THE GREAT PUBLIC PRIVATE
HEALTHCARE DIVIDE-------a doctor speaks
I joined the
medical profession in 1992 technically speaking, as I was a medical student before that. There is a vast
difference in the way I think, the way I behave and the way I treat from then
and now.I used to look for role models then and in my own way I used to always
find them.The calm surgery house surgeon who taught me for hours how to put
intravenous cannulas,the surgery senior resident who taught me how to remain
awake after a 24 hours duty and still have the enthusiasm to teach the steps of
appendicectomy to an intern he would never meet after a week,the medical senior
resident who grilled us for hours during morning rounds just to empower us with
more knowledge. There was always so much to learn and so much to imbibe that not
a moment was spent in procrastination.The medical education in the preclinical
days however was quite ruthless according to me. Hours of cramming fat
dissection books ,15 people working on the same cadaver,tough practical exams
after every two months when the demonstrator would get some animal like
pleasure in announcing your pitiable low scores.The behaviour of the professors
and teachers made one feel that failing in one of these exams was akin to
damaging your career for ever. In the first six months of my starting the
medical journey,there wasn’t a single night when I didn’t cry myself to sleep
thinking that I wouldn’t be able to go to college the next day. The students
who had their siblings as seniors generally fared well.They already knew what
was expected and accordingly crammed up the inticracies of arteries, mucles and
veins in advance.Every thing that we gobbled up whether it was biochemistry,physiology,pharmacology,microbiology
and so on was far removed from the reality that we would be facing in the
subsequent years.But looking back I think that every single day of those long
years of hardships toughened us up for the long corrugated journey of the
medical world.
It was during internship that I got a taste of
professional life that we would be facing in future.The plight of poor patients
moved me and I realised how poor people suffer in disease physically and
socially. Women coming in with a 2 gm%
haemoglobin with inversion uterus,women brought in a charpoy with
rupture uterus ,women with intestine hanging out of uterus dumped in front of
us and relatives untraceable for hours after that. I could see the obstetric
residents working for hours and still not being able to do enough. During my postgraduation years that I came
face to face with human suffering and physical pain. There was no room for
exhaustion. During the 12 hour continous duty we would see sometimes the whole
spectrum of obstetric mishaps starting from intractable postpartum haemorrhage
to secondary abdominal pregnancy.We could save some and we couldnt save some
but each patient taught me to be a better clinician and a more humanitarian
doctor.When I moved to the private sector due to lack of government jobs in the
city the scenario drastically changed. The medical practice in government
hospitals is so different from care giving in private hospitals that as a
doctor I took very long to adjust to it.In the former you had these scores of
patients in the labour room where you
are taking a quick history ,doing quick obstetric examinations and the whole
focus is on making a fast diagnosis and expediate the treatment so that there
is a speedy turn over of patients. Beds were always in demand and the quicker
you were in managing the patient the more competent you were considered by your
seniors. I slowly and steadily improved
my clinical and surgical skills. By the time I became a senior resident I
became quite settled in the art and
science of Obstetrics. We were often so enthralled in the variety and
complication and the challenge of certain neglected cases that we were quite
unaware of the social and humanitarian aspects of these patients. You could say work was worship for
us and for the 36 continous hours that
we were on duty virtually nothing crossed our minds except how efficiently we
could clinically manage our patients. We were also under pressure of proving
ourselves academically to our teachers so that we could be better clinicians.
If we could diagnose a case of silent rupture of uterus or a very rare case of
secondary abdominal pregnancy we got a pat on the back and we felt proud about saving
a precious mother”s life . It really did not matter to our seniors how much we
talked to a sick patient or how much time we spent in counselling the
relatives. The fact is that we really did not have so much time because we had to move on to the next patient who
required our help. At the end of each month we had an audit in which the focus
was how much better and quicker we could have clinically managed a patient
leading to lesser morbidity. The scenario drastically changed when we moved
onto the private sector. It took a long time for me to understand and accept
that 60% of the gynaecology patients belonging to the upper socioeconomic class
who reported to the OPD (outpatient department) did not really need any
significant expert medical help but only routine check ups and a lot of
assurance and counselling. Now how good a doctor you are was solely decided by
the patient and her attendants and their perception on the other hand was quite
often solely depended on your bedside manners and how well you talked to
them. Clinical skill and clinical outcome
was important but secondary. It was a lot about how patient you are in
answering sometimes the same questions over
and over again during a consultation. In this context I must also add that
the success of the practitioner is mostly depended on the referrals she gets
either from other doctors or from her old patients. In the process many bright but novice less
manipulative private practitioners have failed to even make a beginning in this
terribly competitive world of private practice. As a society we are constantly
losing out on the services of some very well trained young enthusiastic doctors
. In a country with an appalling doctor
patient ratio of 1:1700 it should ideally never be the doctor”s responsibility
to procure patients. The
private sector is profit driven. Academic medicine which provides the medical profession the
wellspring to thrive, study, carry out research, evaluate, treat, learn and
improve is often ignored.Academic medicine and Research also contributes to the overall
progress in medicine and brings down health care costs . I know that one day in the far distant future
things will change and more public private partnerships will create a balance between the overworked
exhausted doctor in the public sector and the underutilised dedicated young
doctor in the private sector.I am also optimistic because I know some young
hospital directors who are aware of this paradox and want to change the situation to improve the overall quality
of health care at all levels