18, NUMBER 6
Letter from Mumbai.
WHERE ARE OUR PUBLIC SECTOR TEACHING
Recent experience in Mumbai suggests a very pessimistic prognosis
for medical education and the consequent quality of medical professionals
who will be produced over the next several decades.
In the early years following India’s Independence, teaching
hospitals in the public sector provided medical care of the highest
standards and produced doctors who could hold their heads high
anywhere in the world. Teachers were appointed on an honorary
basis, giving their time and energy for a pittance. They were
urges to excel, impart their knowledge and experience, and produce
students who would eventually do better than them. They earned
their butter and jam either in the early hours of the morning
or in the late afternoons and evenings. The period from 8 a.m.
1 p.m. on all weekdays was reserved for their teaching hospitals.
I recall Drs Gajendra Sinh, Noshir Wadia, Noshir Antia, K. S.
Masalawala, Vijay Dave, Farokh Udwadia and some other of my own
their work in the campus of the Grant Medical College and Sir
Jamsetjee Jejeebhoy Hospital till 4 p.m. on many occasions. When
or treating patients, they focused on a variety of studies aimed
at learning about diseases common in India which were not dealt
with in any detail in western books and journals. In doing so,
they produced papers that have been quoted in India and abroad
over the past 40 years.
Full-time staff members who had no commitments outside their hospital
and medical colleges, gradually replaced these honorary teachers.
The advantage of this change was obvious. Freed from the need
to travel from one institution to another and able to harness all
their energies at their own hospital and medical college, teachers
such as Drs P. K. Sen, Homi Dastur, R. D. Lele, S. R. Naik and
others established departments that were at the forefront for
decades. The subsequent careers of their students and resident doctors testified
to the high standards of these teachers. I can speak from personal
experience of the development of unofficial subsections in the
department of neurosurgery at the Seth G.S. Medical College and
King Edward Memorial Hospital in Mumbai which dealt with neuroradiology
(including selective catheter angiography and later therapeutic
embolization), stereotaxy, paediatric neurosurgery (including
for craniosynostosis), the treatment of aneurysms and arteriovenous
malformations, in addition to the performance of general neurosurgery.
In facilitating these developments, Dr Homi Dastur and his neurologist
colleague, Dr Anil Desai, set national trends.
These full-time teachers shared a common goal: To learn, teach
and treat patients to the best of their abilities and to develop.
Alas! Times have changed for the worse. The powers-that-be in the
Government of Maharashtra and the Municipal Corporation of Greater
Mumbai that run the public sector teaching hospitals in Mumbai
have decided that these institutions are a drain on the economy
and have progressively deprived them of funds and facilities.
The latest disastrous move has been the granting of permission
for private practice to full-time professors. The motives driving
the authorities to grant this permission make interesting reading
and provide food for thought. First, many full-time professors
indulge in sly private practice in any case and it is very difficult
for the administration to detect and punish them. Second, the administration
cannot afford to pay full-time professors the salaries they deserve.
Many full-time professors leave their colleges and hospitals and
enter the world of private practice to the detriment of their institutions.
Ergo, permission to treat private patients will legalize an extant
unlawful practice, and the extra income earned will enable them
to remain in their professorial posts. While granting permission
to practise, the authorities restricted it to after-office hours,
insisting that work in medical college hospitals continue from
8 a.m. to 5 p.m. on weekdays and 8 a.m. to 1 p.m. on Saturdays
as usual. Private practice was to be restricted to just one hospital.
Nothing was learnt from the experience at Tata Memorial Hospital—the
leading cancer hospital in Mumbai—when their consultants
were permitted additional practice at one private hospital. Citing
huge waiting lists of patients at Tata Memorial Hospital and
preying on the fears spawned by the suspicion or diagnosis of
surgeons urged patients seeing them at Tata Memorial Hospital
to attend their private hospital for surgery on a priority basis.
Consultants spent more time in their private hospitals than at
the Tata Memorial. The care of patients, and teaching of residents
and postgraduates deteriorated. It took a strong-willed Director
to take the bull by the horns and outlaw this detrimental step.
We may be pardoned for drawing some unpalatable conclusions.
By confessing that professors indulging in clandestine private
practice cannot be detected and punished, the authorities acknowledge
their own inefficiency and incompetence.
Fears voiced well before the sanctions for private practice came
through were ignored. Since the authorities could not detect or
punish private practice when it was prohibited, how will they monitor
private practice and ensure that it is restricted to after-office
hours or at just one private hospital? What is to be done if a
patient operated upon in a private hospital collapses at 10 a.m.
on Wednesday, when the surgeon is to perform an operation in the
Within a few months of the sanction we are witness to professors
operating in private hospitals in the mornings and afternoons,
and at two or more private hospitals. Some consultants have been
quick to follow the practices of their predecessors at the Tata
Memorial. A senior consultant orthopaedic surgeon at a private
hospital narrated an especially sorry experience at his own beloved
alma mater. He referred a poor patient who was in great pain
and needed joint replacement, to this teaching hospital. He pointed
out that the costs at the teaching hospital would be a fraction
of the costs in any private hospital (including his own) and
be well within the patient’s reach. Since the current professor
was once his resident doctor, he reassured the patient. A few days
later the patient returned to him, pleading with him to proceed
with the operation in his private clinic. When asked why he spurned
the teaching hospital, the patient narrated his experience. He
was unable to meet the professor at the teaching hospital on three
separate occasions, encountering only the resident doctors. When
he finally succeeded in meeting the chief, he was told that owing
to the large waiting list and heavy workload, the operation could
only be performed three months hence and would be carried out by
one of his resident doctors. As the patient stared in shock, he
added: ‘If you want me to do the operation and at short notice,
you must see me at X Hospital.’ The patient ended his account
with the fact that the fees at that hospital were more than those
at the referring consultant’s own hospital. The senior consultant
commented: ‘When we were students, our teachers had high
ideals and lived by them. Today the only motive driving full-time
professors in our medical college hospitals is the urge to get
rich quick at any cost.’
Current trends augur poorly for the future of medical education
and care in India. While we proudly and avidly seek patients from
abroad to fill the beds in our five-star private hospitals, what
of the poor and middle-class patients who can never aspire to such
beds and must, perforce, attend our public hospitals? Worse, who
is to teach our medical students and resident doctors the art and
sciences of medicine when the professors are busy at their private
SUNIL K. PANDYA