Resident doctors from Rajasthan (India) Medical colleges were in news once again due to their strike, alleged mis-behavior and alleged negligence in patient care. Forget the public, even local doctors sometimes wonder about the truth of these allegations.
Are resident doctors truly incompetent, lazy, and arrogant or are they just misunderstood, misrepresented hardworking component of the medical care of medical colleges?
Some genuine factors, which may be working against the resident doctors, should be kept in mind by the general public and medical fraternity before passing any negative comments on them.
Maximum contact: Resident doctors come in maximum contact with the patients. As the traffic density increases on the road, the probability of accident rises, similarly the chances of confrontation and friction with patients and their attendants increases with the high contact hours between the resident doctors and the patients. If we take into account the hours of contact between serious patients and their attendant and the resident doctors, the rate of conflicts will appear quite low.
On the spot availability: Resident doctors are on the spot and therefore, paradoxically, frequently their work and efforts are not appreciated by the patients. They do not feel satisfied with them.
One incident which occurred with one senior surgeon will be illuminating. He was doing Casualty Medical Officer (CMO) duty in MBS Hospital casualty and was also the on-call consultant for that day. One serious patient of RTA (road traffic accident) came to casualty and he was well attended by him.
But his attendants insisted that you call the on-call consultant by ambulance to see the patient. His effort to explain that he is the on-call consultant and ambulance will bring him only was simply not believed by them.
Patient’s attendants attach special charisma to doctors coming from home to especially see their patient. Resident doctors, unfortunately, lack this charisma by being readily available on the spot.
Non-local: When Jhalawar Government Hospital got upgraded to Medical College, it was in news just sometimes later that a senior resident doctor was man-handled there by some patient’s attendants. This may lend credence to the public and even some doctor’s view that the level of hospital falls once it is converted to medical college leading to increased incidence of bad incidents between the patients and the doctors.
This alleged increase in bad incidents once resident doctors come to hospitals attached to medical colleges can be well explained that the fact that the majority of resident doctors are not non-local, sometimes even from outside the states, selected through All-India Pre PG exams.
Local doctors recognize local troublemakers and provide special treatment to them. Even trouble makers stay away from local doctors. Local doctors have found that if attendants start getting heated up, just talking to them in the local accent/ tone/ language to them work wonders, and most automatically calm down.
Sometimes trying to act smart with local doctors can turn out very embarrassing for the troublemakers. Once a local public leader phoned one local doctor. In an angry abusive tone he asked the doctor, ‘why are you not paying attention to my patient. Don’t you know who I am?’ The doctor replied: ‘I quite know who you are. You are the same person who was badly beaten in Jubilee Hostel 2 years ago.’ The public leader instantly disconnected the phone and never again phoned him or came in front of him.
Similarly, one brash young man told the treating doctor: Don’t you know that I was the president of student’s union Government College, Kota 3 years ago? The doctor who had studied for graduation before joining MBBS course, in the same college, replied: ‘Don’t you know that I was the president of student’s union Government College, Kota for 2 years, when you were sucking your thumb in diapers.’ Hearing this reply the youth instantly mellowed and said meekly: ‘You are from Kota? Sorry, sir, I thought you were someone from outside.’
Once Dr. Dev (fictional name) was on CMO duty and a patient of serious head injury came to casualty in MBS Hospital. Dr. Dev started the treatment but it was clear that the patient was unlikely to survive. A mob of his relatives and well-wishers had collected in the emergency. Shortly afterward the patient arrested, i.e. the heart stopped working, and cardiopulmonary resuscitation (CPR) was started by Dr. Dev and his team. In between CPR, Dr. Dev received a call by a local leader who was known to him on his mobile. He asked Dr. Dev about the condition of the patient. On hearing that the patient had cardiac arrest and unlikely to revive, he himself advised Dr. Dev to get away fast from emergency after declaring that the patient has expired as his attendants may get emotional and try to manhandle him. Although he promised that he will try to keep them as calm as possible which he did.
Therefore being non-local is quite disadvantageous to resident doctors but it is something they cannot help. By the time they become recognized locally, their 3 years tenure gets over and a new batch comes.
Overworked: Resident doctors are frequently overworked especially on emergency call days. Being less in numbers works to their advantage as they get maximum clinical exposure and experience but chances of committing mistake and giving vent to angry outburst increases. One study in the west found that doctors towards the end of sleepless night duty have decreased mental responses equal to someone who has drunk 2 bottles of beer.
Youthful appearance: Old age in worshiped in medical profession both by the public and medical fraternity itself. The youthful appearance of resident doctors works against them, and even with the correct treatment, they do not feel satisfied by the resident doctors.
One resident doctor who had come to do Post Graduation in surgery after a gap of more than 5 years after MBBS, and looked quite mature in appearance as compared to his age, told me that whenever he attended any call he was never asked by the patient’s attendant to call someone senior to see the patient. Due to his mature physical appearance, the patient’s relative assume that he was a consultant surgeon and not just a resident doctor.
Satyamev Jayate: Due to their young hot blood and idealistic view of the world, resident doctors frequently say things bluntly in a straightforward manner which they believe is true, while older doctors frequently gauge the mood of the mob and act accordingly.
Resident doctors believe that ‘right’ is always ‘might’ but the older doctors know that today the ‘might’ is ‘right’.
The Label of student: Resident doctors in many places, such as Rajasthan, have given the label of students and they are not officially recognized to do even things that any MBBS qualified doctors should be able to do.
A Medical Officer (MO) posted in a village can look after Medico-legal cases, treat RTA victims and poisoning cases independently, but the same MO if comes as a resident is not deemed competent to deal with the same type of cases, as he is labeled an under-training doctor now. This label of trainee also leads to decreased patient satisfaction even when they may be getting the correct treatment.
This is in contrast to Delhi and other states where resident doctors see officially all cases, sit and independently in separate chambers, even prepare MLC reports, and go to court to give evidence in cases of related to their specialty.
The aspect that resident doctors are proper MBBS qualified doctors having equal right and knowledge as any Medical Officer should be highlighted to raise the public’s confidence in resident doctors.
No favors needed: Most resident doctors do not plan to settle down in the place where they are doing PG. They do not have the fear of transfer from one hospital to another. Therefore, they are not impressed by local politicians and administrative officers and do not feel any need to maintain good relationships with them. This frequently antagonizes them and they may not be supportive of the resident’s side if a conflict occurs between the residents and patients.
Poor media management: Resident doctors frequently underestimate the role of media and do not actively manage the news floating about them. In today’s media dominated world neglect of this aspect can create an unfavorable image in the public’s eye.
So, friends, there are diverse factors responsible for the bad publicity for residents and not just any true negligence on their part. Resident doctors are humans and mistakes can occur by them, but frequently true mistakes go unnoticed and some alleged mistakes get highlighted spoiling their reputation.
(Based on true incidents)
— ND
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost.
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm.
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