TRAINING TO BE A DOCTOR IN MUMBAI- PUNE- 2

RESIDENT DOCTORS

Post-graduation is of 3 years duration for MD.  In Maharashtra Resident doctors are called Junior first year, Senior in second year and Chief in third year (JR, SR and CR respectively). Resident doctors are supposed to be supervised by Registrars who have completed their post graduation.  These are further answerable to Lecturer who is a postgraduate with certain experience. Then come the faculty (typically assistant prof, additional prof, associate prof and prof and prof and head). A number of Departments are managed by Honorary Consultants (- this system unique to Mumbai has found to be a complete disaster and a mention of this fact is stated even in the Joseph Bhore Report which came before independence. But for the benefit of few doctors and to show that government is getting free service, the system still continues.) This forms a unit. 

When a patient comes in the JR sees and works up, then this work is corrected by the SR and then this work is presented in rounds by CR. Effectively ONLY JR does all the work. After the punishing ordeal of JR year, its over and done with, for a lifetime.  This actually is the crux of the problem- that the work of JR, SR and CR is done by the JR alone. It is also an unwritten rule that Registrars and Lecturers should not be disturbed outside working hours. Therefore, the CR becomes de facto supervisor which is an extremely dangerous thing for the patient.  Every Resident gets a full two months of exam leave during which they only study and do no work at all. A number of women doctors also get pregnant and graduate without availing any maternity leave (officially). On paper one has a huge number of people but considering that SR, CR, lecturer and no other doctors do any independent work other than only supervision and procedures, and even among them folks are AWOL- and cannot be replaced because it is unofficial. One can easily confirm this fact by dividing the number of patients with the number of Residents on paper and then seeing how much the workload actually amounts to. (Include the interns, who should be doing medical work instead are doing the work of fixers).

Basically every doctor is rushing madly- not staying still with the patient and concentrating. Every doctor is either butting into another’s work or getting harassed by a senior butting into their work. If an error happens, the junior-most member of the team is taken to task because really there is no way to figure out where the error crept in and no one will admit/ reveal due to hierarchy promoting a conspiracy of silence.

Ideally all Residents should be given independent responsibility to manage patients. Patients should be allotted according to the complexity of the case matched with the competence of the Resident. So a second year resident gets to manage more complex case than a first year resident. Every patient should be managed by the same doctor from the OPD upto discharge. At every stage such as examination, treatment planning, implementation and follow up the resident doctor should discuss the case with one senior resident (who has completed post graduation and is available on campus 24hours) and consultant who is a senior doctor.  Resident doctors should get 30 days paid leave every year and are required to avail of maternity leave and term grant as applicable. This ensures that all resident doctors get almost equal volume of work- more importantly they do not interfere in each other’s work. Quality control and accountability can be maintained as exactly who made the error can be tracked and consequences prevented due to close supervision (and lack of buck passing). In the event of shortage of doctors- due to maternity or other leave which is officially permitted- as things are official they can apply for extra hands in the form of non post graduate residents for short term. 

This system trains the Resident for the real world scenario where it is required to manage patients independently, ask for supervision if required. Finally no preparatory leave should be granted for exam. The logic is that a medical professional with specialist training is required to study all life- long and be prepared for exam any day of life- so it is expected that the Resident would have cultivated the habit of studying during working in the last 3 years so exam preparatory leave is unnecessary and in fact injurious to the development of a complete professional. Therefore the system of getting 'marks' should be stopped. Results should be only as pass and fail. Outstanding students can be given some award like a Gold Medal. Its a laughable system to mark professionals with marks.

Thus a lot more people are available to work, they get leave officially when required and become more confident. And people will give importance to training and learning rather than exam scores.