Tuesday, July 25, 2006

The needle in the haystack

I was watching the Guinness Book of World Record yesterday and one of the amazing feats that they showed was the first successful Craniopagus separation of conjoined twins Vilija and Vatalija Tamulevicius. The procedure was carried out by a Russian surgeon who specializes in brain surgery and later, the reconstruction of their skulls was done by an American surgeon. As I was watching this programme I could not help but feel tremendous admiration for these doctors. They are the Robin Hood and Gulliver’s of modern day world. They fight intricate battles that require skill, presence of mind and oodles of experience.

And then it dawned on me suddenly that had these guys been Indians, they would not stand a chance getting a medical seat let alone acquire the level of expertise they have now. Their skills and aptitude for the profession would be ignored. They would have to buy that seat or be a Reserved Caste person or be lucky to clear the entrance exam from among the multitudes. Their talents would be lost to the world because being a doctor is just another job in this country. And because it is just another job, just about everybody wants to be a doctor. And in this melee many people genuinely interested in being doctors and treating people are lost.

This is not a rant about Reservation. If there are people in the reserved category who can make good doctors then more power to them. I for one frankly don’t care whether my doc is high caste or low caste. When it comes to my health I want someone who knows what he is doing and is sincere about helping me. But let’s face it, when I go to a doctor today all I see is an individual who was lucky to get that seat while the doctor regards me as just another consultation fee and if he is business savvy then more money by sending patients to cooperative labs and hospitals for unnecessary medical tests and caesareans. It is an unhealthy vicious cycle.

How many of us will here go to an unknown doctor without enquiring about him or being referred by someone who trusts him? He is an MBBS and is registered under IMA. Then why do we hesitate? Because we are not certain about the doctor and his intentions or his antecedents. Because have heard horror stories of doctors who overcharge or kill or maim their patients. We do not trust a doctor implicitly. Ironic isn’t it that a man who has cleared his exams and is a certified doctor has to pass another test i.e. the trust of the people? If the selection of medical students was fair and based on merit and aptitude then all of us would blindly trust anyone with a Dr. prefixed to his name.

The fact that I am sitting here in good health and typing this post hoodwinking my boss into thinking that I am writing a brochure is because there is a Doctor Mathew who makes sure of that. A man who is perhaps more qualified to be a doctor than most of his brethren because ‘medicine’ is not a mere profession for him and the crowd that throng his clinic is testimony to that fact. His consultation charge was only Rs 10/- till protests by patients like me made him revise it rather apologetically to Rs. 20/- for people who can pay. For the poor he gives free medicine or charges a token fee. The result? He gets a plethora of patients with all kinds of problems that an upmarket physician will never see in his lifetime gaining him experience and expertise far beyond what most doctors will get in their entire lifetimes.

Another doctor nearby, sits swatting flies because he charges Rs 50 for consultation alone because of the word MD after his name. Guess who makes more money? Guess who takes his profession as a calling and who takes it as a mere money spinner?

Ask those doctors joining Call Centers by the drove where they failed. They will give you many reasons but if they were to only act as doctors and not business men by taking a genuine interest in their patients and lowering their consultation fees, maybe, just maybe they could have survived as GP’s. But most of these gentlemen are in a hurry to make money and end up frustrated when that doesn’t happen. Today doctors who have climbed down their high horses and charge lower consultation fees are doing well. Because there are patients out there, enough for every doctor to make a decent living that is if they are willing to be satisfied with a decent living.

But then you cannot blame them entirely can you? He joined this profession because it was a job and not because medicine excited him or the thought of alleviating people’s suffering moved him.


Anonymous said...

three cheers to your doc, mine is a gem too and he has a busy practise like your doc.

Dr. Pissed said...

Oh the pains I have to go through to getting people to trust me.

But needless to say, I am having a ball. haha.

And moreover, this is so true about the policemen in our city as well. Aint it strange that not a single one of them can run a 400 mts lap?

Immigrant in Canada said...

What do I say? I became a Dr, because i wanted to do something for mankind. But not everyone thinks the same way..
There are loans to be paid back, you have a certain status symbal..( If a doctor uses a cycle as a mode of transport, the society would assume..ah..he is a lousy doctor and that is why patients don't go to him!!, see he is still using his father's bicycle, let us go to the other Dr across the street, he bought the latest Zen car yesterday. He is doing well!!!)

Apart from consultaion fee, there is also tremendous pressure from pharmaceutical companies that encourages(read pushes) you to prescribe their drug in lieu of a latest Zen car!

It is a catch 22 situation. One side is your medical ethics, on the other side is your staus, luxuries, and your own collegues who are not following the ethics who are doing very well and holidaying in Switzerland courtesy of a pharmaceutical company

silverine said...

Anon: Good for you :)

dr pissed: LOL

Sarah: I am actualy talking about the GP's in Bangalore. The golden era of docs is over. Today people would rather go to a doctor in a cycle than a Zen. At least in Bangalore. I was actually talking about the situation in Blr. There is a need for so many clinics here but not one MBBS pass out wants to do that. And the ones who do set up a clinic to do general practise charge the earth driving away patients to people like Doc Mathew who are perpetually crowded.There are so many good docs but they are not enough. We need more people like you who study medicine because they want to do something for mankind.

Anonymous said...

Cant agree with you totally.. In kerala, many people judge docs by the consultation fee they charge.. To them a good doc charges a good fee coz he is good and people will flock to him however high the rates... Pretty lousy argument eh? But i ve heard people mentioning it.Also(happens in rural areas) they give no consideration to docs who prescribe less medication...Its kinda ironical.There are docs who prescibe only the necessary medicines and the patients turn back and comment :"I dont think he knows anything". But give the patient a shot and he is happy.

Mind Curry said...

whoa man.. i saw this post a couple of days ago, but didnt get to read it..but now i did. very well.

well i have lots to say..i agree with you 100%, would be the first. but then there are lot of unsaid stories and exceptions and what not.

i have to say i really like this dr.mathew..ehemm!

on the flipside, people dont want GPs anymore. one has a headache, you have people coming to the OPD asking for the neurosurgeon. someone has a stomach ache, they specifically ask for the surgical gastroenterologist. someone loses 15 hairs one day and they ask for the trichologist. how do we deal with that? an mbbs has become like any other degree and people dont see you as a doctor anymore.

i think theres all kinds of pressure on docs as well to project some kind of image so that they are successful. and sadly, for any profession, just like in business, success is measured in terms of the wealth you create.

personally, i chose to be do MBBS because i wanted to become an IPS officer because i wanted to change the world because i thought the world was full of bull (it is!). but i became a surgeon because i liked blood on my hand and chopping and all..i mean because i liked all those things a surgeon does :) (kidding!)

about call centers, i think its great being versatile. so i wouldnt mind some time at the call center when i can spare some time :)its about time doctors shed the image that all they can do is their "prescribed" job function, and are dumbos about everything else.

i know half the things i have written here are not related to what you were trying to say, but i have this habit of writing whatever comes to my head.

you are right..the golden days of being anything is over, not just docs. you have docs being tied to the tree and being thrashed, you have civil servants being trashed like slaves, you have engineers sitting idle in their houses..this is the era of the communications specialists :) ok..kidding..but you get the point.. man is just racing against time and mankind, to build castles based on designs created by eachother. thats probably why all these yoga and meditation is becoming a hit..and is teaching you to focus more on yourself and cut-short your unwanted desires.

which brings me back to the question "whats the purpose of life?" is it to sit on a mountain and be content without any desires? or is to follow the "social system", reproduce and leave one day? the search is never ending.

i am unable to stop my thoughts silverine! what have you done!

you and i are able to comfortably talk about these things because our folks empowered us with education, good upbringing and comfortable lifestyles. but minus all that, i sometimes wonder what we would have said about every issue in this world. i woulda probably been this rip-off doctor who removed all my patients kidneys when they come for consultation..ahh..

i really liked what you have written silverine. i also wish there are more docs like yours, more genuine people like you.. i wish the world and its people werent so complicated as it is.

Jiby said...

just reading all the comments here and they are all so good. what mind curry wrote shud have been a post of his really!!

i went to a doc last month and there i was surprised to see a patient of his, a not well to do man invite him for his daughters wedding. i was then wondering how many patients really speak good of their docs after coming out of consultation and a huge fee.

its nice to hear of such doctors like yours in blore. even in tvm there are a few respected doctors who charge according to the income of the patients. but i was reading an article that in places like malappuram patients have a high opinion of their docs, when their docs charge them high fees and prescribe them a lot of medicines!!!

silverine said...

Anon: I guess in the rural areas people still go for doctors with cars and money. But I here in Bangalore, people still prefer to go by word of mouth reference. And patients are unbiased in giving their opinions :)

mind curry: That was a really sweet, thoughtful and hilarious comment!!!
I had nightmares yesterday night of you running after me with a Lancet. And then the chase was taken up by Sarah and then by Angel Doc, hyena style :|
lol just kidding, but I was hoping that I would not offend anyone as I was talking about people who take this up as a mere profession only :)
And as Jiby said it should have been a post. I also want you to know that SP is a big fan of yours, Jiby's and Alexis blogs and lately of Sarah's too :) My neighbor is an ENT specialist, He recently joined a call centre as he was not happy with the money in the hospital. Another Specialist opened a Clinic to do GP work which runs packed. The difference in the two is their ability to adjust. The latter Doc in fact says that he earns better than what he did at the hospital :) Clinics with GP's are so few and far between. I just wish MBBS docs would set up small clinics...we need them and they can make a decent living.
"personally, i chose to be do MBBS because i wanted to become an IPS officer "
ROFLMAO doc, I was serious about handing over Poomanam to you and there so many other brilliant one liners in this comment :)) Thank you for this *hugs*

Jiby: I have heard that too…about the fees part. Actually a doctor patient relationship is very close and if he is the regular doc, the patient will confide almost anything to a doc and treat him like a family member :).

silverine said...

mind curry: "i am unable to stop my thoughts silverine! what have you done!"
Anymore thoughts on this are welcome doc :)

Patty said...

Many of our specialist in my area are of Indian desent, and highly regarded. I couldn't tell you if they come for the money, or for the job. We are now seeing a trend of doctors that are ditching insurance reimbursement and working on a cash basis. People are flocking to them like flies because it is more cost effective to pay for you visits out of pocket, then it is to pay the portion left after insurance. Docs are doing it, because the insurance compnies are putting so many regulations on them that they spend most of their time filling out forms instead of treating patients.

We also have this system in which one is almost "forced" to go to a specialist for anything greater than the sniffles or a hang-nail, but of course you can't see a specialist until you see your primary care doctor, hence both docs take a cut out of you..... surgeons or not!

silverine said...

Patty: That is a great thing since medical care is expensive in the US. Here in India we can get affordable basic medical care without insurance. The doctors were very higly paid some time back when India was a closed economy and medicine was the only lucrative private job. Now after the opening up of the economy, they still expect to charge the same when their numbers have swelled. If they could lower their consultation rates they would get a good number of patients. But they refuse to do that and instead look for other well paying jobs. That is the problem here.

Nice to see Ben and you here :)

pophabhi said...

Spot on. I think it might depend on the location too. How people perceive and rate the best person they would like to have as a doctor? The perception changes according to region and preference.

Its correct in Bangalore, but might not be same in villages in Tamil Nadu.Nice thoughts...

mathew said...

wow..so all is not lost yet!!.
kidu doc..
i get irritated by the attitude some docs put up..esp in govt hospitals!!

neways give a same pinch for doc mathew!!! ;)

silverine said...

Pophabhi: There is a doctor next to Infant Jesus Church who is like doc mathew and his clinic is crowded and you can trust him blindly because of the type of exp he has due to the crowd and the resultant variety of cases he handles.

Mathew: Lots of Mathews here :)) But only one with the handle bar moustache :))