Medical Education

MEDICAL EDUCATION – NOT IN PINK STATE OF HEALTH

Dr Anil Bhadoria, President, IMA Indore

The science of healing has been considered a noble profession of service. Since ancient times, civilizations had the first and foremost aim to practice this Science under the oath to serve and to charity. Around 300 years ago, the then physician from Europe excavated human bodies from the graveyard and started dissecting human cadavers to understand the inside structure of the human body and thus practice of Modern Medicine was established. Basic knowledge of modern science evolved in due course which is known nowadays as Mainstream medicine or Allopathy. Allopathy is defined as the treatment of disease by conventional means i.e. with the help of drugs, radiation or surgery having effects as opposed to its symptoms. It’s an Evidence-Based System of healing through many diagnostic tools and the treatment regimen is the product of robust scientific research. Drugs also are scientifically developed from various herbal, animal, human as well as synthetic resources and have natural and therapeutic effects. Drugs may have negative effects too as allergic, adverse, unexpected effects or food interactions. And therefore this science needs to be understood at the molecular and microbiological levels always to minimize treatment failure and maximise cure rate.

Health services and medical education have been declared a State issue as per our federal structure of India and thus Medical Education also is a state affair. To anybody’s understanding with dismay and everyone’s chagrin, the States could not afford the good infrastructure and sufficient manpower in government medical colleges leading to inappropriate and inadequate production of good number of medical professionals who can serve at a primary or secondary level of health care delivery system.

An exclusive teaching of medical science in English language only has placed many barricades for the bright student from small-town who are may produce good results if taught in vernacular langauges. These students struggle with the Medical language of teaching as English which itself borrowed medical terminologies from Greek, Latin, Spanish, Portuguese and Polish.

A European Physician Arthur Oslo, said “The practice of Medicine is an art of probability and science of uncertainty.” So, in this indefinite and infinite science of healing, probability and uncertainty go hand in hand. In 1857, India under English Rule had just 3 Medical colleges. In 1947, the number of medical colleges stood at 19 with 1000 odd students. As of today, 604 medical colleges are operational out of which 290 are in Government Sector while 265 are private and 49 are deemed ones. In all total 90675 UG seats and 42000 PG seats. National Eligibility & Entrance Test (NEET) gets around 1.5 million applications every year to appear in NEET for 95000 seats. And as per population, the number of doctors in India is falling short of, figures like 650 thousand.

Private medical colleges mushroomed in the last 2 decades. Whatever their motive may have been but this is so far sure, we are now producing very expensive doctors at both UG & PG levels. And no aid or scholarship can meet the fee of private colleges. In the last decade or two, the medical profession has been pushed to the wall to cough hefty cash to study in the private sector.

    

Who is at the end of the suffering? 

The common man has to resort to Government hospitals facilities where manpower and diagnostic tools are scarce in quantity as well as in quality. The pathetic situation of Government hospitals at PHC, CHC, District hospitals or Medical Colleges, is not hidden from anyone and that prevails all across the nation. Major problems at Govt Health institutions are decision-making in recruiting skilled manpower, in installation of investigation machines and critical care units at all basic and advanced levels. A poor salary structure doesn’t motivate the young medical graduate to enter the government sector that too in the rural area. The intent of money-making out of this noble profession is fear-driven by life-threatening consequences. This fear factor has imposed a negative image of the medical fraternity and thereby jeopardizing the whole structure of medical service.

What is the way out?

135 crore population will always seek health services for curative, palliative, and conservative modes of therapy as an active ingredient of modern medicine on IPD as well as OPD basis. To impart better medical education through government institutions be planned in such a way that the student’s fee is deposited partly by state govt/central govt & their parent in a single type of fee structure in all Medical colleges. If a subsidy is extended to Medical colleges be it Govt or Private, the burden of fees will be less on students and it will mirror an ethical Doctor in the field. The Doctors will be motivated to attend rural postings as well under the compulsory bond or on Govt jobs. Medical Colleges in Govt sector have been made sustainable by Rogi Kalyan Samiti yet a lot can be done to let them use their vacant land for commercial activities so that medical education fee remains in an affordable range for one and all. Donations from Alumni Associations of the college may be a point of consideration for poor students who require help. CSR from corporate hospitals can be asked for the mother institute in their local area which are upbringing doctors, nurses and other paramedical staff. The corporate hospitals may get students for internships and other postings in return at no expense. This way financial burden of Medical college can be reduced and at the same time, young trainers will get an added opportunity to serve in state of art corporate hospitals in their local area.

 

Secondly, to inject a dose of faith into society, an ethical fee structure may be designed for all doctors to practice in the field. A newcomer Doctor, a moderately experienced medical specialist, a highly qualified super-specialist and a widely experienced surgeon or physician may have different fee structures while practising in private. A fee structure for the service provider as a Doctor may incorporate a variety of factors like a home visit, night call, emergency call, dispensing of drugs, cosmetic cause, life-saving cause or minimal invasive or minimal lesion procedure. All such factors already are functional in Corporate hospital set-up and this can be added to Medical Practitioners in the private sector.

 

Thirdly, preventive medicine practice has to be added to the school curriculum as a part of medical education. The human body works as a machine needing raw material as food for the processor as digestion and disintegrator with waste product evacuation. Yoga, dance, swimming, walking, running, jogging, cycling, and trekking are known physical workouts of this era. If done daily for 45 to 60 minutes these exercise modules will help to keep one’s health in shape by all possible parameters. This will avoid one from falling sick and being at mercy of expensive hospital treatment. The dietary practice has changed in the last few decades and some dietary myths have rendered many people to suffer from Lifestyle diseases. A balanced diet which includes regular additions of water, various pulses, multiple grains, seasonal fruits and vegetables, milk products and enough sun exposure, proves sustainable.

 

Fourthly, a holistic approach towards the attainment of health is a must to accept and understand. No treatment protocol is perfect or full-proof, yet the best of all treatment protocols out there, will get a sound state of individual and social health. A basic profile of exercise, balanced diet and meditation will take care of physical, mental, social and spiritual well-being has to be the first and foremost motto of any living human being.