30 Saturday
June 2018
Do you know How I became a Doctor?

If you find a job that you like, you’ll never have to “work” a single day in your life. Being a Doctor is that thing which excites me every day. Seeing patients coming in pain, sharing their problems, and helping them.I don’t know anything that comes close to what I feel on hearing “thank you Doctor, I got better”.

I was ten years old, playing with my brother, when our neighbor Mr Nakra asked us what we were up to. I’m a Doctor, I said. From then on he’d say “Hi Doc” every time we met. My Chacha is an eminent Ophthalmologist, a compassionate kind generous human being. As kids we were charmed by the aura of him being a Doctor, someone who helped people who couldn’t see, someone who would return the surgical fees if the patients’ buttons were unmatched.

In class 11, I opted for Biology, Physics and Chemistry, having decided that I would become a Doctor. Little did I know what Medicine entails or what a journey I was about to embark upon. Every other teenage activity be it art, sports, skating, cycling took a backseat and books took the centre stage of my life until I emerged into the real world 18 years later! I remember the madness and single minded focus I had while giving endless entrance exams. If anyone shook me out of slumber and asked “what do you want”, my answer would have been “a medical seat”.

The relief of getting into a medical college was immense. The best and brightest minds of every school reach medical college and realize they don’t know how they are going to survive. Nothing in school prepares you for Dissection Hall, and it’s a mystery how at the end of 1.5 years, we manage to memorize every bone, muscle, ligament, blood vessel and nerve in the human body. I was shocked when I scored 63% in my first professional. After being the school topper, this was completely unacceptable. My Biochemistry professor laughed when I asked him if I should get a revaluation done. “Doctor, this is not school! You have done well. Get used to it”

I retrained my mind to study focusing on becoming a good Doctor instead of studying for marks alone. I discovered I could study 12-18 hours a day, and began to enjoy it! The rest of the 3 years flew in a blur of hospital rounds, afternoon classes, tests, exams and chatting with a group who are now lifelong friends.

If medical college was tough, it wasn’t even a patch on Internship. That one year I practically lived in a government hospital. Going home only to change and sleep. Sleep was a huge luxury. Being on duty 24 hours a day is impossible, but every doctor does it. The longest I have done is 82 hours. Every hour spent on working up new patients, drawing blood, giving injections, collecting x-rays, ward rounds. Through the night one is called again and again and again. That’s when we learn the ability to take decisions with the subconscious mind. Sister calls, “patient is having temperature 102”. “Give paracetamol”. Patient is vomiting. “Give ondensetron”. Patient is having stomach ache. “Give pantoprazole”. One learns to reply with the eyes closed, and hopes that sleep will follow uninterrupted. “Doctor!Poisoning!”. Run to emergency. As an intern I have treated cuts, dog bites, rat bite, monkey bite; Road traffic accidents, head injuries, poisonings, burns; vomiting, dehydration, gang war. We see pain, disease and death at such close quarters. There’s a graded scale between empathy and clinical detachment, and most doctors find their own individual comfort point on this scale.The one year of saving lives, losing them, horrors and humor of internship are what make Doctors out of final year medical students.

More entrance exams, two post graduate degrees; 3 years of Senior residency and after celebrating ten years of night duties I finally became a qualified ENT Surgeon.

The world of practice was a different experience. Perhaps the biggest challenge was drawing a line between philanthropy and earning a living. One would like to treat every friend and every poor patient at concessional rates but how would one pay the bills.Most Doctors would be more comfortable not dealing with the financials, happier treating patients instead.

Every patient’s death takes a toll. When attendants say things like “Doctors are just after money” it’s really heartbreaking. Every profession is for making money, but Doctors never willfully make anyone ill. People who adulterate milk, use banned chemicals to ripen fruit, use illegal colours to make food look better, those are people who are willfully making others sick, not Doctors. I would love for my first dose to treat my patient, so I get a reputation of being a magician, not a healer.

In the age of Google, when artificial intelligence is getting better than humans to analyse symptoms, the human touch is what will keep the Doctor relevant. Which computer can hold your hand or look you in the eye and understand the things you haven’t said. Doctors play so many roles in their patient’s lives: advisor, confidante, teacher and sometimes just a listener.

It is quite fashionable to discuss how such and such doctor did wrong to your family member. In a train journey, I’d rather not disclose that I’m a doctor, else the entire journey people around me will give a litany of incidents where “the doctor killed the patient” or “the doctor wanted money”. And there’s always the free consultation in wedding parties, social gatherings and even in the lift.

In the past 3 decades, no government has increased the number of hospitals and primary health centres proportionate to the rate of population growth. Government hospitals provide healthcare to 30% of Indians today, either the super elite VIPs who have access to the heads of departments, or the absolutely poor who have no means to pay for their treatment. With more people getting covered under medical insurance, the average Indian has arrived at the doorstep of Private and Corporate Hospitals.

Most Corporates are run by business houses; obviously with an eye on profits.Doctors have very little say in the billing of these hospitals and doctors’ fee is less than 20% of the entire bill! The lack of communication of the front desk, the billing, the security, reduced visiting hours, lack of transparency all add to serious amounts of mistrust between the patients’ attendants and Doctors. What most people don’t realize is that Indian Corporate Hospitals are providing world class healthcare at 1/5 the cost of the West, but someone has to pay for it. Whether it is the insurance company, or the government or the patients, someone will have to foot the bill. That is where most problems arise.

The neighborhood nursing homes and private clinics provide health access to 60% of Indians. These are smaller private enterprises which provide more affordable healthcare. Rising costs of infrastructure and staff, red tapism, and the risk of violence are making them a less agreeable option; New age doctors would much rather work in a safer environment of a Corporate hospital, than risk getting beaten up by angry relatives. Disappearance of the neighborhood doctor will make access to healthcare more difficult and expensive for the common man.

Modern medicine is improving lives like never before, raising life expectancy from 32 years in 1947 to 68 years today. New diseases threaten to become epidemic, Doctors and paramedics work round the clock to thwart them. Diabetes, Hypertension, Cancer, Tuberculosis, Autoimmune diseases are being managed and patients are living longer than ever before. Everyone has to die, there is no way to achieve immortality; what the doctors do is try their best to treat their patients. The law does not expect anything more. The law in 19 Indian states does state that hitting a Doctor is a non-bailable offence. Considering most hospitals and even clinics have CCTVs installed, it would be wise to not raise voice or hands on your doctor.

There are a lot of ills in the Indian health scenario. Rising costs of healthcare, huge burden of disease, inadequate infrastructure; not enough Doctors. But the trend of violence against Doctors in case of a patients’ death or a disagreement over the bill, is something that’s been written about internationally as well. The government will have to take a Zero Tolerance Policy on the same, and ensure that the law is enforced.

Violence is not a solution to anything. Please take a pause before making carte blanch statements like “sab doctors chor hain”; if you could remember that the outcome of treatment is not in our hands; if you could put yourselves in your physician’s shoes and recall their journey; if you could be kinder to medical personnel: it would be a wonderful way to say “Happy Doctor’s Day”.

Dr.Sarika Verma
ENT Surgeon & Allergy Specialist

09 Saturday
June 2018
Priorities, Prime Minister.

Every day I tell myself I will not write a blog about government policies. Every day I read a news that boils my blood.Every day I struggle to remain a mute bystander and stay out of trouble. Today I didn’t succeed in keeping my mouth shut. I read the news that army personnel will have to buy their own uniforms. So that the money saved can be spent on ammunition for their guns. All the while when they are on the border, they will wonder if their kids and wife are safe at home because the cantonment roads have now become open to public. So the army families are now as safe as their civilian counterparts. In India, that’s really not a comforting thought.

This, after their hands have been bound and they have not been allowed to shoot at Kashmiri civilians while being attacked from all sides with stones and what not. But the cases against all those who pelted stones on our army jawans have been taken back by a government not willing to stand by its own army’s personnel, while eyeing the vote bank at all times.

At the same time ironically, the government deploys plain clothes policemen to shoot at people who were protesting against pollution of their air water and soil. No outrage in mainstream media about the deaths in Tamil Nadu over the Sterlite plant. But a huge furore when army people tied a stone pelter on their Jeep so no one would hit them

How are armed personnel continuing to work in such a hostile environment? I guess they are in as desperate straits as doctors are. To work under the Ayushman Bharat scheme and give quality healthcare, for example an appendicectomy at a cost of Rs 15000 rupees inclusive of consumables! Hospitals can simply not survive on such abysmally low rates. Already most hospitals are turning away CGHS (central government) and ECHS ( ex-servicemen) health scheme beneficiaries because the rates are so low. Now this new scheme is lowering rates further , and all we will have is more anger against Doctors and Hospitals for turning away patients , instead of people asking the government: when are you upgrading the government hospitals and providing us free quality healthcare?

If we were honestly in such dire straits as an economy that we had to auction the Red fort for 25 crore for its upkeep and give private players access to our National Heritage to host private parties, I would have appreciated the government trying to curb their own expenditure. But no! We are spending on media more than ever before . Ever! These are government data on ad spend in the past 16 years….. since 2014, the government is spending 1200 crores of our tax paid money every year to have their achievements in print, television and radio.

Please remember this same government did not pay 60 lakhs to the oxygen supplier in Gorakhpur, and 38 children died in one day. Did the dean or his wife or anyone else go to jail for that ? Nope. The only man who was jailed was the paediatrician who tried to save those children in hospital that day.

When this government took charge and spoke about Nationalism, I liked the fact that we had the National Anthem playing in theatres. I’m all for saying Bharat mata ki jai and filling the next generation with National pride.

But our soldiers getting such a terrible deal,our National heritage being auctioned and media taking so much tax money from a government which is obsessed with self glorification. I would rather not have this farzi Rashtravad. I would prefer a government who has empathy for its people. I wish it would lower its taxes when the crude oil prices went up, just as it raised taxes when the crude prices went down. This raising of fuel prices every day has caused consumable costs to spiral upwards and the common man is saving less and less every month.

I wonder if governance will ever be about helping it’s people. Or will it remain about winning the next election, always.

Dr.Sarika Verma
ENT Surgeon & Allergy Specialist