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“Red Stained-White Coat” Paradox: The Ruckus & The Remedy


THE RUCKUS SITUATION - PLEASE SAVE INDIA

It feels abhorrent and abominable to express that the “I” (eye) of India is dwindling, which is not only embittering the people and tempting other nations to think it an irksome territory but also building its gravitation in envisaging a war on humanity. Yes, this is the truth. India is no more a land of integrity. Let me interpret that not everyone is responsible for it, but then some who are will make this country a hell to live in if the inimical ones are not made to decrease their malpractices. And mark my words, this is assuredly inevitable!

Now, you must be configuring that I am myself an antagonist. Well, I am just one of the thousand voices, which have not yet started to roar. And if they unleash their forbearance, the trauma would be inescapable. Somewhere there is a fight for a Hindu Rashtra, somewhere there is a brawl for army v/s civilians and somewhere there is a rumpus scuffling going between medicos and non-medicos. Who has designed these words that sound like a battle themselves? Earlier, there were prejudices for caste, race, religion and now as we are modernizing, so our ways of predilections are taking a step forward. And now, people are fighting based on what profession they have! Seriously, what is this? Tell me, will India ever be peaceful or just will be ruined like this by a bunch of us?

As of now, I am leaning towards the trend of medico v/s non-medico. I will talk about army v/s civilians in some other interaction. Ok, try to earnestly think that what we actually want from our doctors? It is not an absolute perfection or an act of God or any of that incorporating miracle and heavenly powers. It’s just a proper diagnosis. It is because they are “trained” to perform the operations and surgeries.

But apparently, this should also not happen at any extremity that a medical student /professional shall dismantle their unity with a non-medical student/professional, just because some other irrational people have taken up a flambeau against the doctors, who think that if a patient died, it is because that the doctor himself mislead the patient's therapy.

See, if you are educated and well furnished with guidance, then stop blaming each other as a slaughterer, whether you are a medico or a non-medico. I know that a doctor is our last hope when we face hazardous toil on our health. And by not being able to meet our conveniences, we become helpless. But if a doctor is honest in his/her treatment, don’t see it as a mistake, but consider it a vindication that they are also humans.

Every year, a cry to save our saviours resounds in our government hospitals. Violence against doctors has become so tragically common in India that in 2017, a survey by the Indian Medical Association that every 3 out of 4 doctors face violence at their workplace. But are these isolated incidents?



Junior doctors are usually the first point of contact for a patient. Why is it then, that they are met with threats, abuses and brutality regularly? A junior resident in Mumbai was assaulted by a wooden rod that was broken off of the chair by the patients’ detrimental relatives. What causes the deep distrust between the junior doctors and patients? And what are the conditions that these doctors continue to work in?


The Real Pain of Medical Interns in Rural Area

Almost all states in India have doctor protection laws in place. But when it comes to implementation of these laws, here is the reality: A medical intern of year 4 - MBBS, who was working in her night shift at a rural area medical college in U.P., was sexually harassed by a drunk gang member of the locality to whom she was band-aiding and subsequently, when she called for security, she was continuously hit by the vicious felon by glass tumblers on her head. And the battering was so cruel that not only did she get multiple bruises on her forehead, but also it induced internal bleeding and provoked cerebral haemorrhage.

The other medical associates and her colleagues were themselves in shock and wanted a rigorous pronouncement against the accused. So, they complained to the college itself. The victim had to visit the police station for corroboration one or two times. The accused was never called by police or for a hearing by the medical authorities and as a result, nothing came out of that institutional FIR. In some cases, even the senior-most doctors have contributed to unimaginable acts of persecution towards their juniors’ (mostly females).

But maybe for starters, we should stop treating our doctors as gods and empathize with them as they fight to survive an already crumbling healthcare infrastructure.



What patients should know?

From the central government’s 1992 directive for working hours of junior doctors, one of the rules clearly states that nobody should be made to work more than 12 hours at a stretch. Some interns work for even 108 hours per week.

Ignoring the private hospitals in big cities, the average salary/stipend of a government doctor/intern does not correspond with the effort they put in. So you can imagine the emotional stress they have to undergo while they work overtime for so many hours. This emotional pressure further rises wherever their treatment is unsuccessful because they know that the blame is going to fall on them. Also, when they’ve treated 10 patients, yet see a long queue outside. Patients keep arriving one after the other. Just try and imagine yourself in that situation. The psychological toll is implausible.

Somebody has to cover the hospital 24x7. So the only way to do it is if more people get employed in the health care centres. In our country, according to National Health Profile 2020, on average, the ratio of doctors to patients is 1:11082. This is 11 times what the World Health Organization recommends. In Bihar, the ratio is 1:28000 and in UP, it is 1:19000. This is the reason there is denial and delay in handling the patients.



What happens is that the people frequently hear from the political organizations, the union and the state ministers, Zila Parishad, Block Samiti and the panchayats that the government hospitals are being developed and are rendered with the requisite amount of ICU beds, ventilators and sufficient stock of medications. And if during emergency conditions, a mishap occurs, those people tend to think that it is the doctors who are unjust and are not doing enough to give them even a bed in the ICU. In fact, the money spent by our country on health care throughout the nation, as a percentage of GDP is less than 2%. Whereas in all the other developed countries, this percentage is around 8-9%. Patients’ frustrations and the thwarting exasperation of the relatives need to be better tackled by grief counselling, dedicated centres for the same on hospital premises. Unfortunately, none of these is available. What makes matters worse is often a lack of government infrastructure gets mistaken for negligence by medical practitioners.


What doctors should know?

“Confrontations happen because of the anger caused by non-fulfilment of desire. Hence, the doctors need to understand what the patients really want.”

A survey done by the IMA found that 90% of the patients wanted doctors to acknowledge and address them, 92% wanted doctors to listen, 89% wanted the doctors to explain what the illness is and keep them informed throughout. Around 75% of the people also wanted their doctors to review-ask them, if they understood and, if not, help them understand. 40% of the respondents also wanted the doctors to thank them. This study is called ALERT- Acknowledge, Listen, Explain, Review and Thank.



Inform about delays: Tell them how much time it is going to take upon an appointment. Do not lie about it or keep them in the dark. Do proper Cost Estimates: The patient should be informed beforehand of the price of their treatment and how much it is going to cost. Remove the Jr. Designation: The patients look at the “Jr.” designation and assume that the doctor is not qualified to treat them. Display boards outside ‘OT’: The intricate details need not be mentioned. A little information here would be very valuable to enhance communication between the patients and the doctors and would lead to an increase in trust.


SHOULD DOCTORS NOT QUIT INDIA?

The root causes will always remain the same if something is not done. The illiterates will still thrash the doctors and as result, one day all the doctors will resign and quit India. It is because in foreign countries, at least their lives will be safe with better facilities and good payments will be felicitated too. And if it happens, the ratio of patients to doctors will go in millions and India will be dilapidated.




The Remedy: Indian Medical Services {UPSC}

See, the bond services can be reduced to 1 year, but it cannot be eradicated because there is an urgent need for doctors, but yes a better work could be achieved with the availability of senior doctors in PHC’s and by increasing the stipends. Try tackling the rural area medical institutions and their infrastructure and increase the seats in NEET entrance examination and the medical universities accordingly with decreasing the competition level. A major point of contention is the fact that the wellness programs by medical schools and residency programs push an undertone that burnout is the responsibility of a medico- a failure of individuals to properly self-care, sleep and mitigate stress. Rather, we need to urge our programs and institutions to make meaningful changes. Felicitating social support, sleep, sustainable fixes, vacations and autonomy are areas that are based on the scientific literature, would be beneficial to this growing issue. There should be a forum for all mainstream medical practitioners to complain if they are being overworked and that complaint should be anonymous. This protest should be heard and administered efficiently.

As there is the Indian Administrative Services exam, where many MBBS graduates become IAS and go into public administration for better career growth. I know freedom is important, but if doctors are needed in India now, then something needs to be done. So, the idea is that the government in coordination with the IMC and IMA should start a new examination in UPSC - the Indian Medical Services Exam (IMS), where the MBBS graduates shall become the head of medical colleges/institutions/ rural area hospitals as the district collectors work by the IAS exam.



Now, these IMS servicemen can work both in administration and as doctors wherever required. The basic necessity of grief counselling, strong punishments for crimes against doctors and establishing the frameworks of best government facilities will also get encountered in a varied sense. The Officers should administer the head position for training the medical interns on how to tackle the distrust problems with patients. Also, the deputy should call for immediate action against the criminal if any malpractice has taken place against the saviours with equality and fraternity and he/she should also punish the doctors if any code of conduct is broken by them, as an IAS would do in public cases.

Medical students who are pursuing MBBS or MD are unsafe and insecure mostly in rural areas. So the representative officer should focus upon security personnel and police stations in every rural/village area for doctors. But the doctors should also keep in mind that they will not use the hardcore security infrastructure (if applied) for causing any unfaithful or disproportionate misery to the patients that they will be treating. Its use shall be taken only if the situation goes worse and the attack is from the patient’s side first. Well, if the IMS works transparently and is unbiased and the government is literate as in Delhi, the circumstances should not become substandard, and if not taken care of, IMS will be another aim for stones. Stop being corrupt and do something such that India goes from rank- 131 to under-30 rank among developed countries of the world.

“Doctor is a high profile job and if conditions are going to be appalling, they will surely enter foreign countries and the leftover humanity in India will also die after that. So, either be humane now or suffer when you have to visit foreign countries for minor treatments!”

“Relatives of a patient don’t only have the agitation of losing their loved ones, but also have undefined blasphemy for the prominence of some unruly medicos. So, it’s a plea to enhance faith and stand in unison in this state of disintegration.”




-Ravi Mani Tripathi (A human being)

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