I’ve seen so much of the distasteful face of the ‘noble’ medical profession that it has finally dawned on me: all that nobility is completely fictitious today. The only thing that is real is my passion, and I cannot afford to get it scathed.
(The article wishes to capture the voice of all those MBBS interns who can relate to it, and not just of the author’s.)
Dear one and all,
There are times in life when the best thing you can do is set free your long stifled mind and let out the truth — times when you understand that there are places where you have to drop all the euphemism, erudition and sophistication from your language because they happen to dampen the vigour of reality. What you speak in this frame of mind comes with effortless beauty, freed from pressure, hesitation and pretence — since this time, you gather the balls to say things few of your coevals would even dare to roam over. Today, as some of you might be lying snuggled over your sofas after a gruelling day at work, whereas others might be in the midst of the bustle of office, I would ask for the authority over a few minutes of your time so that you can stomach this piece of tirade which, I foresee, will draw many passionate reactions.
I am an MBBS intern from an understaffed government hospital in the country, and the honest truth is that I form the biggest part of it that keeps it running. I’m a so-called trainee that has to carry out much of the pillar work of the hospital’s healthcare delivery. You need me to carry out the menial (yet vital) jobs — and then at 3am in the night, after 28 grinding hours, you need me to see a hapless patient that knocks at the casualty door. Some of you need me to do the dirty work of batting patients away; you need me to break the suffocating rules for you so that you could be at ease. You need me in OPDs, in wards and in labour rooms — and I’d be sickened if I don’t admit, that if it weren’t for interns and residents, quite a few of the prestigious government hospitals would collapse in just a matter of time. Yet, no matter how many times I prove myself, I’ve to fight for the very fundamental of my demands; I’m frequently looked down upon with disdain; I’ve no voice at all; I’m barely nurtured; I have to rely on my senior’s whims to obtain the most deserved leave — and trust me when I tell you, this ain’t another whine of a cry baby, that at the end of the day, with all the hypocritical claims to saintliness aside, the fact that I’m paid less than half the amount paid to an OT technician indeed makes me sick.
Now it won’t be an overstatement if I say that internship today is a mockery of vocational training, at least in the majority of places out there. Lack of structured tutoring, a farcical concept of supervised training, ill-defined work roles, deficient rules and stringency, non-uniformity in learning experiences and a gaping government-private dichotomy are namely some spokes in this wheel. It’s just that: it’s no nurturing. It’s a ‘swim across or sink down’, kind of thing. No matter how immune you might have grown to all of this, the moment you focus your thought upon it after a brief spell of absence, you realise what a pandemonium this so called vocational training is in. And the moment you feel you’ve seen it all, you hear of those hospitals that can play foul to such a length as to waive the entire internship year against money.
As much as of training, the CRRI (Compulsory Residential Rotating Internship) looks equally a scandal when the stipend of interns is concerned. I have tried to outline this in my article on USMLE and NORI, and this isn’t certainly the place I’d like to beat about the bush. Given the profile of work interns actually do, they are entitled to a much heftier pay and the way this obligation is openly disregarded under the cover of ‘learning and training’ leaves me with a picture no other than of huge sums of money flowing down dark, circuitous tracks.
There was a time back in MBBS days when I was disappointed with the seeming lack of order in medical education, and would hope that in the professional domain, I would discover a much greener pasture. As shocking as it might seem to come so straight, the truth is that CRRI is an arena where rules and laws are bashed openly and with the agreement of many. Behind the drawn curtains, these trainees have to take up jobs that are a far cry from what can be accounted for their level of expertise, let alone those forbidden by rules. And as much as I would like to think the contrary, it’s a fact that many of their seniors from across the hospital hierarchy have assented to this practice, and it’s not difficult to understand why. It’s understandable how the already languid state of healthcare in many government hospitals breathes and thrives on this practice.
Talking of rules and regulations, there is another thing that I’m naturally led to, and that is the apparent lack of rules governing the working hours of interns. Google it as many times as you feel like but you won’t come across any relevant directive. This is something which is easily cashed in on, throwing interns into inhumanly 100-hour weeks. Again, it’s easy to adumbrate how this outrageous practice keeps the show running in many miserably understaffed government hospitals — and the deep gorge of doctor shortage is kept from gaping open into the eyes of the already furious taxpayers.
The saddest part of it all is that no matter how much I serve to conceal the weak underbelly of many government hospitals today — I have my hands tied behind my back, and my tongue tied to the floor of my mouth. In this respect, I’d like to draw the example of PG residents. We all know the travails these people take. Despite the fact that a supreme court directive clearly forbids them from working any more than 48 hours in a week, no one dares to speak out against the ruthless 100+ hour weeks prevalent almost everywhere. It’s because their evaluation and assessment is left unprotected in the hands of their seniors — and speaking out against it could quite possibly screw up their career. And there’s one thing I’d like to assert straight to the faces of those who portray a doctor’s character in bad light — that a large chunk of these residents don’t mind these travails just because of their empathy towards the ill, simply because they want the show to keep running and there are many I’ve personally known whose character I’ll hardly ever be able to measure up to.
And those were just two instances. The lack of stringent regulations can make your life miserable in a multitude of ways: it can make the authority’s whims turn into inviolable rules; it can make you prostrate for a well deserved attendance; and it can make you regret for all your life simply because you refused to fetch tea from a nearby stall and stood up for your dignity and esteem.
As I decide to take a step further from CRRI, what am I left with for envisaging my life ahead? What do I anticipate to happen in the years to come? Well, may be I’ll have to thrust myself into the soul crushing life of a resident that would leave nothing with my passion for philosophy. Or, may be I’ll be bonded with some back of the beyond rural centre where I’ll have to use jute threads as sutures. Ahead of that, may be I’ll have to join hands with some out and out money minded, patient looting corporate that I’ve cursed all my life more than Satan. Or, may be I’ll have to work for a medical college that blatantly auctions its seats not on merit but on money. Or, I might instead have to join a government hospital and helplessly settle myself with the poor state of my interns, residents and patients alike. I’ll be parented by a medical council that has been accused of criminalising medical education, rigging elections and thus brazenly putting people’s lives at risk. I’ll be sheltered by a Health Ministry that can go so far as to deprive me of my fundamental right to emigrate because there is a doctor shortage in the country, and yet deliberately overlook the untapped resource called FMGs that can do so much to obviate our problems. I’ll be represented by a government that is so intoxicated by the quality of care provided by some top notch private centres that it has no problem standing 171st on the list of 175 countries with respect to healthcare spending. And finally, I’ll keep hearing glamorous talks about SWACHH BHARAT ABHIYAAN (which is a noble step indeed) taking the news channels by storm, yet none of those four-month-old children that die of pneumonia simply because there aren’t enough doctors available.
Time dampens everything. Fear and anger lose vigour over time. Even love and hate can die out with time. The same principle has rendered our system so thick skinned that no matter how many strikes, protests, walkouts and diatribes you aim at it — no matter how many solutions you prescribe, it shows hardly even a minuscule of change. And it’s not alone in this. It shares a double relation with you and me. Somewhere, you and I have become so seasoned with ill-repaired and ill-lighted roads; with stinking heaps of garbage around our homes; with begging minors; and with the battery of scams that are shown everyday on TV that we hardly turn to them for the second time. Those of us who might be reading this right now, a segment of us is going to continue to fawn over and cringe in front of our bosses from the very next day, and then at night, seated over our couch in the comfort of our homes, we’ll curse them behind their back for being despotic and blame the government. A segment of the learned and the apparently conscientious people will keep pouring their money and children into the black sacks of the medical mafia owned colleges, infatuated by the nobility of this profession. And a segment of my seniors will keep justifying the imperfections and ordeals of CRRI simply because they too had to face the same in their days (Saas-Bahu syndrome, as some call it). And I completely understand that. We humans are shortsighted beings and will continue to be so no matter what. It’s for the very same reason why we keep buying into the election rhetorics every five years no matter how feeble they might seem to be from our past experience. The grim truth is that we wake up only when it’s ourselves, a kin or a VIP in danger — and I’m afraid we’ll never be able to look beyond caste, breed, region and profession — and realise that the very fact which should be enough to unite us is that my wellness finally depends on yours.
I’ve seen so much of the distasteful face of the ‘noble’ medical profession that it has finally dawned on me: all that nobility is completely fictitious today. The only thing that is real is my passion, and I cannot afford to get it scathed. In a year or two, I’ll leave for a much humane environment that lies abroad. I’m much better off with racism than the justice-travestying concept of reservation that pervades this country. Am I a selfish guy? Oh yes! I am. I don’t move about in a saffron sleeve. But I have enough brains to realise that my wellness finally depends on yours, so I’ll make it a point to hit back at this system with some momentum, or at least aim a rant or two at setting it right.
My intent behind leaving from a formal and euphemistic tone while writing this article to a candid, outspoken one is founded on this universal principle: images don’t work, but impressions do. With this article I wish to leave at least a little bit of that impression. A maxim states that if slaughterhouses had glass walls, everyone would be a vegetarian. You see, that’s how it works. The things I’ve spoken here aren’t a revelation. They are nothing new; everyone knows them. But their mere appearance on a public platform is what brings them the focus they desperately need.
Finally, I’d like to thank the editor and founder of this (India Medical Times) newsletter, Mr Rajesh Barnwal, for giving space to opinions from across the medical community, unlike many prejudiced news-houses that publish only what we like to hear. The opinions column is probably the best thing that could have happened with his newsletter.
Having said all of that, it feels as if my spirit has been set free.
The author of this article, Dr Soham D Bhaduri, is an avid thinker on medico-social issues and a blogger at http://freethinkingmedic.blogspot.com.