TRAINING TO BE A DOCTOR IN MUMBAI- PUNE- 3

 My personal experience is that the medical students, teachers, staff everyone is divided along several parameters. Upper caste vs lower caste. Girls vs Boys.  Brahmins vs other caste. Reserved vs open merit. North Maharashtra vs Rest of Maharashtra. North Indian vs Marathi speaking.  Marathi speaking vs non Marathi- speaking. Doctors’ child vs first generation doctor. Hostelite vs day scholars. Minority vs Majority community. Post graduate resident vs non PG resident. In Postgraduation married vs unmarried. With child vs without child. Pregnant vs non pregnant.  Native vs those from outside city. Urban vs rural. And modern medicine vs alternative medicine (yes, this started after folks from BAMS, BHMS courses began to be posted in Medical institutions for internship). MBBS vs para medics. (this list is indicative not complete)

 In the normal course of the day, when everyone is cool and calm these things are not so prominent (though not completely absent). At times of churning like exam time, admission time, at the start of the new academic year, shifting of units and social turmoil (like reservation announcements/ strikes) the medical community falls apart and people begin to needle each other on these issues.

Overwhelming work stress, intense competition, scarcity mentality and inflexibility are reasons why divisions and harassment get accentuated. It is felt by all those who work in the hospital. It is not merely the high work load, it is the unequal distribution and poor work culture that creates work stress. According to me, this is because of the structure of training and work. The mutual bullying and harassment is done with taunts along all of the above.  Unfortunately the harassment along caste lines and that too of ‘lower’ caste by ‘upper’ caste is alone newsworthy and punishable offence. The fact is- unfortunately and I am ashamed to admit that harassment is the norm in medicine. This harassment starts the moment you stand in line to submit your application form for admission and is unrelenting till death.  

Even patients indulge in harassment of doctors along these lines- I remember a patient refusing treatment for a dark complexioned colleague saying he was ‘BC’. Even now patients do not bother to ask me my qualifications or experience but frequently they are concerned about my caste and mother tongue (also worry about Belgao). I have personally been taunted about my religion, caste, gender and marital status on several occasions during my short period of working in Mumbai hospital for 6 months. Large number of times I was told in internship not to bother about studying for post- graduation and the job of girls is to manage family not to do PG and compete with male doctors. And I believe that though the taunts were based on my gender, caste etc; actually the irritation was provoked by my status as an ‘outsider’. The Gynec department and particularly women residents are the worst and relentlessly harass. 

The type of harassment in hospital could put Guatnamo to shame. Details are-

1. not allowing toilet breaks

2. gossiping, isolating, vicious taunting

3. purposely sending residents for references to different wards to get back at other resident. Once I accompanied a patient for pain in abdomen repeatedly to department of surgery when clearly it was menses pain. Upon reaching the surgery department both the patient and I  get a severe dressing down. Many times

4. not allowing break to change menstrual pad when having periods

5. tearing discharge card prepared by interns alleging poor handwriting and making them write same several times so that they cannot finish work and go home

6. denying them break to have lunch

7. borrowing personal items like pens, stethoscopes, two wheelers and misusing them or not returning/ replacing them

8. not allowing to wear gloves during conduct of procedures like delivery or suturing.

9. calling friends and relatives over and designating the resident/ intern as their caretaker. So the junior has to accompany the persons to all check ups, ensure they get their food etc by buying it and giving it to the relative and sometimes these relatives are not shy of making innuendos to the hapless person

10. making the intern accompany a serious patient to another hospital for further tests. Once I was made to accompany pregnant patient to another hospital for sonography. Something was not right with the patient and I was told to shut up and just do my job when I enquired. Upon reaching the other hospital the matter turned out to be serious and everyone from the consultant to the resident doctor from that hospital began mercilessly firing me and projecting different the serious consequences- one of which was that I may be required to deliver the patient outside the hospital gates in a little while. I was so frightened, that the patient’s husband (kind fellow) and patient themselves took me aside and fed me a cold drink to calm me down and then hired a taxi to return to the first place- all the while comforting me. This was not only once and not only for me.

11. making the intern or junior most resident explain the serious situation or death of patient to the relative. Once in the casualty I was monitoring an accident patient when he suddenly had a voluminous blood vomit and literally died in front of me. I reported the matter to my Resident. The Resident who was seated comfortably casually told me to inform the relatives about the death as I only was witness to same. It was the scariest day of my life- informing about 25 relatives that their young relative was dead

12. Insensitive ‘breaking- in rites’ or ragging. Leaving the intern or resident to deal with troublesome relatives alone, leaving them alone with threatening patients like prisoners/ mentally ill, purposely introducing them to people who are prone to be foul- mouthed or make sexual inappropriate behaviour.

13. Keeping one’s wet clothes on the mattress, hiding underwear and towels after removing them from clothesline, blocking access to bathroom for bath, forcing into drinks/ drugs parties, getting seminars- slides etc made are the ways to harass in hostel

 Anyone who protested would be labelled a ‘trouble maker’. Counseled that this is temporary. And seniors who were supposed to protect always said, ‘how come only YOU have problem? So many of us are working here peacefully. We admit such and such person is a bit rough- but you need to understand that it’s due to stress. Plus this person is bright and will bring good name to institute. So we need to support by tolerating some of the ‘quirks’ or ‘whacky’ behavior’. It is also believed that high intelligence is accompanied by abnormal and anti social behaviour so must be overlooked. I worked in 3 cities and I found that this type of harassment in worst in Mumbai, at all levels-maybe my experience because I was an ‘outsider’.

The medical community also has not figured out the proper way to deal with real troublemakers. Suppose one such is posted in the unit. The person constantly begins to complain about lots of things. They feel sensitive and isolated. So the unit responds by giving them less work or routine non challenging work. Then this person begins to allege of being deprived of training opportunities because no work is being allotted to them. So what should the unit do now? Give work or not give work? Guidelines are available to solve such problems- the medical colleges choose not to use them or even read them. There is no such thing as a human resource management principle in the medical training or profession. People are groomed only on two principles- survival of the fittest and get the work done anyhow.

The culture imbibed during training seeps into work and even in private hospitals. The Consultant doctor peeps in from the corridor and charges a visit fee. Consultants treat only test reports and act on second hand information from the resident doctors- because from the second year of residency they only cultivated this habit. I see that the Resident doctors are over worked, underpaid and taunted mercilessly. I have often advised Residents to seek jobs in other states, especially in the South. There the pay is better, regular and junior doctors are treated with greater dignity and respect.

It is time that Maharashtra doctors sit down and study the administrative part of Resident and Intern doctors training. They always focus only on the knowledge and skills part. Unless this is studied and remedied every year we are going to have things like suicides, drop outs, doctors’ strikes, violence against doctors, poor patient care and progressively worsening quality of medical graduates.