Wednesday, February 18, 2009

Why I left Government Health Service

As I said in my previous post I was happy and satisfied during my early years in Government service. Then why I left it? Let me try to explain my reasons.

As the days and months went by my workload began to increase. The number of patients crowding in to the Medicine out patient department of the hospital became too much to be handled by me alone. Most of the other doctors were also busy. A few were experts in shirking work and nobody could make them see patients.

A similar but smaller crowd waited for me at my house each afternoon. Slowly as the quantity of work increased the quality began to suffer. Knowingly or unknowingly the quality suffered more in the hospital. Attempt to take history from the patients was time consuming and was shelved. My examination became cursory and prescriptions mere symptomatic remedies. In my private practice [which gave me direct income] I was more careful. Being an ordinary human being it was natural for me to be more sincere in that part of my work where I get more incentive.

One day I realized the extend of loss of quality of my work in the Hospital. A patient with a Cardiac murmur came to the Hospital OP. I did not detect the murmur and gave a symptomatic prescription. Not satisfied with the way I examined him; he came to my house one day later. Then only I could find out my mistake.

I tried to be more careful in my Hospital work. It was time consuming and tiring. The rule in any Government Hospital was the more sincere you are the more work you get, with out any added incentive. Actually you will earn less as you spend less time for your private practice.

Later I was transferred to a bigger hospital. There I thought I would be able to do quality work. Here also the first year was good, with fewer crowds to see me, as I was new there. As years passed the quantity of work increased. I tried hard to maintain quality. I was careful in my examination of patients so as not to miss anything.

But my satisfaction level was low. I like to talk to patients. I usually explain the illness and also about the treatment I am planning to give in detail. I had to compromise on that as I could usually spend less than 5 minutes with each patient in the hospital. If I spend more time the patients waiting in the queue will suffer. The lab stops taking samples by 11am and the Pharmacy closes by 1 pm. So if my OP run late many will not be able to use those services provided free of cost by the Government.

The relatives of those admitted under me in the Hospital will come to my house during my private practice as if to enquire about the patient's condition. Then they will try to give me an envelope with money as a form of bribe [or 'gratitude/incentive']. As a rule I will not accept it. More smart among them will get themselves examined by me for vague complaints, get a prescription from me and then give me the envelope. I will be confused and may accept it. Soon I will question myself why I accepted that. One half of my mind will tell me it is only a token of gratitude. The other half will tell me it is unethical and against the law to accept such bribe.

Many of my patients who used to consult me at my house would need admission. They were not willing to get admitted under me in the Government Hospital because of poor infrastructure and cleanliness there. They used to urge me to look after them in the nearby private hospital. Then I used to say sorry, I can’t come there as it is against the rules. But the pressure continued.

The District Medical Officer used to send me to different parts of the district for various Government activities. I was always reluctant to say no. In a way it was a change from the monotony of Hospital work. But soon I realized that most of such activities were useless and a huge wastage of Government money. Once I was send on an emergency basis to a Tribal colony in a rural village to give a report about the typhoid outbreak there. The local MLA [member of legislative assembly] had given a written question about it in the State Assembly. I was not even allowed to complete my ward rounds as the authorities wanted immediate report. I reached there an enquired about the epidemic. Actually there was no such epidemic. A press report based on rumor was the reason for all this.
When a VVIP visits our District I was usually posted for duty. Waking up early in the morning the medical team will have to wait outside the Government Guest House. When VVIP is ready to travel we will be the last vehicles in the motorcade accompanying wherever the VVIP goes. The ordeal may end only late in the night.

All these increased my unhappiness and dissatisfaction in Government service. I realized that my character itself is changing. I was slowly becoming more and more rude to patients. Work quality was going down by each passing day. I stopped enjoying my work.

At the same time my ideological commitment to Government health service prevented me from getting out. One half of my mind was saying I should stay and fight the system to change it. The other half urged me to quit so that I can start enjoying my work again.
I was indecisive, not brave enough to decide either way. Fortunately a tiff with the authorities on a matter of ethics and quality helped me to decide. I quit.

Looking back I feel I did the right thing. I did not have the guts to fight it out to try to change the system. You can call me a selfish doctor who turned away from the poor. Still I am more happy and satisfied now than I would have been in Government service.


CALpumper said...

I read the reason you got into Gov't service and after reading why you left, I can empathize. It was a tough but sound decision. You did not make it quickly, you thought about it, each angle, each perspective.

Maybe one day things will work out that you can somehow "afford" to help the poor again.

Life is full of decisions. Some are easy, some are very difficult.

You are human and you can only do the best you can.

And as you know with me, fighting the system is a Very Hard thing to do.

Keep up the good work Doc!

Bindhu Unny said...

Nice to know a doctor's perspective. So far experienced/heard only patient's side. It's not just in medical practice, everywhere it's difficult to fight the system. You attempted, at least.

Charakan said...

Calpumper, thank you for the words of encouragement. All the best for your fight for better health care for T1s

Charakan said...

Bindhu, May be my attempt was not good enough. Yes tho doctor's side of the story is not that well known.

seema said...

Isn't that an awful state of affairs.

Shaji.k said...

your reasons for joining govt health service and quitting it are valid and substantiated by your experience. the upper and middle classes in kerala no longer use the govt health facilities, just as they don't use the govt's educational and road transport facilities. they don't have a stake in it. rising disposable incomes enable this. the middle classes now make up the majority of our population. one of my friends, a maxilo-facial surgeon, in the govt dental college told me that it's ages since a patient from a 'good family' came to his dept for treatment.
the clerks in the govt, (even secretaries are glorified clerks!) have no idea that the remuneration for all professionals, including medical personnel, in the real world is quite high. Unless govt can match this salary structure and perks, it will be increasingly difficult to attract doctors in to govt service. your post has rightly points out the flaws in the working environment of government hospitals.

and my good dr, don't worry. as you are committed to using your professional skills for the benefit of all, including the poor and the dispossessed, life outside govt will also provide you enough opportunities .
water finds its own level!

Charakan said...

Shaji.thank you for the comforting comment.Govt can match the salaries in pvt only by incentives and perks like those that is available to IAS officers. For that there should be both political and administrative will which is never present.Govt is happy to encourage pvt practice which is a form of semi privatisation of health service.

deepz said...
This comment has been removed by the author.
deepz said...

Very good doctor..I would appreciate the decision you took and the attempt you have done...the situaiton in government hospitals is very pathetic in rural areas...

Kee going on..

Charakan said...

Thank you deepz, the decision making was difficult but I am fairly happy now

monsoon dreams said...

Feels like you have written whats going on in my mind.I agree with you,100%.Few months into the govt service,I could feel my beahviour changing,mostly becoz of frustration,stagnant academics,the arrogant bureaucrats,interfering politicians,lack of professionalism,disobedient staff...Still I love the job,just because of the satisfaction i get when fulfilling the dream of helping the poor,innumerous wonderful patients.I almost lost my real self coz realities and dreams were so different from each,here i am...on leave :-)

Charakan said...

I worked for abt 7 yrs and it was not all bad. The clinical experince I got was great and the love and respect from patients were wonderful,something you will never get tht much in pvt sector.Dealing with calleagues and officials were difficult and a serious tiff with authorities forced me to quit. I envy those who stay and fight the system,[not those who stay and use it for their selfish motives]. Sorry to hear you had to take leave. Thank you for your comments