Doctors have been subjected to a lot of things. They are exposed to sickness, pain and are subjected to watch their patients lose their lives in front of their eyes. The experiences of doctors are difficult and unique to them.

The job of a doctor is tough. They do not have fixed hours of work, costing them their personal lives in many instances. Despite the sacrifices the doctors make for humanity, they are under-appreciated, criticized and even threatened in many cases. In an attempt to appreciate their efforts and know about their experiences, The CSR Journal in association with Cadilla Pharmaceuticals spoke to three celebrated doctors on various topics. Here are excerpts from the conversation.

Doctors During the Pandemic

The crucial role that doctors play has been understood well by the people of the world as we struggle to control a pandemic. Their importance is being realized as the Prime Minister calls the countrymen to recognize and applaud the efforts of every doctor out there. This has made National Doctors’ Day 2020 even more significant as an opportunity to pay tribute to these doctors.

Containing the spread of COVID-19 and treating the infected patients has not been easy for the doctors either. Dr Yatin Mehta, Chairman, Institute of Critical care and Anaesthesiology, Medanta Hospital, Gurgaon said, “The pandemic was unprecedented. In fact, this is one of the ‘first time in life’ experience for most of us and is challenging since we risk health and lives of not just ourselves, but our families too. In addition to this, the unpreparedness of our country to manage such a pandemic in terms of inadequate infrastructure during initial stage only added to our woes. The situation is much better now, because of the support from government and authorities. The knowledge sharing by medical fraternity has helped in fighting against the pandemic.”

Dr Dhiren Shah, DM Cardiology, Mumbai said, “While I have been working to ensure I am able to provide emergency care to patients under my care, I have done so with constant attention to full and adequate personal protective equipment to ensure the safety of those close to me. It has been upsetting to know, however, to hear instances of violence against doctors, discrimination against doctors and preventing them from entering their own homes in fear of them being carriers of the disease, in this period. I hope such incidents don’t occur as they demoralise those most who serve at the frontlines with utmost sincerity and at high personal risk.”

Basic Medical Skills for All

The pandemic-caused lockdowns across the globe have put treatments for all the non-urgent ailments apart from COVID-19 on hold. The fear of infection of the virus has led people to avoid visiting doctors for ailments that do not seem severe to them. Most of the time, they resort to a telephonic or online consultation with doctors giving instructions and patients trying to follow them to treat themselves. Importance of basic medical skills is highlighted at this time because of this.

Dr Shah has said, “Keeping the current pandemic aside, people should know basic CPR skills and when to administer them. Bystander CPR has been shown to greatly improve survival amongst patients that collapse suddenly until they reach a hospital for definitive care. This is more important in a country such as ours where we don’t have a public emergency response service (like the 911 of the USA) and a paramedic force. In the current pandemic however public CPR is something that would require a more nuanced discussion by the situation and with the provision of safety for the provider. People can be educated to look for obvious signs of breathlessness and increased respiratory effort. Taking vital signs such as pulse, blood pressure, temperature, oxygen saturation with the availability of the necessary equipment would be ideal as this information can be communicated to the doctor who would be able to interpret and triage.”

Adding to this, Dr Mehta said, “Basic medical education should be part of the curriculum during high school or university level for all. In addition to this, rural posting for junior doctors should be made as a practical approach for enhancement in rural health care and primary Health Care set up, disaster management protocol should have structured module to fight against the exceptional situations.”

Self-Treatment through Google

The internet accessibility and powerful search engines have opened up all sorts of information to all. At some point in time, every internet user has been guilty of attempting to treat themselves by searching for their symptoms on Google or YouTube. In fact, many times, such information is used to even verify treatment recommended by the doctors. This is often frustrating for doctors since the patient without prior knowledge or experience questions the credibility of doctors’ recommendations who have years of experience and training. Even if it is not frustrating, it can prove harmful for the patient if they choose to disregard the doctor’s advise and follow Google recommendations.

Dr Shah highlighted that Google is not a source of knowledge but a search engine that shows various sources of knowledge, which may or may not be correct. Any website that may even provide correct information may not necessarily help since the patient may not have adequate knowledge and training to interpret it in the correct context. More often than not this ends up scaring the patient who assumes the worst outcome for his disease/condition.

Dr Shah added, “However, it is an asset for the patient to have some information about his disease to better cope with the same and have realistic expectations. I try to ensure that I address the “I C E” – the patients IDEAS, CONCERNS & EXPECTATIONS regarding the disease and management. It ultimately comes down to the faith the patient has in his/ her physician and the strength of the doctor-patient relationship. For good or bad, they need to know about your condition/ disease is a natural one and one cannot fault any patient for the same. We can be patient and communicate best with the patient who needs to know that he has an active role to play in his/ her treatment.”

Dr Mehta reiterated the view by saying, “It takes 20-30 years to acquire experience and knowledge to practice medicine. Internet surfing cannot match the brilliance of each practising Doctor. Patients should take this into consideration and if the doctor fails to answer their queries to their satisfaction, understand that they have to serve all the ailing patients holistically and work towards curing them all. Therefore, sometimes it gets difficult for a doctor to answer each query. Even so, the patients need to trust the doctors as google doctor is unnatural.”

Commercialization of Healthcare

India houses the largest number of people living below the poverty line. They cannot afford quality healthcare because of commercialization. This often increases the income inequality gap among the people. For instance, a family with good economic standing can tackle a healthcare emergency at any point of time in life, without affecting the said economic standing significantly. However, for a poor family who has attempted to save for a safe future and investment, have their entire lives swipe away if a healthcare emergency falls on them.

India being a welfare state has to make provisions to facilitate quality healthcare for its people. Dr Shah has aptly put it by saying, “The COVID19 pandemic has, rather than inform people about the importance of doctors, made them realise the overwhelming need for having robust healthcare systems that can handle public health crises such as this one.” However, an important role needs to be played by private healthcare providers as well during emergencies.

Dr Ramesh Goyal, Endocrinologist, Ahmedabad recommended policy changes needed in India to achieve this feat by saying, “Budget allocated to health care need to increase to cover the needs of the vast population of our country. Some form of medical insurance is required for middle-class people who cannot afford the private treatment and who do not want to go to government hospitals. In the same breath, I will like to say that the quality of care and facilities given in the government hospital should be improved so that more of the middle-class patients can access the facility of government hospitals.”

Reforms in Medical Education

In order to build a strong and robust medical system in India, Dr Shah has recommended the following reforms in the medical education system in India:

1. Reducing, with an aim to ultimately remove (which has been pending), reservations in the field of medicine.

2. Regulating the number of work hours in residency strictly as prescribed by the universal residency scheme

3. The medical system is very hierarchical and has encouraged bullying and exploitation – this has to change

4. Availability for seeking care for mental health issues, more importantly, ways to help residents actively deal with work stress

5. Moving toward an OSCE based exit exam system to ensure more objectivity and prevent examiner bias

6. Removing completely the system of serving bond in the govt system  as it is exploitative

7. Increasing true research opportunities and the provision of adequate funding to encourage more meaningful research

8. Improving working conditions especially in public health care hospitals including hostel conditions for resident doctors

9. Improving the pay scales for resident doctors which continue to remain abysmal and are neither reflective of their academic stature nor the quality and quality of their work

10. Regulation of fee structure but more importantly, prevention of capitation fees in any form

Role of CSR in improving Healthcare in India

Corporates are known for their management skills, efficiency and discipline. Considering the fact that corporates are for-profit institutions, every penny they spend is accounted for, which makes the venture profitable and efficient. The skill can be materialised well in improving the healthcare sector in India. Corporates through their CSR projects can facilitate medical research, quality healthcare for all, and infrastructure upgradation.

Dr Goyal said, “In our country with a population of 130 crores the health care facilities are really scanty. If you talk about public or government hospitals the beds are limited and the doctors are limited in number. The doctor to patient ratio is also very poor so in this scenario where most of our population is not able to afford quality care in private hospitals the role of CSR is to build hospitals which provide treatment to people who cannot access the cost of the private hospitals and still require secondary or tertiary care beyond the scope of the government hospitals.”

Being a doctor is not easy even after earning the title of doctor. The responsibility of a doctor is huge. This is why they are no less than superheroes or angels who deserve to be appreciated and lauded.