Former Director, PGIMER, Chandigarh
Recent events in Kolkata put doctors in the media spotlight, albeit in rather unwholesome circumstances. Though the issue has been amicably settled for the time being, it is an opportunity to address certain underlying and deep-rooted issues which significantly affect the medical profession. The profession of doctors has traditionally enjoyed respect, almost reverence, in our society. It was perceived, in my view correctly, to be a ‘noble profession’, given the element of selfless service inherent in it.
Over the years, however, the validity of this perception of the profession is increasingly being questioned and, perhaps, the respect earned and enjoyed by doctors appears to be declining. To some extent, medical professionals and regulators of the profession are responsible. Unfair or unethical practices by some for monetary gains has eroded the image of the profession as also the confidence of the people. For a few, the practice of medicine is no longer an act of devotion or service, but is principally a commercial venture. Such a mindset threatens the soul of this profession.
Fortunately, right-minded professionals and other social thinkers are alive to the problem, and there has been brainstorming about the possible remedies. The issues have also been discussed on open public platforms in the hope that the unhealthy trends can be checked. I remember taking part in a discussion on issues that plague the profession on the TV show Satyamev Jayate hosted by actor Aamir Khan. A book, with the stark title Doctor: Healers or Predators, authored by my colleagues, was recently published. It generated vast publicity.
Honest introspection is called for. While it is important to highlight the maladies and be critical of the wrongdoers, we must also offer meaningful and pragmatic solutions and be careful not to denigrate the profession. The tendency to malign the profession as a whole is unhealthy, and points to a kind of ‘mobocracy’, akin to a mass ‘professional lynching’. The victims of this approach are the honest and sincere professionals who practise with high levels of professional skill, ability, integrity and compassion.
The medical profession, thus, is slowly losing its position as a sought-after career option for the young, especially among the brightest and the academically high performing ones. I do not believe that the lure of money would ever be sufficient to attract the brightest talent to the profession for the simple reason that there are far easier ways to make the same (if not vastly more) amounts of money. The respect commanded by the profession and the sense of satisfaction that comes from having been of service to a fellow being in pain are both vital for offsetting the sacrifices each medical student makes on the long and arduous road to becoming an able professional. To bring the entire profession into disrepute is, therefore, a recipe for disaster. Instead of attracting the brightest young minds, we would end up further discouraging the best among the youth from embracing a career in medicine. No society can afford to have its needs taken care of by low or mediocre professionals.
There is another side to the coin also. Systemic paradigms from outside the profession have contributed to the problem. For instance, the inclusion of doctors in the legal regime of consumer protection has led to a mushrooming of unnecessary investigations, enquiries and litigation. This has made the practice of medicine to be defensive, writing new and more investigations which only add to further cost. Unfortunately, people are routinely approaching consumer fora in the hope of monetary awards. The litigation drags on for years, creating an insalubrious sense of dread in the mind of the doctor, while cementing a feeling of victimhood in the minds of the patient and his/her family.
Instances of arrests of doctors are not unknown. Recently, a doctor from Civil Hospital, Gorakhpur, was arrested following an unfortunate tragedy in the hospital. Subsequently, the Allahabad High Court came down heavily on the prosecution and held that there was no basis for making out any medical negligence. But the damage was done, and the mental torture suffered by the doctor cannot be compensated.
All this fosters a feeling of distrust between the patient and the doctor and taints this most holy of human associations. Even naturally arising complications during the course of treatment are viewed through the lens of suspicion, and negligence, or worse, are readily assumed. We lose sight of the simple scientific truth that one straitjacket cannot fit all — the effect of the same medicine, for example, may vary in different individuals. We have forgotten, to our detriment, the insightful words of Father of Allopathic Medicine William Osler: “Medicine is a science of uncertainty and an art of probability.”
Some respite was brought by the Supreme Court verdict in Jacob Mathew vs State of Punjab. However, higher levels of sensitivity are required from the law-enforcers to avoid hasty acts which lead to undesirable, even if unintended, long-term consequences. No doctor gains anything by acting negligently. Ordinarily, every doctor would act to the best of his/her judgment and ability to alleviate, to the extent possible, the suffering of any patient, and the threat or fear of legal proceedings could well cloud the judgment of all but the strongest among us.
It is in this backdrop that the recent events in Kolkata must be understood. The reports about what transpired in Kolkata paint a dismal picture. The threat of physical violence in the case of the death of a patient or if the outcome of the treatment is not to the satisfaction of the patient or his/her family is not something we should be willing to tolerate or overlook. The gravity of the existence of such a threat cannot be overstated. No professional can act under threat of physical harm. There is an increase, in recent times, of such instances of violence against doctors despite the existence of legal safeguards. No administration can be a mute spectator to such blatant use of muscle power, and no civilised society should be prepared to allow such actions. Unless strict action is taken each time such an incident is brought to light, potential offenders will only be emboldened.
Doctors cannot be permitted to become soft targets. The incident justifiably resulted in an uproar all over the country, and, pushed to the wall, doctors in different states went on a token strike. While one is averse to strikes by doctors, perhaps the grave provocation, the insensitive attitude of the authorities and the want of any other remedy forced the hand of the doctors.
The medical profession is going through difficult times. Sagacity is the order of the day. Medical professionals and their bodies, the government, regulatory bodies and society as a whole must come together to prevent further deterioration in the doctor-patient relationship and in the profession as a whole. People’s confidence in their doctors must be restored and maintained through whatever measures necessary. It is as if we stand at the crossroads — the path we choose will decide the future health and well-being of this profession. May God guide us and save this noble profession in the interests of society.