Long hours, poor facilities and insecurity: Doctors' distress is real and they have a right to strike
The problem is if medical care is an essential service, then protection of healthcare providers too is essential.
Should doctors strike?
I have been a part of many protests as a medical professional. As a medical student, as an intern, and as a resident. So I can fully understand the sentiments of how this strike has come about. So I believe I can speak on behalf of the striking doctors.
Believe me, it is always a moral and ethical quandary -- we make no bones about it.
As with all doctors all around the world -- Indian doctors too suffer from being absent to their own families, many going through bad marriages and suffering the stress of being overworked. Doctors have a higher incidence of alcohol and tobacco usage as well as drug abuse than other professionals. Depression is real in this profession riddled with uncertainties. In addition to these problems in the context of India, we have several other problems.
We want to treat patients. I could say with some confidence that the vast majority of us in this profession love what we do and would rather not do anything else. That is why we were willing to give the high cost it takes to become a doctor. Not just financially to study and train to be doctors but also cost to our own health and personal life.
Residents in government hospitals are forced to live in appalling conditions.
Every year several doctors die from contracting tuberculosis, malaria, and dengue due to long hours, poor diets, high stress and unhygienic conditions they are forced to work in. The junior doctors of hospitals have a higher incidence of contracting severe communicable illness than the general population. News pieces like Mumbai doctor dies of Extremely Drug-Resistant TB are all too common.
Junior doctors work terribly long hours and much beyond anything they are paid to do. As residents or even as junior consultants 100 hour weeks and 36–48 hour duties are par for the course in India.
Public hospitals in India are poorly equipped. Many of the existing basic equipment -- CT, MRI, ultrasound machines etc., are out of order on most occasions. Tertiary care hospitals are overburdened because the infrastructure in rural areas is mediocre and most patients have to come to cities, stand in long lines to get even basic treatment.
Conditions in private hospitals are somewhat better but come at a price -- which is why the entire middle class hates doctors and hospitals. They won’t go to government hospitals because they have to wait in long lines and know they won’t get personalised care while insisting the private players should work at cost. People who don’t know anything about what medicine is about decide how much doctors should be paid and how much treatments and surgeries should cost.
Politicians do one better -- they get treated in VIP wards in already crowded public hospitals sometimes bending rules -- Sushma Swaraj undergoes kidney transplant at AIIMS or they go abroad for treatment -- Karnataka minister gets treatment abroad, govt decides to foot Rs 1.16 crore medical bill. Either way, they are not affected by the problems of the general public or the doctors. Which is why India has one of the lowest public health expenditures in the world and 80 percent of medical expenses are out of pocket.
I bring up work conditions because one has to understand the cost that the doctors pay in serving the poor patients in government hospitals in India. If people only did this for the financial compensation, you will not have many people in this profession. Doctors working in such challenging conditions should have extraordinary motivations to make them tick in such environments. If a doctor working in these circumstances is now faced with constant threat of assaults it all just blows up.
Whenever doctors in India have a grievance - whether salaries not being paid for six months at a stretch, that there is no access to basic medicines in city hospitals and in rural areas, or now like the present issue - the very frequent assault on our colleagues in hospitals, etc., - we try our best to go through all the available channels so that we not stop what we love doing.
The role of an anarchist doesn’t sit well with what we came into the profession to accomplish. We really don’t want to hold marches in the hot sun catching placards, chanting slogans against the authorities, wearing black ribbons to work, creating awareness over social media about all the bad things happening in the medical profession. We would rather do things that make us happy and talk about the amazing things in our profession (they do exist despite all this). We would like to spend less time on negativity after a day’s worth of fulfilling work.
We understand that strikes inconvenience and antagonise needy patients - our most valuable assets. It is counter-productive because you then pit them against you. It deteriorates an already fast eroding doctor-patient trust as well prevent them from sympathising with your plight. To add to that, when doctors strike it is often the poorest among them who suffer - those that can’t afford a private hospital. We understand this all too well, which is why you don’t see doctors striking without keeping the emergency services intact.
If you see doctors striking, it means the issues have reached tipping point and they have tried all other methods to mitigate this matter. Junior doctors run the entire show in government hospitals in India. So them not working for a few days collapses the entire healthcare system in India. The junior doctors bear the brunt of the attacks when mobs decide to assault doctors. Yet the indifference of the government authorities is baffling. The unwillingness of the successive governments to take action on this issue is what has brought about this strike to a flashpoint.
What does the law say regarding striking doctors?
The state governments are armed with the Essential Services Maintenance Act which they are not shy of using when faced with doctor strikes.
I fully agree that healthcare is an essential service. It might be unethical and morally untenable to go on long strikes for doctors - especially ones that compromise emergency services. The problem is if medical care is an essential service, then protection of healthcare providers too is essential. When the government cannot ensure safe working environments, to expect doctors to work under a sword is unfair. This is a question of safety of not just the doctors but also the patients. What is the quality of care you can expect if doctors are going to be scared about being beaten all the time?
This is not a new issue. This has been happening for many many years. If anything it has become worse in recent years.
Someone recently told me, they have never known that doctors in India are beaten up regularly. I hadn’t either until I started working as a doctor. If people are hearing about it, it is because of this strike and several smaller ones before this. The people who sit in judgment on this issue are narrow-minded and self-serving -- the government, courts, police, media and even doctor-administrators. No one is listening to what the doctors have been saying. There is no interest in protecting doctors from nefarious elements. These junior doctors don’t have clout- they are viewed as cheap workers who are expendable according to the government. There is no incentive - financial or political for any politician to help doctors in their work.
Many doctors today are discouraging the next generation from taking up the same profession. Seeing that this profession comes at such personal costs and there’s so much disillusionment waiting for them further down the road, I really don’t blame them. I keep reading the following article by a doctor from time to time and keep thinking that things haven’t changed one bit.
The author is an ophthalmic plastic surgeon based in Bangalore. This piece first appeared on Quora.
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