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Medical colleges in India

The National medical journal of India

MEDICAL COLLEGES IN INDIA We read with interest the articles “Which are the best undergraduate medical colleges in India?” by Arora et al. and “Do the bells toll for our public sector hospitals?” by S.K.Pandya.1 We feel both were linked, and would like to comment on the declining standards of our profession. Doctors broadly fall into the following five categories: 1. Those who work in primary health centres and other rural areas including non-governmental organizations (NGOs): There are many in these areas who take their jobs seriously, in spite of all the hardships they face. It is they who treat the bulk of our countrymen who live in the rural areas and are responsible for immunization programmes and other curative and preventive aspects of medical care. Corruption, indiscipline and inefficiency among doctors and other staff in many large rural hospitals are leading to migration of patients to the private sector. This is unfortunate as most poor patients are dependent on public hospitals for survival. 2. Doctors in teaching institutions: It is sad that there has been a decline in the number and quality of doctors in the important non-clinical disciplines such as Anatomy and Physiology, primarily because these subjects do not make a doctor ‘successful’. This is probably one of the reasons for the low faculty: student ratio in many of the clinical specialities who teach and train medical graduates and take care of poor patients. THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 9, NO.5, 1996 p.253 Most doctors in teaching institutions concentrate on their private practice and neglect teaching and research. Political interference in postings and bureaucratic apathy are important additional reasons for this state of affairs. The teaching in medical institutions is also flawed with emphasis on curative rather than preventive care. There is a need for radical changes in the teaching curriculum. 3. Doctors in private practice: These doctors are playing an important role in the management of health in India today because, unfortunately, the failure of the public health care system is responsible for many patients preferring the private sector. The major problem in private health care is the high cost of treatment. Many poor patients just cannot afford it and have no other option except to go to public hospitals. Further, unnecessarily expensive investigations and negligence in management have been reported from these private hospitals leading to the enactment of the Consumer Protection Act. Though many of them are doing commendable work, they benefit only the affluent. 4. Superspecialists: Recent advances in medicine have made medical care prohibitively expensive. Tertiary care, except in a few centres, is virtually non-existent in public hospitals. After super specialty graduation many doctors thus prefer to join private sector hospitals rather than teaching institutions. These doctors go abroad and work in the Middle East or Western countries if the opportunity arises. Except for a motivated few, they have no interest in teaching or participating in research. THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 9, NO.5, 1996 p.253 2 5. Doctors doing research: It is this breed, which is fast becoming extinct and it is to their credit that some do take up research careers against enormous odds. It is sad that we still have to read western journals and textbooks to gather information on common ailments in our country. Research need not be only ‘basic’, it could also focus on common diseases in our country and determine guidelines of management in our setting. Research is not a priority in many teaching institutions. Though many attend conferences and present papers, few care to publish these. Therefore, the data on many illnesses are inadequate. India’s contribution to medical science has been dismal. The recent controversy over the ‘plague’ epidemic is proof of the state of our scientific institutions. The result is that we have inherited a public health care system which is headed by bureaucrats and professional whose decisions are far removed from the needs of patients and a private health system which is concerned largely with profits and is not accountable to anyone. There is now a major brain drain from the public to the private sector. If everyone wants to become a specialist and treat only the rich, medical institutions will die. S.Shivakumar J. Amalorpavanathan Madras Medical College Madras Tamilnadu REFERENCES: 1. Pandya SK. Do the bells toll for our public sector hospital? Natl Med J India 1996:9;142 – 3 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 9, NO.5, 1996 p.253 3 View publication stats