ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

Trying to be a Medical 'Consultant' in Mumbai

There are many complex questions that can torment the everyday lives of doctors in India. After all practising medicine in a health care system that is unregulated, monetised & chaotic is never likely to be easy. The answers to these questions are equally complex as the discourse on health care has many confounding factors.  Let me confess however that I have grappled with an extremely simple sounding predicament for many years. It is so basic that it may even border on the trivial and is almost embarrassing to write about. But to me it has been a great source of confusion. And since a blog doesn’t put restrictions on sharing personal concerns with due apologies I share my problem with you.

This question started haunting me around the time I ventured into private practice many years ago after spending more than a decade on the staff of a public hospital. My earliest encounter with this problem was on my very first visit to a large corporate hospital for an interview for the ‘Consultant’ post.  I walked into the precincts of the hospital rather nervous but of course a little excited.  At the door of the elevator a stern looking security man asked ‘Kidar jana hai, ye doctor logoka lift hai’. I said ‘Consultant interview, 3rd floor’. He looked me up and down and said ‘Aapka interview hai?’. Stuttering in embarrassment I said ‘yes ’. Rather disbelievingly he let me inside.  A few weeks later it happened again.  I was sitting rather idle in my clinic  when I got a call  requesting a ‘home visit’. I was rather thrilled as it was in one of the famous high rises of yesteryears, a building famous for being labelled the tallest in Mumbai. I drove down to the building and was stopped at the gate ‘Kidhar jana hai? ‘Doctor hai, patient dekhne aye hai’. He peered inside the car on towards the back seat and said ‘Doctor Kidhar hain? ‘Hum doctor hai’ I said rather hurt. He scrutinised me, asked me to wait finally allowed me to park after  having counterchecked with the patients family.  And soon in what was to be a defining moment in this saga  a senior family doctor who has known me from childhood came to meet me with a patient.

After I had seen the patient and given my views on the surgery that he needed he asked me ‘So when is the surgeon performing the operation going to see me?  The family doctor stayed back.  After the usual pleasantries he rather apologetically blurted out ‘Sanjay since I know you for long can I suggest something if you don’t mind ‘Of course you can’ I said knowing that he was my well wisher. “‘You know you don’t look like a consultant!’. I was dumbstruck. First a bit upset I  regained my composure I asked him ‘ What do you mean? ‘Well’ he said ‘to be a successful consultant in this city you first need to look like a consultant!' I would suggest you start wearing a tie or a suit. And rather apologetically he added ‘I am saying this for your good’. He had indeed set me thinking & perhaps provided the answer to the fundamental question that was tormenting me. I started carefully observing the consultants around me in various hospitals. Who were those who didn’t get stopped at elevators? Who were those who exuded confidence? Who were the ones who were saluted, greeted and made way for when they walked down the corridors of hospitals? Who were the people who inspired awe and respect and authority?.  In short what were the essential attributes of ‘looking’ like a consultant ?  Soon I began to identify some common features.

The first was the attire. ‘ Wear a tie or even better a suit’ I then recollected a senior professor had actually told me when I had gone to him for advice on starting practice .  It was indeed true. If there was one singular attribute that distinguished  the successful  ‘consultants’ from others down the success hierarchy it was their clothing; often a  tie and sometimes a suit. The more I observed the more I was convinced . And then a lot of things fell into place. Many of my colleagues had actually had this foresight and started wearing a tie overnight on starting private practice.   Although they squirmed under their neck in the oppressive heat of Mumbai but ensured that their crisp tie was always on.  Some of them had loftier ambitions (and a higher tolerance to heat) and wore a proper suit. I bet some of them must have had to go through the painful experience of contradicting their commitment to swadeshi politics and make this one betrayal in a life otherwise committed to Indian culture. Was this then the quick fix solution to my problem ? I started giving it a serious thought. I had two problems with wearing a tie. I am intolerant to heat and barely manage to survive Mumbai’s weather most of the year. I have actually checked my thyroid levels on more than one occasion and it just seems like a natural aversion. More importantly though I had never worn a tie in my life.  Having grown up in a middle class Maharashtrian home, educated in a vernacular school and ideologically anti colonial, wearing a tie was not just alien but almost a betrayal.

In the meanwhile my experiences with not receiving recognition as a ‘consultant’ were continuing. All my other efforts in this direction were not really making an impact both on my image and my practice. I tried all the routine, simplistic strategies. Give time to patient care, try to work hard, read, teach & write in my subject.  But it was obvious that I had yet not embraced the key missing link. Finally after a lot of dialectical churning in my mind,  I gathered courage on a shopping trip and bought what I thought was a tie appropriate  for a doctor; a dull colour reflective of  professional sobriety. I got it ironed and put it up in my cupboard right in front as a reminder. Every day when I set out to work I stared at it & went through tremendous angst. Should I should I not? Every day I would come up with excuses ; one day it was the heat, the  other day the colour of my shirt ( I was told that it had to match) and so on and so forth.

However I assure you that I was almost on the verge of donning this wonderful piece of male attire which would have guaranteed me a successful career as a consultant when the worst happened. My terrible habit of reading medical journals did it! The very British whose legacy as our rulers had kept me away from this potential game changer for my career were responsible! A report has appeared in the British Medical Journal presenting evidence that ties worn by doctors in British Hospitals are responsible for the spread of hospital infections! In fact the National Health Service had gone so far as to recommend that doctors stop wearing them.  Now there was a scientific reason not to wear a tie!  I was also worried that this may be the wrong time to invest in ties if the Indian health authorities regulate on this! But it shattered whatever little hopes I had of reviving my sagging career.

Now that I have shared with you one of the fundamental but less known dilemmas of a healthcare professional in India you may perhaps want to know more. Since I am still struggling to be a ‘consultant’ in Mumbai it leaves me with some spare time to share some more with you through this blog.  Whilst I will occasionally share critical issues like those involving the importance of wearing a tie in modern healthcare I may also stray into mundane & boring areas like the increasing costs of health care & how you are likely to die without help if you have a medical emergency today in Mumbai. In the meanwhile the next time you visit your ‘consultant’ do notice the tie or suit for a lot of effort & pain may have gone onto it.

About Author

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Sanjay Nagral is a surgeon based in Mumbai who occasionally puts down the scalpel to wield the pen on issues in contemporary Indian Healthcare from within the belly of the beast.&nbsp;</div>
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