LACK OF ACCOUNTABILITY AILING GMC?

 UNFORTUNATELY, IN government service, the only criterion by which one’s ability is judged is the length of service. No weightage is given to the merit or to one’s capability. I am witness to that. When young medical graduates join medical college, they are full of energy and initiative. They have an intense desire to achieve something in life and work very hard. Slowly it dawns upon them that their efforts are not appreciated by anyone. Rather, very often there is a tendency to overburden them with work, because the other person is not willing to work. Also it happens quite often that they may commit small mistakes in the course of their work, while the one who does not work, naturally commits no mistakes. They are very often reprimanded by their seniors for these mistakes while a non-working person escapes without any such disgrace. All this works as a ‘dis-incentive’ for a hard working young individual and he starts realizing the futility of hard work. Slowly he resorts to the dictum of ‘hardly working persons’ and starts enjoying life without work.

Even if the above mentioned situation does not arise, there is no incentive for extra work put in by hard working doctors. No one even pats him for the good work that he does. On the other hand, those with right political connections are felicitated and are given awards for the work that they have not  done. The cast, creed, religion, region and political loyalty dictate the award of honours to government employees. This again acts as dis-incentive for a hard working person, because he finds it easier to achieve recognition by dubious means than by genuine ones. 

Medical personnel are usually very egoistic. More than money, their reputation is dear to them. They do not like interference of any sort in their work. Small gestures on the part of government can do wonders to lift their mood and they will co-operate and do anything for the institute. This aspect of service condition is very well taken care of by the private sector. Very often, it is seen that the small favours that the employees ask are not granted even when it costs nothing to the government. For example, permission to leave the country when they are invited for a fellowship abroad ( the government does not have to fund this programme), or a sabbatical leave to take a short term employment abroad with an aim to earn some money genuinely. If at all these favours are granted, these are granted selectively.

Lack Of Facilities

GMC also earns a bad name because certain facilities are not available in this institution. In fact no State medical college can claim to be providing all the facilities to the patients more so when the treatment is totally free. This is so because the provision of all the modern diagnostic and therapeutic facilities by the government run hospitals is not possible for various reasons. The acquisition of these gadgets is very expensive as they cost in crores. Also the maintenance of these gadgets is a very expensive thing because of the recurring expenses on disposables as well as on the personnel manning these facilities. Their handling requires a very dedicated and conscientious staff which is difficult to get in a government set up. Moreover, the electronics world is changing so fast that these gadgets get out dated sometimes in three to four years and then require to be replaced. This again costs a fortune.  In a place like the GMC where these facilities are totally free they are misused and overused resulting in frequent breakdowns and the shortages of consumables like film, etc.

Unfortunately, the public in Goa has been so much exposed to the five star culture, by way of mediclaim and reimbursement of medical treatment, that they have started expecting the same type of facilities in GMC also as they have seen in large corporate hospitals of Mumbai and other places. They criticize GMC for not giving computer print outs of the blood test reports, for not giving X-ray, C.T. scan film in crisp envelopes with computer typed reports. They criticize GMC for the behaviour of its employees. They do not realize that these large hospitals in the private sector charge exorbitant amounts for all these facilities and with that they can keep their equipment up to date and can go on replacing them at frequent interval.

Also the patient load in these hospitals is not as much as in the GMC and thus the quality of their reports is bound to be better. Their employees do not have the work load that is on GMC employees and their employees do only clinical work and are not hauled up for administrative lapses, and the most important, the employees there get lots of incentives. These five star hospitals provide excellent food, but you have to pay for it. They are clean because the attendants are not allowed in the rooms or wards there and that is possible because the patient-nurse ratio is excellent. This again is possible because the patients are paying an exhorbitant fee for all these facilities.

Also, GMC does not have and cannot afford to have certain facilities like Gamma knife, MRI scan and other very expensive facilities, because the patient load in Goa is not so big as to make these facilities viable. Government, in its wisdom, feels it is more economical to pay for these facilities by way of mediclaim or reimbursement rather than acquire the same. There is no harm in this. After all this is a form of out-sourcing. Patients should not take it as a weakness of GMC, but should consider this as a generosity of the government of Goa.

Adverse Propaganda

Some people with vested interests have been indulging in adverse propaganda against GMC. This they do out of compulsion or because of misinformation they have got from certain sources. Unfortunately, most of them are from our own profession. Some of them are even the products of GMC. Such adverse propaganda may fetch them some immediate gains, but they must remember that this kind of propaganda is finally going to boomerang on their own practice. In fact, I find it very strange that most of the private practitioners and GMC doctors are at logger heads, while at other places I have found very cordial relationship amongst doctors in private and government. After all they compliment each other and are not rivals. Many a times they need each other’s help to bail them out of the trouble or to help in some difficult cases. Maybe one reason for this rivalry in Goa is a large number of doctors surviving on a small patient population.

This adverse propaganda can be avoided to a large extent by combined scientific meetings, discussions and fellowships. One should respect the other’s opinion and should not criticize the others work unnecessarily more so in front of the patients. The sooner we learn to live in harmony, better it will be. Otherwise the patients will force us to learn this in view of consumer activism.

Lack Of Public Relations

A lot has been written against GMC, a lot has been said against GMC. But no one from GMC has ever clarified its stand on various issues. There has been no attempt to develop public relations on the part of GMC. This is because of an inherent problem of communication skills with the medical personnel and lack of initiative on the part of government departments in general to react to adverse propaganda against them. The GMC has been taking all the adverse comments in its stride and over the years has been labeled a dumping ground in spite of the fact that, irrespective of the social, economic or religious status, every one looks upon GMC only in the case of a medical emergency.

Why this GMC bashing? This is because everyone knows that GMC will not react and also because, unlike private hospitals, we have not been beating the drums of our achievements in public. Neither do we try to cover up our mistakes. At the same time the media likes to sensationalize  medical issues. This is more so after CPA application to medical profession. The news of medical mishaps is read by one and all with great interest. 

The Government will soon have to realize that in view of greater competition in the  medical field, it will have to pay attention to the public relations aspect of GMC sooner or later as it has been doing in other fields where it is in competition with the private sector. Probably the reason for the government’s lack of interest in this field is that GMC is not a revenue generator. However, the government has to look into this aspect, as a good image of GMC will boost the image of the government for good governance and as and when the government wishes to open this sector for revenue generation in the form of health tourism etc. this image of GMC will come handy.