Why I will never allow my child to become a

doctor in India

May 15, 2015

A pup was walking down the street when it came across a group of young
boys. The leader of the group spotted the dog and pointed it out to his
friends. Seeing the boys, the dog too wagged his tail and barked, looking
forward to being petted and making new friends.
However,even as the pup wagged his tail, one of the boys picked up a stone. The boy
turned to the others and told them how dogs are bad because another dog had bitten
his grandfather years ago. As he nodded, a second boy picked up another stone even
as he spoke of the incessant barking of stray dogs in his neighbourhood at night,
disturbing the sleep of his family. A third spoke of how dogs are bad because of
religious reasons. The others realized the wisdom in their friends' words and each
picked up a stone, aware now that breeds like this could not be trusted. The pup stood
where he was, confused as he watched the boys come closer to him.
By the time night had descended upon the land, the boys had dispersed and gone to
their individual homes. There was a sense of accomplishment, having stopped a
menace from entering their streets. Lying bloodied and brutalized, the pup that had
wagged his tail in hope of giving and receiving love licked its wounds. It was too
young to know that the physical wounds would heal in due time... but it was now old
enough to have learned to distrust the species of stone throwers. The most selfless

creature since time immemorial now knew to hate... because that was what it
received for no fault of its own. For the crimes of others, it had paid with its body and
soul.

That, in a nutshell, is the reason why I will never allow you, my child, to
become a doctor in India.
Still confused, I guess? It is okay. Take a chair and sit down... this is going to
take awhile.
Increasingly, I find myself watching and talking to doctors across two
generations and various specialties these days. And increasingly, that sense
of despair and disillusionment is writ large in their words. They find
themselves wondering where things went wrong even as they struggle to
bring a smile on their faces. With 0.7 doctors per 1000 Indians, the
doctor:patient ratio is far below that of other comparable countries like
China (1.9), United Kingdom (2.8) and United States (2.5). Spain's 4.9
seems like an absolute luxury in comparison, I must admit. What this
means in layman's terms is simply this - that you are always going to be
swamped with patients beyond the logical human capacity in India.
Thou shalt sacrifice your time, parents, spouse and child.
Getting a 63 hour a week schedule (7 days x 9 hours) is a blessing and
most of the young guns who join in fresh after post graduation know fully
well that a 100 hour a week schedule is par for the course once you begin
working. And sadly, this is advocated and in fact encouraged by most
hospitals too - who wouldn't want to have workers in a contract which
states 8 hours a day and then get them to work 14, stating that 'this is how
it is for all doctors and besides, we are in the business of selfless

service.' You would never allow a taxi driver to drive you for 24 hours
continuously but asking surgeons to do that every third day is fair game in
India, apparently.
Wanting to do the alloted number of hours in your contract and then come
home to your family is now frowned upon in our field... it implies weakness.
Nay, it implies a a lack of professionalism.
Thou shalt sacrifice thy life dream.

This came in my Facebook timeline. It is

actually quite accurate, when I think of it

It is a sacrifice that will take away your twenties and eat away at your
thirties. You may enter the field bright-eyed at 18 but I must ask you - what
happens if the dream to become a heart surgeon does not reach fruition? If
for some reason, you find yourself unable to get the coveted seat or devote
the fifteen odd years I assume it will take to become the junior most in your
department, would you be happy with your life? Would you be able to live
with losing the dream or would the disappointment eat you up from within?
Who cares for the doctor
A young surgeon working in one of the premier institutes in India spoke to
me the other day. This was a doctor who was so passionate a year ago
about becoming even better, working hard to get into a super specialty
course. She had joined the hospital because of its awe-inspiring reputation
across India, aware that the hard hours she put in would sharpen her skills
and broaden her knowledge of the specialty. The woman I spoke to had lost
that drive altogether.
Walking out of her home at 7 AM and returning home at 10 PM just to fall
into bed and then wake up again at 5 in the morning to restart the cycle,
she wondered what was the point of it all. She was losing touch with her
loved ones and had become a zombie, lost between the politics within the
hospital and a total lack of social life.
All this for a handsome salary of 50,000/- a month (in Mumbai) which she
knew would not buy her two nights in the ICU of the very hospital she was
working in. There would be a pot of gold at the end of the rainbow, I wanted
to tell her. She would earn more in her forties than her techie friends earned
in their thirties, I could have consoled her. But I did not. Because I know
how she feels.

Another doctor spoke out recently on a public forum, talking of his

experience of doing six years of rural service for the government. When he
finally left it two years ago, the man in his thirties had less than Rs 15,000/in his bank balance with no extravagant purchases or trips to boast off. He
needed his parents help at that age to still pay for his rent. It all came to a
head when the guy at the shop recharging his mobile revealed how his monthly
takeaway was more than the doctor's... without any risk whatsoever.
His one plea to all the doctors listening? Do not be a sentimental fool and get
blackmailed by the medical system to go work like he did... because nobody cares for
your service at the end of the day. And I totally agree with him. If after more than a
decade in the medical field, he cannot provide as much for his family as an mobile
shop owner, then why did he need to go through so much of an effort at all? If India
considers it a crime for doctors to earn money while closing their eyes when judges,
lawyers and uneducated politicians magically accumulate crores, is it not the folly of
the person aspiring to be a doctor? How dare he dream of providing for his family?
More statues, less healthcare is the solution

The very fact that our stats are comparable

with Nigeria speaks for itself
The medical field we entered is not the one we are in today. Even the
generations before us acknowledge this. And it is only getting worse.

For a field like ours in a country like ours which is overpopulated and has a
major portion of that hovering below or around the poverty line, having the
support of the government to ensure the benefits of health care reach
everyone is vital to our success. They needed to make medicines more
affordable at the very least. Sadly, rather than increase the amount, they
decided to cut the budget allotted to health care by nearly 20 percent. Key
sectors like HIV/AIDS lost funding rather than having it increased. This at a
time when we spend a mere 1% as it is on public health care in India as
opposed to 3% in China and 8% in United States. What can I say, my child?
I guess India is healthier than those other poor nations, are we not?
Defensive medicine
I wish it were JUST about losing your family life, working twice
the allotted hours and taking home the pitiably disproportionate salary
though. But sadly, it isn't even that anymore. Now, it is about getting home
in one piece. From stopping patients from dying, the medical field is now
being forced to worry about not being killed by the patients bystanders.

The essence of being a doctor - to do the best we can to heal - is being

taken away from us because now we need to be on the defensive. You
remember that cute little thing we've been talking about called selfless
social service? Guess what? It comes with riders, apparently.
Selfless service means you do the extra hours because the hospital is perpetually
understaffed.
Selfless service means you take home a call centre worker's salary because the healing
you do is a service, remember?
Selfless service means you adjust with the lack of drugs and instruments available and
still save people because there is no other hospital nearby.
But that line stops there. If the patient collapses while in your care, suddenly all these
boundaries vanish.

You are then the monster that the public reads in the papers - the one who killed
their loved one because of your greed to steal their money/harvest their organs/molest
their ailing mother or child. Then the very same people who demanded that doctors
take home a salary in 5 digits will have no problems in demanding compensation in six
or seven digits. It does not matter if they are wrong... what is important is that by
spoiling the doctor's reputation, you succeed in blackmailing him or the hospital into a
compromise. If every death inside a hospital were to be called a case of medical
negligence, why would doctors admit the patient at all?
Are you willing to die for your profession?
The Indian Medical Association confirmed in May 2015 that over 75% of the
doctors in India have faced some form of violence at the patient's hands in
India.
75%. This is after admitting that not all cases of violence get reported to
them. There are even instances of doctors being actually killed for following
the law. How do you explain that to his widowed wife? When was the last
time you saw a software techie being killed off for not making an app
properly? Still feel like using the 'Selfless service' card again? That's a
pretty thin card to keep playing while beating every 3 out of 4 doctors,
don't you think?
The recent verdict in the Joseph Eye Hospital case brought the reality of the Indian
mindset home to many doctors. Handing down verdicts of imprisonment to 3 doctors
for the loss of vision of 66 patients following an eye surgery camp, the judicial system
showed an amazing lack of comprehension about what was going on. It does not need
a rocket scientist to realize that a single trained doctor cannot make the same mistake
66 times in 66 different eyes on the same day. The obvious answer to such incidence of
mass endophthalmitis is in the use of unsterile solutions used - the unsterile part being
a fault of the pharmaceutical company that manufactures the solution.

There is no way for a doctor to know (without opening every individual

bottle and testing them!) if the solution contains microscopic bacteria just
as there is no way for you to know if there are any in your coffee before
drinking it. And yet, to please a crowd baying for blood and money, even
though it was obvious the fault lay with the tainted solution, the doctors
were sent to prison. Sounds familiar, does it not? Remember
the Chattisgarh sterilization deaths of 2014? Everyone knows the doctor's
name in that case. It was later proven that the fault was with the tainted
medicines which were made in rodent infested factories. So tell me, what
was the name of the pharmaceutical company and what action has been
taken against it since then? You don't know? How shocking!
It raised the obvious question to many doctors though. Why would we do
such a service at all when we are being cheated? By doing a single private
patient for Rs 60,000 (which is still cheaper than the Dhs 15,000/- charged
abroad), the doctor can choose to use the best drugs from reliable
companies instead of the generic substandard ones and make a hundred
times more money doing one case while being totally ethical. Can you call
them cheats then? No. Except that by doing so, we all know as doctors that
nobody would then care for the treatment of the poor, if we give up on
them too.

That is what being a doctor in India is all about, in the end.

1. You are forced to go to the India that India forgot, the most rural crevices and
cul-de-sacs where healthcare is actually needed.
2. You are asked to bang on doors and seek out the ailing.
3. You are asked to bring as many of them as you can back with you.
4. And then you operate on them all for the handsome fees provided by
the government (Rs 650/- is given to most hospitals, I hear, though I
will gladly accept any revised figure too.)
5. The government cuts its costs by making you do Rs 60,000 surgeries for 600,
citing rural service (which naturally does not apply to engineers and lawyers because these areas don't need them at all.)
6. The doctor carries the moral responsibility of helping as many patients as
possible and so is asked to do work well beyond his physical and mental
capacity.
7. Generic pharmaceutical companies will pawn off their goods made in unsterile
conditions at a lesser rate.

8. When things go bad, the crowd will calmly ignore the government and
pharmacy that cut corners for a profit and be at the doctor's doorstep with stakes
and pitchforks. And celebrities will be there to tut-tut on national television
about how doctors are corrupt and cutting off organs for their own profits.

The malaise within

Are all doctors good? My dear child, surely even you at this tender age
cannot be so naive. Of course not. The one factor that holds good across all
walks of humanity is our tendency to be a mix of good and evil. This
extends across religions and Godmen to politicians and doctors and
everything in between.
Before we were doctors, we were normal people too. And we have
inculcated values from our family and peers for over two decades before we
earned the right to wear that stethoscope. And whether we want to or not,
that does show in the way we carry on.
So yes, there are going to be doctors working beside you who will promote a medicine
not necessarily because it is good but because the pharmaceutical rep gives him a good
incentive. And you will see that doctor taking home more than you do for doing the
same work as you and the devil on your shoulder will smile. He will positively grin, in
fact, as you stare at the price of the new smartphone which is beyond your financial
reach because social service and respect do not pay the bills.
There will be those who need to make back the money spent on getting a
seat... I hear certain post grad seats now go for 4 crores. Well, damned if I
know why people would take it up when you could just as well earn more
with the interest from the bank for that amount but hey... to each his own.
You will find doctors who are forced to do the extra procedure because, working in a
private hospital, they need to answer to the heads above. They need to make a profit
for their bosses who shrug as they remind you that if the hospital runs into losses and
shuts down, the loser is the patient himself. And when you think about it, they are
right, are they not? Private hospitals (which still cater to a huge percentage of the

population) need to make a profit to continue. If they shut down, the healthcare of the
country would collapse in months simply because government hospitals would never
be able to manage the volume. Again, the arrow of your moral compass will tremble as
you grapple between the inner desire to treat people in pain and the requirement of
forcing them away to a less safer center because they (like you!) cannot afford this
hospital.
Know that you are not God. 'Feeling like a God' when you see a patient open his eyes
after a successful surgery is different from believing you are a God. It only need one
mishap for such Gods to fall... and fall hard.
Professional competition exists too, as though you didn't have enough on your plate.
Being competitive probably exists in every field but here the game is played with
people's lives. But when someone discredits you to sway the patient to leave you, you
wonder what the point really is. Was it not supposed to be about healing people?
The imbecilic outsiders.
Case in point: When one state was unable to deal with the number of patients in the
rural areas who needed health care, doctors from the neighbouring state stepped in
and conducted camps there, helping the poor get the treatment they needed. How did
the former state respond? By banning all the doctors from the other hospital for THE
CRIME of providing health care to people in need. They could not provide it
themselves but they would not allow the other state to lend a helping hand. This was
the stand of the elected ministers in the end - we would rather our folk suffer than
allow you to take credit for helping them when we cannot do it ourselves.
You have ministers running tobacco empires who head committees on health and
undo all the work of doctors by claiming that tobacco is good for health.
You have self-proclaimed fakirs and saints telling to raise the population manifold at a
time when we are stretched at the seams due to overpopulation.
You as a doctor are caught in the moral ineptitude of such politicians and
film stars who never attend government hospitals themselves and yet
decide how hospitals must be run.

This is what every young doctor in India today is struggling with - the
disillusionment of it all.
We want to heal... we want that satisfaction of being able to save lives and
see a cheerful smile on the face of someone who came to us in anguish. But
not like this. Not dictated by the whims of businessmen who demand
profits, not by the fear of being beaten up by relatives of patients who
cannot accept death as an eventuality, not while worrying about how to pay
the next electricity bill and not by losing our touch with everyone who
matters to us just because a nation chooses not to strengthen its own
healthcare system. The fear you feel as a doctor should be because you
think you have missed a differential diagnosis when a patient comes to you,
not that you will be beaten up if the patient's condition worsens.
Depending on where you work, you will face some permutation or combination of
the above ills of being a doctor in India.
And it will eat you from the inside. You will wonder how to strike the balance
between being there for those you love personally and those who need you
professionally. You will ask yourself how everyone demands you have a
dozen degrees beyond your name and yet does not seem to think it
necessary that you be paid equivalent to the effort you put in to reach here.
You will see your peers do everything by the book and get beaten down by
hospital politics or physically by patients and you will wonder - should I save
the next critical patient who comes into the hospital or refer him elsewhere
to save myself, knowing that the law has failed me.
And in that moment, you stop being the doctor you set out to be.
'Selfless service' does not require you to give up your soul and
life.

Broken arm? Pfft... There's still have

one arm left!
P.S. Yes, That is me in case you are
wondering!
People only use that term when they want doctors to go the extra mile.
That selfless service tag stops when the time comes to pay the bill. When it
is time to beat up a doctor or insult the entire fraternity based on one
doctor or sometimes, pure ignorance.
You can choose to be selfless in so many ways - donate to the needy, adopt
a child, participate actively in programs by worthy NGOs... heck, just by not
harming or cheating anyone, you are basically being selfless in today's
world, I reckon. Why, you can run over innocent people sleeping on the
pavement and still be called selfless, as long as you have money to donate
in front of the media for a worthy cause, as I found out recently.
Understand one thing - ligating pulsating blood vessels is not a service.
Restarting a heart is not a service. Suturing meticulously with threads
thinner than the hair on your eyebrow is not a service. Identifying the
extent of a tumour in the brain right down to the last millimeter while
operating to remove it is not a service.

It is an art. It is a specialized skill. It is a test of your endurance because

at the end of the 25th hour of straight duty, you better save that 20th
patient on your operation table or else everything you have done before
this does not matter. Above all else, it is a sacrifice.
As a father, you will find me as broad minded and tolerant as they get. You
will have every opportunity to choose whether you want to retain your
religion or change it based on what resonates within your mind. You will
have every opportunity to choose the love of your life irrespective of caste,
creed or even gender (though if you choose to go lesbian, may I just point
out that Ellen Degeneres would be a lovely role model to emulate - kind
hearted, hilariously, smart... plus Portia for a life partner!)
I will let you have every choice in life and I will be there to support you and
guide you along the way. You can be a wildlife photographer trekking
through the Amazons or dance the poles at Las Vegas. But I will never
allow you to become a doctor in India. Because I did not raise my child
for two decades just to watch her lose her sense of right and wrong, of
humanity or worse, watch her die.
And I don't mean just physically.

Authors note:
I have been conversing with a lot of doctors recently and the sound of disillusionment
about the field has never been as loud as it is today. Even doctors of generations past
and heads of departments acknowledge the shift, stating that they are happy that
they are not starting off their careers in today's India. One line which many of them
said and one which I also agree with entirely is the basis of this article - "I will never
allow my children to join this field."

There is also an email sitting in my inbox asking me to sign and share a petition
demanding that applications for licensed guns be fast tracked for doctors. I have
read it and placed a 'star' across the mail. I do not intend to sign it because I don't
advocate guns as a rule... I see children cry everyday when I bring an intravenous
cannula near their tiny arms. I do not wish to have them worry about the gun in the
doctor's pocket too. But I empathize with the sorrow of the doctors who made the
petition. And I know one day, I too may find myself revisiting this petition should a
calamity befall me. As its is, hospitals have started employing bouncers now.
I would love to hear from doctors here as well. Even if you disagree with my
thoughts entirely, I do not mind. I just want to see how far the disillusionment lies
and whether the "Hippocrates Oath" and "selfless service" tag are still as strong in
your hearts today as it was the day you joined your medical college. Where do you
think it is all going wrong in India?
Update (16 May 2015): I would like to thank Dailyrounds.org (for
republishing my article) and all the others who shared this across social
media on their timelines for helping get the word across.
Update (18 May 2015): Thanks to Scroll.In, Scoopwhoop, Ndtv and Quartz
too now, I guess. As for a popular news media site which shared the
blogpost, I guess I should specify here - This is a letter to my future kids. I
DONT have a child yet. :)
Update (19 May 2015): Okay, I have lost track now of who all have shared.
HuffingtonPost, Deccan Chronicle, Navbharat, Asianet... Thank you all.
Some people have asked me to comment on the fun headlines of the media
sites which published this post, focusing on the 'pole dancer' bit. Frankly, I
realize that it is a bit much to use that as a headline but if it serves the

purpose and gets doctors engaging in a discussion, I will gladly take the hit
for it :)
P.S. I am also a little amused by a site claiming I am fed up of my
profession. It is precisely the converse - it is because I (and my fellow
brethren in the medical fraternity) love the profession that we are raising
our voices against the decay we note in the system. We accept it is
derailed and this - getting people to talk on what is now an international
forum - is hopefully the first step to bringing it back on track and fixing the
image that is tarnished so badly.
Posted by Thavam