Working of a doctor and nurses is not free from risk to themselves which can be verbal, physical as well as legal assaults. Everyday globally, the doctors and the nurses greet the new day and return to their work of taking care of their patients, knowing well the risk involved. None of the doctors can guess which one fine morning becomes a harbinger to their doomsday, especially when serving an anarchic and hostile society. No doctor can anticipate which one patient can cause deadly harm to health care workers, while trying to save the one. Unfortunate incident of PPH (Post-partum Bleeding – a natural complication of pregnancy) and subsequent agitation by mob and over-reactive FIR by hostile Police was enough for a brilliant Obstetrician to commit suicide in Jaipur. Possibly doctors are not assured of getting justice anymore from our system.
Jaipur- A woman doctor booked for death of a pregnant woman in Rajasthan committed suicide
Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. Jaipur, Mar 29 (PTI) A woman doctor, who was booked for allegedly causing the death of a pregnant woman at a private facility in Rajasthan’s Dausa district, committed suicide on Tuesday, police said. According to police, the pregnant woman died at the hospital run by Dr Archana Sharma and her husband on Tuesday. An FIR was registered against Archana at the Lalsot Police Station after family members of the pregnant woman held a demonstration outside the hospital and demanded immediate action against the erring doctor. Stressed over the FIR, Archana hanged herself to death, police said. “The doctor was booked for the death of the pregnant woman due to negligence in treatment. Today afternoon, the doctor hanged herself to death at her residence above the hospital,” Additional SP (Dausa) Lal Chand Kayal said.
The risk is generally underestimated, although often it may be major risk to life. Majority of people, society and governing bodies and even doctors themselves do not perceive or acknowledge the possible harms to health care workers in present era. But since these risks are increasing exponentially, they should be known to students, who want to take medicine as a profession. There are lesser set procedures, lack of awareness, not protective equipment or hostile society, lack of governance and laws and doctors continue to work in dangerous environment.
Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.
Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project single stray incident as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves. Doctors need to be careful and remain careful about saving themselves from verbal, physical as well as legal assaults.
Doctor- ‘save the patient but to save themselves also’.
Doctors are just as offshoots of a tree called as society. They essentially are the same as rest of the society. It is a specialized branch of tree which helps other offshoots of tree to save others. As part of same tree, they resemble the parent society, of which they are part. Society needs to choose and nurture a force of doctors carefully with an aim to combat for safety of its own people.
Apple tree will have apples and musk melons plant will grow muskmelons only. One should not expect apples to grow on muskmelon stem. If society has failed to demand for a good and robust system, failed to save them, it should not rue scarcity of good doctors. Merit based cheap good medical education system is the need of the society. This is in interest of society to nurture good doctors for its own safety.
Therefore the quality of doctors who survive and flourish in such system will be a natural consequence of how society chooses and nurtures the best for themselves.
Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college. Even an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 15-20 % marks also becomes eligible to become a doctor. What is the need to dilute and shortlist around half a million for few thousand seats? Answer to that is simple. To select and find only those students from millions, who can pay millions to become doctors?
If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way forward. So children have to be careful while choosing medical careers from the beginning.
MUMBAI: MBBS aspirants who missed out in the initial rounds of seat allotment and pinned their hopes on vacant NRI quota seats have been bested by students at the tail end of the NEET qualifying list helped by NRI sponsors. Overnight, close to 152 aspirants, many of them with ranks in six digits, have submitted documents, including a certificate from the consulate concerned, to prove that their education will be sponsored by an Indian based abroad. Aspirants with much higher scores, who were banking on the addition of vacant NRI seats to the relatively cheaper management quota — the fee differential can be as much as Rs 25 lakh-35 lakh — have been done in by a minor clause in the fingerprint. A medical college in Maharashtra has, in fact, already allotted a seat to a NEET qualifier placed 267th from the bottom in a list stretching into several lakhs. When registration for the all-India mop-up round began on March 10, several Indian candidates had applied to convert to NRI status. The medical counselling committee gave such students time from noon on March 11 to 6pm the next day to change their nationality from Indian to NRI. However, candidates wrote to the NMC asking for their nationality to be converted in the last leg of the admission process, presumably after all other options to secure a seat had been exhausted. “The NMC was forced to open that window. According to a 2017 Supreme Court judgment, a candidate can change his or her nationality at any point,” said Dr Pravin Shingare, former head of the Directorate of Medical Education and Research. NRI seats, which cost Rs 40 lakh-60 lakh per year — 4-5 times more than those in the management quota — and had no takers until last week, were now suddenly in demand and filled by candidates with rock-bottom scores. At Pravara Institute of Medical Sciences, Loni (Maharashtra), the last management seat was filled by rank 83,817 while the last NRI seat went to rank 8,72,911. At Sri Devaraj Urs Medical College, Kolar, the last management seat was allotted to rank 86,416 and its last NRI seat to rank 8,76,357. This scenario has played out in medical institutes across the country. Rank holder 71,474 had named MGM College as his first choice in the mop-up round. He didn’t get a seat, but a candidate more than 8 lakh ranks below at 8,73,286 has got lucky, thanks to the clause which allows a student to abruptly change his/her nationality in the midst of the admission process. Hence, of the 19 vacant NRI seats at MGM that should have been converted to the general category, according to the NMC notification, not a single one eventually remained vacant.
Our society fails to develops a robust system of choosing and nurturing good doctors and therefore itself responsible for decline in standards of medical profession. A famous axiom “as you sow so shall you reap” has an application to health system, Government and Public as well in this scenario, so people should not rue scarcity of good doctors.
Overplayed narrative of fewer doctors in the country, rather than a system for proper utilization is an effort to increase numbers of doctors. But this goal needs to be achieved with preserving quality of medical education. Almost all efforts to increase the number of doctors are associated on dilution of merit. Selling the medical seats is heading towards bubble burst, when despite declining demand for poor quality and expensive medical education, new private colleges being approved along with lowering merit to a dismal percentage.
Future doctors getting admissions by scoring just 10-20 percent of marks, poor teacher student ratio, seats being awarded to highest bidder are few pointers to the poor quality of medical education. Few years back NEET percent system was changed to percentile and now the bar is lowered further, just to accommodate more ‘bidders’ with less marks, to be able to buy medical seats.
This potpourri portends to be a travesty of quality, not just of medical education but more seriously, of the quality of doctors. Allotment of medical seats is being left to the vagaries of populism and commercialism, through a false sense ‘the illusion of merit’ secured via NEET. Admission criteria whittled down to mere 10-20 percent, will result in an irreversible and regressive compromise with quality of doctors. Will patients approve such dizzying choice and at what cost?
Going by selection of candidates as doctors, if given a choice, by which a patient will like to get treated? A candidate who scored 20 % marks or a person getting 60% or 80% marks. NEET eligibility getting lower and a candidate getting around 20 % of marks may be able to secure a degree to treat patients. What will be the deciding factor? The criteria as to why a person with 60% marks not getting a seat and another with 20% marks will be able to secure. It will depend upon, whether a candidate is able to pay the exorbitant fee or not. Present system and mechanism of admission permit and accept such huge variation! That strange equation is acceptable in lieu of money paid!
In a move that is likely to boost uptake in vacant post-graduate medical seats and also improve availability of specialists in future, the health ministry has slashed the cutoff for NEET-PG 2021 by 15 percentile across all categories. The ministry issued a letter to the National Medical Commission on Saturday giving a go-ahead to the proposal. The revised qualifying cutoff now stands at 35 percentile for the general category, 30 percentile for persons with disabilities (PwD) general, 25 for SC/ST and OBC and 25 for PwD (SC/ST/OBC), the letter said. The reduction in the cut off percentile is expected to allow more MBBS passouts to apply for post-graduate courses, an official said. “The move aims to prevent seat wastage. With this reduction in percentile, approximately 25,000 fresh candidates can participate in the mop-up round of the ongoing counselling,” a ministry official said. Nearly 8,000 post-graduate seats are still vacant despite two rounds each of all India and state counselling. “After due discussion and deliberations, it has been decided by the health ministry in consultation with NMC to reduce the cut off by 15 percentile across all categories…” medical counselling committee member-secretary wrote in a letter to National Board of Examinations executive director . TOI has reviewed the letters. The move is also expected to fill a serious gap in the availability of specialists. There remains a severe shortfall of over 76% in terms of specialists like surgeons, gynaecologists, physicians and paediatricians at community health centres. Against the requirement for existing infrastructure, there is a shortfall of 78.9% surgeons, 69.7% obstetricians & gynaecologists, 78.2% physicians and 78.2% paediatricians. The Centre has further directed NBE to declare the revised results and send data of the newly eligible candidates to the counselling committee
The ongoing Russia- Ukraine conflict has generated a discussion about a sub-plot, which links to India’s medical education. There have been reports that there are 18000 Indian medical students in Ukraine. People are wondering why Medical Students from India need to go to Ukraine for studying medicine. Answer is quite simple and does not need an Einstein Brain. It is the steep fee that private medical colleges charge from students which is unjustified and beyond any logic. It just needs a sincere ‘Government Will’ to implement the justified fee for MBBS seats in private medical colleges in India. Medical colleges in Ukraine, Georgia, Kyrgyzstan, Bangladesh, Philippines and China have been benefitted because of the severe exploitation of medical students in India.
It needs a sincere and honest assessment of the fee and expenditure of medical college and education rather than a permission for heavy profiteering. If honest calculations are carried out, the fee should not be more than one fifth of present rates, taking into account the hospital services expenditure.
Why do Indian students go to Ukraine to pursue courses, especially MBBS? Because of affordability, says Manjula Naidu, proprietor of a firm that helps send students to Ukraine’s Bukovinian State Medical University. Usha Rani, an Anekal resident whose son is in first-year MBBS at Zaporizhzhia State Medical University, said she wouldn’t have sent him to Ukraine had she been able to pay nearly Rs 80 lakh for an MBBS course in Karnataka. Though Karnataka has more than 9,000 MBBS seats, government quota seats account for not even 40%, forcing many aspirants to opt for countries like Ukraine, Georgia and Kyrgyzstan. What students and their parents find attractive is the Rs 25-30 lakh package for the entire course. Besides there are consulting agencies to help them with loans and the medium of instruction is English. On the other hand, the first fee slab for an MBBS seat in a government college is Rs 59,000 per year, followed by the second slab of government quota seats in private colleges (Rs 1.4 lakh per annum). The next fee slab is of private seats (management quota) in private colleges that varies from Rs 10 lakh to Rs 25 lakh a year. Even more expensive are the NRI quota seats and those in deemed universities.
With the evolving medical science and health care getting intertwined with business, braided changes in medical regulation and law are not an unexpected development. New models of medical regulation, business and law in health care have emerged and progressed in last few decades. Despite a wish to govern and regulate medical profession strictly, the laws and regulations still have to go a long way to provide real justice to everyone. No one really knows how to regulate this difficult area, which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief , sadness and happiness, smiles and sorrow and other uncountable emotions, all intertwined with financial aspects.But the wish of administrators to govern medical profession strictly with punishments is not new. Hammurabi (5000 years back) at the start of civilization believed that doctors needed to be punished in case there was a poor outcome. Strangely it was at a time, when no one understood the complexity of human body and the limitations of medical science; even basic anatomy and physiology of body was not discovered.
Considering the limitations of medical science along with uncertainties and complexities of human body, regulation of medical profession and system of punishments still remains somewhat unfair to doctors, even after 5000 years. It is still based on principles of revenge and retributions rather than developing a robust system by learning from mistakes. By application of an average wisdom, doctors can be easily blamed for poor outcomes, as they are always and universal a common visible link between treatment and poor outcome.
One of the examples of easy punishments for doctors is Medical consumer protection act that was implemented in 1995 for medical services. Patients were defined as consumers and hence doctors were converted to service providers in lieu of some money. Consequently the changed definitions altered the doctor-patient relationship in an irreversible way.
The reality is that neither doctors, nor patients are ready for such a legal relationship. More-over the system is not robust enough for such a change. To work with weak infrastructure, non-uniform medical education, poor numbers of support staff, inept health system along with legal complexities has pushed doctors into a shell and predisposed them to harassment.
Rather than developing a system to promote good doctor-patient relationship, Medical Consumer Protection Act has created a situation of ‘us versus them syndrome’. It caused erosion of doctor-patient relationship and escalated cost of care. Propagation of stray and occasional incidents about negligence case in court or their outcomes are given disproportionate wide publicity in media. The patients are unable to understand the correct application of such stray incidents to themselves. Such cases may be frivolous, just one in million or a rarity, but people always try to imagine themselves being in the hospital chaos due to the scenario projected. It gives a negative projection about medical services and enhances patients’ fear to seek treatment at right time.
There is a growing mutual mistrust; doctors too have started looking at every patient as a potential litigant. Especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients.
With the mandate to practise evidence based medicine, doctors need to document everything and to offer everything possible, leading to skyrocketing medical costs. To save themselves, doctors have to do mammoth paper work, leading to consumption of time that was meant for real deliberations for the benefit of patients.
Consequently insurance companies, medical industry and lawyers have become indispensable and have positioned themselves in between doctor and patients. Besides creating a rift between doctor and patient, they charge heavily from both sides; from patients (medical insurance, lawyer fee) and doctors (indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall inflated cost of health care.
Not uncommonly doctors are used as scape goats to have a concession on the patient’s treatment from administrators.
Medical consumer protection act has increased the anxiety and insecurity among medical professionals. Doctors can be dragged to courts for trivial reasons, for example the sense of revenge, simply for non-satisfaction, to extract money or simply for avoiding paying for services. In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctors does not exist. These money-making ideas are further stoked by the much publicized incidents of high compensations granted by courts.
Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on their confidence and belief, which takes a lifetime to build.
Whenever there is adverse outcome in any patient, all the doctors involved start looking for whom to blame among themselves. Due to legal pressure they try to pinpoint each other’s mistakes. Mutual understanding takes a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity among medical professionals.
The ease with which doctors can be harassed has led to rampant misuse of medical consumer protection act and it has instilled a sense of deep fear and insecurity in the mind of medical professionals. The act has been used as a whip against the doctors by all, including medical industry, law industry and administrators. Only doctors are visible as those who deliver care, so they remain at receiving end for poor outcomes and all these industries remain invisible. The industry has used the protective systems against medicolegal cases to gain maximum benefits out of doctors’ hard work.
In court cases, a certain element of doubt always remains in mind of a doctor whether he will get justice in the long run, or will end up being a victim of sympathy towards patient or clever lawyering. So taking medical decisions in critical situations is becoming more difficult in view of the future uncertainty of disease.
Windfall profits for lawyers is a strong incentive for law industry to promote instigation of patients by against doctors . One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements on ‘sharing and commission basis’. There is no dearth of such relatives and lawyers who are ready to try their luck sometimes in vengeance and sometimes for the lure of money received in compensations.
Consequently doctors are now an easily punishable human link for poor outcomes. Medical professionals work with continuous negative publicity, poor infrastructure, and preoccupied negative beliefs of society and burden of mistrust.
Strangely Medical Consumer Protection Act applies only to doctors, that too selectively. All other professions and services are out of it, not even other constituents of health services. Selective application is what is demoralizing the doctors. Considering the uncertainty and kind of work done by medical professionals, actually it should be other way around.Mistakes are always easy to be picked with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
Nothing else has ever distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Decision making also becomes difficult by uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight with luxury of time and fault-finding approach. The possibility of complex medico-legal situations in doctor’s mind are enough to distract doctors from their primary point of intentions ‘the treatment’.
Therefore increasingly, financially secure doctors are staying away from the riskier jobs. No wise person will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the entire life.
Patients can have poor outcomes for many reasons. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. Whatever court decides, while consuming years, the harassment of doctor is full and permanent. Even if court decides in favour of the doctor, there is no compensation possible for the sufferings and agony spanning over years. Therefore, a single mistake can undo all the good work of past, and the illustrious future work that could have been accomplished.
If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career at risk, why would anyone put himself in that difficult position?
Medical Consumer Protection Act has become a tool to harass doctors and money making tool for lawyers, medical industry or administrators. But it would be naïve to assume that by whipping doctors and regulating them in such a harsh manner will be helpful to patients in long run. The consequent insecurity among doctors, practise of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment) are few of the side effects, which will definitely be passed on to the patients inadvertently. After all doctors have to save themselves as well. As a result, now the battle of life and death will be fought with less zeal, with subdued and demoralized soldiers.
Patients are unable to realize their loss for punishing their saviours. For doctors, no rewards if you win, but sword hanging if one loses. Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Consequently being consumer may be overall a loss making deal for the patients.
In an era when doctors are being punished for small mistakes or merely perceived negligence, the blunders committed by administrators are not even noticed. Doctors are not paid for four months and for protesting the same, they were given termination letters. It seems that doctors need to live with blatant injustice all their lives.
Any punishment for the administrators for mismanagement? Looks impossible but punishment to the sufferers is on the cards.
Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world.
Doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.
It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.
The indifferent behaviour has also unveiled the approach of tokenism such as ‘mere lip service’ showing respect to corona warriors.
The strong political and legal will is absent to solve Doctors’ problems.
New Delhi: Doctors, nurses and paramedical staff of East Delhi Municipal Corporation-run hospitals continued their protest on Thursday as well over non-payment of salaries for four months. Meanwhile, an order issued by the medical superintendent of Swami Dayanand Hospital, Dr Rajni Khedwal, stated that services of all senior and junior resident doctors would be considered terminated from February 4 and fresh interviews would be conducted accordingly. The order also stated that all Diplomate of National Board (DNB) residents and contractual doctors would be marked absent.
“We all were there in the protest, none of us went for our duties. We have also asked the administration to speak on our behalf because they are too part of the hospital. Maybe the matter will be resolved tomorrow. Unless we get a concrete statement regarding salary, we will continue the protest,” said Dr Atul Jain, president of the hospital’s resident doctors’ association.
Meanwhile, EDMC commissioner Vikas Anand said that no order had been issued regarding the termination/suspension of the striking doctors’ services so far. The termination order is only for the DNB workers and for the rest of the medical staff, it is based on ‘no work no pay’ as per the SC rule, he clarified.
“The salaries will be provided at the earliest. We have a very good team of doctors at Swami Dayanand Hospital. The only request is that they should join back and resume services,” said the commissioner.
Anand also said that the salaries for the months of February and March would be paid on time. “EDMC is going through a financial crisis and even in such difficult times, the corporation is sensitive towards the interests of its employees. Their due arrears will be paid in the month of May as per the availability of the funds,” he added.
Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world.
At a time when Political groups, terrorists, drug addicts, celebrities commit crimes and get a priority hearing by courts and speedy relief (whether deserve or not worthy), doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.
It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.
The barbaric response of Police towards peacefully demanding doctors has unmasked the real indifferent attitude of Government and administrators as well as apathy of courts towards medical profession. The cruel behaviour has also unveiled the approach of tokenism such as ‘mere lip service’ showing respect to corona warriors.
The strong political and legal will is absent to solve Doctors’ problems.
It also shows the scant concern of the Government to provide a real good health care system despite showing a verbal concern for medical services. It also explains why successive Governments irrespective of political moorings have terribly failed to provide healthcare to its people. Why patients fail to get a bed, oxygen, doctors or nurse is consequence to the misplaced priorities of administrators.
Who would be the worst sufferer of the apathetic attitude of the Government? Doctors will suffer initially till they continue to choose medical profession. Once they also become apathetic like administrators, it would be the patients.
A day after resident doctors protesting delays in NEET-PG counselling alleged that they were assaulted by the police, doctors from the All India Institute of Medical Sciences (AIIMS) as well as those associated with the Federation of All India Medical Association (FAIMA) have decided to join the stir.
Doctors from AIIMS, one of the only big tertiary-care government medical college hospitals that had stayed away from the protest, in a letter to the Union health minister, said that they would withdraw from all non-emergency work on Tuesday if no concrete steps are taken.
“It’s high time for the government to release a report of what has been done till date, and what are the government’s plans moving forward for expediting NEET-PG counselling. If no adequate response from the government is received within 24 hours, AIIMS RDA shall proceed with a token strike on 29/12/21 including shutdown of all non-emergency services,” the letter read.
This would hamper patient care in the city further. With emergency departments of big hospitals like Safdarjung and Lok Nayak affected by the strike, patients were being referred to the AIIMS for treatment.
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In addition, FAIMA called for its resident doctors’ association to withdraw from all work, including emergency services, after Monday’s incident. The protest began with withdrawal from outpatient department (OPD) services in November end by two national organisations – the Federation of Resident Doctors’ Association (FORDA) and FAIMA.
The protest slowly intensified with doctors boycotting even emergency work, following which on the insistence of the government the strike was paused for one week.
The strike resumed on December 17 as FORDA members withdrew from all services.
Non-uniformity of medical education is treating medical students as slaves and killing enthusiasm of young doctors.
Medical profession is an extremely strenuous and highly specialised field that requires individuals to dedicate their lives in the service of others. As part of medical professionals’ education and training, they are necessitated to undertake training across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government. In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman for proper pay and working conditions.
Great disparity in stipend at Govt. Private Colleges
Medical education is one field where one can notice the extreme variations of the unimaginable magnitude that are beyond comfort.
Falling standards of medical education is the most important side effect which should be an important issue, but sadly it is the last priority on the list of administrators. Each and every medical college can be different and student passing out of many colleges receive below average medical education.
Another important variation is in the stipend and remuneration of young trainee doctors receive. It varies from college to college, city to city, state to state as well as North to South and East to West. Besides being a cause for heartburn. it is a cause for extreme dissatisfaction among medical students.
Needless to say the arbitrariness exercised by various authorities to pay them at their will is a reflection of grave injustice imposed by administrators.
Another arbitrariness reflecting injustice is variation in fee of medical colleges. The steep fee charged by private medical colleges and restrictive bonds of Government medical colleges in name of expensive medical seats need a sincere and honest introspection by authorities. The basis for calculations of the cost of medical education should be transparent and shown in public domain.
Needless to say that medical students have been sufferers of poor and arbitrariness of inept administrative policies. Just because they decided to be doctors, they have to endure poor, unjust and arbitrary policies.
Ironically as a child decides to be a doctor, he is exploited in name of such policies of unreasonable high fee, poor education and low pay. That too while working in extremely inhuman conditions, long and hard working hours. Strangely these medical students suffer grave injustice inflicted by the society since start of their medical education, but when they become doctors, everyone expects sympathy, empathy and honesty.
In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman.
Still the sufferers of grave injustice themselves are expected to impart justice to everyone along with burden of mistrust.
Ensure uniform stipend to Interns: Great disparity in stipend at Govt. Private Colleges
Binoy Viswam, Rajya Sabha MP, has urged Union Health Minister Mansukh Mandaviya to ensure equity in payment of internship to medical students in private and government medical colleges across the country.In a letter to the Minister, Mr. Viswam said that the National Medical Commission’s Draft Regulations on Compulsory Rotating Internship, 2021, issued on April 21 and gazetted on November 18, had said that all interns shall be paid stipend “as fixed by the appropriate fee fixation authority as applicable to the institution/university/State.”
Ambiguity
“The phrasing of this provision allowed for great ambiguity and arbitrariness. It may also result in management of private colleges denying stipend to the interns as they have complete discretion without any safeguarding mechanism. The ramifications of the same are already being seen in colleges across the country as great variance exists in stipend amounts being paid in government colleges as opposed to private colleges,” he pointed out.
A right, not charity
Mr. Viswam said that medical profession was an extremely strenuous and highly specialised field that required individuals to dedicate their lives in the service of others. “As part of medical professionals’ education and training, they are necessitated to undertake internships across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government,” he said.
The MP requested the Minister to consult with all stakeholders, including State governments, medical college managements, medical professionals, and students to formulate a policy that ensures equity among medical students. A uniform stipend to all interns would ensure that, he added.
The erstwhile Medical Council of India had come up with a public notice on January 25, 2019, on Graduate Medical Education Regulations, 1997. The Board of Governors that superseded the MCI was considering a provision that said “All the candidates pursuing compulsory rotating internship at the institution from which MBBS course was completed, shall be paid stipend on par with the stipend being paid to the interns of the State government medical institution/Central government medical institution in the State/Union Territory where the institution is located.” However, it was not gazetted until the Board was dissolved.
The old adage “All that glitters is not Gold” is particularly relevant in current era of media domination where media projection shapes the perception and may defy the reality. Media has dominated our lives and can sway the opinion formation of masses. Written media, television, social media can collectively influence the mass opinion.
Society, in general, needs to be wise enough to realize the importance of getting rid of these blinders in real life . One such factor that causes an illusional mist in the thoughts of masses is projection in films. They create a mirage of illusional glitter wherein there is blurring of real life from the reel life of heroes. The larger-than-life unreal persona of the celebrities on screen looks too charming and sometimes becomes undeniable and dominates mind of masses. The super-human characters played out in films appear to be real. The problem arises when the imaginary characters of the reel life stories are emulated in real life. Individuals as projected character fill in peoples’ imagination and are perceived as real and becomes ingrained in mind. The naivety of masses to perceive the projected character as real one goes beyond a reasonable thought process and imagination.
These roles played in films are not really act of inspiration in real life as the actual purpose accomplished in the end of a movie is entertainment of society and business for themselves. A recent candid admission by the actor Mr Irrfan Khan that film stars should not be role models was impressive (Hindustan times) .
At the best, a particular projected character (and not individual acting star) may be a role model. An actor or super star, is simply doing his work of “acting” in the end. This work of acting may bring an entertainment of few hours at the most.
One cannot stray away from the wisdom to choose between what we consume merely for our entertainment and what we believe or face in real life. One needs to differentiate between rationale truth behind the celebrity gimmicks in the media and exaggerated sensationalism. Sensation created merely for a commercial successful venture should not be allowed to overpower the judgments of real life.
But the problem starts, when these false perceptions created merely by a projected glimmer takes the shimmer away from the real worthy. The real professionals and people who are worthy of glory become invisible behind the glittery mist, a haze, which is unreal and unhelpful in real life.
A soldier contributes to our society much more in real terms. Even a junior doctor saves many lives in a day in emergencies as compared to work of a superstar in films. A teacher, nurse or scientist have contribution which is more fruitful to our generation. Also the scientists, who contribute immensely and bring about the real change in our lives. Their contribution is huge to our society and much more than doing just acting on screen. The reel actor merely imitates the real life lived and actual work done by real heroes like soldier, doctor or teacher. Someone who only acts and behaves like one, is respected and paid thousand times or more than the real one. In reality, people need more than mere entertainment and reel role models and actors in their real lives.
Compare the trivial amount of remuneration, fame and respect the real worker gets as compared to the film stars, who merely imitate their actions. Reel projection for purpose of entertainment is more easier to enact and more profitable than actual performance in real life. It is easier to become a reel hero, as it requires little hard work or just connections to get an opportunity. Some one can be a reel hero just by dynastic factor easily. Hard work is definitely required but that may or may not be prerequisite.
Even good films may raise some social problem, which everyone knows already and offer no practical solution in reality. Therefore what good it brings to the public, beyond entertainment, is any body’s guess. The persona, actors usually project on screen, may actually be far from his or her real personality. In most of cases, what he does in movies and reel life, is actually away from possibility of real life . But strangely in present era, people lose sight of what is mere perception. It is clearly a story, tale, a drama, a myth and is not the real identity of the people, we see on-screen.
In present era, real contributions by people, who are saviours of human life and the real heroes, remain unappreciated. People are so besotted by fame and money that they fail to appreciate the sacrifices made by real heroes. Filmy super hero just imitates a doctor, soldier, dacoit or a street hooligan and just pretends to be one on the screen.
But there are real life heroes that exist around us. Doctors awake at night saving lives every minute or soldier in freezing cold are worthy of more respect and are real heroes. And it is up to the society to look beyond the superficial and reel story, and focus on the real life actors. There has to be an true effort to make, respect and appreciate real heroes.
Point to ponder is that whether society needs people just acting like doctors, soldiers and not the actual and real ones, who saves lives. Does Society need only entertainment, because respect which is paid to someone who is just an actor, is not extended to real doctors, soldiers or other altruistic professions.
A reel hero who acts like a soldier, is famous and richer and than the actual soldier, who dies unnamed and in penury. Children of today’s times will strive to become, who is worshiped and paid respect by society and therefore will prefer to become reel heroes.
A society truly needs the real people, who work and act for them, more than just entertainment. It will need total change in attitude of people to deconstruct the perceptions, which are based on mere projections and are away from reality.
It is time to recreate and worship real heroes, who have become invisible behind the glittery mist.
Society needs to envisage the bigger real picture, and should not be mistaken for another projected story.
The perception of the projection will decide, what does the society actually need- or desire-or deserve , “Reel Heroes or Real Heroes”.
The medical profession and education have become a business and now the regulation of medical education has also gone that way which is the nation’s tragedy, an anguished Supreme Court said on Tuesday, giving one chance to the Centre to put its “house in order” and take a call on reversing the changes made to the NEET Super Speciality Examination 2021 syllabus.
The apex court was not satisfied with the justification given by the Centre, National Board of Examination (NBE) and National Medical Commission (NMC) on making the last minute changes after the notification for examination was issued in July.
“This is how botched up our education system has become,” it said.
A bench of Justices D Y Chandrachud, Vikram Nath and B V Nagarathna in an over two hour hearing gave time to the Centre, NBE and NMC to come up with a solution by Wednesday morning and said it will continue hearing the matter to avoid any prejudice to the young doctors.
“This matter is part heard and you can still put your house in order, we will give you time until tomorrow. We will not adjourn the part heard matter now as this will only cause prejudice to the students but we hope better sense prevails. If there is a sense of obduracy, then we are armed with law and they are long enough to reach out to the obduracy. We are giving you one opportunity to reform,” the bench said.
The top court was hearing a batch of pleas of 41 Post Graduate doctors and others who have challenged the last minute changes made to the syllabus after the notification for examination was issued on July 23 for the test to be held on November 13 and 14.
Additional Solicitor General (ASG) Aishwarya Bhati, appearing for the Centre, said the court should not get the impression that the last minute change in syllabus was done to fill vacant seats in private colleges and they will try to persuade the court to dispel this notion.
“We are getting a strong impression that the medical profession has become a business, medical education has become a business and the regulation of medical education has also become a business. That’s the tragedy of the nation,” the bench said.
The authorities should show some concern for the students, as these are the students who do not start preparation for these course two or three months in advance but right from the time they join a Postgraduate course, they aspire for a super speciality, which requires years of commitment, it said.
The government has to balance out the investment made by the private sector in these medical colleges but it should equally think in the interest of the medical profession and the interest of students, the top court said.
“The interest of students must weigh far higher because they are the people who are going to be a torch bearer of providing medical care and it seems perhaps we have forgotten them in the whole process,” it said.
The top court said that prior to 2018, 100 per cent questions came from the feeder courses; from 2018 to 2020 there was major modification under which 60 per cent marks were from super specialisation and 40 per cent from the feeder super specialisation courses.
“Now what is sought to be done is one hundred per cent questions will be from primary feeder speciality which is general medicines. It is completely overlooking the facts that you are fundamentally changing the examination pattern and you are doing it for an examination announced to be held in November, 2021,” it said.
The bench added that NBE and NMC are not doing any favour in asking the court to push back the examination by another two months.
It told Bhati, “It does not matter as these doctors will join the Super Speciality courses two months later, so long the seats are filled up it does not matter. This shows us the length to which your clients are willing to go to ensure that seats are filled up. Nothing should go vacant”.
Bhati said that seats going vacant is not the only consideration that has weighed on experts but it is the comparative opportunity and comparative ease which will be in larger public interest of the students that has weighed with the experts.
The bench said, “So what really happened is this for all specialisation of super speciality, starting from critical care medicines, cardiology, clinical haematology and other courses the specialisation is only going to be and the examination will be on general medicines.”
“The idea is that general medicine has the largest pool, the largest group in PG, so tap and fill up the vacant seats. That seems to be the logic behind this, nothing more and nothing less”.
The top court said, “You may have a rationale; we are not saying you may not have a rationale. The question is that all changes, which you have brought has caused serious prejudice to the students. Problem is that you didn’t plan for the future. You did not have a vision and all that you do is that just because you have a certain degree of authority you will exercise it in whatever time you want”.
The bench asked Bhati and senior advocate Maninder Singh, appearing for NBE, what was the great hurry to do it for this year as heavens would not have fallen except for the fact that some 500 seats would have remained vacant in some private medical colleges.
On September 27, the top court said, “Don’t treat young doctors as football in the game of power,” and warned the Centre that it may pass strictures if it is not satisfied with justification for last minute changes to the syllabus.
Evolution of Medical profession-Extinction of good doctors 