A Surgeon’s Dilemma

Many times, I face a dilemma – can a surgeon achieve a higher level skilled position without the sacrifices of many of the patients who come for treatment to her? After doing MBBS (the Bachelor’s Degree), a prospective full-fledged surgeon has to do a 3 years’ PG Course in Surgery where one has to work day in and day out. When the first appendicectomy case to be operated upon independently is given to this greenhorn, the abdomen of the patient opens up like the map of the whole of India and one fails to decide as to from where to where the skin incision should be made. On many patients who do not have any option except to come to public sector hospitals, one learns so many things for the first time : how to give I/V drip, how to put a ryles tube, I/V cut down, intercostals tube drainage, urethral catheterisation, tracheostomy – the list is endless.

Even after doing MS, however, one does not feel confident of doing major surgery. One is then supposed to work as a Senior Resident where one goes through the experience of undertaking emergency surgeries and feels, to some extent, confident of doing things satisfactorily. During this period one is doing so many things for the first time and the patient is more of a guinea pig and less of a human being in some ways. After Senior Residentship, one may become a Consultant(Assistant Professor) in a Medical College in General Surgery or may opt for doing M.Ch in super specialities and then may become a cardiac surgeon, Neuro-surgeon or Onco-surgeon. Lots of inputs are required during the course of this process.

Again after doing M.Ch., one starts learning through the ‘learning by doing’ approach and slowly becomes a real expert of the area and now people start recognising one as a surgeon of repute in the chosen field. Unfortunately at this stage, accessibility of the Surgeon to those patients on whom one has learnt such a lot in the course of the process of becoming a remarkable specialist, becomes really difficult in many cases. Now one starts thinking in terms of being a great surgeon. The question, however, remains – for whom is one a great surgeon? The global market – be it the Indian corporate sector or the foreign one – is there to allure “the great surgeon” for a good package of salary and other facilities. One study shows that 80% of the AIIMS doctors who passed out in the last 10 years are now settled outside. Should one go there or not is a dilemma ! Many of us will say, “ What is the harm in going to the Corporate sector for a better package? Simple idealism does not work if one has to lead a happy life these days.” We might have decided either way but the question still exists – whether we owe anything to those patients or not?