Dr Sanjay K Bhasin
sanjaybhasin6009@gmail.com
Grooming of a Medico
Hippocratic Oath, which doctors world over are exposed to at their entry level in the profession says, “First, do no harm”. Additionally, Medical education in India has an inbuild feature of grooming the doctors into thinking that they, as individuals, need to work beyond their capacity to make up for systemic failings at the expense of their own well-being. They spent whole life in the pseudo image of ‘Demigods’ as representatives of “Noble Profession” created through teachers, colleagues, family and friends in their lives. After forty years in this so called Noble profession, I have learnt this that pseudo glorified image hides behind it the systematic exploitation, frustrations and something very precious last in all these years.
Another taught narratives, “You must put the patient first and yourself last”, creates havocs in personal life of a doctor as asking for basic human needs like rest, mental health care, or fair pay is seen as a weakness and a lack of moral fortitude rather than a necessity.The COVID-19 like situations has added to the woes of medicos by virtue of getting ill-treated by the public and the authorities in spite of risking their own lives for the safety of suffering humanity. Unfortunately,frontline health care workers have become vulnerable to the behavioural and mental health fallout resulting from this global crisis. Efforts to reduce or prevent our acute and chronic stress while promoting positive, adaptive ways to face our ongoing challenges may seem impossible, but experiences in previous epidemics suggest that we can successfully enhance our resilience.
Healer Struggling Thyself:
India’s public healthcare system faces significant challenges from chronic understaffing and weak infrastructure.According to the Rural Health Statistics 2021-22, over 4,000 Primary Health Centres (PHCs) in India operate without a doctor, and nearly 25% of Community Health Centres (CHCs) lack essential specialist staff. Ironically, projected overall doctor-to-population ratio stands at 1:834 in India, against WHO’s recommended minimum of 1:1000, this figure on ground masks serious disparities in rural and underserved regions.
A report reveals that less than 20% of ambulances under the National Health Mission met the Basic Life Support (BLS) standards. Many public hospitals also lack pharmacies and diagnostic labs, rendering prescriptions and referrals practically useless for underserved patients. This systemic fragility compounds the pressure on medical professionals and undermines the very purpose of accessible healthcare. While operating within this broken system, the doctor takes on a heavy burden of ensuring the patient’s health while many, if not most factors are operating against it. If untoward consequences happen to the patient, the medicos have to face wrath of the public, media and the people in governance with allegations of a personal failing of the doctor rather than the system failure, in spite of taking care of patient needs during extended duty hours.
Over the past several years, medicos burnout has emerged as an alarming phenomenon which is wide spread and growing unchecked. A 2017 study by the Indian Medical Association (IMA) found that over 75% of doctors across India have experienced workplace violence, with nearly 63% feeling unsafe while treating patients. Another study reported that nearly 70% of doctors encountered violence at work. Violence against doctors has become a new norm in the society backed overtly/covertly by all components of the society including media and the politicians, sometimes resulting in serious injuries or even death.
The Physicians Foundation’s “2018 Survey of America’s Physicians” found that burnout phenomenon have increased from 74% in 2016 to 77.8% in 2018 amongst medicos. Burnout is “a stress reaction marked by depersonalization, emotional exhaustion, a feeling of decreased personal achievement and a lack of empathy for patients.” Post-COVID it has further increased. The 2021 Medscape National Physician Burnout & Suicide Report found that for 79 per cent of U.S. physician experienced burnout even before the start of the COVID-19 pandemic.Medicos are overworked, bogged down with administrative tasks and saddled with unreasonable volume expectations. But in spite of all this, the society, we expect a lot from medicos perhaps now more than ever, as technology has enabled the patient to be in the driver seat.
Who Does This Indoctrination Serve
In India, a doctor’s identity is often inseparable from their professional role, made so by the education system. When illness, age, or physical limitations affect their ability to work, the system offers little room for vulnerability or support. They are taught not just to care for others, but to become professionals entirely, where over-sincerity is rewarded and personal boundaries are blurred. Further, accountability is demanded almost exclusively from doctors, without examining the surrounding environment and system lacunae. The scenario not only isolates those in crisis but quietly punishes anyone who can no longer perform at full capacity, pushing some to devastating ends in spite of system failures.This indoctrination basically is influenced by hospital administrators, politicians, and policymakers thought process and working.
The idea that a doctor must sacrifice their own well-being to prove their dedication is flawed and unsustainable. I personally feel that true dedication lies not in self-sacrifice but in the ability to provide the best care while maintaining one’s own well-being. My point is, to be a good doctor, one should not require martyrdom. Medical competence and compassion are not proportional to suffering endured. Basically a system that forces doctors to the brink of exhaustion does not create better healers; it creates broken individuals who struggle to function. We must recognize and accept that “a healthy doctor is a better doctor” without equating him with anything else and drawing parallels.
Healing the Healers: A Call to Action
The phrase “physician, heal thyself” has been used as a proverb to allude to the notion of attending to one’s own illness before attending to that of others, but lessons form COVID-19has added a new proverb, “healing the healer”, that sounds not only alarming but warning also. The consequences of overlooking these stressors could cost much to the society. Doctors needs not only to protect the lives of patients but their own also to remain the tireless stewards of the public safety for all times.
So herein;is the big question, How are doctors expected to be the advocate of patient’s health needs if they are in need of healing themselves? Can they? In fact, it’s extremely difficult and it’s an emerging big problem. The well-being of medicos is under scrutiny like never before, with good reason.
Conclusions:
Both communicable and non-communicable diseases are on the rise world over and the healthcare delivery system of the world is not so healthy in almost all developing countries. The healthcare providers are suffering due to system failures and the solution is not just about policy changes but a fundamental shift in perceptions. Administrative machinery including Hospitals must acknowledge that burnout impairs judgment and patient care. Institutions must integrate mental health support into medical training rather than treating it as an after thought. Governments must invest more on pay, perks and better facilities for medical professionals including providing them with better infrastructure so that the burden is distributed fairly. Doctors deserve safe workplaces, free from the threat of violence, and society must see this not as a privilege but as a necessity for effective healthcare.If doctors are expected to heal others, shouldn’t we ensure they aren’t broken within themselves?
The system must move beyond conversation and temporary outrage to systemic reform, without exaggerations and subduing the sacrifices of the professionals. The medical profession should be one of dignity, not distress. Without urgent intervention, we risk losing not just individual doctors to burnout and despair, but the very foundation of our healthcare system. The system needs healing before it breaks beyond repair.
(The author is Professor of Surgery, GMC Jammu National GC Member, Association of Surgeons of India)
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