While the suicide of Dr Preethi — a first-year junior postgraduate doctor at Kakatiya Medical College (KMC) in Telangana’s Warangal district — has created an uproar amongst the people, it has also started a conversation about the relationship between junior and senior postgraduate (PG) doctors.
Warangal Commissioner of Police (CP) AV Ranganath told reporters that there was apparently a targeted harassment of Preethi by a senior at Kakatiya, Dr SA Saif, which allegedly drove her to attempt suicide.
Stating that the medical college had a culture where junior students had to address their seniors as “sir”, the police official said that Saif probably did not like the woman questioning him. He also said that Saif was “bossing” her around.
However, speaking to South First, PG doctors from medical colleges across Telangana tended to have a different view. They felt that, overall, the relationship between junior and senior PG doctors in medical colleges is cordial and quite unlike what the commissioner stated to the media.
The junior-senior culture
Much like any college, senior PG doctors often double as mentors, guides, and even friends for the newly-joined junior PG doctors at a medical college hospital.
“In the first year, we learn the basics of our chosen specialisation. Seniors are there to help us understand how to treat a patient,” Dr Kavya Chinta, a PG doctor at Kakatiya Medical College, told South First.
She added that it’s the seniors who do most of the work and junior doctors are not asked to do all the work. “But they are not left out either. We give our juniors some of the work, but we also cross-check it so that no mistakes are made,” she said.
The junior PG doctors are asked to write case sheets by the seniors, who also help them understand how to react to patients when they say something sensitive, she added.
“The juniors observe us, how we proceed with patient care step-by-step, how to see a patient, even how to touch them. They have just passed out of MBBS and have only internship training, so they are not fully equipped with the patient care knowledge,” said Dr Chinta, assuring that it was the same when she was a junior.
A ‘different’ relationship
On the question of “bossing” around juniors, which CP Ranganath had alleged in the case of Dr Preethi’s suicide, PG doctors said that the environment at hospitals is quite different than what anyone on the outside can understand.
Speaking to South First, postgraduate surgery student Dr Vanya Jasmine of Osmania General Hospital, said, “When I, as a senior PG doctor, ask my junior to do certain duties in an environment where I have to save the life of a patient — as well as when I am responsible to my Head of Department and also to the family who is waiting outside the door — I have to be perfect and any mistake can harm the patient.”
Dr Jasmine added, “Also, we are on duty for dozens of hours, so if a junior makes a mistake, we hold them accountable, and are sometimes harsh with them. However, once we come out of the surgery room, we are normal; we go out together and talk about anything and everything.”
Dr Chinta concurred that this happened when she was a junior PG too, when she made several mistakes and learnt from them. “One of the seniors who scolded me for my mistakes got married a few days ago and I attended it. We have very cordial relationship,” she said.
The culture of ‘sir/madam’
On the question of calling seniors “sir” or “madam” in medical college hospitals, PG doctors said that it is a culture that is shaped by the nature of their experience.
“When you are in the operation theatre with several of your colleagues, there is one person who is leading the surgery and that person has authority. This authority comes with years of experience the person has spent in treating patients,” said Dr Jasmine.
She added that with this authority also comes responsibility, where the person who is leading the treatment will be answerable to everyone.
“So, juniors call the responsible person ‘sir’ or ‘madam’. It’s not really about the age,” said Dr jasmine.
The responsibility hierarchy
After completing their MBBS course and cracking the NEET PG exam, students take admission to one of the various specialities offered in medical colleges. These departments include general surgery, radiology, orthopedics, anesthesia, general medicine, obstetrics and gynecology, and so on.
After joining these courses, the junior PG doctors start to practice at the hospital attached to the medical college. Kakatiya Medical College is attached to Mahatma Gandhi Memorial (MGM) Hospital and Maternity Care Hospital (MCH), just as Osmania Medical Medical College (OMC) is attached to Osmania General Hospital (OGH).
Junior doctors of surgery, medicine, and anesthesia are the first line of workers when it comes to emergencies.
“We have long shifts, we even work continuously for 36 hours at a stretch. That’s how work is in hospitals,” said Dr Jasmine. She added that they have to be on their toes all the time and cannot make any mistake as it will impact the life of a patient.
“When any emergency case like an accident comes at the hospital, we have to save the patient within the ‘golden hour’. Usually, the ‘golden hour’ is about six hours, but most patients reach the hospital only five hours after the accident, giving us just an hour to check all the vitals, see if the patient needs blood transfusion, fluids, and so on. Junior doctors from different batches of anesthesia and surgery all work together in this hour. But senior PG will be responsible for everything around,” Dr Jasmine informed South First.
A difficult job
The junior doctors are also tasked with calming the patient’s attendants, who usually expect the patient to be revived within a few minutes.
“People come to tertiary hospitals like MGM Hospital in extreme situations. If there is some small accident, they will go to the periphery hospital but if it is a serious case, the periphery hospital refers them to tertiary care centres,” Dr D Srinath, a PG junior doctor at Kakatiya Medical College, told South First.
He added that when these kinds of cases come, the senior PG doctors have to handle the care of the patient along with conveying the message to the 10-12 attendants who come with the patient.
“In recent times, you might have seen how attendants behave with the doctors. They even attack the doctors if something happens to the patient,” said Dr Srinath. A few months back, an attendant of a patient at Osmania General Hospital misbehaved with an intern doctor.