This is an invitation; but unusually long; so I’ll explain. QPMPA is dormant for the last 3 or 4 years and as a revival measure I’ve been selected as the new president. I’m convalescing from a spinal surgery and my age restricts an active presidency. But I am willingly shouldering the responsibility and with your support, we together can bring in a positive note to the depressing professional conditions. If we look back we can see that if any of our professional bodies can reverse the present down-slide, it is the QPMPA.
Many friends discuss with me their problems. It is almost always the same story... “I find myself in two minds... whether to continue as a doctor or not. When I look back at my career; I see, that in many ways I have become the kind of doctor I never thought I‘d become: impatient, indifferent and at times dismissive”.... I am sure most of us are in the same boat. We have lost our professional ideals. Or we are forced to shed them.
In the past four decades, we have gradually lost the status we used to enjoy in the society. In mid-20th century, we were the pillars of any community. If one were good in studies, sincere and idealistic, there was nothing more rewarding than becoming a doctor. QPMPA had stood by us all this time, but it is also in a sort of mid-life crisis. We take it for granted. But we want it to fight our wars for us. There is no increase in membership. Even our children keep away. The ideals we held as doctors don’t hold with the present generation. Doctoring is a profession no more; it is just a job like any other jobs, to make money. We have become like everybody else: insecure, discontented and anxious about future. Only a few describe their morale as positive. Majority of us have diminished enthusiasm for work and say we would discourage our children from following our footsteps. It is not a problem of age or money. We spend much of our time doing un-necessary paperwork or visiting offices or attending courts. Many friends wish to gradually reduce the number of patients and then stop altogether.
We strove; we made sacrifices — for what? We get too little respect from patients and public, despite good clinical judgment, hard work, and compassion. Working involves writing too many unnecessary tests (everybody now gets a CT!) We know patients don’t really need them. Being aware of such wastefulness sucks the love out of what we do. We feel like pawns in a moneymaking game. There are so many other ways we could have made our lives worthier. The sad part is we chose medicine because we thought it will be noble. But it has degraded into a charade.
How did we get into this collective discontent and despair? To some degree, we ourselves are at fault. In the halcyon days of mid-20th century, medical practice was also in a golden age. We set up hospitals, far and wide in Kerala, where the governments dared not. We gave people, health and hope. Poor patients in villages were saved from death and quacks. Life expectancy increased. Infant mortality came down. We pioneered the ‘Kerala health care’, which won international critical acclaim. Even WHO acknowledged QPMPA’s efforts. Popular depictions about us were overwhelmingly positive, almost heroic. We weren’t subordinated to politicians or bureaucracy.
But as we profited, we were increasingly pictured by vested interests as bilking the system. Distorted and biased reports of waste and fraud began to surface. People suspected that surgeons are performing unnecessary operations to collect money. Noble seniors warned colleagues “to quit strangling the goose that can lay golden eggs.” But sadly, very few, cared. Year after year, health-care spending grew. If doctors were mismanaging patients’ care, someone else will have to do it for them, claimed the media and politicians. To draw the circle full, we are now portrayed by all as professionally and personally fallible. We are at the mercy of wily clerks, incompetent health inspectors and newshounds and what not.
Reasons are many. One consequence of the so called ‘progress in medicine’ is... we don’t have enough time to spend with patients. Another is we had changed terminal conditions like cancer and physiological conditions like pregnancy into complex medical emergencies. While patients today pay more for the care, less of that money comes to us who are the real care providers. Our incomes haven’t kept pace with expectations. Then there is the loss of professional autonomy. Now we are pawns to be played by greedy and unethical players. And there is that constant fear of lawsuits. This growing discontent has serious consequences for patients too. One is the trend for defensive practice. We see every patient as a potential litigant.
Another is the looming shortage of doctors, especially in primary care. Today’s young population is going to require more doctors and aging doctors are getting ready to retire, with nobody to replace them. Interest in primary care is at an all-time low among medical students. Another consequence is – unhappy doctors make for unhappy patients. Patients are becoming disenchanted with doctors who are indifferent to their needs. In our days, patients used to talk about “my doctor.” But now, they have an average ten different primary care doctors and fifteen specialists in a year. Yet, they cannot find a doctor who remembers them. In patient-doctor relationships, insensitivity has become the rule, rather than the exception.
Of course, doctors aren’t the only unhappy professionals. Many lawyers and teachers are constrained by politicians, corporate structures and vengeful media. But the fact remains that for most of the 20th century, medicine was the ‘heroic exception which still sustain independent professionalism'. But, now we see it was ‘an exception’, the age of which has expired. Will this down slide reverse?
There are many measures of success as a doctor. Income, of course, is a main thing. But the art of creating relationships, the ability to make differences in peoples’ lives and providing hope and care for them while masterly managing the limited resources are more important. I believe most of us still want to become like the ‘physician knights’ of the golden age of medicine.
We went into medicine to help people; not to make money. It came naturally. We, the members of QPMPA, still want to practice medicine the right way, but many forces propel us in the opposite direction. In the end, the problem is one of resilience. We need an internal compass to navigate the changing landscape of our profession. For most of us, this compass begins and ends with our patients. We know the cherished part of our jobs is taking care of people, not making money. And, this is the key to cope with the present crisis.
Medicine is all about taking care of helpless people in their most vulnerable moments of life and, of course, making ourselves somewhat vulnerable in helping them. Those moments are what other professionals envy about us. No politicians, lawyers or newspapers can take those away from us. The most important, are those unforgettable human moments and they are the best means for our professional salvation.
We are installing the new office bearers, on Jan 23 at 7 PM in Kumar Palace, Punalur. This rather long invitation letter is the speech I wanted to make that day. But due to my condition I cannot make it in an effective way standing and talking to you, all the while. Hence I am sending it in advance. Please bring your family also because our meetings are always family affairs.
I solicit your continued support and expect your participation on Jan 23, 7 PM (Kumar Palace, Punalur). On behalf of QPMPA Punalur, I extend my invitation and New Year wishes.
Dr. Devadas (sd/-)
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