Staggering apathy to injustice

I enjoyed reading the editorial by Nagral (1) on the Ketan Desai/Medical Council of India issue, but regard it as yet another expose of the general and overall apathy to injustice and procedural irregularity among our Indian population, be it medical or general, and this is both staggering and depressing.

India faces Ketan Desais at every corner, not just in the medical sector, but in every walk of life; the only way forward seems to me to be for the government to wake up and lay down the rules very strictly. Should it do so, I expect the largely law-abiding population (at least 75%, although the figure will ever remain debatable) will fall in line. There is then the scope for governmental agencies to use their resources to target those who don’t play the game by the rules. They can use deterrents to enforce discipline and a civil code. This is how western societies have survived and flourished and we need to borrow the good in their systems, rather than adopt some cultural disorders.

India can best be summed up by the observance of road rules – no courtesy, no rules, no give! However, strict fines and deterrents work. Look what happened to the laws banning the use of mobile phones and requiring the use of a seat belt, both of which are being largely adhered to after a stringent system of fines.

Given the scenario of an unruly free-for-all system, private medical colleges are a major problem. It is perhaps incorrect to blame the private medical system alone, as the problem lies in the failure to set norms and enforce them. If training processes were standardised and supervised, some standard could be achieved, of that I am certain. Certainly the majority of students entering these institutions must do so on merit. I have heard of a son of a famous industrialist winning a place in Harvard Business School on the basis of his pedigree, rather than his academic performance, but that cannot be said of the majority. If the entry system is good, then the system is bound to improve.

Private systems can have checks and balances, and be sensitive to the needs of the population, provided there is law and order. Currently, those who follow the law do so because of their own conscience, not because civil law requires them to.

I cannot but recall the appalling standards in public hospitals during my student days, where untrained students and trainees ran riot, unsupervised by accomplished professionals. There were notable exceptions then, and things have changed somewhat for the better in terms of infrastructure, but we are still far away from providing standard medical care to the public. Opinion leaders in medicine often remark that private hospitals running accredited training courses do not provide enough operating opportunities for surgical trainees, whereas public hospitals provide these opportunities. Does that mean that patients in public hospitals can receive substandard care because they may be operated on by unskilled personnel? I think revision of the training programme for both undergraduate and postgraduate education is required, and this can be achieved only if medical students are allowed to apprentice during their student years in the wards and the procedure rooms, where they watch and learn, and, when it is their turn to perform, are better able do so in a manner that will ensure the patient’s wellbeing, rather than harm it.

The last paragraph makes two interesting observations. It suggests that India is too far gone on the road to perdition, and revolutionary change is required to bring things on track. And the reference to perdition brings to me a sense of despair. Is God the only solution for this country?