WhyIwillneverallowmychildtobecomeadoctorinIndiaApupwaswalkingdownthestreetwhenitcameacrossagroupofyoungboys.Theleaderofthegroupspottedthedogandpointeditouttohisfriends.Seeingtheboys,thedogtoowaggedhistailandbarked,lookingforwardtobeingpettedandmakingnewfriends.However,evenasthepupwaggedhistail,oneoftheboyspickedupastone.Theboyturnedtotheothersandtoldthemhowdogsarebadbecauseanotherdoghadbittenhisgrandfatheryearsago.Ashenodded,asecondboypickedupanotherstoneevenashespokeoftheincessantbarkingofstraydogsinhisneighbourhoodatnight,disturbingthesleepofhisfamily.Athirdspokeofhowdogsarebadbecauseofreligiousreasons.Theothersrealizedthewisdomintheirfriends'wordsandeachpickedupastone,awarenowthatbreedslikethiscouldnotbetrusted.Thepupstoodwherehewas,confusedashewatchedtheboyscomeclosertohim.Bythetimenighthaddescendedupontheland,theboyshaddispersedandgonetotheirindividualhomes.Therewasasenseofaccomplishment,havingstoppedamenacefromenteringtheirstreets.Lyingbloodiedandbrutalized,thepupthathadwaggedhistailinhopeofgivingandreceivinglovelickeditswounds.Itwastooyoungtoknowthatthephysicalwoundswouldhealinduetime...butitwasnowoldenoughtohavelearnedtodistrustthespeciesofstonethrowers.Themostselflesscreaturesincetimeimmemorialnowknewtohate...becausethatwaswhatitreceivedfornofaultofitsown.Forthecrimesofothers,ithadpaidwithitsbodyandsoul.That,inanutshell,isthereasonwhyIwillneverallowyou,mychild,tobecomeadoctorinIndia.Stillconfused,Iguess?Itisokay.Takeachairandsitdown...thisisgoingtotakeawhile.Increasingly,Ifindmyselfwatchingandtalkingtodoctorsacrosstwogenerationsandvariousspecialtiesthesedays.Andincreasingly,thatsenseofdespairanddisillusionmentiswritlargeintheirwords.Theyfindthemselveswonderingwherethingswentwrongevenastheystruggletobringasmileontheirfaces.With0.7doctorsper1000Indians,thedoctor:patientratioisfarbelowthatofothercomparablecountrieslikeChina(1.9),UnitedKingdom(2.8)andUnitedStates(2.5).Spain's4.9seemslikeanabsoluteluxuryincomparison,Imustadmit.Whatthismeansinlayman'stermsissimplythisthatyouarealwaysgoingtobeswampedwithpatientsbeyondthelogicalhumancapacityinIndia.Thoushaltsacrificeyourtime,parents,spouseandchild.Gettinga63houraweekschedule(7daysx9hours)isablessingandmostoftheyounggunswhojoininfreshafterpostgraduationknowfullywellthata100houraweekscheduleisparforthecourseonceyoubeginworking.Andsadly,thisisadvocatedandinfactencouragedbymosthospitalstoowhowouldn'twanttohaveworkersinacontractwhichstates8hoursadayandthengetthemtowork14,statingthat'thisishowitisforalldoctorsandbesides,weareinthebusinessofselflessservice.'Youwouldneverallowataxidrivertodriveyoufor24hourscontinuouslybutaskingsurgeonstodothateverythirddayisfairgameinIndia,apparently.Wantingtodotheallotednumberofhoursinyourcontractandthencomehometoyourfamilyisnowfrowneduponinourfield...itimpliesweakness.Nay,itimpliesaalackofprofessionalism.Thoushaltsacrificethylifedream.Itisasacrificethatwilltakeawayyourtwentiesandeatawayatyourthirties.Youmayenterthefieldbrighteyedat18butImustaskyouwhathappensifthedreamtobecomeaheartsurgeondoesnotreachfruition?Ifforsomereason,youfindyourselfunabletogetthecovetedseatordevotethefifteenoddyearsIassumeitwilltaketobecomethejuniormostinyourdepartment,wouldyoubehappywithyourlife?Wouldyoubeabletolivewithlosingthedreamorwouldthedisappointmenteatyouupfromwithin?WhocaresforthedoctorAyoungsurgeonworkinginoneofthepremierinstitutesinIndiaspoketometheotherday.Thiswasadoctorwhowassopassionateayearagoaboutbecomingevenbetter,workinghardtogetintoasuperspecialtycourse.ShehadjoinedthehospitalbecauseofitsaweinspiringreputationacrossIndia,awarethatthehardhourssheputinwouldsharpenherskillsandbroadenherknowledgeofthespecialty.ThewomanIspoketohadlostthatdrivealtogether.Walkingoutofherhomeat7AMandreturninghomeat10PMjusttofallintobedandthenwakeupagainat5inthemorningtorestartthecycle,shewonderedwhatwasthepointofitall.Shewaslosingtouchwithherlovedonesandhadbecomeazombie,lostbetweenthepoliticswithinthehospitalandatotallackofsociallife.Allthisforahandsomesalaryof50,000/amonth(inMumbai)whichsheknewwouldnotbuyhertwonightsintheICUoftheveryhospitalshewasworkingin.Therewouldbeapotofgoldattheendoftherainbow,Iwantedtotellher.Shewouldearnmoreinherfortiesthanhertechiefriendsearnedintheirthirties,Icouldhaveconsoledher.ButIdidnot.BecauseIknowhowshefeels.Anotherdoctorspokeoutrecentlyonapublicforum,talkingofhisexperienceofdoingsixyearsofruralserviceforthegovernment.WhenhefinallyleftittwoThiscameinmyFacebooktimeline.Itisactuallyquiteaccurate,whenIthinkofityearsago,themaninhisthirtieshadlessthanRs15,000/inhisbankbalancewithnoextravagantpurchasesortripstoboastoff.Heneededhisparentshelpatthatagetostillpayforhisrent.Itallcametoaheadwhentheguyattheshoprecharginghismobilerevealedhowhismonthlytakeawaywasmorethanthedoctor's...withoutanyriskwhatsoever.Hisonepleatoallthedoctorslistening?Donotbeasentimentalfoolandgetblackmailedbythemedicalsystemtogoworklikehedid...becausenobodycaresforyourserviceattheendoftheday.AndItotallyagreewithhim.Ifaftermorethanadecadeinthemedicalfield,hecannotprovideasmuchforhisfamilyasanmobileshopowner,thenwhydidheneedtogothroughsomuchofaneffortatall?IfIndiaconsidersitacrimefordoctorstoearnmoneywhileclosingtheireyeswhenjudges,lawyersanduneducatedpoliticiansmagicallyaccumulatecrores,isitnotthefollyofthepersonaspiringtobeadoctor?Howdarehedreamofprovidingforhisfamily?Morestatues,lesshealthcareisthesolutionThemedicalfieldweenteredisnottheoneweareintoday.Eventhegenerationsbeforeusacknowledgethis.Anditisonlygettingworse.Forafieldlikeoursinacountrylikeourswhichisoverpopulatedandhasamajorportionofthathoveringbeloworaroundthepovertyline,havingthesupportofthegovernmenttoensurethebenefitsofhealthcarereacheveryoneisvitaltooursuccess.Theyneededtomakemedicinesmoreaffordableattheveryleast.Sadly,ratherthanincreasetheamount,theydecidedtocutthebudgetallottedtohealthcarebynearly20percent.KeysectorslikeHIV/AIDSlostfundingratherthanhavingitincreased.Thisatatimewhenwespendamere1%asitisonpublichealthcareinIndiaasopposedto3%inChinaand8%inUnitedStates.WhatcanIsay,mychild?IguessIndiaishealthierthanthoseotherpoornations,arewenot?TheveryfactthatourstatsarecomparablewithNigeriaspeaksforitselfDefensivemedicineIwishitwereJUSTaboutlosingyourfamilylife,workingtwicetheallottedhoursandtakinghomethepitiablydisproportionatesalarythough.Butsadly,itisn'teventhatanymore.Now,itisaboutgettinghomeinonepiece.Fromstoppingpatientsfromdying,themedicalfieldisnowbeingforcedtoworryaboutnotbeingkilledbythepatientsbystanders.Theessenceofbeingadoctortodothebestwecantohealisbeingtakenawayfromusbecausenowweneedtobeonthedefensive.Yourememberthatcutelittlethingwe'vebeentalkingaboutcalledselflesssocialservice?Guesswhat?Itcomeswithriders,apparently.Selflessservicemeansyoudotheextrahoursbecausethehospitalisperpetuallyunderstaffed.Selflessservicemeansyoutakehomeacallcentreworker'ssalarybecausethehealingyoudoisaservice,remember?Selflessservicemeansyouadjustwiththelackofdrugsandinstrumentsavailableandstillsavepeoplebecausethereisnootherhospitalnearby.Butthatlinestopsthere.Ifthepatientcollapseswhileinyourcare,suddenlyalltheseboundariesvanish.Youarethenthemonsterthatthepublicreadsinthepaperstheonewhokilledtheirlovedonebecauseofyourgreedtostealtheirmoney/harvesttheirorgans/molesttheirailingmotherorchild.Thentheverysamepeoplewhodemandedthatdoctorstakehomeasalaryin5digitswillhavenoproblemsindemandingcompensationinsixorsevendigits.Itdoesnotmatteriftheyarewrong...whatisimportantisthatbyspoilingthedoctor'sreputation,yousucceedinblackmailinghimorthehospitalintoacompromise.Ifeverydeathinsideahospitalweretobecalledacaseofmedicalnegligence,whywoulddoctorsadmitthepatientatall?Areyouwillingtodieforyourprofession?TheIndianMedicalAssociationconfirmedinMay2015thatover75%ofthedoctorsinIndiahavefacedsomeformofviolenceatthepatient'shandsinIndia.75%.Thisisafteradmittingthatnotallcasesofviolencegetreportedtothem.Thereareeveninstancesofdoctorsbeingactuallykilledforfollowingthelaw.Howdoyouexplainthattohiswidowedwife?Whenwasthelasttimeyousawasoftwaretechiebeingkilledofffornotmakinganappproperly?Stillfeellikeusingthe'Selflessservice'cardagain?That'saprettythincardtokeepplayingwhilebeatingevery3outof4doctors,don'tyouthink?TherecentverdictintheJosephEyeHospitalcasebroughttherealityoftheIndianmindsethometomanydoctors.Handingdownverdictsofimprisonmentto3doctorsforthelossofvisionof66patientsfollowinganeyesurgerycamp,thejudicialsystemshowedanamazinglackofcomprehensionaboutwhatwasgoingon.Itdoesnotneedarocketscientisttorealizethatasingletraineddoctorcannotmakethesamemistake66timesin66differenteyesonthesameday.Theobviousanswertosuchincidenceofmassendophthalmitisisintheuseofunsterilesolutionsusedtheunsterilepartbeingafaultofthepharmaceuticalcompanythatmanufacturesthesolution.Thereisnowayforadoctortoknow(withoutopeningeveryindividualbottleandtestingthem!)ifthesolutioncontainsmicroscopicbacteriajustasthereisnowayforyoutoknowifthereareanyinyourcoffeebeforedrinkingit.Andyet,topleaseacrowdbayingforbloodandmoney,eventhoughitwasobviousthefaultlaywiththetaintedsolution,thedoctorsweresenttoprison.Soundsfamiliar,doesitnot?RemembertheChattisgarhsterilizationdeathsof2014?Everyoneknowsthedoctor'snameinthatcase.Itwaslaterproventhatthefaultwaswiththetaintedmedicineswhichweremadeinrodentinfestedfactories.Sotellme,whatwasthenameofthepharmaceuticalcompanyandwhatactionhasbeentakenagainstitsincethen?Youdon'tknow?Howshocking!Itraisedtheobviousquestiontomanydoctorsthough.Whywouldwedosuchaserviceatallwhenwearebeingcheated?BydoingasingleprivatepatientforRs60,000(whichisstillcheaperthantheDhs15,000/chargedabroad),thedoctorcanchoosetousethebestdrugsfromreliablecompaniesinsteadofthegenericsubstandardonesandmakeahundredtimesmoremoneydoingonecasewhilebeingtotallyethical.Canyoucallthemcheatsthen?No.Exceptthatbydoingso,weallknowasdoctorsthatnobodywouldthencareforthetreatmentofthepoor,ifwegiveuponthemtoo.ThatiswhatbeingadoctorinIndiaisallabout,intheend.1. YouareforcedtogototheIndiathatIndiaforgot,themostruralcrevicesandculdesacswherehealthcareisactuallyneeded.2. Youareaskedtobangondoorsandseekouttheailing.3. Youareaskedtobringasmanyofthemasyoucanbackwithyou.4. Andthenyouoperateonthemallforthehandsomefeesprovidedbythegovernment(Rs650/isgiventomosthospitals,Ihear,thoughIwillgladlyacceptanyrevisedfiguretoo.)5. ThegovernmentcutsitscostsbymakingyoudoRs60,000surgeriesfor600,citingruralservice(whichnaturallydoesnotapplytoengineersandlawyersbecausetheseareasdon'tneedthematall.)6. Thedoctorcarriesthemoralresponsibilityofhelpingasmanypatientsaspossibleandsoisaskedtodoworkwellbeyondhisphysicalandmentalcapacity.7. Genericpharmaceuticalcompanieswillpawnofftheirgoodsmadeinunsterileconditionsatalesserrate.8. Whenthingsgobad,thecrowdwillcalmlyignorethegovernmentandpharmacythatcutcornersforaprofitandbeatthedoctor'sdoorstepwithstakesandpitchforks.Andcelebritieswillbetheretotuttutonnationaltelevisionabouthowdoctorsarecorruptandcuttingofforgansfortheirownprofits.ThemalaisewithinArealldoctorsgood?Mydearchild,surelyevenyouatthistenderagecannotbesonaive.Ofcoursenot.Theonefactorthatholdsgoodacrossallwalksofhumanityisourtendencytobeamixofgoodandevil.ThisextendsacrossreligionsandGodmentopoliticiansanddoctorsandeverythinginbetween.Beforeweweredoctors,wewerenormalpeopletoo.Andwehaveinculcatedvaluesfromourfamilyandpeersforovertwodecadesbeforeweearnedtherighttowearthatstethoscope.Andwhetherwewanttoornot,thatdoesshowinthewaywecarryon.Soyes,therearegoingtobedoctorsworkingbesideyouwhowillpromoteamedicinenotnecessarilybecauseitisgoodbutbecausethepharmaceuticalrepgiveshimagoodincentive.Andyouwillseethatdoctortakinghomemorethanyoudofordoingthesameworkasyouandthedevilonyourshoulderwillsmile.Hewillpositivelygrin,infact,asyoustareatthepriceofthenewsmartphonewhichisbeyondyourfinancialreachbecausesocialserviceandrespectdonotpaythebills.Therewillbethosewhoneedtomakebackthemoneyspentongettingaseat...Ihearcertainpostgradseatsnowgofor4crores.Well,damnedifIknowwhypeoplewouldtakeitupwhenyoucouldjustaswellearnmorewiththeinterestfromthebankforthatamountbuthey...toeachhisown.Youwillfinddoctorswhoareforcedtodotheextraprocedurebecause,workinginaprivatehospital,theyneedtoanswertotheheadsabove.Theyneedtomakeaprofitfortheirbosseswhoshrugastheyremindyouthatifthehospitalrunsintolossesandshutsdown,theloseristhepatienthimself.Andwhenyouthinkaboutit,theyareright,aretheynot?Privatehospitals(whichstillcatertoahugepercentageofthepopulation)needtomakeaprofittocontinue.Iftheyshutdown,thehealthcareofthecountrywouldcollapseinmonthssimplybecausegovernmenthospitalswouldneverbeabletomanagethevolume.Again,thearrowofyourmoralcompasswilltrembleasyougrapplebetweentheinnerdesiretotreatpeopleinpainandtherequirementofforcingthemawaytoalesssafercenterbecausethey(likeyou!)cannotaffordthishospital.KnowthatyouarenotGod.'FeelinglikeaGod'whenyouseeapatientopenhiseyesafterasuccessfulsurgeryisdifferentfrombelievingyouareaGod.ItonlyneedonemishapforsuchGodstofall...andfallhard.Professionalcompetitionexiststoo,asthoughyoudidn'thaveenoughonyourplate.Beingcompetitiveprobablyexistsineveryfieldbutherethegameisplayedwithpeople'slives.Butwhensomeonediscreditsyoutoswaythepatienttoleaveyou,youwonderwhatthepointreallyis.Wasitnotsupposedtobeabouthealingpeople?Theimbecilicoutsiders.Caseinpoint:Whenonestatewasunabletodealwiththenumberofpatientsintheruralareaswhoneededhealthcare,doctorsfromtheneighbouringstatesteppedinandconductedcampsthere,helpingthepoorgetthetreatmenttheyneeded.Howdidtheformerstaterespond?BybanningallthedoctorsfromtheotherhospitalforTHECRIMEofprovidinghealthcaretopeopleinneed.Theycouldnotprovideitthemselvesbuttheywouldnotallowtheotherstatetolendahelpinghand.Thiswasthestandoftheelectedministersintheendwewouldratherourfolksufferthanallowyoutotakecreditforhelpingthemwhenwecannotdoitourselves.Youhaveministersrunningtobaccoempireswhoheadcommitteesonhealthandundoalltheworkofdoctorsbyclaimingthattobaccoisgoodforhealth.Youhaveselfproclaimedfakirsandsaintstellingtoraisethepopulationmanifoldatatimewhenwearestretchedattheseamsduetooverpopulation.Youasadoctorarecaughtinthemoralineptitudeofsuchpoliticiansandfilmstarswhoneverattendgovernmenthospitalsthemselvesandyetdecidehowhospitalsmustberun.ThisiswhateveryyoungdoctorinIndiatodayisstrugglingwiththedisillusionmentofitall.Wewanttoheal...wewantthatsatisfactionofbeingabletosavelivesandseeacheerfulsmileonthefaceofsomeonewhocametousinanguish.Butnotlikethis.Notdictatedbythewhimsofbusinessmenwhodemandprofits,notbythefearofbeingbeatenupbyrelativesofpatientswhocannotacceptdeathasaneventuality,notwhileworryingabouthowtopaythenextelectricitybillandnotbylosingourtouchwitheveryonewhomatterstousjustbecauseanationchoosesnottostrengthenitsownhealthcaresystem.Thefearyoufeelasadoctorshouldbebecauseyouthinkyouhavemissedadifferentialdiagnosiswhenapatientcomestoyou,notthatyouwillbebeatenupifthepatient'sconditionworsens.Dependingonwhereyouwork,youwillfacesomepermutationorcombinationoftheaboveillsofbeingadoctorinIndia.Anditwilleatyoufromtheinside.Youwillwonderhowtostrikethebalancebetweenbeingthereforthoseyoulovepersonallyandthosewhoneedyouprofessionally.Youwillaskyourselfhoweveryonedemandsyouhaveadozendegreesbeyondyournameandyetdoesnotseemtothinkitnecessarythatyoubepaidequivalenttotheeffortyouputintoreachhere.YouwillseeyourpeersdoeverythingbythebookandgetbeatendownbyhospitalpoliticsorphysicallybypatientsandyouwillwondershouldIsavethenextcriticalpatientwhocomesintothehospitalorreferhimelsewheretosavemyself,knowingthatthelawhasfailedme.Andinthatmoment,youstopbeingthedoctoryousetouttobe.'Selflessservice'doesnotrequireyoutogiveupyoursoulandlife.Peopleonlyusethattermwhentheywantdoctorstogotheextramile.Thatselflessservicetagstopswhenthetimecomestopaythebill.Whenitistimetobeatupadoctororinsulttheentirefraternitybasedononedoctororsometimes,pureignorance.Youcanchoosetobeselflessinsomanywaysdonatetotheneedy,adoptachild,participateactivelyinprogramsbyworthyNGOs...heck,justbynotharmingorcheatinganyone,youarebasicallybeingselflessintoday'sworld,Ireckon.Why,youcanrunoverinnocentpeoplesleepingonthepavementandstillbecalledselfless,aslongasyouhavemoneytodonateinfrontofthemediaforaworthycause,asIfoundoutrecently.Understandonethingligatingpulsatingbloodvesselsisnotaservice.Restartingaheartisnotaservice.Suturingmeticulouslywiththreadsthinnerthanthehaironyoureyebrowisnotaservice.Identifyingtheextentofatumourinthebrainrightdowntothelastmillimeterwhileoperatingtoremoveitisnotaservice.Itisanart.Itisaspecializedskill.Itisatestofyourendurancebecauseattheendofthe25thhourofstraightduty,youbettersavethat20thpatientonyouroperationtableorelseeverythingyouhavedonebeforethisdoesnotmatter.Aboveallelse,itisasacrifice.Asafather,youwillfindmeasbroadmindedandtolerantastheyget.Youwillhaveeveryopportunitytochoosewhetheryouwanttoretainyourreligionorchangeitbasedonwhatresonateswithinyourmind.Youwillhaveeveryopportunitytochoosetheloveofyourlifeirrespectiveofcaste,creedorevengender(thoughifyouchoosetogolesbian,mayIjustpointoutthatEllenDegenereswouldbealovelyrolemodeltoemulatekindhearted,hilariously,smart...plusPortiaforalifepartner!)IwillletyouhaveeverychoiceinlifeandIwillbetheretosupportyouandguideyoualongtheway.YoucanbeawildlifephotographertrekkingthroughtheAmazonsordancethepolesatLasVegas.ButIwillneverallowyoutobecomeadoctorinIndia.BecauseIdidnotraisemychildfortwodecadesjusttowatchherlosehersenseofrightandwrong,ofhumanityorworse,watchherdie.AndIdon'tmeanjustphysically.Authorsnote:Ihavebeenconversingwithalotofdoctorsrecentlyandthesoundofdisillusionmentaboutthefieldhasneverbeenasloudasitistoday.Evendoctorsofgenerationspastandheadsofdepartmentsacknowledgetheshift,statingthattheyarehappythattheyarenotstartingofftheircareersintoday'sIndia.OnelinewhichmanyofthemsaidandonewhichIalsoagreewithentirelyisthebasisofthisarticle"Iwillneverallowmychildrentojointhisfield."Brokenarm?Pfft...There'sstillonearmleft!P.S.Yes,Thatismeincaseyouarewondering!Thereisalsoanemailsittinginmyinboxaskingmetosignandshareapetitiondemandingthatapplicationsforlicensedgunsbefasttrackedfordoctors.Ihavereaditandplaceda'star'acrossthemail.IdonotintendtosignitbecauseIdon'tadvocategunsasarule...IseechildrencryeverydaywhenIbringanintravenouscannulaneartheirtinyarms.Idonotwishtohavethemworryabouttheguninthedoctor'spockettoo.ButIempathizewiththesorrowofthedoctorswhomadethepetition.AndIknowoneday,Itoomayfindmyselfrevisitingthispetitionshouldacalamitybefallme.Asitsis,hospitalshavestartedemployingbouncersnow.Iwouldlovetohearfromdoctorshereaswell.Evenifyoudisagreewithmythoughtsentirely,Idonotmind.Ijustwanttoseehowfarthedisillusionmentliesandwhetherthe"HippocratesOath"and"selflessservice"tagarestillasstronginyourheartstodayasitwasthedayyoujoinedyourmedicalcollege.WheredoyouthinkitisallgoingwronginIndia?Update(16May2015):IwouldliketothankDailyrounds.org(forrepublishingmyarticle)andalltheotherswhosharedthisacrosssocialmediaontheirtimelinesforhelpinggetthewordacross.Update(18May2015):ThankstoScroll.In,Scoopwhoop,NdtvandQuartztoonow,Iguess.Asforapopularnewsmediasitewhichsharedtheblogpost,IguessIshouldspecifyhereThisisalettertomyfuturekids.IDONThaveachildyet.:)Update(19May2015):Okay,Ihavelosttracknowofwhoallhaveshared.HuffingtonPost,DeccanChronicle,Navbharat,Asianet...Thankyouall.Somepeoplehaveaskedmetocommentonthefunheadlinesofthemediasiteswhichpublishedthispost,focusingonthe'poledancer'bit.Frankly,Irealizethatitisabitmuchtousethatasaheadlinebutifitservesthepurposeandgetsdoctorsengaginginadiscussion,Iwillgladlytakethehitforit:)P.S.IamalsoalittleamusedbyasiteclaimingIamfedupofmyprofession.ItispreciselytheconverseitisbecauseI(andmyfellowbrethreninthemedicalfraternity)lovetheprofessionthatweareraisingourvoicesagainstthedecaywenoteinthesystem.Weacceptitisderailedandthisgettingpeopletotalkonwhatisnowaninternationalforumishopefullythefirststeptobringingitbackontrackandfixingtheimagethatistarnishedsobadly.