Every time there is a doctors’ strike, the natural reaction of our very voluble media and people on social media is to lay the blame at the doorstep of the striking doctors. They are called selfish and callous with no sense of responsibility towards their noble profession. Coupled with incidents of rude behaviour by doctors, this perception is only strengthened. But are we correct in our hasty assumptions? Are we aware of the working conditions of doctors and the stressful lives they lead?
Dr Narendra Saini, honorary secretary general, Indian Medical Association, says, “Resident doctors are the backbone of the Indian medical system. Yet, there is no proper space for them to sit, no proper hostel facilities, no proper food or say even salaries. They do 24-hour duties and constantly remain in touch with patients. If the patient is not getting proper treatment or drugs or investigation, they are the ones who bear all the brunt. If they are always at the forefront, bearing the violence of attendants of patients, then why are they not provided a proper facility or security at the hospital?” He adds, “They have no guarantee of jobs. After labouring for more than eight years of medical studies, they still work ad hoc. Their services as resident doctors are terminated after three years.”
In government hospitals, the doctor-patient ratio is abysmal and resident doctors are fewer compared to patients admitted on an everyday basis. Resident doctors work 24x7 as the senior consultant doctors are only supposed to monitor the former. The major workload is divided among resident doctors. Three or four doctors can be asked to work in the emergency department of the government hospital, where about 600 to 800 patients are admitted every day. If there is an emergency, resident doctors whose degrees are dependent on successful completion of their residency are seldom fully supported by the nursing staff. If anything goes wrong, the doctor can be disqualified, while the staffers on the permanent roll of the hospital hardly ever get blamed.
They often wake up in the wee hours and are on duty 24x7. The shift can extend to 36 and, in cases, 48 hours without sleep despite many state governments, including Delhi, issuing circulars to restrict their duty hours to not more than 12 per shift per day. These long hours of work add to the frustration that leads to severe emotional stress. Getting leave is also hard, since India has a ratio of just one doctor to every 1,700 people. About 6 lakh-6.5 lakh doctors are available, but India would need another four lakh by 2020 to reach a required ratio of one doctor per 1,000 people.
There are also instances of resident doctors being manhandled by attendants of patients due to inadequate security arrangements at public hospitals. Night duties are even worse, as there is hardly any security or proper lighting in the corridors of hospitals.
Delayed salaries and poor wages have added to the misery of resident doctors in government hospitals across India. There is no personal life for resident doctors, and their professional life, too, is unsatisfactory. In Delhi, a junior resident doctor gets around Rs 60,000 and a senior resident gets around Rs 80,000, whereas in other states it is about Rs 12,000-Rs 19,000. This is why doctors from all other states flock to Delhi. There is a dire need to enhance stipends and scales across India. Resident doctors often live in miserable conditions, as their hostels have very little to offer.
In 2013, 56 doctors from Mumbai’s government hospitals reportedly contracted tuberculosis, leading to two deaths. Such conditions prevail in government hospitals across the nation. In government hospitals, even in the hostels for doctors, either the bathrooms and toilets have no doors or the doors are jammed or have broken locks. Long working hours, pitiable working and living conditions, low salaries, no security of life or jobs can make the best of us rebel or crack, so why blame only the poor doctors?
The next time you are made to wait in line for the doctor, don’t curse him or her; just imagine yourself being surrounded by pain and misery 24x7 and being stuck in a noble but thankless job. It may help you to understand your doctor better.
Dalmia is chairperson of Grievance Cell, All India Congress Committee