Just Read this Article in StdBMJ. Since our society is more or less similar to Indian, I want to put it here for discussion.
Medical profession and public perceptions: an Indian perspective
In the West, medical professionals are subject to increasing levels of public scrutiny. In India, the medical profession has remained pretty much unscathed, and doctors are widely praised, thinks
Balaji Ravichandran
Our society undervalues doctors yet expects, and will accept nothing short of perfection… Even with perfect risk management, mistakes will be ‘made’… people will die young or decline with age, and not all pregnancies will have a good outcome. Unfortunately, doctors are more easily sued than God, and, moreover… pay cash.”1
Even respected doctors get confused
sipa/rex
This is how an Israeli intern responded when the BMJ asked its readers to define a good doctor two years ago. The quotation succinctly summarises the heavy scrutiny to which medical professionals are increasingly subject, especially in Western communities. And this begs the question: can the increasingly prevalent negative sentiments towards doctors be fully justified? A moment’s reflection made me think otherwise. A doctor ought to be respected not just for his academic and human qualities, but the very name of his profession should command instant respect.
The Indian perspective
India, the second most populous nation in the world, obviously presents a huge challenge when it comes to health care. As in Western societies, the Indian medical profession is increasingly subject to public scrutiny, especially due to a recent and unimaginable growth in the hold of mass media over its viewers. From the recent announcements of a breakthrough in stem cell research by Korean scientists to the subsequent allegations that eggs were acquired using unacceptable practices and that two pieces of research into cloning human stem cells were faked, no issue of medical importance escapes the eye of the public.
Most Indians hold doctors in remarkably high esteem. Consider, for example, how the entertainment industry portrays an average medical student or doctor. Regardless of the plot, often if the writer decides to raise the status of a character, the character is most likely to be a medical professional. If the character in question is a medical student, he or she is most likely to be the paradigm of all that is intellectual and virtuous. Once the student becomes a doctor, they are portrayed as skilful healers, providing relief to every patient entering their clinic. Their practice is flawless. Of course, readers might share my own incredulity at this portrayal. Yet underneath it all is deep seated respect for medical doctors.
To help illustrate my point further, let me draw a few of my own experiences. When I came first in the state in my medical entrance examination (which was publicised widely in state media),2 I became a celebrity in my neighbourhood. People with whom I barely had an acquaintance came forward to congratulate me. And now, after having entered medical school, every time I visit a close friend or a relative, I’m almost immediately asked to do a “thorough medical examination.” All my relations are explicitly proud of me having taken up “the noblest profession in the world.” And I admit, I’ve enjoyed this position immensely.
Soon after my clinical rotations began, in my second year, I happened to witness an inspiring event. One of the residents in the outpatient department allowed us to examine a patient who had gained miraculous motor control after suffering from Guillain-Barré syndrome. As five of us were examining the patient, her mother explained to us, in rather crude language, how thankful she was to the “gods” (she was referring to our ward physicians) who “worked miracles with their hands.” And just before they both left, the mother fell down to the ground in front of our chief and thanked him for all eternity for making her son walk again.
Why the sharp difference?
I admit to my ignorance of what a medical student from the United Kingdom or the United States would make of all this. But I wonder if anyone would be able to perceive it without a sense of awe. Of course, some people hold negative views about the medical community in India. But, the number of lawsuits under medical jurisprudence is low, and large sections of society do not have particularly negative attitudes towards medical professionals. So, why are doctors worshipped in India, and why is there a sharp difference in how we judge the medical communities in India and in the West?
Indian health care consists of two equally powerful arms—one public and one private. The latter comprises of innumerable private practitioners and well established single specialty and multispecialty private hospitals, which admit rich patients. The public healthcare system, which is largely free, is accessed primarily by poor patients. Thus a large fraction of the population uses the public healthcare system. This leads us to some interesting observations and conclusions.
Firstly, the most important complaint lodged against medical professionals here is their greed for money. Understandably, this is principally a problem of the private health sector, and most often lodged against multispecialty hospitals and private practitioners. Secondly, few complaints of gross negligence or serious professional misconduct have been made. Because the incidence of any such complaints is largely restricted to the private sector, some people believe that the illiteracy of the patients attending public hospitals might be responsible for this trend. I believe this to be partly true, though not entirely.
Thirdly, public and private healthcare facilities differ widely in their approach to health care. Private institutions and doctors tend to rely rather on relatively expensive approaches. Government run hospitals and institutions rely more on traditional and cheaper approaches, partly because of limited funds. This might also explain why the Western public is increasingly distrustful of their medical community; technology is increasingly replacing cost effective approaches to diagnosis and treatment.
Fourthly, most Indian doctors receive their training from government run institutions. Considering that India is a tropical and developing country, the number of different clinical entities that a doctor in training encounters and the frequency with which he encounters them are greater than in any Western country. I wonder if repetitive exposure to these conditions can improve the acquisition of important clinical skills that could make a crucial difference in medical practice.
Finally, it must be conceded that health care is not up to Western standards in India. Patients’ care is often marred by lack of political will and inadequacy of allotted funds. Some of the most sophisticated technologies available in the West are not available here, and patient satisfaction may not always manifest into reality.
Each of the foregoing statements can stand alone. Let us consider them again and try to answer the question: Why does the Indian public not complain? It is not because of the better standards of health care that obviously exist in the West, or because of the educational and socioeconomic status of the larger fraction of Indian society. I would ascribe it to a greater public understanding of the enormous difficulties that come with the territory of being a medical professional (as expressed in the opening quote to this article). Despite being scrutinised by the sensationalist media as in the West, public opinion still swings in the direction of the medical community. Does this still seem puzzling? No.
The value of a doctor
So then, should medical professionals be publicly scrutinised? And is such scrutiny justified? Certainly it is. But a rational limit exists to which such scrutiny can exceed. The Western public and media must recognise the unparalleled challenges faced by a student as he or she enters medical school, graduates, and subsequently begins his or her practice. When they start this profession, medical professionals swear the rest of their lives to its unending and ever renewing demands; absorbing all the information exploding in front of their eyes and processing it all for the benefit of their patients. A third person can easily sit outside the realms of a medical community and scrutinise and criticise. But ask a medical doctor who has just saved a patient from life threatening cardiac arrest, or the patient who has survived it, and you know the value of a doctor in the society.
You have to view the entire medical community and all its wings with a remarkable sense of optimism, in which the individual patient has become the centre of attention and towards whom all the efforts and fruits of years of research are channelled. Glitches occur everywhere, but the medical community is the quickest to learn from its mistakes and orient them towards patient care. And taking all this into account, the world (especially the West) does little justice in its ever harsher judgments of the medical community, to whom humanity accords first place in society. Perhaps not so surprisingly then, most Indians hold a special place for doctors in their hearts—and, not surprisingly, we remain thankful to them.
Balaji Ravichandran, second year medical student, Madras Medical College, India
Email:
balaji.ravichandran@gmail.com Source: studentBMJ 2006;14:45-88 February ISSN 0966-6494
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