Why, despite being a doctor in India, I advised my friend not to return home to practise

My long time buddy from the medical college days, who left for the UK many years ago, to flourish as a critical care specialist thereafter, suddenly called me today (December 10) morning and generously thanked me for the profound advise that I had given to him when we had met an year back.

Then, he was sitting on the horns of a dilemma, and wanted my opinion on his deep desire to return to India, his "Motherland".

I had brushed it off as a "mid-life crisis situation", which needed deeper introspection.

I briefed him about the pros and cons vis-à-vis the challenges faced by us as doctors in India, which stoked enough apprehensions in his already clouded mind. As a result, he put his idea on the back-burner, temporarily.

And today, when he called me for saving him from committing a major blunder, there was a tinge of anguish and sympathy as he said: "I am so shocked at the reprehensible and uncivilised manner of the unabated media trial on doctors in India. It gives me nightmares at the utter thought of practising in India, you saved me, bro." "You saved me," sounded like music to my ears, amid the shrill cacophony of the resonating rants pronouncing all doctors "murderers, plunderers, looters etc etc".

I still vividly remember the meaty portions of the discussion I had with my friend, R, at a coffee house, and I present it to you verbatim, as under. 

R: How about joining the government sector, I want to serve my country. I have acquired some specialised skills that, if implemented, may usher in a change in the critical care management aspects in India at an affordable cost.

Me: Dear R, most government hospitals are struggling to fill up the vacancies for doctors for sheer want of funds. To get into the few famed medical institutions, where your talent can actually be put to use, you need to have the "right connections". As far as I know about your background, your father served the Indian Army and after retirement, like other hoi polloi, joined the herd of the massive "cattle class". Then again, by the grace of the almighty, even if you are able to gatecrash the system, your excitement would soon fizzle out by the pathetic remuneration you would be handed over, as it may be difficult to take care of the decent lifestyle that your family is used to by now.

Bhabhi ji will curse you at every month-end, and the children would go into depression because of the glaring comparisons they may be subjected to at school, by the flashy lifestyles of wards of affluent parents. Your dream of implementing your novel ideas in the prevailing system would never see the light of the day, as policy matters are not decided by experts with up-to-date knowledge and first-hand experience. They may invite a suggestion from you at best, but implementing it would be impossible.

R: That sounds scary Amit. But what about the private sector in the metros? Or maybe I can go back to the small town where I received my primary education, I feel so nostalgic about those days. Time has not moved for my little town it seems. There were no roads there when I was child, the primary health centre and the schools were monuments of neglect, with no teachers, no doctors, no medicines and no facilities; and to my horror, it was exactly the same when I visited it last month. I can open my own hospital there, and serve the needy.

I shook him out of his fantastical world of idealism and narrated some recent incidents of violence against doctors in small towns.

Me: One nursing home in a small town was ravaged and the doctor attacked viciously because he was held responsible for the death of an 80-year-old patient, who was suffering from a chronic liver failure that he acquired due to 40 years of binge drinking, kidney failure and recent bout of chest infection.

A doctor was shot in the OPD, in broad daylight, by some miscreants because he refused to pay the ransom termed as "protection fees" by the goons patronised by a local politician.

"A gang of goons attacked a small hospital because the doctors could not save a young man, who suffered multiple fractures, severe head injuries and a circulatory shock, almost drained of all the blood from the body because of the delay in shifting the patient from the accident site to the hospital. The boy was the nephew of a local MLA, and all his supporters vented their anger on the hospital.

I can go on and on, if you don't stop me. And then, you will have to face a stiff competition with the local quacks, who rule the roost in small towns. Will your conscience allow you to genuflect before them and offer them cuts for the patients they send to you? Will you give a share to the ambulance mafia that picks patients and drops them at hospitals of their choice. Then comes the sarkari babus who will trouble you with frequent inspections and objections.

These are necessary evils that you need to deal with, if you need to survive in small towns because no matter what you do for the patient, he will trust his primary physician/quack because the guy talks sweet and charges less money.

The assessment of the ethics and honesty of doctors has a skewed parametr in our country, especially in the hinterlands, the lesser fees you take, the more ethical you are. As far as the degrees are concerned, the worst man has the longest list of "decorations and awards" under his name, and there is nobody to check on them.

R: Hmm, that sounds tricky Amit. And all this without local governments taking any action? That's really disgusting.

He was left amused at the anarchy and disorganisation prevalent in the healthcare sector in India.

Then you leave me with only one option to consider I think, a metro city, maybe Delhi should to be my next destination then.

Me: In bigger cities, much of the problems are taken care of, still it's not the utopia that you imagine.

You may get an offer from one of the many state of the art corporate hospitals, which can justify your talent and skillsets, and give you immense job satisfaction. But for every 100 satisfied patients, there may be one that can drag you to court. Especially, when you deal with critical patients, for whom chances of mortality and morbidity are high.

As per records, most litigations over negligence are slapped by grumpy relatives, whose patients died despite treatment. And as they were made to "cough up a heavy amount despite losing the patient. This forms the basis of their complaints in most cases, because the prevalent mindset here is that you have to ensure 100 per cent recovery of every patient.

Death of every patient in the hospital is due to the negligence of doctors, until proven otherwise.

In big cities, by default, doctors have become the face of the corporate hospitals, which is factually not the case. Major share of profits are made by hospitals, and let's be honest, they are not out there to do charity.

The costs of running such massive establishments are not realised by anybody.

But the government lashes out at them time and again, less with the sincere intent to help the distressed masses, but more to divert attention from their own inefficiency, corruption and shortcomings in running government hospitals.

And my friend, in the clash of the titans, the minions suffer.

While deaths due to preventable infectious diseases happen in a seasonal pattern year after year like dengue, swine flu and malaria - due to the gross apathy and criminal neglect of the government machinery - here also, doctors are held responsible for all deaths that evoke public outcry.

People are dying of open potholes, rail accidents, road mishaps and daily pollution, without any accountability, but the activism of politicians, media and courts starts and stops at the doctors' doorsteps.

The courts sit on decisions for years on end, and verdicts of lower courts are casually upended by the higher courts, but nobody is held responsible for a "wrong decision" and penalised accordingly.

But you, and only you, my friend, are the apostle of honesty and integrity, and the society expects exceptional moral and social behaviour from you.

You are god, so you can't have the liberty to err.

R could read the sarcasm in my tone, and laughed at me.

Me: Interestingly, we as doctors are forbidden from any type of personal advertisement flaunting our skills, as it is against medical ethics and you can even be punished for the crime, but ironically, there are no legal safeguards when your image is sullied in public, by ill-informed media persons, eminent personalities and social media trolls who have zero knowledge about our subject.

This peculiar phenomenon is the best at display in big towns.

R: But tell me honesty Amit, are we really being persecuted because of no fault of ours?

Me: That's a valid question R. We are probably paying for the sins of our ancestors, and many arrogant and greedy cousins of present times, and unscrupulous half-brothers (read quacks), who have brought bad name to our profession. And then the habit to criticise each other and question diagnosis and treatment, just for the sake of petty one-upmanship and dirty competition to impress the patients, has sown a lot of suspicion in the minds of the patients. The practise of taking cuts and referrals needs to be immediately stopped.

All said and done, it is also a fact that people are after the life of doctors because they still have some respect left and expectations are a result of that. We should try our best to come clean in matters involving ethics. But gradually, we are learning and evolving for good I guess. But the sorry state is that generalisations are applied so casually, that many times innocents suffer the brunt of it.

R: So, Amit, the subtle message for me is to wait for some more time, before I jump the gun?

Me: Stay back for a few more years, earn some more, and come back to India as a businessman, India doesn't need educated doctors, they are a dime a dozen. Plan some start-up, some small-scale industry, or a solar energy plant or any other idea. Venture into anything else but the healthcare sector, as it is never a priority here, it just attracts temporary attention to arm twist the doctors.

And with these final words, I bade adieu to my bosom friend.

Looking back, I feel so proud of my clairvoyance.

I saved a life, indeed.

Also read: Max fiasco: A doctor makes sense of why a hospital declared a living baby dead