Doctor, teach thyself

In this column below Pamela Phillipose has given a sound critique of the Medico strike. The author debunks the manner in which the entire issue was dramatized by the striking students. Moreover, being published in Indian Express or Bania Express, it becomes our duty to appreciate the efforts of Ms Phillipose.
Although the newspaper has given some space to criticise the doctors but it has continued its vigorous and senseless rant against reservations.
Rahul Bajaj has got Rajya Sabha seat, please ask BJP to give one to Shekhar Gupta.

Pamela Philipose in Indian Express

There was an edge to the recent doctors’s strike that surprised many. It needed the Supreme Court to threaten contempt action before Delhi’s resident doctors decided to resume work. As for the students, they have made it clear that their mutiny continues. What accounts for this extraordinary spectacle of an otherwise de-politicised professional community taking to the streets, facing water canons, staging hunger rallies, defying the authority of the prime minister? That the protesters were backed by some powerful and well-heeled players is without doubt. But that still does not fully explain their dogged persistence and impassioned demeanour.

This strike, in fact, tells us a whole lot about the state of the medical profession in India today and the education it is based on. The profession has come to be measured by the same yardstick of success that a career in technology or management is measured by — its income-generating potential. So the frustration voiced in those tents rigged up in the AIIMS courtyard was genuine, make no mistake. When an IIM graduate can walk away with a salary of Rs 86 lakh a year after putting in, say, seven to eight years of intense study, these poor, bright, white-coated young things have first to get into the gruelling MBBS course, then complete it, then — if they are lucky to land a seat in an post-graduate course — swot for another two or three years for an MD. Even that may not be sufficient. The goodies may come, but they are indefinitely deferred to some point in the future. This realisation must be galling for those who believe that they are among the most “meritorious” young people in India, comparable to the best an IIT or IIM can churn out. The sheen of being in an “honourable” profession can only take one so far.

This is where we come across an irony: the medical profession, if it is to be useful to society, cannot but be judged by a standard that is unique to itself, because there is no other profession quite like it. IIT or IIM graduates can remain unconnected with social reality; live each in his/her discrete bubble and still be successful professionals. MBBS graduates cannot afford that luxury — if luxury it is — because the profession demands that they touch the human body in a bid to heal it, and the health of that human body is in turn determined by the society in which it lives. The disparities of caste are a part of India’s reality, whether these students would like to recognise it or not. Addressing them is also part of India’s reality. Medical students, therefore, at least those who counted themselves on the anti-quota side of the divide, need to take a more considered view of reservations.

Is the country’s medical education fostering this tunnel vision? That would indeed seem to be the case. First, take the rules of entry. A school graduate of 18 years, or so, is required to answer 400 multiple choice questions in order to make it into an MBBS course (interestingly, the entry point in medical schools in the West is far less rigid — kids do undergraduate studies in the arts there and still make it to medical school and, in any case, they are generally older when they take the decision to opt for a career in medicine). There is little “merit” involved in our system that a good coaching institute or a handsome sum of money cannot take care of. The fact that a significant percentage of kids who make it into medical college have parents who are themselves doctors is proof enough of this.

The 18-year-olds are then put through the paces of the MBBS course, comprising nine semesters over a period of four and a half years. The syllabus is singularly lacking in the larger themes that could instill in the student a broader view of the world. While the IITs make some effort to teach the humanities, medical schools don’t generally think this necessary. Even the nodding acquaintance with “community medicine” and “welfare planning” that the MBBS course makes mandatory, is cursory in the extreme. Besides, it is taught so indifferently that students routinely bunk these classes. The system clearly places no premium on issues of social welfare and it is not surprising that the students don’t either.

Everywhere in the world, there is a constant public effort to review and measure the standards of medical education. After Hurricane Rita signalled the failure of the US medical system to respond to a great humanitarian crisis, there was an extended period of brain-storming on the issue. One of the conclusions reached was that there was a shortage of at least 90,000 physicians, and that there was a lack not just of facilities in the areas that needed them most but of “diversity” in the ethnic composition of the medical community. Finally, it was also recognised that the quality of teaching in medical schools needed to be enhanced in order to produce socially responsible physicians.