A Doctor's Dilemmas

Looking at the health situation in our country, there is no doubt that we need more doctors every year. Far more than the country currently produces. Unfortunately, in recent times, not many students are inspired to take up medicine as a profession, unlike the old days when anyone and everyone’s parents wanted them to be either doctors or engineers. And sometimes one feels it is justifiably so. From the moment a student harbours the aspiration to become a doctor, he or she is looking into at least decades of long hours of effort, burning the midnight oil, and fighting the odds. Add to that the fact that the number of applicants for the MBBS programme far outnumbers the available seats, at least at the popular centres. So, there is always that lurking anxiety of making it to the admitted students list. Even the admission process comes much later, before that students have to put in over a year in preparing for the entrance exam, which of course isn’t easy. And if you are unlucky, in a particular year, you may be faced with the occasional scam on question papers being leaked or sold. And after that comes the admission rut. It is often thought that once the entrance tests scores are out, students who have made it would heave a sigh of relief. But this relief is quite short-lived.

The infrastructure for admissions is not in place and the process is hardly streamlined. They do say that students have to go for ‘admission’ counselling regarding the college they get, but there is no one to answer their queries. If that process goes well, sometimes (well, most of the times) the unsatisfied lot who have not secured admission to a college of their choice will move court over a particular issue, and then the matter gets stayed until a hearing is held. This brings forth unforeseen delays. “Even if a student is prepared for all of this and lives through the ordeal, there will surely be something else,” says ophthalmology student Rushita Rajesh, adding, “In going through so much, the student becomes thick skinned enough to go through the four and a half years of torture which is part of the process of becoming a doctor in India.”

 An article published in the Indian Academy of Clinical Medicine Journal says, “The state of medical education in India presents a scenario marked by rhetoric and wishful thinking rather than concrete steps in the right direction. The search for a need-based curriculum is not new. It has been felt for ages, but the curriculum has not really changed. It is an oft repeated criticism that our medical colleges are producing graduates who are not well equipped to tackle the health care needs of society.” “Looking into the current state of affairs, the article rings completely true,” says senior physician Dr Atul Mashru.

According to Dr Mashru, students who have cleared the MBBS programme have all the knowledge of diagnosis and administering treatments, but is that knowledge enough? And if that is not enough, who is to blame? The student, the system, or the curriculum?” Is the structure of the average medical programme good enough for students to turn into motivated doctors? “That is hardly the case. The learning is still very information oriented, where practical learning comes in, but it is more patient-centric than learner-centric,” says senior orthopaedic surgeon,” Dr Ajay B Shah. Yet others opine that many times, students are just left to deal with the overload of information and patients. And yes, even if it is one of the most dynamic fields to be taken care of, the new knowledge takes a while to make its way into texts.

Shrunal Sanjeev who recently cleared her final year MBBS exam, says that students are left at their tether’s end since they have to deal with the old as well as the new procedures. Keeping up with the guidelines provided by the Medical Council of India (MCI), the structure of the programme offers one year of basic sciences, one and a half years of paraclinical sciences and two years devoted entirely to clinical subjects. According to many experts, the breakup of the subjects is fine, but the problem lies in the execution where subjects are taught in isolation, and there is hardly any attempt to integrate the sciences. Needless to say, a curriculum that is integrated will make for a more meaningful experience. “Not only that, it’s a wholesome approach to patients and their problems,” says final-year MBBS student Anish Kadakia.

The problems do not end with college. Dhara Sharma, who finished her degree two years ago and is working with a general practitioner, laments about the real life situations, where doctors are not made aware of medical ethics and behavioural, communication and management skills. “For any profession, these skills are essential. Medical practitioners have to take care of language and should know the local language apart from English. They should be trained to talk softly, tyrants,” she says. Dr Mashru is of similar opinion. “Generally, students are left on their own to develop these skills. Also, a doctor has to portray a stern image; otherwise folks are not very inclinedto listen. Fresh graduates should use their internship period effectively to build these skills since they are busy with two things – handling way more patients than appropriate and preparation of postgraduate entrance examinations,” he says. Field experts feel that to uplift the standard of learning and to improve the system, focus should be given to the practical care of patients. Faculty members need to be made accountable for their actions. They should motivate juniors and students to be exemplary medical practitioners.

Volume 1 Issue 9