Doctors are humans. They are not super humans. They have limited energy. They too get tired. They too have to eat breakfast, lunch, dinner , with fruits or salad portions. They too have to exercise and hit the gym, to stay fit. They too get sick, have Malaria, infections contacted from patients, diabetes, hypertension, depression, Bipolar disorder, cancers, etc. They too undergo treatment including medications and surgeries. They too have families with regular family responsibilities and stressors as well. Family responsibilities start after they complete their MBBS or during Post Graduate years when their financial reserves are tight or on loans. They too have children who attend school or colleges who demand and deserve appropriate attention. They also have personal, social, financial, occupational needs and also dream to provide their family with decent amenities and provide their children with best schooling and upbringing.
Competitive exams and rigorous curriculum are the constant stressors. A Specialists doctors training lasts for at least 10-14 years with sub-optimal financial, personal and occupational conditions constantly. Then there is the pressure of updating knowledge and skills regularly. Then there is work place pressure. Working at corporate chain of hospitals will give a good platform to start a career. But as these 5 - star hospitals are run by businessmen who employ MBA's ( from top management schools), the medical practice is sometimes dictated by profit oriented managers. The managers have no loyalty like doctors. Once they show profits on paper, they jump from one hospital management to another by negotiating their performance. These hospitals largely support those specialties which are income generating and neglect other specialty services though the need is enormous.
Then comes the compulsory rural postings. No other profession like Lawyers and Engineers have to contribute compulsorily though they have jobs affecting peoples lives. Let government make rules for IITians, IIMs , Nalsar graduates and other state or central govt. institutes to do rural service. I can imagine the hue and cry by the graduates of these institutes when government wanted to curb Brain-drain to USA, forget about rural service. Doctors bear all these, but are still willing to work with the Government and their various health policies. Despite excellent training, government fails to provide sufficient staff, quality equipment and infrastructure for doctors to practice. Standing in the frontline, facing the distraught patients, trying to explain their limitations, doctors still face barrage of choicest abuses, 'neglect' accusations, threat of consumer courts etc.
Yes, it is agreed that there are black sheep in any profession. Just because 1% are bad, it does not mean one can castigate the remaining 99% whose intentions are good and even better.
Despite all these, a doctor greets his patients with a smile, talks to them, intends to alleviate their sufferings and distress. And above all, doctor has to diagnose the illness then and there, give judgement, take a clinical decision within minutes and treat with immediate result. The doctor has to review in his brain 14 years of study and his experience in years and diagnose and start treatment without any margin of error within few minutes. The doctor also has to tell whether the illness with occur again in the future, how long is the treatment, when will the patient get better, will the patient get married and have children and will the children get the illness. All this is supposed to be done at the same first consultation within 10-15minutes because there are other patients similar to this patient waiting in the outpatients area. I am yet to see if engineer can build a house or a bridge within days, if lawyers and judges can make a judgement within days or even months that too without a mistake. If doctor orders investigations to confirm the diagnosis or prescribes some medicines, there is still is a doubt in the mind of the patient as to doctors aspirations.
Some conversations with patients which can get on the nerves of anyone.
- A client has come with typical depressive symptoms of lethargy, tiredness, weakness, headache, depressed mood, negative thoughts and low confidence. He has scored high on depressive scales. I explained to him about the illness, its pathology, the treatment process, counseling sessions etc. After I wrote the prescription, he asks - what is this medication for? I would have liked to say Knee pain, but I have to tell him it is for depressive illness for which he had come. If a patient goes to a doctor for cough or fever for what will the doctor write prescription for?
- In another patient, I wrote the prescription and specifically told him to take it in the morning so that it will activate him. He then asks is this a sedative medication? I wanted to tell why would doctor write sedatives in the morning? Even, if he does, he would definitely tell the patient in the first instance.
- A patient was misusing and got addicted to gutka, alcohol and at times Cannabis. His parents brought him for consultation. I wrote the prescription after counseling, then his parents ask me whether the medications are addictive or has sideeffects that can harm him. I would have liked to say yes medicines prescribed by qualified doctors are poisonous, so let him continue gutka, alcohol and cannabis which are harmless and have medicinal value and good for health!!! Why would a doctor prescribe an addictive medication? If someone goes to the doctor for cough, will the doctor give treatment to decrease the cough or increase his cough?
- In another instance, after explaining in detail about the illness, treatment process to both wife and husband, then the husband wanted me to explain the same to his brother who is software employee. Then, they asked me to explain the same to wife's parents. Then doctor can you talk to my uncle on the phone to explain.... the list was continuing. Where is privacy or , confidentiality issues in India? When I said stop, they thought I was rude and not giving enough time, though I have other patients waiting in the clinic who were getting delayed.
- After explaining in detail about the illness and treatment, after another client is in the room, the previous patient comes repeatedly and asks when to take the medications etc and interrupts 3-4 times with questions already explained and answered.
- One patient calls up at 2am in the night and asks whether I would be coming to the clinic in the morning and at what time the he can come? Where is the emergency? Doctors previously used to give their personal numbers for any emergencies. Patients used to respect and call only during emergencies. But nowadays, non-emergency calls are more than real emergency. We are afraid that we may miss that one in hundred chance of not answering a really emergency patient.
- Yes there are patients who 'forget' to get their previous medical records, prescriptions and investigation reports. They come as if the doctor is the first professional they are consulting, to test the doctors' knowledge. Doctors are more than happy to give any second opinion as well. The patients need to get all past medical reports for their benefit only and not to test the doctor.
In my experience, uneducated, people from rural backgrounds and yes completely knowledgeable people are easier to treat and explain the process. It is the "google search" people with their medical knowledge of 1-2 hours, trying to debate about and argue with a professional with more than 10-20 years of study and experience, who are difficult to convince and treat.
Dr. Devisetty, an eminent Cardiac Surgeon once said - In the previous generation, a doctor took 1-2 hours to explain the need for surgery to a patient and relatives. Nowadays, a doctor takes 1-2 hours to explain why surgery is not needed. ' Google uncle' said surgery can also be done, so doctor has to do surgery.
Finally, I would end by writing that doctor is also a professional with personal life. Doctor is also a human with limitations and doctors practice with good intention of treating the illness and alleviating the patients suffering as soon as possible with the best available skills, knowledge and equipment.