An appeal to the judicial system, law makers, fresh MBBS graduates, MBBS students and aspirants for MBBS.
Dr. P K Sasidharan
You would have noticed the Honourable Supreme Court commenting on inflated bills of modern medicine hospitals and also criticising IMA that when it is pointing one finger at Patanjali the other 4 fingers are pointing at modern medicine doctors in private hospitals. In fact the IMA is not responsible for all these, the health system in India ( a non-system) and its policy makers are responsible for the whole issue. This unfortunate comment has come only because of a totally disorganised health system that India has now by imitating and copying all possible bad trends from USA, but failed to copy their goodness too.
We need a proper health-system under good government control for the people with a strong foundation made by trained family doctors and a referral system. Ideally all doctors should be working for the government which is a distant dream now. Instead we are experimenting with the lives of our people encouraging private business lobby (the doctors are just working for them), the unscientific practitioners and super speciality hospitals. The solution lies in establishing a large network of trained family doctors sitting in all the PHCs, CHCs and private clinics with strong government control. That’s the only way to solve this issue rather than the IMA fighting against Patanjali. All the bad trends are just symptoms of the disease of a damaged health system (please read the news in The Hindu).
My sincere appeal to all the upcoming young generation doctors
Please do not focus on PG entrance coaching during MBBS or after MBBS. Do not waste your precious time in entrance coaching centres after passing out MBBS, instead make maximum use of the MBBS period to acquire maximum clinical skill and try to become good primary care doctors (family doctors/general practitioners). They are the most important doctors in any evolved society and India alone is ignoring it—Therefore please all of you should try to become good family doctors. Specialities are already super saturated and they are facing problems due to their own inadequacies and due to absence of true family doctors, the friend philosopher and guide kind of doctors. There are enough and more opportunities waiting for family doctors all over India, the only problem is that you do not see it due to poor polices of the government and hence you have to explore it.
The private dominated speciality crazy disorganised non-system in India does not show case the opportunities for family practice as everything here is profit-centric. By not focusing on entrance coaching and instead focusing on acquiring the skills, you always have an added advantage too in case you become specialists later. That is an untold secret, only those who acquire clinical skills to work as a generalist during MBBS and afterwards can become good specialists too. But our authorities controlling medical education in India are ignorant of the basic health needs of the people and the inadequacies in the health system and they focus only on bringing out specialists, superspecialists and to accommodate the increasing number of specialists they go on building more and more corporate 5 star hospitals and medical colleges. They unfortunately are not even aware of the huge demand for trained family doctors in India. Therefore what you all should do, even if the government is not offering training programs to become family doctors – You all should try to become good family doctors on your own. It is not difficult, provided you have made up your mind and if you know that family doctors are the most important class of doctors in any developed society all over the world. Since their work is entirely for the people and without an eye on profit, you will naturally be needed in large numbers but you should have acquired the necessary skills (I can assure that you will get enough money naturally to make a decent and happier life than a specialist).
Therefore what you should do is to complete your MBBS sincerely focusing on acquiring clinical skills-like history taking, physical examination and the practical skills in managing patients but without any bias for any particular disease or system. And during internship you focus on acquiring maximum hands on skill in doing all procedures expected to be done by family doctors- like improving your skills in eliciting history taking, proper physical examination, interpreting common investigations, doing common procedures, starting IV fluids, choosing the right kind of IV fluid, inserting indwelling catheter, doing I& D wound care and dressing, applying slings and castes, Ryle’s tube insertion and other necessary skills that you may have to do when you are in practice in in a community setting. Learn to use vitamins and antibiotics wisely too besides proper diet and good lifestyle. The skills needed for family practice in the community setting will remain the same even with all future developments in technology. Also remember that the only kind of doctors which cannot be replaced by artificial intelligence (AI) is family doctors.
Soon after completing your MBBS program, if possible try and get into an organised family medicine training programs- there are enough opportunities now in the form of DNB family medicine diploma in family medicine and MD in family medicine. Even if you do not get any of these do not get upset, still you can become good family doctors. Even without any PG program also you can become good family doctors by your own effort. After MBBS start working under good internal medicine doctors, good gynaecologists, good paediatricians, good orthopaedic doctors and good surgeons for a minimum period of 3 months each. Throughout this period you can get online materials on principles of family medicine and then you just start a clinic of your own. Once you have acquired the skills, announce proudly that you are a family doctor or a general practitioner or a primary care doctor. Start a small clinic of your own or join a PHCs. Initially you will not have acceptance or patients, but they will come to you once they know slowly that you are capable of helping them. But you need to have interest in their overall health and well being too.
Please realise that people need your kind of doctors in large numbers and not the specialists. It is because the family doctors are missing, people throng the medical colleges and super speciality hospitals and that is exactly the reason why family doctors are not being promoted in India. This is because there are enough people to capitalise on the absence of family doctors- the corporate hospitals are getting enough and more patients due to this and they all encourage doctor-shopping and the private lobby is enjoying this situation.
The cry for increasing medical colleges and superspecialist centres everywhere happens only because we do not have enough genuinely trained primary care doctors. This situation forces the government to build more and more medical colleges and corporate superspecialist hospitals and because of that now people are encouraged to go for primary care by doctor-shopping to specialist doctors or to the traditional practitioners. Finally as a result of all these, the government on one side is promoting only the traditional systems and on the other side they are promoting only the super speciality centres and the health care in India is going to dogs. IMA as an organisation is not responsible for this scenario and the honourable court is not wrong in its observation, but that does not mean Patanjali kind of quacks have to be supported. Let us wake up and save the health system in India- it is already too late. (the IMA, NMC and NBE should take note of this)
