Suicide by medical student : Global, world wide Rotten system of medical education


A Resident doctor student of Surgery at GMC  Surat allegedly committed suicide last week by jumping from ninth floor. He blamed work pressure and torture in his suicide note. Actions and conversations are generated only after some terrifying incident and finish with making few scapegoats to blame for  one, like five seniors doctors in this case. But the whole system continues to function in same      inhuman way.  This rotten system ignores the deleterious culture of medicine and dangerous working conditions to which junior doctors are subjected.

http://timesofindia.indiatimes.com/city/surat/5-booked-for-abetting-suicide-of-gmc-doctor/articleshow/59463184.cms

Medical students enter medicine as inspired, intelligent, compassionate humanitarians. Soon they turn into cynical and exhausted humans. How did all these totally amazing and high-functioning people get so disillusioned so fast?

Problem does pertain to doctors all over the world, as evidenced by suicide by Dr Chloe Abbott in Australia in January. Her sister Micaela said she was Eaten Alive by the medical profession.

http://www.dailymail.co.uk/news/article-4325812/Investigation-medical-profession-suicide-epidemic.html

 

Inhuman duties, neglect, apathy of regulators towards genuine problems, chaotic  system of working have left doctors, specially in residencies vulnerable to mental illness. Sometimes even driving them to suicides  because of  system failures of medical  administration and inaction by Government.

The terrible conditions have engulfed not only junior phase of doctors, but continue for longer period of their lives, for most of doctors. Because medical professionals find themselves  at the wrong end of stick of government, courts, media for brutal expectations. They face public wrath for system failure.  There is an urgent need for change in work culture and regulations, to make conditions safe for doctors. Grueling shifts, inhuman working hours have to end now, if society really wants to be treated by good doctors.

 

Untenable working conditions, long inhuman hours, unrealistic expectations of patients and thereby creating pressure situations, fear of complaints, physical assaults and medical lawsuits have killed profession largely. Bullying and harassment from all possible quarters is unavoidable consequence.

My earlier article “ enslavement of medical profession” highlights the plight of doctors.

  Almost every doctor will have horror stories to tell, about working conditions. For which medical regulators should be ashamed, there is nothing to be proud of.

      

Happy doctors day:  merely a hollow slogan?


On 1st of July, doctors are usually greeted from multiple quarters. Newspapers, media and some prominent people  congratulate doctors in their speeches or on their social media pages. However, what doctors need are not just verbal wishes but reinforcement of public’s belief in them . It is this renewal of faith in their saviour which will help  doctors in discharging their duties smoothly and in alleviating their problems.

National Doctor’s Day: India, USA

Despite the paucity of the highly trained medical professionals, the identity of medical professionals as a community in society is not getting its due right  because of  misplaced priorities of  certain people. The society tries to impose a stereotype role on them in an effort to control them fully. And as a result of these various controls, regulations and public pressure, doctors experience unrealistic performance pressure on professional front.

     Doctor is the pivot  point between patients, medical industry, government and insurance sector. Huge number of patients, expensive medicines, poor medical infrastructure has produced tremendous resentment against medical system amongst public. But the brunt of this entire angst has to be borne by the doctor or medical professionals alone. Often they are blamed for circumstances beyond their control and punished for system failure. Fear of public wrath and lawsuits is smothering the medical profession.  And increasingly there is a feeling amongst medical professionals that they are getting a raw deal despite doing their very best.

     In such a situation, there should be some introspection by all stakeholders every year, on doctor’s day. The doctor’s day should be more than just greetings and wishes for doctors. Some real resolutions need to be  taken so that their working atmosphere and eventually delivery of medical care is improved and this ultimately will benefit patients only.  I can think of some much needed changes-

1.       Government should take some concrete decision to improve medical  infrastructure and manpower. A better planning needs to be done to spend more for health of people, availability of resources and for improving the working conditions for doctors. Government should ensure that doctors are better protected.

2.       Medical industry should collectively think of protecting doctors or there should be provision for some financialresponsibility of medical lawsuits of all doctors.  Pharmacy industry, medical device industry, insurance industry  and others earn huge profits because doctors need to use their products. Although medical industry makes huge profits still they remain behind the scene.

3.       Police should provide  assured protection to  doctors better against physical violence.

4.       Medical education institutes should resolve to promote the education of best doctors and not indulge in profiteering in education of doctors.

5.       Courts should take an initiative to protect doctors against frivolous lawsuits ( which are often done to prevent paying their bills), revengeful attitude of patients  and harassment?

6.       On doctor’s day, public should resolve that they will not unnecessarily fight or abuse the doctor.

7.       And last but most important is that all medical practioners , be it allopathic, ayurvedic, unani, homoeopathic or others who play a role in maintaining health of patients, affirm that they will do everything to protect dignity and integrity of this profession.

If the above are not practised and followed, then mere sloganeering on doctor’s day  makes no sense . The  effort to improve training and working condition of doctors has to come from the bottom of the heart of all those involve, both giver and taker.  Mere tokenism on a day in a year is of no real purpose. If the present scenario continues, soon a common man will have problem in accessing good medical care which is currently available at nominal cost . One needs to ponder seriously, if we do not save doctors, who will save us? 

Death declaration by doctor: complex communication skill. “No negligence in alive baby declared dead: hospital “


The death pronouncement is one of the most sensitive and complex part of communication in and out of hospital, intensive care. It comprises more than the actual declaration of death. It may be a relatively straight forward when the death is expected and the family is mentally prepared and accepting the outcome. However, when the doctor is interacting with a grief-stricken family, dealing with the death of a child, or coming to terms with the death of a personal patient, a death pronouncement becomes complex. Problem is compounded often in presence of violent relatives, non acceptance of death, medico legal cases and   especially in cases of unnatural causes for the death. Relatives often refuse to accept death and within no time mobs swell in number, threatening of physical and verbal assaults and revenge against the doctor in various forms. Although there can be specific protocols and hospital policies, it will still depend upon the timely thoughts and skills of the doctor, how to handle the situation. Doctors should be better trained for handling of death as it can put them in risky situation, because of following reasons.

  1. Death itself is a complex issue. Even today modern science has not reached scientifically at the bottom of life and death.
  2. Communication of death is complex. It varies with each patient, type of relatives, place, country and every situation in same hospital is different.
  3. Declaration of death is a legal matter. How a doctor verifies death, communicates and documents death, it can create legal and other problems for doctor.

Any problem related to declaration of death is immediately picked by media and the initial reaction is to blame the doctors. The doctors in such cases are projected as incompetent and callous, and that makes a media news. Invariably one stray incidence is used as to project whole medical community in negative manner. Later inquiries and further inquiring continue, and even later truth emerges, that is not enough to bring back the lost prestige for medical profession.

Take for example the latest news of “ Alive Baby declared dead.”

http://timesofindia.indiatimes.com/city/delhi/alive-newborn-declared-dead/articleshow/59208765.cms

Later after two days, news was “ hospital enquiry claims No negligence in alive baby declared dead”

link   http://www.dnaindia.com/india/report-no-medical-negligence-in-case-where-newborn-was-declared-dead-2479826

Above news just conveys the complexity of situation, doctors often face. My aim here is to convey  that communication of death is a very complex subject. Ironically no structured training of emotional, communicative and legal issues is imparted to medical students. But they are supposed to face the situation everyday, when they function as doctors.

 

Most legal determinations of death are certified by medical professionals who pronounce death when specific criteria are met. Two categories of legal death are death determined by irreversible cessation of heartbeat and breathing (cardiopulmonary death), and death determined by irreversible cessation of functions of the brain (brain death).

Especially new doctors need to realize that the structure of modern society is to make life and death, medical and then legal matters, and to subject the most basic elements of our existence to professional authority. The birth certificate and the death certificate are signed by doctors, and then registered by the civil authorities.  Because of all  these sensitive issues, emotional aspects and legal dimensions of death being  huge, so need more attention. .

In remote areas doctors are totally alone and helpless, so security issues will remain. There is no solution in sight for these problems. Already I have written about a “real story of female doctor assault”.

Problem is that doctors during training days or residency are not trained in such kind of communication. Although while doing their duties they observe seniors and learn how they are communicating. But still when actual situations arise, which can be diverse, complex and challenging, and everyday getting more demanding. In view of current scenario against doctors, they need better training on these issues. Basic question is, if doctor needs help, where can he turn to for help or information. The resources, other staff and the setup is not of much help in difficult scenarios.  It is not uncommon that doctors are left to themselves, if a difficult situation arises. Medical education and Hospital systems need to be better equipped to provide more support to doctors in present era. For doctors, if they make a mistake, there is no one to support them or save them from verbal, physical assaults, law and medico legal cases.

Harassment is tremendous. Therefore   doctors, be careful – save the patient, but save yourself also.

NEET implementation vital and will decide quality of doctors in future


NEET, the common test for MBBS admission all over nation, is perceived as most basic step  towards uniformity of medical education. It is a welcome single most important step to transform the medical education. But its effective implementation is extremely vital for it to be successful and that is possible only if government takes strong measures to implement it in a true spirit. NEET can reform medical education, weed out corruption and in turn can radically transform healthcare. This new system should allow fair play, transparency and should set an example for promotion of merit in other arenas too. But it needs to be seen how NEET is finally implemented. It will be very unfortunate if it is diluted for any reason and merit becomes another casualty in accommodating other priorities, rather than having best doctors. It  is a now or never situation for the country to pick up best brains of country for  training as prospective doctors , decided purely on basis of merit.  By diluting the merit criterion, not only do less deserving people get ahead of deserving ones, but it breaks the faith and enthusiasm of the best and deserving people in the system, thereby generating a negativism in the whole system. Failure to implement NEET effectively and strictly should be interpreted as government’s inability to control vested interests in the system.

Enthusiasm and the zeal is what we need here in medical care. With the shortage of thousands of doctors, and our infant and maternal mortality rates matching sub-Saharan countries, it is not only the number of doctors which matters. The most important factor, I think, will be quality and enthusiasm of the people who are working for the system.

Besides Infant and maternal mortality rates, innumerable diseases like tuberculosis, heart and respiratory, cancer, neurological and mental ailments, accident and trauma etc need work on war footing.  But the medical system has to be built on the touchstone of merit and enthusiasm for a greater impact. Merely creating number of doctors is not the solution. The need of the hour is more but pure meaning on pure merit. If that does not happen sufferers will be poor genuine aspiring doctors and casualty will be medical profession and ultimately health system and its users.

Let merit not be made a casualty of the system. The ball is now in government’s court and they should ensure that NEET is implemented in its true spirit, to fulfil the dream for which it was envisioned and introduced which is to bring medical care in India to its most cherished peak.

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