The
first time I went out of Maharashtra for work was to join NIMHANS. Before that
I had to clear the entrance exam and interview. The scene at the entrance exam made
me think that I was lucky to have chosen to work out side Maharashtra. Firstly,
I was among the youngest- only among the handful fresh graduates. Everyone else
was older and much more relaxed- they had put in a couple of years working as
medical officers for fat salaries (unheard of in Maharashtra). They were
totally cool and relaxed, unlike my classmates in Maharashtra who were just
waiting to kill themselves if they missed even one year. Many were happily
married.
When
we started work as Junior Residents, each was given complete responsibility for
their own patient. Nothing like in Maharashtra, where an elaborate pecking
order ensures that the freshest and junior most Resident does ALL the work
while all others just give suggestions and present the work done by this
hapless resident in the clinical rounds. My supervising doctor called ‘Senior
Resident’ made a fair distribution of the work and Consultants had a close eye
on our performance. The first day itself we were told to take days off to
manage our stress and to not ever believe that we were indispensable to the
hospital. Contrast this to the attitude when I did my internship- both in KEM Pune
where I hardly was allowed to do any work as it was a private set up and in J J
Hospital where loads of work used to happen- any mention of even going for
lunch break or pee break would invite horrible cold stares and wicked jibes
from the supervising Residents. On most days, I had no option but to leg it on
the sly.
Yes, and there in J J they had an issue with
‘extern’ as well. In NIMHANS- all are equal and equally welcome. During my
posting in St John’s hospital, I noticed that the interns were also treated like
equal professionals. In Pune as well as in Mumbai the only work interns did was
the work of ward boys technicians and staff nurses....collect blood samples,
transport them, make appointments, dress patients, label samples, accompany
patients to tests, record blood pressure. Only work done as doctors was
suturing wounds and securing iv lines. Pune was better- at least important
skills like performing normal delivery, closing wounds, reducing dislocations
were taught generously to us. In Mumbai, lesser said the better. Or maybe
because I came with the label of ‘extern’ as Mumbaites love to function in
closed cliques.
My personal experience does not matter- I
understand it takes two hands to make a clap. It is more important to
understand that precious opportunity to train doctors and make them confident
is lost due to the extreme hierarchy, mutual parasitism and faulty method of
delegating work in Maharashtra. The medical graduates of Maharashtra can rattle
large lists from thick textbooks- but in practical situations they really are
never taught to function as professional. This I feel is the key fault of the
medical training here. I feel that the duties for interns and postgraduate
students have to be clearly spelt. And how will we know that these have been
done? Hence an exit exam at the end of internship and end of bond period is
essential. For Psychiatry I will say every graduate doctor should be able to do
a mental status examination, rule out common organic factors, manage common substance
abuse, do emotional first aid, manage simple cases of depression and psychosis,
screen for psychiatric disorders of children and elders. Every doctor needs to
be given mandatory leave and learn to function within set working hours. Medical
training is long and strenuous, doctors will need to learn their manners on the
job. How will it happen when they are given tasks of paramedicals and harassed
endlessly during training?
