Expensive Medical college education (NEET) & poor health system: systematic root rot


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 20 -25 % 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.  

      Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession. By allowing a intentional dilution of quality  can be advantageous only to  few and detrimental to others.

  • Beneficiaries are rich candidates, medical colleges who collecting fee and may be public who will get numbers of doctors. Surplus of doctors is thought to be an advantage to society. But here quality is least of the consideration.
  • Disadvantage to students, who are meritorious but can’t pay, and possibly society in long run, who is deprived of good quality doctors.

 

Dilution of Merit :

  • Before NEET was made mandatory in 2016, the cut-offs for admission were 50% marks for the general category, and 40% for the reserved categories. From the 2016 admission year, these were changed to 50th and 40th percentile, respectively, opening the doors to candidates with just 18-20% marks in the NEET aggregate. Thereby candidates securing 5% marks (physics) and 20% in  biology are also eligible to be doctors (times of India).
  • The student with the highest NEET marks among those admitted into the private university had lower marks than the last student admitted to the open category in each of the government colleges.
  • In the private university, the fees for the MBBS course are Rs 64 lakh compared to just Rs 4 lakh in the government colleges.
  • when NEET was introduced, many private colleges increased their tuition fees many fold.  This  ensured that meritorious students without money would never get admission. The tuition fee is fixed arbitrarily to cater to only rich or super rich students. (times of India)         System of medical business and  medical education is created based on willful dilution of merit.   Quite a few successful candidates may eventually feel that the money spent and the hard work may not be worth it especially those candidates who may have invested in heavy fees or bought a seat in medical colleges with hefty amount. Some of them, who invested millions for becoming doctors, will be even probably unable to recover their investments. The students with strong financial backgrounds may be more benefited as they can become health  investors or health managers. But for others, it could be a dream turning into a nightmare.

    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.

    A famous axiom “as you sow so shall you reap” has an application to health system in this scenario, so people should not rue scarcity of good doctors.  

Real story of a female doctor assault: serving an uncivilized society


Few words here can’t describe the plight of a female doctor, who was brutally assaulted by a mob at her residence, for no fault of hers. This incidence happened about a year back, about 200 KM away from Delhi.

It was an evening time and a boy had an accident with a bus. He was brought to a community health centre.  Female medical officer who had her residence inside the hospital in staff quarters examined the patient and found that he was already dead. She explained the situation to the family members with due sensitivity, did all the paper work and returned to her residence in about an hour. Mob kept on gathering and after half an hour, they barged into the house of the lady medical officer.

They dragged her by hair in front of her teenage daughter. Mob started assaulting her with fists and legs along with a rod. Her daughter cried and shouted for help.   Mob even tried to set her on fire. This brutal and devilish assault continued till neighbours from other staff quarters saved her with great difficulty and took her away. Mob continued rampage in her house and hospital, trying to break everything.

She sustained severe head injuries and was admitted in a hospital for about ten days. What was her fault and why mob did this to her? Is being a doctor and working in remote area her fault? Everybody knew that the reason for death of the boy was what happened outside the hospital.  There was an errant bus driver, who was responsible.  Then why was she made a punching bag for venting out emotions of the bereaved relatives. Nothing and really nothing can justify this barbaric act. Emotions should not be allowed to take such a demonic form.

This is simply jungle raj, goonism and  expression of a most  uncivilized kind of society, which simply cannot be excused by any sort of reasoning. The incident was protested by the professional bodies as is the routine and after few day things normalized for everybody else except that terrorised family. The said lady medical officer took posting elsewhere and as is usual, nothing much happened to the accused.

Woman doctor assault : Era worse than MAHABHARATA for female doctors

There was again same silence and little concern shown by our media, courts, prominent people, celebrities, human right commission, woman right activists and women commission. This again brings forth the hypocrisy of these people and organizations, who otherwise cry about woman rights and empowerment.  Whenever a female is assaulted, there is an outrage but the same support is not extended to a female if she is a doctor. Such bestiality should create havoc in minds of civilized people but this apathy to such incidents clearly indicates otherwise. Have we become so uncivilized that an incident such as this just remains as a small news item in a local paper? Can’t we see that such incidents are harbinger of many more in future? It is important to realize that this is the time to unify and condemn such episodes vehemently and prominently so that the miscreants realize that they cannot get away with it.

Doctors in remote area, where there are minimal medical facilities, doctors are  at more risk  than ever. In larger institutions and cities, doctors still gather and have some support. But at remote places,  they are at mercy of local goons with no protection.

Beti bachao Beti padhao vs Violence against female doctors

Violence against female doctors: Silence of human and  woman right commissions

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system 

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Apollo Hospital fined 5 lakh: “Doc, Talk less, write more”.Doctor save yourself by “documenting the communication”


Doctors are trained to treat patients and  that is they keep on  doing. But in today’s era that is not enough. They are expected to examine, investigate, diagnosis , treat correctly   and communicate to the family or patient. Everything should be speedy and  financially suitable to the patient’s expectations. Even if that is done, the things do not end here. Doctor need to document, what has been  communicated to the family.  It is hard to believe that  doctor at a hospital like Apollo,  who really did well to diagnose a disease like SLE and still did not communicate. Yes, news item mentions that in file that  there was no evidence of communication. Doctors still behave like doctors and do not treat patient as consumer. Usually , doctor trust their patients  and there is lot of verbal communication takes place. Verbally they sympathize, communicate  and  tell many things which are not documented as a routine.

The Delhi State Consumer Commission, in its judgment, made it essential for a hospital to disclose to the patients or their attendants, the line of treatment and the potential risks involved in it.
The judgment came in connection with the death of a 23-year-old student, who died during a treatment at  Indraprastha Apollo Hospital in 2004.

Many times patients are sincere enough to admit to  verbal  communication. But sometimes when  during ongoing  medico legal lawsuits, a feeling  of revenge prevails  or as guided by lawyers, patient  may not admit  to the verbal communication.  Specially if verbal communication is not documented in file.

How to  save yourself  by  “documenting  the communication”

  • examine, investigate, diagnosis , treat correctly and communicate
  • Make a note of plan of treatment and prognosis, and communicate to patient or attendants.
  • Sign yourself and ask the patient or nearest relative to sign.
  • It is not uncommon that relative will refuse to sign. In that case just write a note and mention that attendant refuses to sign.
  • It is also a common issue that after listening to everything, relative will say that he does not understand or will ask his uncle or aunt. These are difficult moments and commonly happen. Just make a note of everything. Besides it wastes crucial time.
  • Can use camera for communication in difficult cases.
  • Never rely on verbal communication. It has little value.  Commonly people refuse to admit verbal communication, and will say that they were not told anything.

As time for everything is limited in life, be it treatment, communication, consent or documentation. So message is clear for doctors. “Talk less and write more”. You will be judged by documents after many years. Therefore,  do save the patient, but save yourself also.

 

 

Two doctors from Fortis Hospital arrested – How doctors may save themselves by learning from such cases.


Doctor,  do save the patient but save yourself also.

Doctors continue to treat and save  many patients in the years they work. But present law and regulatory system does not take into account those years of  good and hard work. It does  treat doctor as a petty criminal for some single mistake or unfortunate incident. Law just deals with it in a harshest possible manner.  Patient may have died because of disease, but when in side the hospital, it is very easy to relate death with actions or inaction of doctors.  Specially because inquiries are always done  with  retrospective analysis, with wisdom of hindsight. Although there is a feeling among doctors that what is really happening these days, something may not be very appropriate, but there is no room  for leniency here.

News of this kind brings tsunami of fear in minds of doctors all over. It can be anyone in such situation, where  it is just   that a particular doctor did not have that eye for danger in that moment. The  doctor did  not realize or anticipate the gravity of  the consequence and outcome of the patient in real time. It may be difficult to pick up or just not take the situation very seriously. That can simply be poor training or working without good application of mind. But  looking retrospectively, situation becomes clear.

Two senior doctors of Fortis Hospital in Haryana’s Gurgaon were arrested on Friday for a “delay in administration of emergency medicines” to a 51-year-old woman, who died of cardiac arrest last year, police said.

 

      Lessons to be learnt:  What options doctors have at present? Because they are at receiving end always. They have to learn from such cases and do something in their routine to prevent disasters. How can they save themselves?

  1. All patients to be seen by primary consultants or someone from concerned unit at the earliest. It is important as emergency doctor may  not be equipped to deal with specialty  problem.  Prompt diagnosis by specialty doctor and written findings are important.
  2. Initial assessment should be quick and with in minimum time.
  3. Good communication and documentation of the problem.
  4. Assess the patient and make a note of treatment to be given.
  5. Document the plan of action, that is investigation and management.
  6. Avoid phone call consultations and leaving treatment loosely. Well thought documented plan should be in place.
  7. Situation may be different for smaller nursing homes. Treatment of an emergency will remain same, whether patient goes to bigger or smaller hospital.   Nursing homes may not be equipped for all the emergencies. So challenge before the smaller hospitals will be to identify the problem and diagnose them quickly  and  if required send them to proper  hospital, rather risking themselves in today’s times.
  8. Aspiring doctors can have a cue about what they are getting into. So as to adapt to prevalent adverse circumstances for doctors, if they aspire to be one.

 

Doctor, do save the patient but save yourself also.

 

21 occupational Risks to doctors and nurses, while performing their duties


Doctor save the patient, but save yourself also.

Working of a doctor and nurses is not free from risk to themselves. The risk is generally underestimated, although it often involves major  risk  to life and may be frightening. Problem is that  majority of people, society and governing bodies  and even doctors themselves do not perceive or acknowledge it many times  the risks seriously.  But since  these risks are increasing exponentially everyday, because of changing scenario, they should be known to students, who want to take medicine as a profession. They need to take an informed decision. There are lesser set procedures, lack of awareness, not protective equipment or supportive society, governance and  laws, at most of  the places globally, and  doctors continue to work  in danger zones. These risks can be of varied types. Contracting the diseases is just one of them.

Even when doctors and nurses contact the diseases, there may or may not be proper support for further treatment, compensation and rehabilitation. Most of the time, they  have to fend for themselves. Because quite many of them , in government and private sector work on adhoc basis, temporary posts and on contract. Doctors  may have following risks, readers can add, if I have missed few:

Occupational health hazards

1.Tuberculosis: Common among health care  workers

2.Hepatitis B, Hepatitis C

3.HIV

  1. Influenza, Swine flu and other viruses of similar type.

5.Chicken pox

6.Rabies

7.Patients some times comes with unknown viral illnesses, which can not be tested. At the time, when treatment is going on, even diagnosis is not known. Doctor can contract these bacteria or viruses. There can be many more.

Risks related to stress and overwork

8.Depression, suicide, hopelessness

  1. Burnout.

10.Restricted social life

11.prone to alcohol/ drug abuse/ drug exposure.

Stress of balancing Family life: Kind of work and night duties effect family life very adversely. 12. Specially  female doctors. Completing  family will effect their careers, most of time.

13.High rates of divorces

14.Stress related diseases

15.Life style diseases: mainly sedentary work and long hours of working, makes them prone to life style diseases like ischemic heart disease , hypertension etc.

16.Exposure to radiations: specially in radiology and oncology. female doctors are more affected.

17.Lack of exposure to sunlight: effects bones , deficiency of vit D and predisposes to depression

  1.   Risk of catching resistant infections and sometimes there is risk that they carry these deadly bacteria to their homes. So their family members and children are at risk.
  2.   Risk of  working in disaster area and transport of sick , floods, earthquakes. Accidents of    ambulances .
  3.   Change in natural bio flora  of doctors and nurses. It is replaced by hospital bio flora. If they get infection, it is difficult to treat.
  4.  Risks because of legal problems and violent patients:  adds to stress Patients may not have favourable prognosis. But it is common for doctors to be blamed  even for naturally poor prognosis of the  disease. Legal trouble adds to further stress.

    –verbal abuse and threatening is very common. So spoiled mood unnecessarily.

– fear of  physical   assault can really harm doctors and family members.

– excessive and unilateral regulation puts doctors at the receiving end of the discontent.

Worst part is that our systems are not defined to prevent, treat or compensate or even acknowledge for these big disasters, if it happens to healers. These problems are not known to students, when they decide to take medicine, nor they are taught in medical school. Most of the time they have to fend for themselves, if problems occur.

Administrators and regulators refrain to study data that would establish and quantify the occupational hazards of being a doctor and nurses. Some of these hazards may be known, but there is no comprehensive analysis of workplace risk for physicians and nurses, like those that have been done for other professions. As physicians, we have a sense of the risk, and yet we remain engaged, continuing to care for our patients as we know  “these things” happen. Perhaps society prefers to remain blissfully ignorant of the sacrifice and risk their doctors take on, comforted by the fantasy of the serene  hospital. Perhaps we  all despise to let reality and data shatter the illusion.

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.

Maybe it is time that we are little more aware  and acknowledge that even doing everything in best manner and honestly , we are in a  conflict zone and  we are all in harm’s way. Just be careful and be mindful that  doctors, nurses, and healthcare workers,  may get  sickened, injured, disabled, or can be dragged to court or harassed even  as they care for their patients in best manner.

Doctor save the patient, but save yourself also.

Advantages Disadvantages of being doctor. pros cons of medical profession


Advantages of being a doctor, Good points of being a doctor:

In ideal situations, it is a great profession to be in.  Children strive hard to become doctors either because they idolize someone or were inspired by some doctor or were guided by their parents to become doctors.  Some favourable features of this profession, to my mind, include:

  1. Noble profession-One of the main reason of choosing this profession is the gratification achieved on treating a human being. Relieving a patient of his agony or bringing back a patient from brink of death gives immense satisfaction and this cannot be matched by any other profession.
  1. Decent earnings-In the process doctors usually make average to decent living. Most doctors actually earn a decent enough income. But it is quite variable depending upon city, country and specialization.  Those willing to work extra hours by sacrificing their family and personal life can earn more.
  1. Respectful profession– The moment a person comes to know that you are a doctor, a respect for the person is generated. Some patients, when cured, even start equating you with divinity.
  1. Working conditions– In most of the developed countries around the world, the working conditions are good. But these vary according to country, state, city and hospital (government or private) where one works.
  1. Continuous learning- A doctor is learning something new everyday. There is continuous mental stimulation which keeps the doctors mentally agile. 
  1. Independent profession- A doctor can be independent in his profession on his own. He doesn’t always have to work in a set-up and can have his own practice. There is no retirement age in such setup and he can continue working till he remains fit. Rather the more senior a doctor is, the more experienced he is in handling complex medical cases.
  1. Social profession- This profession entails active interaction with public and society. Hence the doctor learns many social aspects of life unlike other professions which involve deskwork only.
  1. Preventive and Social responsibility– The doctor can be instrumental in changing certain aspects and taboos which are ingrained in society. For example doctor can highlight the effects of smoking or talk against certain habits like open defecation to all sections of society. And he is someone who is heard and followed by his patients.
  1. Asset to family and friends-A doctor in a family is a real asset. He not only treats his patients but also gives preventive advice to his family and friends. There must be many of you who first turn to a doctor in relation first, for an informal advice, before consulting the specialist.
  1. Healer of mankind- All said and done, medicine remains the only profession that alleviates pain, heals and cures the mankind. The credit of increased longevity with much better quality of life goes solely to the advances in medical arena and research done by doctors and scientists. Without doctors, the human race would have long back become extinct due to epidemics and infections. 

These advantages and good points of being doctor are in IDEAL CONDITIONS, gradually dwindling  and disadvantages are increasing every day.

Disadvantages of being a doctor, Drawbacks of Medical profession: 

Choosing medical career  or being a medical professional  a disadvantage to doctor in comparison to other professions?

In the present circumstances, when doctors themselves are doubtful about the advice for choosing medical career, some are naïve enough to spend millions on securing an expensive medical college seat.  Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted   about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.

  1. Medical courses are comparatively lengthy and expansive study course and difficult training with slave like duties.enslavement of doctors”.
  2. Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.  They have to just flow with system ultimately.

3.Hostile environment for doctors to begin: Suddenly young and bright children complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

  1. Difficult start of career:After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
  2. The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
  3. Blamed for all malaise: The society gets biased because of the   media reports and some celebrity talking glib against medical profession. The blame for inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
  4. Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
  5. Risk doctoring himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include   tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.
  6. Unrealistic expectations of society:  Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.
  7. Retrospective analysis of doctor’s every action continues all the life. It could be by  patients and relatives every day  in the form of  “ Why this was not done before?”Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

The decision taken in emergency will be questioned  and  in retrospect they may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight with luxury of time, may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.

  1. Physical assault,routine instances of verbal abuse andthreat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent  people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.
  2. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
  3. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such   relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigations of lawsuit against doctors is a  major disadvantage for medical profession.

14.Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

 

25 FACTORS- WHY MEDICAL TREATMENT  ARE EXPENSIVE

REEL HEROES VS REAL HEROES

21 occupational risk of being a doctor or nurse

expensive medical college seat: is it worth

Fading charm of medical profession:complex working scenarios for doctors- no solution in sight


Stark reality of complex medical scenario hits the studious and meritorious medical students on the face when they come out of college and start working in present environment. After a difficult time at medical college with slave like duties, an unsettled family life and with no money, these brilliant doctors begin their struggle. They work at various hospitals to gain more experience and slowly acclimatize themselves to the real problems of this profession. They realize that the actual medical world is far different than what was apparent from inside the medical college. Suddenly they find that their lives undergo a sea change. The goals that were taught in the medical college are now just not enough and they actually constitute only smaller part of a much larger system. And the scenario seems to getting worse for doctors with each passing day.

There is increasing discontentment amongst doctors because of complex and punishing system in addition to the unrealistic expectations of society which takes the enthusiasm out of these young bright doctors. Every day now, the informal discussions with colleagues regularly dwell more on problems faced by doctors, rather than real goals. There are routinely instances of verbal abuse and threat for no fault of theirs. Some unlucky ones get physically assaulted as well. Sometimes there are threats of dragging the doctor into a lawsuit which sometimes do really happen. Even if court, after years of deliberation, does decide in favour of the doctor, the harm to the doctor in the form of mental harassment and tarnished reputation is already done and that is something which cannot be undone even after he has been proved innocent.
Even if such events don’t happen to everyone, the very fear of such possible scenarios and their possible complications always lurks in the back of the mind and affects the treatment because the doctor tries to be doubly safe. The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient always colours the final decision in treatment. Many become punching bags in place of inept medical system and invisible medical industry. Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment.
And if these were not enough, these problems have been further compounded by unnecessary utterances by celebrities against doctors, negative projections by media who never acknowledge the great work done day and night by doctors. Stray mistakes by some doctor, or treatment failure due to a poor prognosis and sometimes due to system failure are projected and widely highlighted by media and celebrities to tarnish image of all doctors .Though these do sensationalise their news and promotes their business, but the repercussions are heavy and it breaks the trust of the public in their doctors. This eventually does harm to innocent public in the long run but has also done enough irreparable damage to the medical profession.
If children of current generation do not hold the profession in high esteem, then obviously they wouldn’t want to be part of this profession. And if brilliant students shun this profession, then how would society get good doctors? If there is always fear in their mind, no one can do justice to his job and this you’ll all agree, applies to all professions

advantages disadvantages of medical profession

enslavement of medical profession, doctors and nurses are modern day slave

nurses and doctors, altruistic professions not treasured in present era

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