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Experts Talk
Dr Sanjay Bhattacharya
Associate Consultant,
Department of Microbiology,
Tata Medical Center, Kolkata
DoctorNDTV: What, according to you, are the attributes of a good doctor?
Dr Sanjay Bhattacharya: Knowledge, attitude and skill is the triad, which defines the attributes of a good doctor. The knowledge has to be holistic (medical as well as social), evidence based and up to date. The skills (technical and communication skills) need to be appropriate for the intended purpose, and need to adapt to the changes in technology and working practices. However, it is the attitude, which is the essence, and probably as important if not more as the aptitude. Since, a doctor is an instrument of the society, he has to be receptive to the social issues of his time and place, and respond adequately to those issues in a timely, responsible, and meaningful way. To summarise, a good doctor is not just a skilful technocrat who attempts to heal a diseased body, but also a good social being whose practice contributes to the amelioration of social maladies.
DoctorNDTV: What is your opinion about medical training in India? Why are we not able to retain talent?
Dr Sanjay Bhattacharya: For a country of the size, diversity and complexity of India, it is an achievement to have a medical training infrastructure for about 28,000 MBBS students annually in 300 medical colleges. However, these numbers should not detract us from the fact that quality of training has suffered immensely due to poor health care infrastructure, administrative laxity, politicisation of education (including that of medical colleges), and lack of funds. In spite of these problems and deficiencies, India does provide a reasonable opportunity to its medical students to get a level of training to deal with many of the burning medical issues of the day. The success of Indian doctors locally as well as internationally is testimony to this fact. At the same time we have to remember that medical science is advancing at a very rapid pace in many areas. These include laboratory and diagnostic technology, pharmaco-therapeutic and surgical options, hospital designing, and communication & information technology.

It is a fact that many of our medical students are not exposed to these state-of-the-art facilities (barring few private corporate hospitals or government funded apex hospitals). Also, there is not enough emphasis on communication skill development (including how to communicate effectively with patients, relatives and other staffs), medical ethics and research. I think with better hospital administration, periodic appraisal of our medical curriculum, greater public health care investment in proportion to our GDP, more efficient utilisation of available resources, and enforcement of standard procedures, the quality of publicly funded medical training and health care facilities could be significantly improved. Medical training and medical care for the general population are closely related issues. It would not be possible to upgrade the standards of our government medical colleges and medical training without improving the quality of our public sector hospitals.

The inability to retain medical talents is multi-factorial. Poor pay (although this has improved to some extent in recent years), difficult working conditions due to lack of infrastructure, slow progress of many development projects due to administrative or bureaucratic delays, lack of transparency in the selection and recruitment process, perceived lack of meritocracy during promotion or appointment in important positions are some professional concerns. Besides there are social factors such as quality of life issues in India compared to the developed countries, security and law & order issues, which may encourage migration. However, there are issues attached to social values, idealism and personal commitment to a just cause. Many Indian doctors despite the obvious attraction of money and enhanced living standards of foreign lands decide to remain (or return) and serve their country of origin.
DoctorNDTV: Do you think health information websites are useful? What are your views about DoctorNDTV?
Dr Sanjay Bhattacharya: The utility of health information websites depends on the quality of the information available, the target audience. Its effect could be limited by the density of population using the Internet as a means of information gathering and communication. However, in a country like India, its effect could much be more than could be measured just by taking into account the computer literacy and Internet usage of its population. There is serious deficiency of easily accessible high quality medical and health care related information within and about India. And, the health information websites can potentially play a very constructive role in building up the knowledge base of the general population and professional groups. As for example, for large parts of India, there is no easy way of knowing where is the nearest hospital, the pharmacy, or a doctor's clinic (or their contact numbers and modes of transport and communication).

The quality of reliable real-time data and information about the incidence and prevalence of disease (and their management) in different population groups, and geographic locations is also quite variable. With increasing use of mobile phones and Internet, it might be possible to link these two together to provide information to health care workers and general public in remote areas, which have otherwise remained isolated from the mainstream of information highway.

The DoctorNDTV is best seen as a manifestation of NDTV’s commitment to social responsibility. It is also about its role in giving back some of the riches to a society from which it derives its nourishment, personalities and ideas. I hope it emerges not only as the best health information website within India for the general public but also for health care professionals. It will take a lot of hard work and new thinking to make it more comprehensive and inclusive, and at the same time ensure its financial viability. Information deficiency is as important as resource deficiency as a potential cause of human suffering. I would like to see DoctorNDTV as an effort to bridge the gulf that separates ignorance from cognisance.
DoctorNDTV: Why did you choose your present job?
Dr Sanjay Bhattacharya: I am basically a medical microbiologist with a specialisation in clinical microbiology and virology. From the beginning of my medical career, I had been more interested in the basic scientific aspects of medicine - issues such as how diseases occur, what causes them, how to diagnose them. Microbiology and virology are aspects of medicine, which answers some of these questions with an elegant objectivism. A large number of diseases attributable to humans are infectious, i.e. they are caused by the spread of infectious agents, such as bacteria (e.g. tuberculosis), virus (e.g. HIV/AIDS, swine influenza), parasites (e.g. malaria) and fungi (e.g. candidiasis).

Infectious diseases as a group are different significantly from non-infectious diseases (such as diabetes, hypertension, asthma, many cancers) because many of them are preventable (through public health measures, infection control, immunisation), and curable through the use of anti-infective agents such as antibiotics / antiviral agents (in contrast non-infectious diseases such as diabetes, asthma, raised blood pressure are controllable but not curable by the present state of technology). Infectious diseases are also among the biggest killers of mankind (e.g. tuberculosis, malaria, gastroenteritis, HIV/AIDS, viral hepatitis, pandemic influenza).

My area of specialisation - clinical microbiology and virology - deals with ways to diagnose, treat and prevent these infections. It deals with both laboratory medicine (concerned with diagnostic tests) and clinical medicine (concerned with treatment of patients). It is also an area, which is witnessing rapid change in diagnostic technology and therapeutic options. Vaccines to prevent infectious diseases (BCG, polio, DPT, measles, rabies, hepatitis B vaccines) are the saviours of millions of innocent lives.
DoctorNDTV: Could you describe your typical working day?
Dr Sanjay Bhattacharya: My basic work station is my laboratory (microbiology / virology) where I along with my colleagues get involved in organising, maintaining and administering a system, which enables the rapid, sensitive and specific detection of microbial pathogens causing human diseases (viruses, bacteria, fungi, parasites). These are done by a variety of methods (such as PCR, serology, bacterial / fungal culture, microscopy) depending on the pathogen involved.

A typical working day involves reviewing and authorising diagnostic test results on microbial pathogens, teaching medical students or junior doctors (post graduate trainees), attending multi-disciplinary meetings, communicating important test results to clinical colleagues, taking telephonic calls (regarding diagnosis, treatment, prevention of infections), undertaking clinical / laboratory audit or research, reviewing or appraising medical literature on recent advances, attending laboratory management meetings. As a clinical microbiologist / virologist, I am also involved in undertaking ward rounds (e.g. in intensive care units) or visit specific patients and offer diagnostic, therapeutic (antibiotic / antiviral) and infection prevention and control related advice (in hospital or community settings).
DoctorNDTV: Does the Indian health care system have any problems? If yes, how would you tackle these?
Dr Sanjay Bhattacharya: One of the greatest failures of our health care system is our inability to deliver to the common man a basic standard of service, which is achievable with the present level of investment. In many cases, these are due to poor training, poor practices, absence of proper monitoring or absence of enforcement of basic standards. It is about people not doing or being unable to do their job properly at almost all levels. In some cases, the problems are structural and strategic related to design of hospitals or their financial planning, but more often, the problem is operational and executive in nature. All these lead to wastage of precious resources and invaluable lives. It is also true that there is inadequate allocation of funds compared to the magnitude of health care challenges we face.

The figures from WHO show that although our total expenditure on health as percentage of GDP (5%) is comparable to that of China (4.7%) and Russia (5.2%), but, we lag significantly behind UK (8.2%), or even Brazil (7.9%). Moreover, our total expenditure on health per capita is only $100, compared to $2597 in the UK, $755 in Brazil, $561 in Russia and $315 in China. These figures show that we certainly need much more investment in health care, but these resources must be used appropriately. We simply cannot afford wastage due to inefficiency - when so many people are dying or suffering due to resource deficiency.

Health care in India, first and foremost need capable administrators, from level of the apex hospitals to that of the most basic primary health centres. It is not just about inaugurating a new health care facility or a centre of excellence, but ensuring that they function to the best of their abilities. It is about raising standards, ensuring accountability, enforcing best practices with the available resources. There are two aspects of infrastructure development - structural and functional. In many cases, we have a structure in place, but we do not often have an institution, which functions and delivers consistently high quality and reliable service. These are not insurmountable problems. But it must receive a higher priority with the government like internal security, defence or foreign affairs.
DoctorNDTV: Is there anything you think must be done for the better health for all?
Dr Sanjay Bhattacharya: The health of a nation is a national asset. If we cannot reduce infant mortality, childhood mortality, maternal mortality and morality and morbidity due to preventable causes, our GDP growth rates and foreign exchange reserves would mean very little in real terms. The health of a nation is also closely linked to a country’s overall social and economic development. We have to get our basics right - safe drinking water, sanitation, education, road safety, communication and transportation networks, agricultural productivity and food security, population control, human resource development - all these are closely related. The relevant government departments need to work in unison if we are to achieve better health for all.
DoctorNDTV: What would you have been if not a doctor?
Dr Sanjay Bhattacharya: There is difference between what we fancy and what is possible in view of our intrinsic abilities, proclivities and limitations. For me, I fancied the idea of being a man of science trying to understand and unravel the deep and intriguing mysteries of the universe. However, my inherent abilities or inclinations were of such a nature that I think, I would have probably gone into humanities and the social sciences (history / philosophy / political science / economics) had I not become a doctor. I think what we eventually become in life is by and large a fair outcome of the battle which goes on between our intrinsic abilities and interests on one hand and the strong selection pressure exerted by social forces on the other.
DoctorNDTV: Who is the person you admire the most or are most influenced by?
Dr Sanjay Bhattacharya: For me, I do not think there has been a single person or an element. My parents, like many of us, have been my first teachers, and their contribution is more than anyone else to have shaped what I grew up to become. They opened my mind to new areas of knowledge and ideas into, which I could venture on my own, and derive my inspirations. And there have been many different elements that have influenced me and shaped my outlook. The list includes: the astronomer Carl Sagan (his book and television series “Cosmos”), the poetries and stories of Rabindranath, the writings of Swami Vivekananda and the life of Sri Ramakrishna, Nehru’s “The Discovery of India” and Shyam Benegal’s “Bharat Ek Khoj”, Indian Classical Music, the films of Satyajit Ray, Prannoy Roy’s news TV series “The World This Week” (which was our window to the outer world when we lived in a relatively closed society), the BBC television series on Western Philosophy and philosophers by Bryan Magee (from Aristotle to Wittgenstein). And, last but not least there have been my teachers who consciously or unconsciously have shaped my outlook and attitude towards life.
DoctorNDTV: What has been the professional achievement that has made you most proud?
Dr Sanjay Bhattacharya: I was tempted to say that these days I find pride to be vanity and an emotion, which is essentially futile. But it would be dishonest for me to say that, since there are clearly certain elements of my professional career, which makes me feel happy when I reflect upon them. This includes some of my scientific writings. However, I do realise that I have a very long way to go in order to do real justice to the training and education I have received. Scientific knowledge in itself is not of much value unless it is put to social usage and creates positive changes in the life of people around us. I have tried in some of my articles to communicate my scientific thoughts on issues related to how microbiology could be practised within the Indian context. It is really a very small step in a very big area of human endeavour and medical scientific activity. Ultimately, however, our sense of pride has very little to do with the intrinsic worth of ‘an achievement’. If the achievement is real and substantial it will stand the test of time, if not, pride is nothing more than an illusion.
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