Leisure, Lifestyle & Wellness
Good Doctors for Indian Villages

Training good doctors must begin ground up

 

The usual complaint from politicians is that doctors are reluctant to go to villages to serve the rural population. Politicians try and devise quick-fix measures, some of which appear draconian. Yet, nothing seems to work in the long run. Today’s MBBS courses do not train a doctor in good bedside medicine, to practise in villages where diagnosis cannot be left to technology and tests. Their training is technology-focused and diagnostics-dependent; as such, it cannot be extrapolated to a village setting.

 

Scientific studies show that 80% of accurate diagnosis can be made by simply listening carefully to the patient and physically examining him/her. This message does not get through amidst the cacophony of the technological claptrap. Today’s doctors cannot diagnose a brain attack without MRIs and CAT scans. Even a simple tension headache needs a CAT scan to rule out early cancer! Healing outcomes were much better before any of these gadgets were invented. The obsession with tests and reports is more to save the doctor’s skin in this era of consumerist action.

 

Today’s MBBS courses are top heavy with theoretical information, cramming information for exams, and little hands-on bedside experience. Except during the end of the year examinations, students rarely spend enough time at patients’ bedsides. Doctors-in-training have little time in the midst of ever increasing specialities and the race to get their nose into graduate teaching and evaluation. We need a completely revamped course, much shorter than the present-day MBBS course, with more stress on bedside diagnosis. The filtered lot of terminally-ill patients in the teaching hospital ward setting, gives the student a distorted version of disease incidence and prevalence in society.

 

The course could be three-year long, with anatomy being taught in the first three months and alternate medical systems’ knowledge being taught in the final three months, along with medicine, surgery and midwifery. The evaluation system should be an on-going process without the need for end of the year exams, except in the final year where the student appears for an all-India test.

 

We can even relax the entry criteria. Admissions need not be based on the marks obtained in the entrance test, but on a well-devised aptitude test, with pass marks in the so-called 10+2 level as the cut-off. We should foster a culture of the intern ‘following in the footsteps’ of his mentor, in the true sense of the phrase. On successful completion of the internship, the young graduate must be made to serve in a village for five years, before qualifying to go for a one-year condensed MBBS course.

 

Nowadays, students also avoid the vital internship year during which they are supposed to have hands-on bedside experience. Post-graduation should depend not on the marks obtained in the final examination, but on the number of years of village service—the longer the better. The condensed MBBS course should be devised to fill the gaps in their initial degree course. This will ensure that we have a steady supply of good, humane, clinically trained doctors for our villages. The present public health centres (PHCs) could be closed to make room for village schools as the centre of village health.

 

The two new ideas, in tandem, will ensure that every Indian village is adequately covered for sickness and healthcare. On each of the topics discussed here, I have been writing exhaustively for years; these are available in books and articles all over the world. These ideas could be modified, depending on local needs. We must move fast in this direction; otherwise, our Western-oriented medical training will produce second-grade doctors for Western hospitals and not for our masses in far-flung villages.

 

This approach is also fair to the new doctors, since all of them would get an opportunity to go up the ladder, if they do well. In addition, this will deter young doctors from trying to get their post-graduate (PG) degrees without any hands-on experience, immediately after MBBS which only makes them good technologists and very poor doctors. We could then easily abolish the burden of huge amounts of black money changing hands under the table, for PG seats, ranging from Rs2 crore to Rs4 crore per seat, depending on the subject.

 

(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.)

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COMMENTS

vinayak mahajan

2 years ago

why should doctors only do rural service? government is spending more money on engineering, particularly on IITs, after 4 years of engineering they fly abroad not even thinking about country and thinking that it's a birth right to serve MNCs. Make a rule that every engineer should work first in government offices, then only they can do private or Govt jobs. Now a days it has become a fashion (including film stars and leaders) saying that doctors only have social responsibilities and to maintain moral values, ethics etc. An idiotic leader takes one rupee salary per month and maintains a Benz car, another stupid star takes crores for one episode and comments on DOCTORS professional services. Lets demand that every charted accountant should work in government banks and audit department, every engineer should work in government engineering offices, every lawyer should work in courts for one year before they were given their degrees.... WE HAVE LOT OF BACKLOG OF CASES.. Why only doctors?????

Mahesh Kumar Tennati

2 years ago

Dr. Hegde, Great suggestions. May be you should directly write to PM with all your suggestions, at the following url
http://pmindia.gov.in/en/

'No more, no less, buy the exact quantity you paid for'
IG Sanjay Pandey, who is Controller of Legal Metrology (Weights & Measures), says, a short delivery, excess demand and overpricing are considered offences against the society and lead to penalties if consumers file a complaint
 
If consumer gets short delivery of the commodity or thing than it is paid for or contracted for, similarly in the services also, it amounts to an offence. However, not many consumers know about remedies available to them to get justice. Such consumers can easily file a complaint before the Legal Metrology Organization (weights and measures).
 
 
Speaking at a seminar organised by Moneylife Foundation in Mumbai, Inspector General (IG) Sanjay Pandey, who is Controller of the Legal Metrology Organization, said, "Due to improved lifestyle of the people, consumer protection movement is now going on in an aggressive manner. Therefore, it is not only just and fair to enforce the provisions strictly but is absolutely essential to enforce the provisions of the Acts and Rules in the interest of common consumers."
 
"We are looking into three areas. One is how builders sell property on square foot basis and how registrars are registering it on sq ft basis. Second is defining call duration standards for telecom companies. How these companies measure the second? It is certified by the authorised government agency. Third area is digital measurement. How the companies are selling GB or MB and who and how it is certified? Soon you will see some action in these areas," he added.  
 
The main role of the Organization is to protect the consumers' interest by surprise visits or inspections at Traders premises, packers, importers, packaging units and industries to verify the accuracy of weights and measures as well as to check the net contents effected by them. A short delivery, excess demand and overpricing are offences against the society. The legal metrology organization keeps a strict vigil on the offenders and enforces the provisions of law by firm hands.
 
 
Deterrent penal provisions are prescribed for errant traders and other persons under the Legal Metrology Act. Such offenders are brought to book and punished accordingly. There is a provision in the Act to compound prosecution cases at the department level if the offender has committed the said offence for the first time. Under such circumstances the Authorities impose compounding fees upon the offender and the matter is settled at the department level. However, if the option is not exercised by the offender to get it compounded at the department level, then the case is sent to the Judicial Magistrate First Class (JMFC)/Metropolitan Court and then it attracts the provision of Criminal Procedure Code (Cr.P.C.) as it is treated as criminal case.
 
According to Mr Pandey, even builders who are selling properties using square feet instead of metres for measurement can be booked under the Act. "This is because, in 1956, the Indian government passed a Standards of Weights and Measures system to introduce metric system based on Punjab Act. The metric system began in October 1958, making metric weight mandatory by October 1960, and the metric measures mandatory by April 1962 banning all other systems."
 
"Puranik Builders published an advertisement that promised 45 sq feet free. We then issued a notice to them. Now the advertisement says 45 smiles instead of 45 sq feet. But let me make it clear again that no builder can sell property on square foot basis as it is illegal. Under the metric system it can be sold only on square metre basis. We have written to MHADA and are gathering more information on this," he added.
 
While buying any pre-packaged commodity, Mr Pandey said, consumers need to check mandatory declarations. This includes...
a) Name and address of the manufacturer or packer or importer.
b) Generic name of the commodity.
c) Net quantity in terms of standard units of weight or measure or number.
d) Month and year in which a commodity is manufactured or packed or imported.
e) Retail sale price of package in the form of maximum retail price inclusive of all taxes or in the form of MRP Rs...... inclusive of all taxes.
f) For complaint redressal, every package shall have name, address, telephone number and email if available, of the person of the company. 
 
Several times, consumers are charged more than the MRP of a product. Many times, there is an alteration in the MRP printed on the package. Under the Act, both sale of packaged commodity more than the MRP printed (overpricing) and alteration in the MRP printed are offenses, said Mr Pandey. "Even MRP printed without mentioning 'inclusive of all taxes' amounts to an offence and consumers approach our department for all these violations. We will immediately initiate appropriate action," he added.
 
According to Mr Pandey, to avoid the legal scanner, many packaged water suppliers are selling bottles with higher MRP printed to 5-star hotels and malls. Sometimes, they even use a separate brand name for these water bottles, which are sold only at these places. “Since they sell at MRP, we cannot initiate any action. However, if they charge more than the MRP printed, we can certainly initiate an action against them,” the chief of Legal Metrology Organization added.
 
Earlier in October and also in this month, the Organisation, headed by Mr Pandey conducted several raids on companies, dealers and owners of CNG and LPG filling stations. It was found that over 20 CNG and LPG filling operators across Mumbai, Thane and Navi Mumbai, never bothered to use the dispensers (regular pumps) approved by the government.
 
“Our department realised that the dispensers used by these owners and dealers were not fit enough to serve the consumers and they could possibly swindle them. Hence, we decided to conduct surprise checks and the results were surprising. Our department has seized 20 dispensers and disciplinary process has been initiated against the dealers in the court of law,” Mr Pandey had said at that time.
 
The Legal Metrology Organisation was launched on 6 June 2007 by former chief minister Vilasrao Deshmukh to protect the consumers’ interest by surprise visits or inspections at the traders’ premises, packers, importers, packaging units and industries to verify the accuracy of weights and measures as well as to check the net contents supplied by them. 
 
Indian weights and measures (From Wikipedia)
 
Before the introduction of the Metric system, one may divide the history of Indian systems of measurement into three main periods: the pre-Akbar's period, the period of the Akbar system, and the British colonial period.
 
During pre-Akbar period, weights and measure system varied from region to region, commodity to commodity, and rural to urban areas. The weights were based on the weight of various seeds (specially the wheat berry and Ratti) and lengths were based on the length of arms and width of fingers. Akbar realized a need for a uniform system. He elected the barley corn. Unfortunately, this did not replace the existing system. Instead, it just added another system.
 
British entered India as traders. They accepted barleycorn as a unit 'grain' for weighing gold. They minted coins using wheat berry as the standard. Eventually, British introduced their own system for weighing gold (Troy ounce), commodities (Pound/Cwt/Ton). Now, the roads had Furlong and Mile markers. In 1939, Government of India passed the Standards of Weights Act that came into effect in 1942. This allowed Tola/Seer/Maund system to coexist with Pound/Cwt/Ton system.
 
In 1941, the Punjab Weight and Measures act provided a sense of uniformity. In 1956, Government of India passed a Standards of Weights and Measures system to introduce metric system based on Punjab Act. The metric would begin in October 1958, making metric weight mandatory by October 1960, and the metric measures mandatory by April 1962.

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COMMENTS

Bapoo Malcolm

2 years ago

We came away with a sad feeling. Officers of this calibre, instead of being encouraged, are being shunted. One could see, sense, feel the frustration. How long will we have to tilt at windmills?


Bapoo M. Malcolm

manoharlalsharma

2 years ago

'No more, no less, buy the exact quantity you paid for' we r filling complaints since last 15 years to JTR/CBD,CIDCO and also filling at HC what happened at final-A co operative minister TERN DOWN the orders and than HC admits FRIVOLOUS or VEXATIOUS CASE / MERIT LESS ad than YEARS of LOOT.NO ONE do nay thing because grant of STAY from HC

Nifty, Sensex shoots up due to crude oil price collapse – Weekly closing report
Nifty will weaken a bit mid-week but the trend is higher, thanks to fundamental change caused by oil price collapse
 
The S&P BSE Sensex closed the week that ended on 28th November at 28,694 (up 359 points or 1.27%), while the NSE's CNX Nifty ended at 8,588 (up 111 points or 1.31%). Previous week, we had mentioned Nifty may keep pushing higher, as long it does not close below 8,350 for the week.
On Monday, Nifty had a positive range bound move until the noon session. However, it then gathered strength and rose to close at a new lifetime high. Nifty closed at 8,530 (up 53 points or 0.62%).
 
Parliamentary Affairs Minster M Venkaiah Naidu, said Sunday that there is the need for early passing of Insurance Laws Amendment Bill that seeks to enhance FDI limit in capital-starved insurance sector by the Rajya Sabha.
 
On Tuesday, Nifty recorded a loss on higher volume on the NSE. The loss was the highest since 16 October 2014. Nifty closed at 8,463 (down 67 points or 0.79%). The current up move was shaken with the SEBI imposing restrictions on issue of offshore derivative instruments or P-notes by foreign portfolio investors.
 
On Wednesday, the move on the Nifty in the morning session seemed like it would book loss for the second consecutive session. However, in the noon session the benchmark moved higher and remained in the green zone till the end of the session. Nifty closed at 8,476 (up 13 points or 0.15%).
Global rating agency Moody's said India's credit trends in 2015 will depend on steps governments takes to address high fiscal expenditures, recurrent food price inflation, and wide infrastructure deficit. The sovereign outlook for India (Baa3) remains stable.
 
On Thursday, Nifty witnessed a volatile session especially due to the expiry of November futures and options (F&O) segment. Nifty closed at 8,494 (up 18 points or 0.22%). Moody's expects the country's GDP to grow at 5.3% in the July-September quarter of the current fiscal, better than 4.8% clocked in the year-ago period. The Indian government will announce data on gross domestic product (GDP) for the quarter ending September 2014 on Friday.
 
With the fall in crude oil prices, the benchmark back home witnessed an upsurge. Nifty closed at 8,588 (up 94 points or 1.11%).
 
The Indian government is considering a plan to reduce stakes in state-run banks to 52% that could enable it to raise about Rs891.2 billion ($14.39 billion), Jayant Sinha, junior finance minister told lawmakers on Friday.
 
Out of the 27 main sectors tracked by Moneylife, top five and the bottom five sectors for this week were:
 

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