Physician heal thyself!

Physician heal thyself! “Today’s Doctors”!

Some heroes don’t wear capes. They wear white coats! We call them doctors!

Cough and cold is not where the job of a medical professional starts and stops. Fractured bones and gaping wounds find solace in the hands of the doctor! Patients are able to live near normal lives with Heart disease, hypertension, cancer, stroke, due to care and concern of doctors!

There’s TB, there is cholera and there’s plague. Black Death and smallpox have wiped out millions of people throughout history; polio paralyzed thousands in the 20th century. By working to contain potential epidemics, doctors prevent disasters and save the humanity!

Now the Pandemic due to COVID! Nearly 2000 medical personnel have sacrificed their lives trying to save you and me from getting COVID. without hyperbole — that they are true heroes a reflection of what health care workers have done historically, by putting themselves in harm’s way so that you and me are safe!

The difference between God and a doctor is that nobody wants an appointment with the God! Even those pious god fearing persons who hope to join him in Heaven refuse to take an appointment with god. They gladly take an appointment with the doctors to postpone the appointment with god!

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Health is also the ability of a body to adapt to new threats and infirmities.

When they are ill, doctor is looked upon as the saviour, friend, and guide and often as a second god.

When cured they call him duty bound and has done his duty. Afterwards a delusion supervenes and he suddenly becomes The Devil — when they need to pay!

Doctors share the same needs as rest of citizens. Doctors need to be dedicated and be available 24 hrs of the day and seven days of the week. They need to go through a rigorous 5yr course to become a doctor. No other profession or any other citizen need to go through this.

Doctors have been cut to size. Partly the greying of their public image is because doctors are now seen as fallible. Society is less willing to bow to a doctor’s once sacred authority. The white coat is not so white anymore!

I am convinced 2020 is a cursed year, probably the worst in the history of human civilization.

A virus unknown to the world a few months back brought the world on its knees — without anyone immune, no treatments, no vaccines, high transmission rates, long incubation period and high asymptomatic cases. Politics and misinformation and we had chaos staring at us.

India COVID numbers: 3.5 crore cases the official figures. Several Sero surveys draw a figure ten times that!

Deaths -452,321

Every tear shed by every citizen should be acknowledged by those in power- politicians, administrators and Medical professionals in the COVID management- be held accountable for their failures.

On the national and regional channels we have seen what we as a nation should never have seen. I will not dramatize the tragedy. It is disturbing. The Indian immune system primed with BCG, triple antigen, small pox and influenza shots just fought the virus better. And people survived.

The development of the COVID-19 vaccine represents one of the most astounding achievements in modern medical history. Never has a vaccine been developed so quickly. And never did anyone imagine, it could be so effective to the tune of 90 to 95%.

Thanks to Politics and Bureaucracy- we are struggling to roll out the vaccines from the freezers into arms. And as a result, this moon shot achievement flounders.

I am no big fan of the Pharmaceutical industry in this country. They have shown, time and time again that they do not care about the people. They do not care if someone can afford the drugs that they deem “necessary” for overcoming certain health obstacles. I believe that there is a worldwide conspiracy to keep the population sick as a means of further lining the pockets of big Pharma- houses.

Why there is no cure for illnesses such as diabetes, hypertension, heart disease, cancer, AIDS and hepatitis affecting such a large portion of the world’s population especially when billions of dollars are spent on “research” each year.

They have given us nothing more than a way to live with the illnesses. WHY? So that you can come back and get that next treatment….and pay more money!

Our entire medical system is based around PROFIT.

How can you ever trust an industry that worships the almighty dollar or euro to do what’s best FOR YOU?

What benefit comes to them for curing your lifelong illness?

So, keep the customer coming back!

The germs and the viruses and the diseases we fight are probably going to be the least of our problems going forward.

What do we need?

For the people: Accessible, affordable, adequate health care for everybody. Better and Enhanced quality of life! Universal insurance!

For the physicians: Pay based on quality. Autonomy! Dignity and respect!

The future of health care depends on reducing cost and raising quality.

But there has been a steady rise in the cost of care without measurable increase in quality of care — leading us to a situation of low-value health care. This is the root cause of Patient — physician trust deficit!

In my mind, the doctor-patient relationship is sacrosanct. There is no relationship where the bond of trust should be so strong. Trust has many components- The Four Cs drive the trust– The Compassion, the Communication, Consistency, and Competency.

The patient is not just a group of symptoms, damaged organs and altered emotions. The patient is a human being comes to you worried, searching for relief, help and trust. You are the hope for him!

There has been so much talk on the unethical practices among doctors. Bad apples are there in every profession. Lack of transparency, lack of communication, unethical practices and low quality of service have all contributed to the trust deficit.

Today’s society is run by money, everybody is after money. The greed for money is overwhelming! The corrupt practices have permeated every aspect of our public lives. Doctors are no exception.

Today’s doctor is in a predicament. Medicine is a science which has many probabilities and possibilities. A patient places his very life in the hands of the doctor. It increases the responsibility of the doctor and is expected to exercise a very high degree of skill and care.

The media has always looked at doctors with a jaundiced vision. While a doctor is expected to be altruistic and above temptation. But he is not above suspicion, reproach and ridicule. Certainly, the relentless negative press coverage of physicians sets the tone. Often media blames physicians for things the doctors have no control over.

These days Doctors trust patients less due to fear of litigation. There has been an increase in medical litigation cases by 400% in the last decade. There are about 5.2 million cases of medical error or negligence every year. Doctors are forced to practice Defensive medicine- With increasing lawsuits and violence, doctors will practice where you document more than you diagnose and treat.

Independent for 74 years and India has not been able to achieve the target of “Health for All” so far. The burden of diseases in India still remains large. Government of India wanted to achieve the target of “Health for all by 2000. It is 2021- this national goal is yet to be achieved. India has a dual challenge of facing both communicable and non-communicable diseases.

The ethics of medical education the concepts of right and wrong.

Medical profession should be proactive rather than reactive in approaching the ethics of medical education. It is said that evolution is as much of a biological issue as it is an ethical one: the higher you are on the evolutionary ladder, the more important become ethics. In fact, what sets humans apart from animals is a heightened sense of ethical and moral values.

Substitute the profit motive with the service motive in the field of medicine. This means we still do what we want to do, but we do it to serve society and not to make money.

STEEEP model of health care- stands for safe, timely, effective, efficient, equitable and patient-centred care — a motto that was supposed to be shared by doctors and all the hospitals. STEEEP replaces the old philosophy of “First, do no harm,” as it tackles the issue of patient safety and quality on a broader level.

It focuses on the need to provide safe care at all times. All care that is provided should also be timely, as delay in care can potentially lead to grim consequences.

Medical education is just a business.

At present India has 554 medical colleges that annually provide 82,950 MBBS seats. It is estimated that by 2024 India would achieve a ratio of one doctor per 1000 population. There have been aspersions on the quality of medical education provided in our medical colleges.

Despite the presence of more than 500 medical colleges including prestigious institutes such as AIIMS, PGIMER, JIPMER, Vellore medical college etc. none of the Indian medical colleges feature in the top 100 global medical colleges. This is a cause for concern.

The Parliamentary standing committee to overhaul Medical Council of India in 2016 — chairman Prof Ram Gopal Yadav called MCI a “club” of influential medical practitioners who act more as per their whims without any fear of regulations.

There was and is widespread corruption in granting approval for setting up medical colleges. The licensing process is irregular. The inspections are opaque leading to massive corruption.

The composition of MCI has neither met professional excellence nor medical ethos.

The commercialization of medical education had a profound impact on quality of graduate doctors. Anyone with money bags can buy seats in these colleges. Thus sanctity of education was lost as medical education became a field for unscrupulous practices and profits.

We need Doctors by merit, not privilege. In majority of cases ability to pay, and not merit, is what counts. Some seven lakh students “qualified” for 70,000 and odd MBBS seats this year. How can this possibly be true? Shouldn’t the cut-off be raised, so that just the top scoring 80,000 students get placed, allowing a margin for drop-outs? Here lies the master plan to subvert merit in medical admissions.

The NEET exam is supposed to assess the competency of candidates for admission into MBBS/BDS courses. Since NEET became mandatory in 2016, the cut-offs have been decreasing every year. This year, the cut-off in the unreserved category went from 131 to 119, out of a total score of 720- 16% Is this merit? The cut-off in the reserved category has also fallen by a similar margin, from 107 to 96, out of 720- 13%. Is this merit? So much so, often, the candidates selected do not have the right attitude or aptitude to learn the divine art of ‘healing the ailing’.

The ultimate aim of the colleges is to “pass” the inspection. Many colleges struggle to find faculties both in the clinical and non-clinical disciplines. Appointments, promotions, and transfers of faculties are common just before an impending inspection. Arranging” patients during the inspection is a major challenge. Hospital staff and hired people make up for the patients.

India is the only country that authorises, as official policy, the sale of medical seats by private medical colleges, implicitly accepting the principle that the ability to pay, and not merit, is what counts.

The world needs doctors. Doctors are seen as a symbol of dignity, responsibility and service towards the community. Medicine is a career driven by service where your field of expertise continually expands. It requires quick thinking and decision-making. People will look to you for answers. It sounds formidable and daunting.

Indian medical education does not focus on Evidence-based and research-based education. Like it or not, Medicine today values intervention far more than it values care. There is more money in interventions than in treatment.

Medicine needs complete and total reform of the curriculum in medical schools to protect patients from excessive medical intervention and trigger happy surgeons. It is quite obvious that we can’t change anything if we are not honest about what needs to be changed.

50% of what is taught to day is either inaccurate or invalid 5 years hence! There is no upgrading of the curriculum of undergraduate students. This phrase is a recognition of the ever advancing nature of medical knowledge .Update or perish!

Would I choose to be a doctor all over again! One hears this question all the time. The truth of the matter is that the day to day struggles and frustrations weigh heavily on our professional and personal lives. There were once rewards, hefty pay checks, had autonomy and respect. Now Hypocrisy has become a common denominator.

I am a medical teacher myself for some forty years now. I find myself interacting with my students and doctors across two generations and various specialties in the medical conferences and convocations. And increasingly, a sense of despair and disillusionment is writ large in their words.

57% of the doctor parents, said I will never let my child become a doctor. In a nutshell, many felt that they will not want to allow their child, to become a doctor in India. The Indian Medical Association confirmed that over 75% of doctors in India have faced some form of violence at the patient’s hands in India. Often Doctors on duty have to pay the price with their lives in the violence from the relatives of the patient whom they were trying to save a definite death in the emergency room!

In a country with the world’s heaviest health burden, and highest rates of death from treatable diseases like diarrhoea, tuberculosis and pneumonia, corruption at medical schools is an extremely pressing issue.

The medical profession and education have become a business and now the regulation of medical education has also become a business which is the nation’s tragedy, an anguished Supreme Court said. This is how botched up our education system has become,” it said.

Many agents have brazenly admitted to issuing thousands of fake medical degrees at around Rs 50,000/- apiece. This cannot happen without the knowledge of the police and health authorities! Majority of them still are having a free run!Few of them had the gumption to tell that they were doing a service to the country that desperately needs more doctors!

Private medical colleges have proliferated rapidly in India. When in 1980 there were around 100 public medical colleges to eleven private medical colleges. Now the private medical colleges out number government Medical colleges’ by 215 to 183. Most are run by businessmen with no medical experience.

I hear certain post-graduation seats now go for Rs4 crores. A PG qualification may fetch you many times more in the form of Dowry in certain states.

The most productive medical college in India is also its largest public health institution, the All India Institute of Medical Sciences, or AIIMS. In a 10-year period AIIMS published 11,300 research papers. For context, that is about a quarter of what Massachusetts General Hospital produced in the same time frame.

The most recent reports revealed that more than half of those 579 college didn’t produce a single peer-reviewed research paper in over a decade. It gives credence to the long-standing suspicions that many private colleges in the country are in medical education only for just a business.

Open secret: Doctors take cuts for referrals.

On the likely doctor and diagnostic center nexus, the “racket” is leading to unjustified profit margins and a heavy burden on the patients. Medical profession with the entry of big business houses and heavy investments have become a centers of big corruption. There is cartelization among diagnostic centers and pathological laboratories.

Medical errors!

Doctors are no Gods! To err is human! I am confident that errors by the doctors are much below done by other professions! It happens in every profession! That is no consolation! Medical profession is also the profession trusted by the population! Medical errors should not be at the cost of patient’s life.

The Institute of Medicine- USA published “To Err Is Human” which concluded medical errors are not caused by ‘bad people’ but in general are caused by good people working in bad healthcare systems that must be made safer.

A medical error is a preventable adverse effect of care and includes an inaccurate or incomplete diagnosis or treatment of a disease.

How Common Are Medical Mistakes? Although exact estimates are difficult to find, it is not surprising that an industry as stretched, complex, and burdened as the medical industry is fraught with errors. Many errors go unreported and tracking their exact prevalence is difficult.

Poor bedside manners, Long wait times and no apology, rushing the patient, Not being responsive to the patients concerns, Disrespectful staff, Being unavailable when needed, Cancelling/rescheduling appointments too often adds to trust deficit.

I think it is incumbent on physicians to recognize- they need to earn this trust, and not take it for granted; to watchdog their profession and to monitor themselves to promote respect from the public and the media; Let not business of medicine influence the practice of medicine.

Patriotism has always been associated with armed forces! Now it is also associated with doctors, nurses, Paramedics — many of whom were suddenly saddled with unfathomable tasks, compounded by an increased risk of contamination and death they never signed up for.

We, Physicians and scientists have cured polio and most childhood cancers and infections. We have reduced deaths from heart disease and stroke and developed better treatments for diabetes and kidney failure.

We routinely transplant organs and use robots for surgery, remove brain tumors with minimally invasive procedures, and perform surgery on babies while they are still in the womb. We are up to these challenges, and we can fix our own faults and deficiencies.

· A physician shall uphold the dignity and honor of his profession.

· The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. A physician should be an upright man and an expert in the art of healings. He shall keep himself pure in character and be diligent in caring for the sick; he should be modest, sober, patient, prompt in discharging his duty without anxiety; conducting himself with propriety in his profession and in all the actions of his life.

· A Physician should participate in professional meetings as part of Continuing Medical Education programs.

· We live in unhappy times. doctors have failed in their duties to the very poor.

• Do unto others, as you would have others do unto you.

• Patient first

ACT WITHOUT FEAR OR FAVOUR — Ensure that your decisions and actions are scientific, humane, effective and in the best interests of the patient and his family. Record them. Once this is done, you need fear no individualor administrator !

Dr N Prabhudev

Former Vice Chancellor Bangalore University

Former Director sri Jayadeva Institute of Cardiology Bangalore

Former director of Sri Jayadeva Institute of Cardiology, Former VC of Bangalore University and former chairman of the Karnataka State Health Commission