Sab Theek Ho Jayega !

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Kochi / Ernakulam, Kerala, India
A Doctor who loves to Live, Love and Laugh with the World! Absolutely crazy about Cricket ! Other Qualifications: A Tired Bathroom Singer, Retired Gully Cricketer and Satire Writer !

Friday, May 27, 2011

Good Doctor and Bad Doctor: It's a Doc's Life !

Apology: This is an extremely long post because it is a true incident I was witness to. I could not have edited the dialogue simply because it was continually connected and editing out any part would have rendered the story incoherent.
We hear and read a lot about medical malpractice and the greedy behavior of Doctors and about the degeneration of the noble profession. But what do Doctors think ? I believe nobody ever has tried to find out. Doctors it seems are there to be condemned.
I would like to thank all those who would show the patience to read through the post because it deals with my profession. It says something about how do Doctors feel about people !

Me and my wife, after suffering a lousy movie through a night show, decided to compensate for that with a late night dinner. Thus we went to a nice restaurant that has been our haunt for most of our late night dinners ever since we got married. We made ourselves cozy in a corner of the dimly lit place playing old Kishore Kumar songs. We settled down ordering some hot and sour soup, masala papads, vegetable noodles and baby corn Manchurian.

As we were waiting for our food to be served, I could overhear two people conversing from our neighboring seat. As much as I tried to avoid, I couldn't escape the exchange. That was because the conversation dealt with Diagnosis, practice, malpractice, MCI, Consumer Protection and Doctors. The men turned out to be Doctors. From the entire story, I could make out one was a Physician and the second one was a Pediatrician.

The Pediatrician was the first one to talk about Medical ethics and malpractice. Let us call him the Good Doctor or simply GD. The Physician was more vocal about the plight of Doctors, Hospitals and why it was wrong about what was wrong. Let us call him the Bad Doctor or BD. Simply because he doesn't conform to the ideals a Doctor is supposed to follow in his noble profession of the healer.

They were switching between English, Malayalam and a little bit of Hindi as frequently as our Politicians switch loyalties. Let me stick to complete English narration of the whole story to avoid the hassle of translating for the Malayalam uninitiated. So here goes the dialogue...

GD: Whatever you say, we should keep the profession and practice above all corruption. What else will be the difference between Doctors and the Government workers and Politicians if  Doctors accept cuts and commissions ? The MCI has brought in stringent norms and then there is the Consumer Protection Act. The system needs a thorough revamp.

BD: MCI and norms, that is a joke. Some of those idiots are behind the bars for corruption. And who is controlling the affairs now ? The Politicians and Babus. Those shameless guys who sell the country for a song. Nothing will change  by your Gandhigiri !

GD: No, I don't agree. Someone somewhere has to make a beginning. If one Doctor starts not accepting any favor from Medical Companies or Scan Centers or Labs, this will permeate into the entire community slowly. I never encouraged it and never will.

BD: What do you think ? All Doctors are corrupt from the beginning ? Congenital corrupts ? You are wrong little brother. Most of them don't fall for these allurements so easily. The companies will come to you only if you have a decent practice. You will refuse favors from Companies initially, most of them do so too. But if you don't accept those favors, someone else will. You are the only one to lose out on it. Gradually the whole system gets corrupted. Nobody does it deliberately. Corruption is like love in Karan Johar movies. You don't do it, it just happens.

GD: That is why there is a trust deficit among patients and common man. You justify everything without being honest. How much money does one need to live ? Why should we mortgage our conscience to greed ?

BD: My dear friend, you live in a different world. Let me tell you a story. There was this Physician in a local hospital. He was a JIPMER Pondichery product. He was extremely dedicated. Every morning, he was at his hospital by 7:15 AM. Always smiling, he helped thousands of patients. Only demand he made of Medical companies was to supply costly medicines free of cost for poor patients. He never took any cuts. He never allowed the hospital management to hike his consultation fees in 15 years. And he worked till 8:30 PM every week day.

Even at odd hours, he was always available. So much so, he had practically neglected his family. And then one day, he developed Cerebral Hemorrhage. After surgery and rehabilitation, he is now just a shadow of his old self. He can't remember medicines or anything about practice. Just 8 months since, all his clients have moved over and see other Doctors. Only that family he always neglected is now taking care of him. He is income-less at 56 years of age. Now imagine you or me in that position. What will our families do ?

GD: You can't change destiny. That is unfortunate. He must have made a living. His family should look after him. You can't expect patients to take care of him. And IMA schemes are there to help people like him.

BD: My story isn't over Dear. They manage to survive, fine. But what will happen to him and his wife if they live up to 75 and beyond ? Today, he is only 57. Without income, how long can a family survive. He struggled for almost 15 years and was settling down with a house. Now both his daughters are ready for marriage. Elder one is 26 and younger one 25. What will happen to them ? I say he was foolish. Not a single soul he had helped will help him today. They have completely forgotten him and moved on. That is cruel !

GD: But that is life. Time and tide wait for none. You have to accept that.

BD: You are in such hurry. I still am coming to the point. I saw an article on a newspaper. They had written about the plight of an olden days Cinema actress who was struggling to make ends meet. Soon, some producer comes in and offers her a role in a movie. When a writer or a poet or an artist is living in difficult conditions, all the visual and print media goes to town demanding better deal for them. I know so many old Doctors who are struggling today. Have you ever seen any media person reporting the difficulties of a retired and struggling Doctor ?

Part one of our dinner was there before us. The piping hot soup and Masala papad. We began the attack in all earnest. But my ears were all ears for what was going on behind us.

GD: That is why we have IMA and they have so many schemes like the professional protection scheme and retirement schemes and all. Why should a Doctor beg in old age ?

BD: That exactly is my point. A Doctor or family should never beg. You and me too will be old some day. We don't know what is in store for us. IMA and all schemes will support you to a certain extent, not all your life. My question is, "Why is charity a one-way traffic when it comes to Doctors ?"

GD: What do you mean ? What charity ?

BD: Look, most of the Politicians amass wealth enough to support 16 generations. Their children succeed them in Politics. No qualifications necessary. The businessman's kin inherit their legacy. No qualifications demanded. If a Government employee if meets with premature death, someone from his  family will get a Government job and all the benefits associated. An Engineer starts earning by 22 or 23 and settles down well by 28. 

Whereas, we spend the longest learning life and shortest earning life. 5 and a half years graduation. 3 years post-graduation and another 3 years of specialization. Many years in between are spent in preparing for and writing Entrance examinations. By the time we are finished, we are already 32 or even older. It will require at least 10 years to build up a practice. That means you are into middle age. That is where we are today.

If you develop some problem like what happened to that poor Physician, you are doomed. Just 10 - 15 years of earning period. And what do most of the Doctors get paid ? It is peanuts compared to what the Engineers and Management people get paid. Do you know my 27 year old cousin earns more than me and I am almost 20 years older.

GD: Are you jealous of your cousin or do you hold some grouse ? Why do we have to compare ourselves to other professions ? Why can't we be happy with our life ?

BD: Well, I am not jealous, just a little bitter. I have spent years in the Intensive Care and Emergency Rooms attending calls during day and at night. I don't have a count of the number of people who have survived serious illnesses. I have done my duty to the best of my abilities and with utmost sincerity. Most of the Doctors do that.

See, people come to you with illnesses, cough, vomiting, body odor and what not. So many patients have vomited in my cabin. On some occasions,  the stinking mouths breathe out on your face and you have to take it all on your chin or even nose in the name of duty.

People spend 150 rupees a day on cigarettes. They have no qualms paying same amount for a ticket to a movie in a multiplex. At the end of the day, many people drink to the brim and never even remember how much they spent. You have a small problem with your shoe while you walk on the road. You get it repaired by a cobbler sitting by the footpath. He charges 100 rupees for a 15 minutes job. People have no complaints. But when a Doctor's consultation fees is 150 rupees, that becomes fleecing.

A chap with some management degree from a private institute earns three times of what you and I earn. There is no value for your lost sleep. Your personal time is not your time. It is your burden to help people because that is a Doctor's bounden duty. Do people ever remember the Doctor ? Far from it. They remember only when things go wrong.

Almost always, when a seriously ill patient survives, it is God's grace. But when a patient dies in spite of all our efforts and good intentions what do we get ? The relatives will blame us, sometimes beat us up and even burn down the hospital. Do you have any idea how many Doctors have suffered ? And don't forget the Consumer Protection Act. This Act has acted against the profession and also lead to the breach of trust. 

People blame Doctors for the trust deficit. But nobody blames those who framed this one-sided act. If a Doctor is blamed of corruption or malpractice, he is suspended or transferred even without a proper trial. He or she is branded corrupt and will lose all the goodwill and often a chunk of hard-earned practice. When the truth comes out and the Doctor is proved innocent, it is too late. 

Though I still love the feeling of seeing people recover and go home happy, I wouldn't want either of my children taking up this profession. You spend sleepless night for the sake of a patient on ventilator and another with a heart attack. Then come home to rest for the next night and you have a neighbor who wakes you up at 2 AM asking for a headache medicine. If you sound annoyed, be prepared to listen to pearls of wisdom on how you should be nice to people. And if you don't have the required tablet, then face a lecture on the duties of a Doctor and how you should be ready for emergencies all the time and be generous with help.

Our Dinner had arrived. The crispy noodles and the Manchurian were more than enough to compensate for the spoiled mood. By this time, even my wife had stopped talking and joined me in spying in on our neighbors. Our dinner and their banter went on.

GD: Well, I do agree with this. I too have been woken up several times by people wanting to know what to do with a crying baby. They often do everything except feeding the baby. But that is occupational hazard. A Scientist faces chemical hazards. A manual laborer will have to sweat to earn his bread. An Advocate will have tremendous stress and so do the business and banking sector people. With us, it is this. I have learned to live with this.

BD: You asked me if I was jealous. I said I was bitter. Do you know why ? It is because the people who accuse Doctors of malpractice, unethical behavior and greed are these same Laborers, Advocates, Scientists, Bankers and Businessmen. People who don't know what is an infection and what is an infarction will sit on judgement on your profession. 

A family of a patient accused me of unnecessarily ventilating their father. They said, he came with some mild Asthma and I had ventilated him to make money. Bloody that man was in heart failure and was in Cardiogenic shock. I told them to take him to whichever place they would like and gave them the ECGs, X-Rays and other reports and asked them to take a second opinion, third opinion and any number of opinions. 

They came back the same evening and wanted us to continue treatment on same lines. Once the patient was out of danger, I discharged him and asked his people to take him to a place where they don't ventilate people to make money. When they said, they had no problem, I still asked them to take him because I was hurt by the unfair allegations and would not like to be part of treating their father any further. I told them that I kept him till he was fit to be shifted only on humanitarian grounds. They didn't even apologize and were bitter that I had not understood their feelings. But who cares for what a Doctor feels ?

GD: But, you could have been more magnanimous. Their consent to continue treatment was the admittance of their guilt. Tense and grieving relatives can behave thus. You should have left it there. You were vindictive. That is not very nice.

BD: Hey Gandhiji, listen. You are fast asleep and are woken up by your resident with an emergency at 2 AM. Not only you but even your family members are woken up. You rush to hospital to see this man sinking. You promptly ventilate him, stabilize him and go home by 4:30 AM.

Next morning some smart Alec comes and tells you that it was 'MILD' Asthma and you had 'unnecessarily' put the old man on the machine. He even threatens you with a consumer case. Even as other relatives try to pull him out, he says as a parting gesture, "You will never prosper in life for this kind of unethical behavior".

I can understand relatives getting upset. But once they realized the truth, at least someone had to admit the mistake and apologize. We too are human Yaar. What is the guarantee that these people will not create further problems ? So I discharged him. I would treat only those who show trust and respect to the profession.

GD: All people are not like that. You can't generally blame people for what some of them might have done. There are so many good people out there.

BD: Exactly my Dear, exactly. There is no doubt that there are some Doctors who do unethical things. Malpractice is there without a doubt. But then that is not the rule. The Public has a tendency to brand all Doctors as greedy and business minded. They can talk anything, hurt anyone and escape Scott free. That is what I feel is unfair and unethical. 

That exactly is why I don't want my kids to be Doctors. There was a time when I was a young boy, everyone wanted to be a Doctor. Only the lucky would make it. There was so much respect. There was a GP in our town who was a decent Doctor by the present day standards. But he commanded enormous respect and none ever questioned him. All Doctors wanted their kids to be Doctors those days. But today, I know a lot of my friends don't want their kids to be Doctors. 

You don't have holidays. No off days. No earned leaves. No paid holidays. No LTC. We are the people who work longest through a day and then night. But that never gets appreciated. Even if you have an off, you are disturbed by a neighbor with some silly complaint that he has been carrying for 3 months. Just like they say "It's Dog's Life, I would say It's a Doc's Life" !

We had finished our dinner and made the payment. We had to leave. Even though the conversation was still on and still worth following up, we had to leave because my better half was showing signs of unrest. That is something I couldn't afford. So off we went at this stage. I would really have loved to share the entire conversation. But alas, all Good and Bad things have to come to an end. And this was the end ! 

Post Script: I endorse many views expressed by the BD and almost all that was spoken by the GD. That may be because I am an amalgamation of both good and bad. Most of the Doctors are like that. I hope to be more good than bad. But after listening to the 'Bad Doctor', even I had my sympathies with him. I think most of the Doctors will be able to empathize with him.

In the end, the Doctors are as human and as fallible to the vises and greed as the other fellow humans. Does a community that doesn't respect discipline, law and order and traffic rules deserve anything better ? How can the people who accept or give bribes expect Doctors to be above board ? How can a nation which elects Corrupt candidates as their representatives demand for blemish-less Doctors ? Those people who vote on caste or religious lines hold no special rights to question the integrity of Doctors, Actors or even the traitors.

Like Politicians, the People get the Doctors they deserve.
Conversely, the Doctors too get the People they deserve !

Dr. Pundit

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