Regressive policies, Failing system and Medical education-The Ugly Business of Headcount
The Department of Health recently issued a circular that in-service doctors will not be allowed to pursue higher education. After criticism from doctors and pressure from the media, the circular was falsely claimed to be withdrawn. It was argued that higher education is a fundamental right of everyone including doctors and the order was regressive and dictatorial. The department seems to suggest that leaving doctors for further training will worsen patient care. Let us be clear, it is not just about right to education, but it is about the greater good of society and benefit to patients when their doctors are properly trained. Half-baked doctors are unsafe and likely to do more harm than good. Taking such decisions without any evidence by ill-informed pen pushers is surely going to put more lives at risk.
The J&K state has currently four medical colleges, two in each province providing training in both undergraduate and postgraduate courses. There are plans to open more medical colleges and also a rumour of setting up a medical university in the state. The J&K State Medical Council (MCI) registers the doctors who practice in the state. In theory, the MCI is responsible for making sure that quality medical education is imparted and doctors produced have some minimal basic standards. The MCI also decides upon the intake numbers of the medical schools, staffing levels and other necessary infrastructure. The MCI is mandated to make doctors accountable, making sure those doctors who indulge in malpractice do not go free and face the consequences.
There has been a growing concern about the quality of medical education and the type of doctors being produced over the years. Many factors are responsible for the degrading education in the medical schools starting from admission, teaching, examination system, and more importantly, the quality of practical training. It is hard to blame a single factor or agency. It is no exaggeration to say that the MCI is good for nothing. MCI has made a name for scandals and corruption at various levels. Apart from inspecting medical colleges for registration purposes, it has hardly shown any leadership and interest in improving and modernising the medical education. Hence, it is hard to know what the basic requirements or standards for a safe doctor in India are. Even being there for nearly a century now, the MCI is yet to come up with a proper curriculum or syllabus for MBBS and other post-graduate degrees. There is no uniformity and everyone seems to be doing their own thing based mostly on hearsay. The medical education is still delivered by the archaic methods devised by the British well before 1947. In short no one has bothered to review the methods of training and teaching. On the other hand, medical science has evolved beyond imagination. The size of the textbooks has gone beyond reason, but students are still expected to cram everything to pass the exams. It would make sense if the medical curriculum is updated and tuned to the practical training so that when doctors pass MBBS and finish internship; at least they are safe to practice.
Most countries around the world have made it mandatory to have further two to three years training after MBBS to be able to practice as general practitioners. But we are still stuck with the myth of MBBS doctor knowing and doing all, and put people’s lives in their hands in a badly run and underfunded heath service. Just passing MBBS is not enough for a doctor to practice independently at least for first few years. We need to train doctors further and allow them to acquire the required competencies if we want to be treated safely and not come to any harm. Not only should doctors be allowed to pursue further education in various specialities, those who are recruited as medical officers in the health department should have further training for few years before they are posted in the periphery as general practitioners and allowed to work unsupervised. The General Practice as a speciality ought to be started sooner so that doctors get the required qualification to work as independent general physicians.
As for the shortage of doctors in the health department; it is no mystery why despite producing hundreds of doctors each year, most find it hard to get a job in the state. Those who get lucky, find themselves in a whirlpool of a badly run system, poor work culture and unnecessary bureaucracy making sure they are unable to function to their potential. The focus is always on headcount than the expertise and training of the doctor. One of the doctors who trained as ophthalmologist was posted to a place where he could not treat any eye problems due to lack of equipment. When he went to higher officials begging that he is losing his skills and is not doing justice to his patients, he was told to collect his monthly salary and stop bothering about people. Similarly, another surgeon found himself in the same boat and finally decided to leave the job. There are many such examples and state is losing good and competent doctors, when in reality they want to serve but are frustrated to the extent of no return by the current policies and nepotism of the health department.
To fool the vote bank, a mere statement that a doctor has been posted, does the trick. No one bothers about the credentials of the doctor. Although the health system is supposed to provide treatment based on evidence-based medicine, people with alternative degrees are posted in hospitals and there is no way for the patients to know who is treating them. Even in the district hospitals, one cannot be sure about the doctor’s competence and background. People come in good faith and want to be treated by competent and qualified doctors, believing that they are in safe hands. Would it not make sense that specialists are allowed to do the job they are trained and competent in? We produce enough highly skilled doctors in specialities like medicine, surgery, orthopaedics, paediatrics, obstetrics & gynaecology etcetera. If all of these specialists are allowed to run their units with proper setup and least interference, they would not hesitate to work in the periphery. The truth is no doctor wants to harm their patients and when they are forced to perform what they are not competent to do, they usually chose to leave or use all means to be posted where they can function. If they are not able to get away, they get disheartened and in the process are not able to function to their potential and ultimately can become unsafe doctors. This also breeds malpractice and corruption among doctors. I am not suggesting that doctors should not be held accountable. Let the MCI take action against corrupt and irresponsible doctors so that others tread carefully. But please don’t leave it to the revenue or police department to unnecessarily harass health professionals.
If the authorities are really serious about providing safe and equitable health service, they need to review the archaic policies. It is time to move beyond the idea of headcount and focus on the training and competence of doctors. Doctors are usually highly driven people; they would not stay if they are not allowed to do what they are good at. Let surgeons do surgeries and ophthalmologists treat eyes, do not push them to perform what they cannot. Remember demoralised workforce is no good and that applies to doctors as well. Patient safety comes first and there is no place for the Babus to play with lives of common people. Hope some sanity prevails in the health department and they start thinking beyond the lucrative business of postings and transfers. The answer to staff shortage is to recruit doctors and then let them work. Banning would not stop them pursuing higher education but would deprive common people of safe and competent doctors. So, it is for the greater good that doctors get proper training and those regressive policies are binned.
