our own colleagues like nurses and paramedic workers and even the police have as challenging, if not more, work hours as we have. As for self-sacrificing, ever heard of young social workers like the RTI activists or the social reform bloggers?
What however worries me most about the doctor’s complex is how we insult other professions while talking about payments. Statements like ‘I don’t get paid as much as even that mobile shop owner’, or ‘Even a call centre employee earns more than a doctor’ are common in our conversations. While under-payment of medical professionals is a serious concern (again, this is not exclusive to us — other public professionals like the police and school teachers also suffer from it), I find that a tasteless way of trying to make our point. In our fight for demanding dignity for ourselves, we should not forget the very basic principle of dignity of labour.
Patients’ growing distrust in doctors, of which violence is an unacceptable extreme manifestation (which, again, is not exclusive to just doctors or to even Indian doctors) is perhaps the most important problem we need to tackle currently. Acknowledging and getting rid of the doctor’s complex is essential for that, because it is this sense of exclusivity that has maintained an impenetrable and uncomfortable wall between us and the society all these past decades. With a narrow-minded understanding of key issues, we have taken to blaming Aamir Khan for just about everything negative that happens to us. But we should also remember that before Satyamev Jayate happened, no (or very few) prominent member from among us ever reached out to the society and took a strong and unflinching public stand against the shameful corruption affecting the Indian medical and health services.
While it is tempting for us to resort to extreme outpourings of anger and frustration, I believe we can do more constructive things. The challenges we face can be broadly grouped as technical and sociocultural. Resolving technical issues like poor quality medical education, corruption, archaic legal framework for medical negligence cases, etc depends upon our active engagement with the government and the judicial system. While it is frustrating to interact with a government not progressive enough to regard healthcare as a key national issue, and a judiciary which is in a state of overwhelming limbo, we have no escape from this unenviable task: a task which perhaps can be best accomplished by those among us who go on to study topics like public health or health policy or ‘law and public health’. But then, our system is so obsessed with ‘clinical’ fields that very few choose to look beyond. I myself was ridiculed by colleagues when I decided not to take the PG entrance exams after my MBBS — as if that is the only thing a doctor in India is born to do. We need to change this parochial attitude and actively encourage alternative career tracks. We are fortunate that the health sector in India is still fairly amenable to progressive reform: if some of us decide to take the first plunge, we have enough good people around who’ll support and encourage. And this is also a reason why we should encourage young individuals to think of joining the health services: because our community direly needs young minds and new ideas, and because the unique challenges of the health sector will keep passionate socially-inclined young persons fruitfully occupied.
The other type — the sociocultural challenges — can be best tackled by a sincere and active engagement with the society around us. The general non-participation of the Indian Medical Association (IMA), our ‘representative organization’, in important national health discourses is symptomatic of our failure to do that. While the IMA was quick to call for a ban on a Hindi movie, it wasn’t so keen to publicly oppose the ridiculous and dangerous statements of some government officials on the (non)lethality of cigarette-smoking. If we had come out as strongly against Dilip Gandhi as we had against Aamir Khan (we demanded a ‘public apology’ from the latter), that would have been a powerful and bold display of our honest intentions to care for the well-being of the nation’s citizens (and not just the nation’s doctors). The IMA urgently needs to break out of its exclusivity to doctors and show itself as a strong, active and vocal advocate for the best medical and health practices regardless of political and other considerations.
Lastly, we should strive to eliminate the information asymmetry between patients and us. Hospitals need to take patient grievances more seriously and be more transparent in billing practices. And doctors need to break traditional barriers and reach out to patients and the society in new, unique ways. It is astonishing how our country, with almost one million doctors, does not have even a single well-known physician figure who directly connects with citizens through the media (print or television). There’s a lesson here that we can learn from the US, where physician-writers like Abraham Verghese, Atul Gawande and Sandeep Jauhar, and CNN medical correspondent Sanjay Gupta, are among many medical persons doing a great job of eliminating barriers between the doctor and the patient through sensitive portrayals of medicine and honest opinions about health systems. There’s a lesson for the Indian media too, to learn from the likes of the New York Times (with its frequent articles on medicine and health) and PBS (with its ample documentaries about health) how to cover health matters seriously and sensibly, rather than going for over-dramatized and loud versions.
Long before Gabbar Is Back, there was a movie in 1971 a scene in which also, as the IMA likes to put it, ‘lowered the dignity of the medical profession’. Many of us will be surprised to know its name: Anand. It showed the character of Dr Kulkarni (played by Ramesh Deo) prescribing an obviously ‘unnecessary’ blood investigation to a patient and then justifying the act as a ‘means of professional survival’. But then the film also did a balancing act through the other doctor-character of Amitabh Bachchan (Babumoshai). We should acknowledge that cinema is an important mirror of the society and for the most part it always has some connection with the truth. Instead of wasting time in calling for bans, we should get our act together, introspect, cleanse our system, and take it to newer heights. It is in our hands to not let Gabbar Is Back be to doctors what Krantiveer is to politicians (that popular film depicted the political class in an extremely debasing manner 21 years ago, and even now we regard politicians in a generally negative way because things just never improved much). Who knows: if we succeed in reforming our system, our beloved Bollywood may make a movie like Babumoshai Is Back in future.
Dr Kiran Kumbhar is a physician from India currently studying health policy at Harvard University, Boston. His writing frequently focuses on public health, history, cinema and the intersections between the three. He blogs at kirankumbharblog.blogspot.com.