life of management

It's not just wondering about the diseases of individual patients, nor is it just paying heed to tendencies of groups, epidemics, mentality and educational levels of patients... it's not just following the government rules, or adjusting with current political trend... answering to media, local over enthusiastic political activists eager to make issue of anything to gain some political benefit, managing a team of workers elder to me by decades, paying attention to jobs of newcomers, their friendships and rivalries with each others, answering to taluka and district offices... managing economy of scanty drugs, the sanitation of operation theatre and the instruments... managing the government funds, salaries of workers, and government schemes... being a medical officer is being more a manager than a doctor...

It's hard to keep in touch with your medical knowledge, to handle everything according to standard norms, the conditions being slightly strange or not as mentioned in books... x ray machine is here though not properly trained technician, doctor is here—me of course, though not proper health facilities like even basic drugs... patients are uneducated, politically alert villagers wanting me to diagnose and treat every disease with the x ray machine and whichever drugs I have. PHC is a referral service, they say, but they don't provide any means to convince the people to move to higher centers if they show signs of  malignancies, heart diseases or diseases not treatable at PHC level... People look at the referral chit as a proof of the doctor's incompetence, or ignorance—overall lack of interest in their health condition. Many are not willing to invest that much time and energy for their own health or health of their relatives...

I'm out of my big lovely standard books, in real world, among real patients—posing conditions similar to those described in my beloved books but in highly different circumstances, learning to deal with people with very different viewpoints than that of me—very different from one another, to convince them, to handle their differences and sometimes to make use of them, to handle unforeseen circumstances. Maybe this extended part of medical education is worth a year....