Doctors down the drain

Having completed 2 years as a teacher and therefore learning things (different things) again, I looked back at my first stage of learning. Did I make a good decision in taking up medicine? I’m sure I did. I enjoyed almost all of it. Very seldom did I feel it was awful or boring to have to go to work.

So I am surprised to discover that many of the doctors with whom I studied and some who were either senior or junior to me (most of them quite successful and in various countries across the globe) are retiring early from the profession. How strange!

Going way back in history to the eighteenth century there wasn’t much that medicine could do. Then we could open an abscess, relieve pain, do a Caesarean, relieve an obstruction in the gut, take stones out of the bladder and cut off hair and legs (that was when we were barber-surgeons), not much else. However, the profession was regarded with much distinction because all medics had passed an examination, or even more than one.

Nowadays we can do very much more, but are no longer thought of with nearly as much awe. And we have passed many more exams. Why then?

A few doctors are criminals. That has always been so. However, few are beggars. Even fewer are seriously rich. Most of us rub along in the middle of society. Quacks do, too, who practice alternative medicine, and have never passed any exams, but are good at believing unbelievable things and contemptuous of us skeptical sloggers at textbooks.

When we qualified we expected to practice our profession by asking questions and getting a good history, by examining the patient and finding physical evidence of disease, and by doing various tests. Then, with luck, we might reach a diagnosis and give the patient some useful advice.

Nowadays in the UK and to some extent the USA and Australia doctors are urged to spend lots of caring time with each patient, but also to get through lots of patients every day, to fill in form after form containing rubbishy information, and, at the same time, urged to protect themselves against legal actions for negligence, actions they have already paid expensive protective insurance against to give themselves peace of mind. But peace of mind doesn’t come, unfortunately, at the drop of an insurance receipt. Defensive medicine is now the thing.

In these countries surgeons and physicians are compared, one with another, so that each should lose a similar number of patients. That results in easy problems getting fixed but difficult ones getting little chance. One’s clinical judgement is preempted by the state, as is one’s clinical kindness.

Is the same thing happening in India? It seems to be beginning or rather as some of my friends put it – It’s roaring like a fire out of control. No health service can be immune from criticism. There will always be patients who believe themselves ill-used – and some are indeed ill-used – but outside our governmental institutions there is much less complaint, and private practice appears to thrive, as do the many forms of alternative medicine. “Anti-medicine” would seem a better term for that. And anti-medicine consultants cannot ever, I think, be prosecuted for negligence.

Our beloved politicians who rule us and tax us can easily handle all those millions of Rupees without any degree from the Indian College of General Politics. Some specially kind ones can even take a million or two, without the need of a public vote, to give our money and our love to those marvellous countries who are in “Need”. And some pilfer the above said millions into their pockets every year!!

So maybe we should give up the idea of doctors having to pass exams. Let them compete with their rivals on equal terms. “Failed M.B.B.S.” can be a sufficient recommendation, and appointments to Government institutions could be, as maybe it should be, a matter of politics and sincere friendship.