Friday, 30 June 2017

Only Dreamers can be Doctors

If there is one thing I regret in life, it is not studying to be a doctor. I am not usually the regretting kind –but I have enormous respect for those that heeded the calling and chose this profession.

There are a number of reasons I could possibly give for my not choosing to be a doctor – but below all that is a lack of courage. I simply lacked the courage to withstand the trauma and the gore. I lacked the commitment it takes to work endless hours. I doubted my ability to go those long hours without sleep and still be available, when needed, to address the next, inevitable, crisis. I wasn’t sure that I could cope with the expectation – to be that model citizen who unselfishly puts others’ interests ahead of his/her own.

Fourteen years ago, I made amends in a small way by committing myself to a career in healthcare – to support these wonderful people in their quest to keep people healthy. 

A few years ago, I was discussing a mutual passion in music with a doctor friend. The conversation veered to affordable player options and I talked about my latest acquisition, a Bose Sound Dock. My friend laughed and said “Rs 13,500/- isn’t a small sum of money on an associate professor’s salary, Harish”.  I came out of the room very embarrassed by my lack of sensitivity and suitably chastised. The incident also got me reflecting on the cost economics of becoming a doctor.

A little known fact is that a professor in a Government Academic Centre of Excellence takes home a salary comparable to that of the Company Medical Representative across the table from him. The figure could multiply several fold if they choose to move to the private sector - a fact that every doctor is aware about. This begs the question “Why do these doyen of the medical profession choose to stick to their government careers?” “Why do they resist the large financial incentives to jump ship?” and “Will this last?”

Medicine is amongst the most expensive educations one can pursue. Even in a relatively less expensive country like India, the cost of qualifying as a doctor can top Rs 1 Crore ($ 150,000) – in terms of facilities, equipment, teaching faculty and support staff. It also takes significantly longer to qualify – there is the 4 year undergraduate course, residency and a possible 3 year post graduation. Doctors often earn their first salaries when other professionals have bought a car and are planning their first child. The starting salary for a General Practitioner in India averages ~ Rs 7 lacs per year. This is only marginally higher than that of an office assistant – and significantly lower than an executive’s starting pay. Most start as duty doctors manning the toughest shifts and the worst timings – or are left to fend for themselves in the uncertain world of private practice.

Layer on top of this the huge gap in the availability of qualified doctors to manage the health of a population as large as ours. The WHO norm for is 2.5 doctors per 1000 population – a number that several developed nations have reached and exceeded. China and Brazil have 1.8 doctors per 1000 population. The corresponding figure in India is 0.7 doctors per 1000. Given the amazing range of professional choices available to an aspiring youngster in our country, will this gap ever be covered? I, for one, have my serious doubts.

What, then, is the recourse available to us? How do we continue as a country to march towards Universal Healthcare, the Sustainable Development Goals and delivering on the promises an “emerged” nation needs to make to its citizens. I have listed out my list of “must do’s” below :


  1.          Value our doctors – they chose to be where they are so they can serve us. Value their time and respect their inputs
  2.          Support every healthcare professional to work at their highest capability level
  3.          Use technology to free up precious doctor time
  4.          Empower patients to take care of themselves
  5.          Focus on prevention and early intervention

Each of these is a complex problem in its own right – and each deserves to be dealt with in detail as I hope to do in my future writings.


For the moment, though – I would like to end with a salute to our doctors. You are truly an inspiration. We might not always show our appreciation but we depend on you to keep us healthy and happy!

63 comments:

  1. Very touching, I must say as a doctor!

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    1. Very well written. Touching, atleast few people realize the sacrifices we make

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    2. Excellent writing. The Karnataka Govt. must read this. The people of our county should realise this.

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    3. Thanks mr harish ..At least some one spoke good about doctors . Such a analysis should be presented to more common people . Ther are black sheeps i all profession .i wish and hope our profession should not suffer a slow death 🙄

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  2. Such realisation and appreciation is the reward that has kept such academician doctors to keep working even with limited resources. Very nicely drafted

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  3. Such realisation and appreciation is the reward that has kept such academician doctors to keep working even with limited resources. Very nicely drafted

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  4. True. Touching. And not many outside our circle know what an academician doctor is...

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  5. Came to know about the feeling of an intellectual. Thanks that someone somewhere at least had courage to express. But if anyone doesn't take me otherwise, I personally think that such feelings if really taken, hardly 1 percent of Indian population have ever given this thought and if not be taken as negative but the tangible truth is that Doctors value is not going to increase in coming 10 years. Dr Anil Thakur.

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  6. Well written. It certainly needs courage and madness to be in medical profession. Doctors are burning out and they will burn faster with the recent turn of events.

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  7. Technological advances in every field have given many people false believes and out of the world expectations of recovery of sick patients however grave their illness is.such people hold the treating doctor's incapability as the reason for poor outcome. This is one sad part of todays practice.Well written words Harish.

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  8. Technological advances in every field have given many people false believes and out of the world expectations of recovery of sick patients however grave their illness is.such people hold the treating doctor's incapability as the reason for poor outcome. This is one sad part of todays practice.Well written words Harish.

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  9. I am surprised that someone has this insight especially after what Aamir Khan and later most of the press has helped on the medical fraternity. One of the issues due to the poor support is the utter lack of original research across India and consequently no solutions to our pressing problems.

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  10. Thanks Mr Harish. It certainly takes guts yo enter and complete MBBS, and those who are more stronger in will power go further to do their postgraduation, superspecialisation and frllowships etc etc. It all comes with a cost. The cost of education, which is many times not affordable to us as a qualified MBBS doctor, becose we are paid penny while getting education. And I still remember admiring my engineer friends flat and car at age of 26 while , I was largely still dependent on picket money.
    It's not only plight of academician, even in private set up, doctor has to battle whole 5-8 years to set up consistent, Regular decent income.
    Well written.

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    1. Will the health minister of Karnataka trying to pass a draconian bill read this?

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  11. Thanks Mr Harish. It certainly takes guts yo enter and complete MBBS, and those who are more stronger in will power go further to do their postgraduation, superspecialisation and frllowships etc etc. It all comes with a cost. The cost of education, which is many times not affordable to us as a qualified MBBS doctor, becose we are paid penny while getting education. And I still remember admiring my engineer friends flat and car at age of 26 while , I was largely still dependent on picket money.
    It's not only plight of academician, even in private set up, doctor has to battle whole 5-8 years to set up consistent, Regular decent income.
    Well written.

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  12. Eye opener for dumb people,who are self concentrated.

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  13. Harish
    So well written

    Can you post it for me on my Facebook page
    Made for entry to medical colleges

    The link is
    https://m.facebook.com/nextexamneet2017/


    Thanks


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  14. Thanks for appreciating our hardwork , dedication . People like you motivate us and give us the vibrant energy to keep doing good for the welfare of the patients .

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  15. Mr Harish just read ubr well written blog. I am not appreciating it because I am a doctor

    Appreciation come from the fact that u analysed so much about the young 18 yrs old who aspires to be a doctor and then 8-10 yrs of hard work and then meagre salary and the. The hard work for years till one day the doc gets recognised.

    Fantastic and thanks Harish

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    1. Thank you so much for your kind words, Dr Mohan.

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  16. Thank you very much. I am very touched by all your comments. These were my closest held beliefs - and my small efforts at recognising a truly noble profession.

    I think we have an opportunity in India just now - of learning from not only the successes, but also the mistakes made by more developed countries, several of which cannot claim an effective healthcare system even today.

    It will take courage, resolve, trust and commitment at several levels - but I for one am positive that we will see this happen sooner than we think.

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  17. Thanks for the support specially now , when the whole country seems to blame doctors for every death, mishap or illness. Apparently no one dies of natural cause , behind each death is an incompetent doctor. Leave alone the monetary part, physical abuse , verbal abuse and threats of being dragged to various courts is breaking our morale.

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  18. Thanks harish, nice article, it's so sad that very few people know we are working so hard, times are changing, lifes becoming difficult, with God's grace we continue

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  19. Thanks Dr Harish...
    After doing Medical practice of 19 yrs..
    When I c drs beaten up, dragged in courts, seen with suspicion, Govt drs getting so less salaries,
    Sometimes I regret choosing this field,
    But
    Every week some patient say thanks with wet eyes, some father touches my feet fr giving services in free without charging any fees..
    N
    Sometimes
    Educated people like u write such things,
    It really makes us Positive, gives us more energy to stretch ourselves further n work more towards saving lives...
    Thanks Mr Natarajan ..
    It means a lot...
    Dr Anupama Varma Mumbai

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    Replies
    1. Hope more people add Positivity in our society

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  20. I see only doctor replay......

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  21. I see only doctor replay......

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  22. #Medicine is amongst the most expensive educations one can pursue. Even in a relatively less expensive country like India, the cost of qualifying as a doctor can top Rs 1 Crore ($ 150,000) – in terms of facilities, equipment, teaching faculty and support staff.# Here I beg to differ as interns and residents we medical students are the work force of all tertiary health care facilities across the globe. Our stipend is a small amount. So that way that human resource cost has to subtracted. All the infrastructure and equipment is for the health care of the population so it can't be said the cost of medical education is 1.5 crore

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  23. Realistic n appropriate to judge n best judgement to write down here like this.

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  24. excellent answer by a patient on why she supported Drs during the protests in Karnataka against KPMEA :
    I am NOT a Doctor,
    I am a patient
    i have more faith in my doctors than i have in my govt.
    My dr survives on my fees
    My govt survives on my taxes

    I get so much attention from my doctor
    I get jackshit from the govt

    Doctors save my life
    The govt kills me with potholes & pollution

    yes, maybe there are bad doctors.....
    But there NEVER has been a good govt
    NOT in my lifetime

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  25. excellent answer by a patient on why she supported Drs during the protests in Karnataka against KPMEA :
    I am NOT a Doctor,
    I am a patient
    i have more faith in my doctors than i have in my govt.
    My dr survives on my fees
    My govt survives on my taxes

    I get so much attention from my doctor
    I get jackshit from the govt

    Doctors save my life
    The govt kills me with potholes & pollution

    yes, maybe there are bad doctors.....
    But there NEVER has been a good govt
    NOT in my lifetime

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  26. excellent answer by a patient on why she supported Drs during the protests in Karnataka against KPMEA :
    I am NOT a Doctor,
    I am a patient
    i have more faith in my doctors than i have in my govt.
    My dr survives on my fees
    My govt survives on my taxes

    I get so much attention from my doctor
    I get jackshit from the govt

    Doctors save my life
    The govt kills me with potholes & pollution

    yes, maybe there are bad doctors.....
    But there NEVER has been a good govt
    NOT in my lifetime

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  27. Thank you for your kind words. In these times, when our profession is blamed for almost everything that goes wrong, when in spite of all our hard work,there is little faith in our ability , when webare subjected to needless scrutiny,mistrust and suspicion, your words give much needed hope

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  28. This comment has been removed by the author.

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  29. Vikas Tripurneni23 November 2017 at 06:05
    Indeed very apt and touching.. you my friend have excelled in expressing what most doctors want to say but can't because either they don't have a command of English or they just don't think anyone cares..wish the general public had a fraction of your understanding.. Well written

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    1. I've been a GP for 35 years and I cannot afford a much required holiday.i practice in a village.

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  30. Agree Vikas. I think most of us just get on with the work and are too busy to pen up such thoughts and express ourselves.

    Dear Mr Natarajan, Its a well written article/blog. Thank you 🙏🏻

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  31. Thank you for being empathic & sensitive

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  32. Thank you! at a time when we are villains in the eyes of the society at large.. admist the verbal and emotional abuse we are facing it's feel good to know somebody outside the circle thinks like this. A very big thank you. We are trying hard to push aside the cynicism that has crept in and continue to work ,cos this is a vocation best done in and with good faith.

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  33. Dear Emmanuel. I am honoured - please go ahead.

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  34. Good article.thank you for the kind words...
    :)

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  35. Nicely put up.thanks for atleast understnading the side

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  36. I have a different take on the viewpoint expressed in this article compared to most of the people who posted comments.

    I feel that doctors more than a generations ago came close to the type of "inspiring human beings" described by the author. However, I'm sorry to say that the noble reason for entering the profession has all but changed in recent times. The warmth, the human touch, the willingness to spend time and LISTEN to the patient are all scare commodities among modern doctors (for the most part). This is adequately demonstrated by the public's increasing distrust and frustration with modern doctors.

    There are exceptions of course.

    Consider the following: Most MBBS doctors these days are unwilling to work in rural areas and in tier 3 and 4 cities. This noble role is now filled by Ayurvedic and Homeopathic doctors. As a result, many of them are more skilled in emergency medicine than their MBBS counterparts

    So where is that sense of sacrifice the author speaks of? Most of these MBBS docs have their eye on going for their PG (not so much to garner knowledge, but to get jobs in the big corporate hospitals). This is not my opinion, this comes straight from the young doctors' mouths. I know because I tried to hire many of them.

    And another ugly fact: Many people literally buy their medical college seats and as a result the educational system is turning out more and more incompetent doctors who have no aptitude for medicine.

    So, while I definitely admire those doctors who do an admirable job, I am cautious not to deify the profession at large because it has morphed into something it was never intended to be. The kickbacks, the referral fees, the cosy drug company relationships, etc. are all quite troubling and unless we make drastic changes to the healthcare system, the future looks bleak.

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    1. Thanks for raising these issues. I would love to reply to ur article as per the respective points made by you.
      Para1
      I feel that doctors more than a generations ago came.............
      Reply: No one asks for nobility on either side. However distrust leads u nowhere. If u pay someone for any service, u have to trust him esp if he has spent more than half his life in education.

      Para2
      Most MBBS doctors these days are unwilling to work in rural areas.
      Reply
      Why should they b forced to work in subpar conditions & at poor salaries with non existent infra structure.

      U also mentioned about AYUSH counterparts- Why not make them go thru the same & competitive difficult entry as NEET & also make their curriculum/exams as difficult as the 5.5 years we spend. Then no issues in letting them work in our positions.
      Para3
      Most of these MBBS docs have their eye on going for their PG.
      Reply.
      Is it wrong to go in for PG.
      The world over more & more people would like to do PG including PG courses for general practice as Family Medicine.
      If Medicine is becoming specialised, why not go ahead and acquire PG skills.
      Para4
      ugly fact: Many people literally buy their medical college
      Reply
      COMPLETELY AGREE.
      Who is to blame.
      OUR CORRUPT POLITICIANS & GOVT.
      Have u ever pondered whom do 90% or more pvt med colleges (& engg too) belong to?
      Of course POLITICIANS.
      So who is to blame.
      The doctor or the politician/govt.
      Para5
      The kickbacks, the referral fees, the cosy drug company relationships, etc.
      Truly, there are black sheep in every profession incl ours, but once u have a cleaner setup with strict laws incl implemented laws, most of these scheming doctors would also fall in line.
      Many of them do it as they cannot survive in competition if they do not deliver the cut.
      Pharma companies ROT - very difficult to solve. Even in US pharma companies are amongst the strongest. Money & political support allows them to get away with it thereby corrupting the doctors mindset.

      In short, GOVT LAXITY & LACK OF A GOVERNING MEDICAL BODY (MCI is a TOOTHLESS WATCH-DOG that too only on paper) are the only 2 causes needing correction. Once u tackle these two, rest everything falls in line easily

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  37. हिंदुस्तान के मरीजों को इलाज़ अमेरिका के किसी अस्पताल जैसा चाहिए। इलाज़ के दौरान दुर्भाग्यवश कुछ घटित हो जाए तो तोड़ फोड़ ऐसे करेंगे कि मानो अस्पताल सीरिया का है।कोर्ट में जज साहब अस्पताल पर जुर्माना ऐसे लगाते हैं जैसे अस्पताल यूरोप में है और इलाज़ का बिल मरीज ऐसे देना चाहता है जैसे अस्पताल बांग्लादेश का हो।

    धन्य है मेरे देश की जनता।अपने पड़ोस के छोटे और सस्ते नर्सिंग होम्स को बंद करवाने पर तुली है, पर कॉर्पोरेट का बिल देख कर रोना आ जाता है।चाहते क्या हो भाई?

    70 साल में आपकी सरकारें आपको फोर्टिस,अपोलो के स्तर का एक भी अस्पताल नही दे पाई।अपने बल बूते पर ये अस्पताल आपको विश्व स्तरीय,उत्कृष्ट स्वास्थ्य सेवाएं ,पश्चिमी देशों के मुकाबले कई गुना कम दामो पर उपलब्ध करवा रहे हैं,फिर भी आपकी शिकायते हैं कि खत्म ही नही होती।और शिकायत हैं भी तो हिम्मत है तो जा के फोर्टिस अस्पताल के मालिकों का सर फोड़ो।काहे गरीब डॉक्टर्स को गरियाते हो रात दिन।
    याद रखो जब भी तुम किसी डॉक्टर को पीटते हो या जब भी किसी छोटे अस्पताल में तोड़ फोड़ करते हो, तुम जाने अनजाने इन्ही कॉर्पोरेट अस्पातालो के फलने फूलने का मार्ग प्रशस्त करते हो।अंग्रेज़ी में कहते हैं" You get,what you deserve"
    तो मेरे प्यारे देशवासियो , आप खुद अपनी नियति के रचयिता हो।अगली बार जब किसी फोर्टिस अस्पताल का लंबा चौडा बिल देख कर रोना आये तो बजाय निरीह डाक्टर्स को कोसने के एक सवाल खुद से भी पूछना।पूछना कि कहाँ खो गया मेरे पडोस का वो छोटा सा अस्पताल जो मेरे परिवार की 80-90 प्रतिशत बीमारियों का सस्ता इलाज़ कर देता था!
    कहाँ गया मेरा वो फैमिली डॉक्टर जिस पर मेरा पूरा परिवार आंख मूंद के भरोसा करता था और जो रात के 2 बजे भी 100-200 रुपये फीस लेकर मेरा इलाज़ कर देता था। और फिर एक सवाल अपनी सरकार से भी पूछना । पूछना कि इतना टैक्स देने के बावजूद क्यो मुझे इलाज़ के लिए फोर्टिस आना पड़ा? क्यो किसी सरकारी अस्पताल में मेरा विश्वस्तरीय इलाज़ नही हो पाया?

    - डॉ राज शेखर यादव
    MD (Medicine)

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  38. Thanks Mr Harish for this excellent write-up on doctors with inclusion on the troubles that a doctor goes thru in his life, esp those in govt teaching colleges.

    However this appreciation & understanding has come TOOOOOO LATE.

    The damage has already been done on both sides.

    The irreparable damage done in the eyes of the public feelings towards doctors fuelled mainly by Government apathy (in many ways) + some public mobsters + significant contribution by corporate hospital policies.

    The contralateral side's damage includes Doctors trying to play safe with unnecessary investigations, moving patients to higher facilities even at the slightest risk.
    This self risk reduction of doctors results in a much higher cost for the patient.

    About the governments role, less said the better. These scheming theives have done little to improve the PUBLIC HEALTH SCENARIO over the last few decades. The govt is incapable of stemming the ROT IN MEDICAL EDUCATION (UG & PG both)-Vyapam scam, NEET scam, capitation fees etc. + Government corruption in healthcare budget utilisation.
    Also a significant portion of the corporate hospital profits is taken away by the govt as GST & Income Tax.

    Next profiteers are the corporate hospital with their policies (obviously these hospitals are out to make profits, so one can't expect much).

    But in all this muck, the reputation of doctors has gone for a toss (No doubt one has to acknowledge the presence of bad sheep amidst our fraternity too indulging in Cut practice, extra investigations, unnecessary hospital references and surgeries.)

    It is probably too late in this battle as possibly many in the fraternity are already disgusted by the events in last couple of years and many would be wishing their children not following their footsteps in medicine.

    Repercussions of this fallout between the public at large & the medical fraternity will be evident in the times to come with resultant spiralling of health care costs & fewer students willing to venture out & become doctors in future

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    1. Thank you very much, Dr Anil. Agree will all that you say - seriously hope, though, that your prediction on the future of the profession is unfounded.

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  39. I guess the person writing this blog is simply trying an eyewash. A country spending less than bangladesh obviously don't consider health as a priority. Even if all hospitals are closed in one instant it won't bother general public. With a population of 125 crore we can afford much higher mortality and morbidity rate
    Let's accept the reality and prepare future generations accordingly instead of false beautification of a profession which is no longer needed by society

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    1. Dear Dr Rishi - are you a doctor of medicine. I have no reason to "eyewash" - I am not a doctor, I have moved out of corporate healthcare and having to gain from speaking well or speaking ill of the community!

      Agree wholeheartedly with you about the lack of seriousness about healthcare in this country though. Have been researching how successful countries manage their healthcare - and the features of their healthcare system that makes them successful. We can learn a lot from the experiences of these countries - be it a Singapore, Israel, the UK, Cuba, Mexico, South Korea, Thailand etc. Neighbouring Thailand is my hero - for the manner in which they have transformed the sector over the last 2 decades.

      I do hope that our government follows these examples - it will need political will, commitment and an unbiased approach. Not to mention much larger spends

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  40. Hi Mr. Harish,

    Did you get the answer to your query in the passage, "Why do these doyen of the medical profession choose to stick to their government careers?” “Why do they resist the large financial incentives to jump ship?” and “Will this last?”

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    1. Dear Sir - as you possibly guessed, the questions are rhetorical and intend to provoke thought. I have my opinion though - that we are throwing the baby out with the bath water here. As in every profession, there are self serving, money minded practitioners in this profession too. I do believe, though, that by focusing only on these, we miss out the achievements of the large number of practitioners who have done what is right without being swayed by the material aspects.

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  41. As to "will this last?" I wish to tell you that these days Governments are finding it hard to get doctors particularly super-specialists. Even, only MBBS & Specialists are difficult... The attrition rates are so high... Ultimately, by the end of the year only about 20-25% of those selected remain in service (except for Delhi & Central Governments where situation is a little better)

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  42. Well said truly I served for 26 years in govt service in all capacities to run the health services.At the end of my career I realised that I did not have money to build my home nor enough funds for my children education.I have to borrow and even after retirement I am repaying the amt borrowed .Salary drawn was so meagre that it was so difficult to fulfil the needs of the family.inspite of all the difficulties you are happy and satisfying to serve the people .at times the corrupt non medical officials and superiors take a toll of this system.It will be a long journey in this country to address to the evils of the system.

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  43. Had the privilege of re-connecting with Dr TP Lahane at Grant's Medical, Mumbai a couple of days ago. If I needed any re-inforcement of the nobility of the profession, this meeting was surely the recipe. Dr Lahane is in the Limca book of records for being the most prolific cataract surgery. Over his lifetime he has operated on close to 150,000 eyes - a large number being poor patients who do not have the means to pay. A Marathi feature film in his honour was released just 10 days ago - titled Dr Tatya Lahane. His colleague, Dr Ragini Parikh, is in the Guiness book of records as the most prolific lady surgeon. When I met him, Dr Lahane was in the midst of a very busy Outpatient day - after a full day of surgery the previous day. He and his small team were attending to 780 patients who had lined up from far and wide to seek his intervention. He had got 3 hours of sleep the previous night - and yet had 10 minutes to spare for me, introducing me to his colleagues as a close "Mitr"! Amazed at the sheer energy, commitment to humanity and humility of this dynamic duo. Truly an honour to be a part of their universe

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  44. A sensitive take..sympathetic..
    However..I feel as a doctor myself..its time to make a difference between the science of medicine and the profession.
    The science is an applied one..and rapidly changing as are the basic sciences they are based on.
    The profession is the bone of contention..its ethics..its rules..controls..methods of revenue generation..service motive etc.

    Once this basic difference is appreciated..the discussion can start rationally without creating schisms.

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  45. Very well articulated Harish . While going through this article I remembered with gratitude all the doctors who have been my saviors in different stages of life

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