I felt the need to ventilate in the wake of the recent unfortunate happenings in Dhule, Maharashtra. I bet such happenings are not isolated events and violence against doctors continues on various scales in every part of India. Are doctors really to blame entirely for poor medical facilities across India? As a medical professional, I have been fortunate during my training to see the medical infrastructure across many states in India, including Delhi. I shall share my experience in this regard.
As a postgraduate first year trainee at the King George’s Medical University, Lucknow, back in 2009, we, junior residents, were used to the great inrush of patients during evening hours. It was so much that we used to compare it to the arrival of the Sitapur Express. Sitapur is a neighbouring district. Guess the number of doctors attending 40-50 odd patients at any time. Just three to four! That too in a tertiary care hospital, catering not only to the local population but also to the adjoining and far-flung areas.
Fast forward to 2017 and I am sure the situation is no different. For heaven’s sake, how can you even imagine 40-50 critical patients being treated by four doctors in one go? Mistakes and irregularities are bound to happen. Add to it, the long hours of duty of a first-year junior resident, sometimes 20 hours at a stretch, on a daily basis. Second-year residents too had a duty schedule stretching up to 12 hours daily and third-year residents up to eight hours daily. The situation is no different in the hospitals across Delhi. Every patient reaching the emergency department of a hospital considers himself too sick and should ideally be quickly attended to. However, that’s not possible if there are three doctors for 30-40 patients at a time.
Most of the incidents of violence happen in the emergency department. So, why is it so common there? Let me enumerate the causes with an example. The Delhi government, for example, hires many post graduate doctors as senior residents. These senior residents are well trained in a medical college to handle emergencies. However, they can handle the emergencies only when they are fully equipped. You go to a government hospital and you will sometimes find even the basic laboratory facility in tatters.
So, what happens is that despite having well-trained doctors, secondary level hospitals refer patients to tertiary care hospitals, which are attached most of the time with medical colleges. As a result, tertiary care hospitals are burdened by patients. On top of that, many requisite and common medicines are usually not available in these secondary care hospitals. Doctors might even write prescriptions with their clinical judgement. Working as a senior resident in a Delhi government district level (secondary hospital) in Karkardooma, I had raised these issues and had even shot off a letter to the then health secretary, but things have not changed.
Talking of duty hours again, I must emphasise the role of the residents. They certainly are the skeletons of any hospital. But they are the most poorly treated lot. Very rarely you will come across a consultant or an assistant professor on emergency duty in a hospital. So, it’s the resident only who is the first and last resort of a patient. A junior or senior resident represents a hospital at any given moment and he is the one who usually defends the hospital. So, whenever a bereaved family member vents his ire for poor facilities or lack of requisite non-medical help, it’s a resident doctor on whom the ire is vented. So, hierarchy is also one of the culprits which fails the medical system.
Still, resident doctors do their best to serve the patients and they are the ones who are most happy when a critical patient recovers from illness. I have been a testimony to such happy things myself.
A government cannot shirk its responsibility by merely providing two constables at the emergency gate. What the health system needs is a concerted and sustained effort to heal it and bring it back to good health.