ESCAPE THE CAREER TRAP

For a very long time after I graduated, I desperately wanted a job. Actually at that time I needed one too- for financial and emotional reasons. But as things happen, I could not get any job. In that time I managed to keep afloat professionally and personally.... And right at the time when I did not need the job, I got one. Of course, I wanted it- very badly so I jumped into it. It made me happy for exactly 5 days. After that I kept hearing ‘this is a job not a career’...’this is a career not a life’......’this is work not passion’. The day I understood what all these platitudes meant I gave my notice and quit....and escaped the trap called ‘career’.

For the last 50 years, men and women, boys and girls have been brought up on the myth of a ‘career’. The word evokes such a mix of accomplishment, status, affluence and sheer snobbery that a majority fall for it. Everybody is supposed to decide and understand something called their ‘identity’ and stick to it. Young women with little babies become depressed because they have been unceremoniously shut out of their ‘career’. Kareena gets a thumbs up because she does not let motherhood interfere with her career. Men are expected to relocate to wherever their jobs are because they have a career to make. This is not a gender issue at all....the myth affects all who are naive enough to be drawn into it.

Gender equality is the phrase used to fire young women into giving up everything in the service of industry. Men are expected to settle for no less than 16 hours of work and aspirations to be the CEO. So even if some people would rather choose needlework or to spend time with family, they are made to feel stupid about these choices. To assuage their guilt we invent childcare centres with cctv camera, quality time parenting, certified elder care manpower, spouse- dating and art exhibitions. Actually all these amount to nothing if you are doing it just to further your career.

A career is meant only for three categories of people- people who are competitive by nature need it to remain sane. People who have poor social and financial support need it to make something of their lives. And a third category is people who have nothing else in their life to look forward to....this last category need career only for a while though. All other folks should look at education only as a means to acquire the wherewithal to do what they like so that it can start paying them. Then proceed to work as few hours as possible working to earn money and rest of it to enjoy the work. One must be able to cut down on the working hours to be able to do anything that one needs to do or wants to do....including non-remunerative tasks like being with one’s children and parents, or doing embroidery or painting one’s bicycle.

A person without a career could be a lucky person.....for this person has a life                                                  

Consumer is king.....but what about patients?

The Tide of corporatisation of healthcare has swept over India in the last decade. From being sanctuaries in the middle ages to being temples of healing in the last century, hospitals are now evolving into commercial centres. Patient is cast as a ‘consumer’ while healthcare professionals are ‘service- providers’. Today the hospital is designed like a factory with its staff as workers. Unfortunately, health can neither be manufactured nor be bought. In this fact lies the irony- while patients’ narcissism is massaged by advertising spiel- the larger population have not understood what to really expect. 

Consumer- patient

No human willingly chooses to become a patient. (Only exception, being the cases of psychological disorders in which persons are fascinated by doctors and treatments. Let’s leave this category aside.) For illness is an unwanted imposition to be got rid of as soon as possible. In the best cases it is treated as a character- building adversity.  So a person just happens to become a patient. A patient becomes a consumer when he chooses to ‘buy’ healthcare ‘products’. This product maybe an investigation, treatment, therapy, convalescence or palliation.

Service- providers or expert professionals

 The difference between corporate medicine and rest of corporate India is vast. Except few administrators and expert doctors all other staff are either contracted, interns, students or observers. Every corporate hospital runs its own nurses training, post graduate medical training and other courses- the students provide free or cheap labour to run the hospitals. While rest of corporate India enjoys a 5- day week, corporate hospitals work 6 days (the hospitals are manned by rotation duties. These rotations are done every 6 days with one day off). Mandatory 36 days paid leave, maternity leave, on site child care, medical facilities- are not usually given.

The problem is the problem

Common complaint against corporatisation is high expenses. This is a genuine problem and activists are working on it. Bigger concern is changing framework of illness and its treatment. The reality about illness and treatment is this- one cannot choose the illness, its timing or intensity. Similarly no patient can hope to recover by mere administration of treatment without an interest or effort on part of the patients. Corporate healthcare is trying to actively hide these facts.

Advertisements make tall claims about prevention of illness by undergoing battery of diagnostic procedures. No tests can prevent illness. If you become ill at an inconvenient time, the corporate hospital promises to give you treatment without a break in your commitments. A part of this is the active encouragement given to patients to arrive late for appointments and to not be compliant towards treatment recommendations which get in the way of their life (eg alcohol use during treatment). Has anyone ever heard of a running car being repaired? But corporate healthcare promises that to humans.

As stated earlier, health is a commodity that can neither be manufactured nor bought. A few lucky people are born with good health and continue to enjoy its benefits without much effort. Many of us are able to cultivate healthful habits. Yet for most of us illness is inevitable. Patients have to approach for help. The responsibility of arriving on time, reporting problems honestly, taking treatments as advised- is completely with the patient. Going to a corporate hospital with excellent quality ratings alone, never helps. Patients should learn to differentiate between hospital and hospitality and between treatment and pampering. In this lies the difference between a common patient and a wise one.

Conclusions

The trend of corporatisation has given a false sense of security that they will be assured of good health with payment of steep charges. But no illness can be treated just from the outside without participation of the patient. Patients should be willing to do their part of the hard work to recover, merely throwing money will get them nowhere.

MENTAL HEALTH PROFESSIONAL AS A LIFE COACH

Lately I come across a number of business cards of my colleague Psychiatrists where they mention their work as being ‘Life Coach’. In general, I have been sceptical of the concept of life coach- I think it’s just a modern version of ‘Guru’, ‘Baba’, etc. It appears that talented, accomplished people cannot trust their own judgements at some point of their lives and the above category of persons fill the need so created. I wonder if there are any courses to become a life coach and I have heard of highly questionable methods like ‘whats your favourite colour today?’ being used to guide the person by life coaches. Anyway, this post is not about life coaches- but about mental health professionals functioning as life coaches.

Mental health professionals like Psychiatrists, Psychologists or Psychiatric Social workers are trained in the diagnosis and treatment of mental disorders. During training, their exposure to problems of ‘normal’ life is limited- at least in India. Most of the times the number of mentally ill is in such excess to the people dealing with problems of daily living- so critical and professional evaluation of persons with functioning lives is quite rare. Professionals in private practice may have a greater chance, but again I have my doubts. Psychiatrists spend about 5 mins with one patient, while psychologists have simultaneous tests running in 3 cabins. Very few professionals actually see their patients for long durations. And then there is the problem of doctor- shopping by the capricious patient, because of which the drop-out rate of patients in therapy is considerable. So I doubt how many mental health professionals are really doing therapy and have accumulated the diverse, rich and deep experience to be able to contemplate on the problem that is ‘LIFE’.

So when I see life coach printed on the business card- I am prone to be sceptical- particularly if the professional is young, has a busy practice and not known to be contemplative (through lack of writing/ presenting/ researching).

ATTENTION- FORMER CHIEF JUSTICE, SUPREME COURT OF INDIA

To,

Justice R S Lodha,

Supreme Court committee,

Overseeing working of Medical Council of India,

Delhi.

Subject-  Requesting your intervention in matter of ‘cut- practice’ in medicine

Respected Sir,

I read in the newspaper that a committee under your able chairmanship has been set up to study and monitor the working of Medical Council of India, with particular reference to corrupt practices. I am writing this letter with the hope that something may be done about  ‘cut- practice’ in the medical profession.

‘Cut practice’ is the system of earning commission for referring patients to a particular doctor or medical organisation. It undermines medical care and harms the patient. Hence, it must be stopped as soon as possible. Cut- practice is labelled ‘unethical’ but the MCI or Maharashtra Medical Council have no set procedures to investigate or punish violations. It is not ‘illegal’ as there is no law against it.

 In 2013 Dr Bawaskar filed a complaint in the Maharashtra Medical Council about one such instance. Though the fact of giving cuts in this case was proved and admitted to by the defendent, no action can be taken on basis of a technicality- that the cut was issued not by an individual doctor but by a medical organisation. In effect, it seems that cut-practice is unethical for individuals but a legitimate business practice for groups of individuals. This can only be termed as a travesty. The case is now stuck at this point at the Mumbai High Court. Meanwhile, the Medical Council of India has passed a circular stating expressly that its mandate is only to act against individual registered doctors and not against organised group of doctors, further bolstering the above case. (I can provide you the details, if you wish. Meanwhile, you may see them on my blog mentordoc@blogspot.com)

 These developments are dangerous for the public. It endangers the ability to choose medical treatment that is competent and affordable. The most important intervention would be to bring medical organisations, associations and commercial healthcare entities under regulation by making registration under medical councils mandatory. Medical ethics and laws should be the same for individuals and groups.

I, therefore request you to study this matter deeply. With your knowledge, experience and authority you may be able to suggest a suitable remedy to stem this rot. Sir, an effective action will bring succour to all Indians. I exhort you to please do something in this matter.

I also request you to kindly acknowledge this letter, at least through email.

With much anticipation

Sincerely,

Dr Vani Kulhalli

(I HAVE POSTED ON BLOG BECAUSE EVEN AFTER 3 mts of SEARCHING I WAS UNABLE TO GET THE POSTAL OR MAIL ADDRESS. I JUST HOPE THIS WORKS.)

TIME MANAGEMENT IN PRACTICE

http://bmjopen.bmj.com/content/4/5/e004679.full

This is a continuation of my previous piece about time management in medical practice.

There is a lot of anger among the public over waiting in the doctor’s clinic. As  patient is in discomfort and pain, there is an expectation of relief at the earliest. When this expectation is not met- anger is likely. Some doctors do not care to organise their practice leading to time mismanagement and delays. The worst offenders are doctors who call all patients at the same time, so that they can arrive after a sizeable number assembles and then proceed to rush through the que. This is wilful waste of the patient’s time which is completely unforgiveable. Some doctors have given up on time management thinking it is a hopeless attempt and just announce their working hours. Any patient arriving within that time is seen on a first come first served basis. So essentially there is no appointment given. In all these scenarios the doctor has designed a schedule which is heavily weighted in the doctor’s favour and in favour of a patient who is disorganised consumer. Yes, some patients do feel reassured taking treatment from a busy doctor who makes them wait for hours- these patients are welcome to wait.

Working by appointments is by far the best way to work. It is good for the doctor as well as for the patient. It is the doctor’s responsibility to implement a system that ensures time management. The most important intervention to reserve the first two slots of the day to patients who are known to be punctual. Work must BEGIN ON TIME.  Second important intervention is to turn back and reschedule appointments of patients who come late. Patients should be accommodated for reasonable delay which may be upto 15 mins. Beyond that appointment stands cancelled. Thirdly, after every 4-5 appointments, an empty slot should be kept to accommodate delays and extended sessions. On certain days, when time- consuming interventions like therapy are to be done , patients come prepared to wait because I inform them in advance- so that is okay by them. I keep my side of the deal by not charging patients if I make them wait excessively, irrespective of who is at fault. Majority of patients appreciate the doctor’s punctuality. There are some patients who cannot understand all the fuss- but well the doctor has to take responsibility for clinic management not the patient.

After doing this for 15 years, I have a beautiful practice which allows me to start my day as planned and end it on time. 

UPDATE ON CASE

The case Dr Bawaskar vs N M Medical Centre reached the hearing stage this Saturday, that is on 16th April afternoon.

Justice Kanade and Justice Dharmadhikari heard the case and admitted the petition and have granted a stay to the defendent.

I can only hope for an outcome that benefits the common person who is unable to take any measures to protect himself/ herself from the systematic crime of cut- practice.

MCI, PLEASE OBLIGE

When we were students, we had to learn medicine, surgery, obstetrics and gynecology, ophthalmology, ear-nose-throat diseases, orthopediacs and paediatrics as separate clinical subjects. Psychiatry was dealt with in 1-2 lectures, 15 days in the second year and about 15 days of posting in internship. The medicine paper was supposed to have a question on Psychiatry which was usually a short note on one of five favourite topics (which unfortunately did not include depression).

This was 15 years ago. Now when I meet my classmates, irrespective of speciality or area of practice or even if some of them have switched their professions- all my classmates rue the lack of special training in Psychiatry. Most of my non- psychiatry colleagues have told me how a significant portion of their practice is actually psychological intervention or psychiatric treatment. One family physician joked to me that he will have very minimal practice left if he begins to refer patients with psychological problems to Psychiatrists instead of treating them himself! Considering all these experiences, it is very clear that a special training in Psychology and Psychiatry would have been indispensible.

All things cannot be covered in undergraduate medical education because of the vast and changing nature of medical science. Invariably, some amount of learning happens on the job when the doctor actually settles down to start work. So some authorities have argued that psychology and psychiatry will be ‘automatically’ learned by doctors when they need it. So we see a good attendance at CME programs of medical associations when the topics are related to psychiatry. But what about clinical skills? CME programes are only lectures and I don’t know how doctors will learn the clinical skills of mental health care.

Unless the MCI mandates that clinical skills have to be learned, the students will not be able to do so during MBBS. After MBBS, even if they want to pick up these skills, who will teach them? Technical knowledge in psychiatry can be picked up in the CMEs but clinical skills have to be learnt during undergraduate clinical training only. So our MCI should include testing of clinical skills in psychiatry and psychology during exams. Then there is a higher probability that students will imbibe these skills. Leaving market forces to create motivation for this learning is not the right approach. I hope the MCI will oblige.