Dr Milind Nayak
Daddy, What would it take to be that person?’ Jaee asked me after the dinner. I understood. She was obviously referring to our conversation during the evening walk an hour ago. (Its a long read! If you would rather hear an audio version, visit: https://youtu.be/9lc5loAzyqc
Jaee and I had gone for a walk down the street that evening. Just around the corner, we spotted a puppy, bloodied and brutalized.
It had several wounds over its body, and it appeared haggard, angry and irritable. There were a few street boys nearby, and I suspected pelting. But then, we realized the dog was ill. It ran around aimlessly and had banged itself on the pole, and the curb.
‘What is wrong with that Pup Dad?’ Jaee asked. She thought someone had hurt him. ‘He probably suffers from Rabies Jaee, and no one can save him’, I replied.
‘Isn’t there a cure for Rabies?’ she asked while she worried about the dying pup. ‘There’s a preventive vaccine Jaee, but there’s no cure once you acquire Rabies’.
‘Why haven’t we yet found out a cure for Rabies Dad?’ asked Jaee…and I was speechless. Jaee was silent through the rest of the walk, and throughout the dinner. I could sense that she was in deep thoughts.
‘Which person Jaee?’ I asked not knowing what she meant. ‘The one who finds out a cure for Rabies’, ‘Well Jaee, it may take a lifetime. But it will be worth it. ‘The process starts with becoming a doctor’, I replied.. ‘But Daddy, lately, I have been reading about the growing concern amongst doctors about the light in which their profession is perceived. Some worry about the long training period while others worry about the pay scale.
Yet others are angry about the misconducts of assault over the doctors. I hear how the healthcare system is at fault, how the other professionals in comparison enjoy a better life, and how this country is not fit to practice medicine in’, she said worryingly.
‘Jaee, it all depends on how you look at it’ I said to my daughter, aware that she was reflecting on career choices, poised as she was at the crossroads following her 10th Grade exams.
Daddy, I hear that the training program is too long when you compare it to other professions. Agreed, the medicine course isn’t as short as other graduation courses. But performing a heart surgery is hardly comparable to writing a software code, or being a systems analyst. As doctors, we deal with living human beings, who have pain and emotions. If India were to choose a team of astronauts, do you think they would choose the I-graduated-in-4-years geeks? Nah! More likely, they would choose those who have spent years focusing on that one single field: Much similar to a cardiothoracic surgeon who has put in years of hard work to master that one specific skill.
Yes, it may appear that the medicine course is lengthy, but the most complex stuff you want to master, the more time you need to give it. The obvious trade-off there is the easy-going life you might have otherwise enjoyed in your twenties or even the thirties. So it’s a choice between doing something extraordinary, versus enjoying an ordinary life.
But I hear that Doctors have No Social life Dad, and they are sucked into overwork. For some, the medical field can appear as a wicked charmer, that drags you into a life of ill pay and 100-hour work weeks, with no family or social life. Now for a minute, imagine if all our Jawans out there on the border thought on similar lines. What if they whined about being far away from family (not to mention, zero social life), and compared their pay to a bouncer at the Bar in a Metro (recently promoted to hospital postings!). What if they said that a Bouncer’s job is easier than the mandatory government posting on the border?
You can very well imagine what would happen to our country if our Jawans succumbed to such thoughts. When a Jawan swears in, you expect him to be fearless and be ready for a war against the perpetrators. As a doctor, you too have to be ready for a war: not just against disease, but also the diseased health care system.
Doctors have one of the most active social life! The colleagues at work, the extended family of the patients, and their extra-curricular activities keep them socially connected. A doctor can settle in any state in India, learn the local language, and connect with people. Performing arts, sports, trekking, traveling.. you name it, and doctors are seen amongst the fore-runners in almost every field!
Dad, in other professions, you are never sent for mandatory government duty to the rural areas. Then why is the doctor alone Punished? Jaee, let me give you a different perspective of it and I’ll leave it to you to decide if it makes sense. During your training as a doctor, you will have to learn the art and science of diagnosis and surgery. This, like it or not, will happen on real patients, who visit the hospital attached to your medical college. You may turn out to be the best plastic surgeon in the next 20 years and operate on celebrities, but you need to remember that those skills were initially honed on the bodies of patients who were too poor to complain, yet they made your learning possible: sometimes, risking their health. Don’t you think you owe a year’s selfless service to them as a thank you for making you a Doctor? Do not judge what other professionals should do on similar lines. I am sure they have their own ways to serve the society in ways we do not understand.
Dad, they say it’s not safe for doctors out there anymore. They get beaten up for no reason. Won’t it hurt you to see my swollen face dad? Making mistakes is an integral part of any profession, and Doctors are no different. If an architect builds a faulty house the client may punish by non-payment; If a software engineer designs a faulty code, he might miss a promotion. When you become a doctor, you would be dealing with people’s most precious possession: the people in their lives. That coupled with the urgency of the interaction in some medical specialties takes this equation to a much higher level that is full of emotion and spontaneity.
It is natural for the relative of a sick person to have a low emotional threshold. I am not justifying an assault on doctors here. There are all kinds of people in the society, and it is essential to have strict laws against the assault on any professional, not just doctors. All I am saying is, the very fact that we deal with the lives of people makes the whole doctor-patient relationship charged with emotions. When you are in a profession that is likened to the Gods, you will face demons.
Tomorrow, if someone were to hold a gun at your temple and pull the trigger for not mentioning the gender of their unborn child, I would be devastated. It would be an irreparable loss. I would be proud that you stood up against foeticide, and would spend the remainder of my life in the back alleys of Law, seeking justice. But, for the fear of this rare possibility, am I justified in holding you back from becoming a Gynecologist and helping hundreds of women safely deliver their babies?
The pilots don’t avoid flying after a plane crash. Instead, they work together with the airline industry and make their systems better to avoid further accidents. Let us learn from our Pilots!
Dad, but what can a lone doctor do? Shouldn’t there be a system in place for them to work in? What is the government doing? Isn’t settling abroad a good option for me? I agree, Jaee, the concern of inadequate health care facilities in India is a real one.
The government hospitals lack basic medicines, safe surgical facilities, and good doctors. Fixing all of that is a long process, and would stretch across years. This process begins, with ensuring that the training is uniform, and only Institutions that follow strict teaching standards should be allowed to train medical students. This requires, that as doctors we should neither support colleges that provide sub-standard training nor should we seek such colleges for the post-graduate medical education of our child. This will ensure, that the intellectual quality of our medical graduate will be the highest.
In the absence of stringent rules to unify training environment, it is impossible for a common man to judge the quality of a doctor’s service. For medical services, there are no star ratings, no online reviews, and no easy options to ‘compare’ two doctors.
It is a paradox, that an Indian, who has access to accurate comparison data before buying a Mobile phone, chooses a Cardiologist or an Ophthalmologist for his mother in the absence of reliable quality data. If the National Health Services in the UK can provide good medical care for the common man, we too can achieve it if all doctors chip in. For this to happen, we need to stop being a spectator and become a player.
If the medical fraternity is a sizeable one, we should be seeing more doctors in positions of political power. Discussions on social media are important and can create awareness but that awareness should be positive with the ultimate goal of motivating our children to take up medicine. Yes, there is poor infrastructure, yes there is a difficult government system to fight against. But is opting out of the profession really a solution?
Yes, there is poor infrastructure, yes there is a difficult government system to fight against. But is opting out of the profession really a solution? Jaee, in order to ensure a healthy life for your grandchildren, you need to take the bull by its horn… and that has to be done now! As a Doctor, India needs you more than any other country. I’d rather admire you toil in India and make a small difference than read your ‘posts’ about the big earnings you make in the West!
So is it only the Government and the People at Fault? Are the Doctors Spotless? A doctor is limited by his/her training (quality of medical college) and the work facilities provided. Within those limits, every doctor does his/her best. However, there are some grave concerns on the doctor’s side too.
The exodus of many professors from government medical colleges to the private sector is worrisome. To double their pay, many choose to represent a Hospital that isn’t (there!). Then there are several doctors who ‘purchase’ post-graduation seats for their children in medical colleges, each costing up to a Crore of rupees or more. And what should I say about the rampant ‘cut-practice’ (kick-backs) that is almost a pandemic.
Well, they would rather not discuss that black envelope which secretly transports 10% (approximate) of the patient’s bill to the referring doctor! Add to that, the corporatization of medical practice, where examples of over-treatment and overcharging often happen. The medical fraternity gets upset when a Celebrity accuses them on a TV show, or when a movie exaggerates the reality, but can any doctor stand up and confidently claim that their profession is totally corruption free? Like any other profession, we too have our set of black sheep. No profession is spotless. But there’s good news. Fortunately, this part of the problem is the easiest to fix: they simply have to stop doing it!
Dad, I hear that the doctors are poorly paid, and can barely support their family. Would I be able to live a comfortable life if I become a doctor Dad? Jaee, one cannot expect to have a handsome pay package during the training period. A pilot-in-training cannot expect to be paid like a pilot. Moreover, Medicine is not a business. If your primary goal is to make money, medicine is a wrong choice. Not because making big bucks is not possible in Medicine, but because that profession simply cannot be practiced with passion if money is the top priority.
A doctor who treats his work as a ‘job’ would have the time and space to crib about a poor pay. One who treats it as a noble profession would have his or her life filled with contentment despite the immense sacrifices. I feel sorry for the doctors who compare their salaries with other professions. That, to me, is comparing jobs, not professions or careers. No amount of pay can buy you the satisfaction of a doctor who thumped someone’s heart back into sinus rhythm while the other bystanders on the road drove past the collapsed person. The money will follow your good work. Let it remain as a byproduct and not your main driving force.
As a Doctor, what all is possible for me to achieve Dad? Well, the sky is the limit Jaee. Apart from being a respected doctor to your patient, you have the scope to invent new molecules and vaccines, novel surgical procedures, and even take technology to the next level to reach the unreached. The impact of any such invention far overshadows your personal gains such as pay, or a comfortable life!
Dr Jonas Salk, after successful inoculations in monkeys, tested his polio vaccine on himself, his wife, and even his children. When asked who owned the patent to the vaccination, Salk was hardly bothered and stated tha7t anyone could make a profit from a much-needed vaccine, as long as it cures.
The German doctor Forssman inserted a catheter into his own vein until it reached the right atrium of his heart, and then took an X-ray of himself to prove successful self-catheterization. His approach though drastic became an important contribution to heart research. Fortunately, in today’s era, the field of scientific research is advanced, and such life-threatening experiments are not required.
What is required is to rise above the routine, mundane ‘survival’ and dedicate your life to a path-breaking research that will make a dent on the surface of the earth. Watch the famous movie ‘Gifted Hands’, that depicts Dr Ben Carson, a pediatric neurosurgeon who was raised by a single mother, and had a violent life as a child. Despite all the difficulties and resistance, his mother encouraged him to pursue medicine, and he became the first neurosurgeon to separate craniopagus conjoint twins.
I think every doctor should read the life story of Dr Prakash Baba Amte, the winner of Magsaysay award for Community leadership who dedicated his life to provide medical services in the remotest part of India. Agreed, everyone is not going to win a Nobel Prize. But that’s the height you can reach, as a doctor!
‘So tell me dad, if I become a Doctor in India, how much would I make?’ “HOW MUCH WOULD YOU MAKE?” … You can make holding a scared patient’s hand seem like the most important thing in this world. You can make someone’s child breathe again if it suddenly turns blue. You can help someone’s father survive a heart attack by acting in seconds. You can wake up in the middle of the night to make sure someone’s mother in the ICU gets her medicines at the right time. You will then work straight through the night until the morning to keep her alive, and start the day all over again! You will work all day to save the lives of strangers. You would drop everything and run for a ‘code blue’ for hours trying to keep someone alive. You will make us proud.
udly wait for you at the dinner table until you are sure someone else’s family member is taken care of. You will work through weekends and holidays and all through the night because you know what ..people don’t just get sick Monday through Friday and during normal working hours.Who knows, one day you might save my life. How much would you make? All I know is, you will make a BIG difference! And how will my life be Dad? Your life, my child, will not be an ill-paid, lack-lustre life. You would not need a bank balance to measure it. Yours will be a life that Gods will be envious of! Let it be spent inventing medical breakthroughs that will keep an entire future generation alive, long after me and you are gone! So my dear Jaee, you need to step out. There’s lots of work to be done. Years later, when you look back at your life, you will see a Jaee who not just ‘survived’, but lived an extra-ordinary life fighting the challenges. India needs you my child….. Go, become a Doctor!
The article first appeared at Docplexus.in
Dr Milind Naik acquired his post-graduate training in Ophthalmology at the Christian Medical College, Vellore, India, He further completed his Ophthalmic and Facial plastic surgery fellowship at the prestigious University of California, Los Angeles in the year 2006-07. Dr Naik currently heads the Ophthalmic Plastic Surgery Services at LV Prasad Eye Institute, Hyderabad, India.
The article pertains to discussion with her 16-year-old daughter, Jaee.