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Re: [iapsm_youthmembers] Solutions to combat " Downfall in the interest of psm/community medicine"

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  • ganesh kumar
    Dear members     Reason for glamourous look of other field , what i thnk is,   MONEY and FAME   the same what we lack in our field due to some disorders in
    Message 1 of 7 , Jun 1, 2009
    • 0 Attachment
      Dear members

       

       

      Reason for glamourous look of other field , what i thnk is,

       

      MONEY and FAME

       

      the same what we lack in our field due to some disorders in the grey matter

      of the professionals at the higher level and some ignorance of the public

      at the end level.

       

      one of the example of higher level disorder - GDP spent over the health sector.

       

      one of the example of end level disorder  - lack of community level work by us.

       

      If there is more salary and more money making options in our field , then automatically

      there will be boon of interest over our field.

      But tht way wil be incorrect, because we lost our conscience.

       

      The higher level policy makers are just making justifications for the poor performance

      of healthcare.(Just look for examples like healthcare field in France, UK , Canada)

      Health is entirely state's responsibility.

       

      Improvement in private healthcare sector is the worst indicator of universal health of the people.

       

      Ok...after all this what can be a solution...

       

      Why cant we start from higher level...

       

      Why cant we represent in addressing this issue to the MOHFW or even PM...

      Why cant we frame some perfect remedies in this issue in addressing...

       

      We can Stop talking and start doing things..

       

      If EXPERTS guide for a good solution i am ready to accompany to address directly to MOHFW.

       

      THANKS & REGARDS

      GANESHKUMAR

      DEPT OF COMMUNITY MEDICINE

      UNIVERSITY COLLEGE OF MEDICAL SCIENCES

      DELHI

      EMAIL:gane_spm@...

      MOB:+91 9899948487




      From: Anuja Pandey <anuja_2kn@...>
      To: iapsm_youthmembers@yahoogroups.com
      Sent: Sunday, 31 May, 2009 11:41:28 PM
      Subject: [iapsm_youthmembers] Solutions to combat " Downfall in the interest of psm/community medicine"

      Dear all...
       The topic regarding downfall in interest in our specialization been an issue of hot discussion in this forum for the past few weeks. We've come up with better understanding on the topic with some excellent inputs from our members.
       
      Presently public health in India is in it's golden era, with well designed public health programmes, initiatives like IPHS standards,relevant public health policies and centres of excellence like IIPH/PHFI coming up. Perhaps the nation needs competent public health professionals now, more than ever. This downfall in  interest from undergrads, will lead to compulsive entries, in this field , rather than 'by choice' entries from passionate and competant students. And such students, who come by chance, are likely to work with less involvement, leading to an adverse and depressing picture of our speciality to the medical grads....  That means the cycle of downfall shall continue, until we do something to combat it.
       
      Let's come up with possible solutions to combat this problem. I completely hold with Dr. Subodh Sir, regarding demonstration of effects of pubic health initiatives to orient undergrads on the actual role of the subject. From my personal experience i can say, that it was just one round of pulse polio immunization which i  had worked for, as an undergrad, when i felt,that it is this branch which has the potential to affect lives of the entire population, instead on a group of patients. Public health department has the potential  to eradicate disease from the world.. what more to ask for ???  and that's how i chose my specialization.
      I request other members too to share experiences ,and solutions to combat this disinterest in community medicine among undergrads.. . Our country desperately needs a competant public health force & let's all strive to make that happen.
       
      Regards,
       
      Anuja Pandey
      Junior Resident. GMC, Nagpur.

      --- On Sun, 5/31/09, neeti goswami <drneeti2003@ yahoo.com> wrote:

      From: neeti goswami <drneeti2003@ yahoo.com>
      Subject: Re: [iapsm_youthmembers ] Downfall in the interest of psm/community medicine?
      To: iapsm_youthmembers@ yahoogroups. com
      Date: Sunday, May 31, 2009, 6:58 PM

      Hi all,
       
      Thanks sir ( Dr. Sai) for sharing the crux of problem and making it evident in tangible manner.It was an opportunity to be your student  and the interactions and discussions we had were really encouraging and motivating.
       
      Presently while doing my senior residency i am really searching for ways to connect to my interns on academic platform. Almost every day  as a group we get around thirty min after completing regular OPD's in field practice area. I have tried discussing topics of current interest but most of the time  they enquire that how this knowledge can help them in solving MCQ's, leaving a very narrow base for discussion.
       
      What maximum i have been able to achieve is that giving them random case and making them work on whole clinico social profile and the responses again are variable ( full interest to total lack of it, making the whole exercise kind of a nagging task )
       
      I wish if community members can pool in their experiences and initiatives to help me out.
       
      Regards
      Dr. Neeti Rustagi
      Senior Resident
      Deptt. of Community Medicine
      Maulana Azad Medical College
      Delhi


      --- On Sat, 5/30/09, psai kumar <psaikumar2000@ yahoo.com> wrote:

      From: psai kumar <psaikumar2000@ yahoo.com>
      Subject: Re: [iapsm_youthmembers ] Downfall in the interest of psm/community medicine?
      To: iapsm_youthmembers@ yahoogroups. com
      Date: Saturday, May 30, 2009, 2:12 AM

      Thank you Sir.
       
      Regards,
       
      Sai

      --- On Fri, 5/29/09, Jugal Kishore <drjugalkishore@ gmail.com> wrote:

      From: Jugal Kishore <drjugalkishore@ gmail.com>
      Subject: Re: [iapsm_youthmembers ] Downfall in the interest of psm/community medicine?
      To: iapsm_youthmembers@ yahoogroups. com
      Date: Friday, May 29, 2009, 10:03 PM

      Dear Sai Kumar
       
      Very good statement. All the best. 


       
      On Thu, May 28, 2009 at 5:31 PM, psai kumar <psaikumar2000@ yahoo.com> wrote:


      Dear All,
       
      I have been following this debate on interest in PSM/Coomunity Medicine. As someone who has always been the passionate about the stream and interested in the welfare of students, I for the first time wished to join the discussion board.
       
      To be fair not many students have an interest for Community Medicine during initial years in Medical School. Unfortunately, the PSM departments in medical colleges contribute in a big way to this lack of interest, or rather rejection. The rejection is not for the subject, but for what the departments in medical schools project. The faculty who shape the minds of young doctors do not sufficiently enthuse the students.
       
      To be able to enthuse the young minds, the departments need good teachers, there needs to be a change in attitude - do not try to teach and control the students, grow with them and learn with them; and lead by example. The Public Health stream needs more role models: we have them. Create opportunities for self and young doctors to interact with such role models - not for teaching on a subject but to share their experiences..
       
      Change the teachning style - which I see some changes of late. It is difficult to teach and create interest about insects or toilets. But they can also be made exciting and interesting. New curriculum have course works/projects - get them to do something that interests the group and not what you want - from nano technology to computers to environment - make them think. But do work with them at all stages to make them understand the epidemiological approach, the public health importance and what is reasearch - validity of findings. I always believed the entire world of public health lies within the definition of Epidemiology (by Last) 
       
      Second in line are the post graduate/registrars /residents. Do you set an example - are you confident? I was lucky to work with my seniors and colleagues/juniors  who were confident of their future, reassuring, and had positive attitude to life. Smile and positive attitude are infectious. Try and spread it.
       
      Mentor the students. Mentoring is a purposeful effort where you need to show interest in the growth, professional and personal, of your colleagues, friends and juniors. Are you interested in their growth - or just focussed on your growth. Public health is about being selfless.
       
      We are here to make a difference, and together we can. So let us make it.
       
      Regards,
       
      Sai Kumar
      PS: Some of you might know me as a resident in LHMC, New Delhi and a faculty in IAMS/DAMS for a brief period.
       
      I would like some young, dynamic and active members like Dr Chandrakant, and Dr Sonali, to share their views. It is about shaping the minds of people in the professions who can make a difference - those in medical colleges.
       
       

      --- On Tue, 5/26/09, sandeep.panigrahy <sandeep1983_ vssmc@yahoo.. co.in> wrote:

      From: sandeep.panigrahy <sandeep1983_ vssmc@yahoo. co.in>
      Subject: [iapsm_youthmembers ] MUST READ(Re: downfall in the interest of psm/community medicine?)
      To: iapsm_youthmembers@ yahoogroups. com
      Date: Tuesday, May 26, 2009, 8:17 PM

      Hi everyone
      I may be the youngest one here in this forum to comment but i totally agree with the supporters of the forum
      Its not by hard luck that i opted for this seat, I was in waiting list in the PGI and was doing well in AIIMS PG entrance, but I was looking for this seat in community medicine.. may be I dint get the premier institute finaly yet i joined in fresh....

      we need more young mind in the team of community medicine
      and like we do IEC activities we must develop curiosity in Under Graduates while we teach them... which i do always...

      Together we can join hands and do it..
      REMEMBER IF WE WIN THERE WILL BE MORE ENEMIES AGAINST US... COZ NONE OF THE DOCTORS WOULD BE HAPPY TO SEE LESS PATIENTS IN THEIR CLINIC...

      Morever you will be surprised to know that in preparation institute like SPEED and IAMS it is being told as the most growing branch now and the best subject to choose if any one has little interest for it.....

      Well hope to meet you all who are in this forum

      With regards

      Dr. Sandeep Kumar Panigrahi
      MBBS, MIPHA
      PG in Community Medicine
      SCB Medical College,
      Cuttack (Orissa)
      --- In iapsm_youthmembers@ yahoogroups. com, dinesh kumar <drdineshkl@ ...> wrote:
      >
      > hi all,
      >
      > What else do you expect on a subject which is taught based only on a single book? we need to make the subject feel more relevant to young minds and that can be done only by incorporating more and more community based experiences for the UGs may be in form of projects, case studies, problem analysis or any thing else. Imagine we teaching students teaching about ANC in field and a daily labourer who just can not move out of her work asks about her options of getting free ANC at her work place and we suggesting her some thing.The kind of impression students get out of this will be far more lasting than then our recting entire ANC protocol to them in a class room. Community is our lab ,as long as practical teaching in lab is being neglected we do not blame students for sleeping in class.
      >
      > dinesh.
      >
      >
      >
      >
      > ____________ _________ _________ __
      > From: Dr Parag Chavda <chavda_parag@ ...>
      > To: iapsm_youthmembers@ yahoogroups. com
      > Sent: Monday, 25 May, 2009 2:14:46 PM
      > Subject: Re: [iapsm_youthmembers ] downfall in the interest of psm/community medicine?
      >
      >
      >
      >
      >
      > Hi ,
      > The topic of the discussion is very relevant. It is good that there are many persons here who are spreading the positive vibes. I am proud to have taken community medicine by choice in my PG .There is no question of regretting. At the same time we also need to acknowledge the fact that community medicine is not very popular among UG students. At present very few would like to take up community medicine for PG thats a sad reality.. Many do not know the scope and function of community medicine people outside medical college. Only we will have to be THE CHANGE and popularize the subject. I know it is a daunting task but we will have to start from somewhere. Lets inspire others....
      >
      > Thanks & regards,
      >
      >
      > Dr PARAG CHAVDA
      > M.B.B.S.
      > Tutor,
      > Community Medicine Dept,
      > Medical College,
      > Vadodara.
      > Gujarat, India
      > Cell: +91 9429111940
      >
      >
      >
      >
      > ____________ _________ _________ __
      > From: drneeraj_g04 <drneeraj_g04@ yahoo.com>
      > To: iapsm_youthmembers@ yahoogroups. com
      > Sent: Sunday, 24 May, 2009 11:55:23 AM
      > Subject: [iapsm_youthmembers ] downfall in the interest of psm/community medicine?
      >
      >
      > hi to everyone,
      > here can we start a discussion so as to unearth the reasons behind the downfall in the interest of PSM/Community Medicine among the aspirants of prepg.
      >
      > thnkx,
      > Dr.Neeraj Singh Gour
      > resident IIIrd yr
      > Dept. of Community Medicine
      > GRMC, GWALIOR
      >
      >
      > ____________ _________ _________ __
      > Explore and discover exciting holidays and getaways with Yahoo! India Travel Click here!
      >
      >
      >
      > Cricket on your mind? Visit the ultimate cricket website. Enter http://beta. cricket.yahoo. com
      >





      --
      Dr. J Kishore
      MBBS, MD, PGCHFWM, PGDEE, MSc., MNAMS, FIPHA
      Professor Community Medicine, Maulana Azad Medical College, New Delhi 110002,
      INDIA,
      (Mobile) 09868010950; 09968604249

      Please visit for more details: http://drjugalkisho re.blogspot. com

      President (Hony)
      Kishore Foundations; Sabasva Foundation,

      Director (Hony): Center for Inquiry Delhi Branch

      Author of
      * National Health Programs of India,
      * A Dictionary of Public Health
      * A Textbook of Health for Health Care Worker,
      * Biomedical Waste Management in India,
      * Vanishing Girl Child (on Female Feticide), Bhrun Hatiya: Apradhi Kaun?
      * The Pioneering Social  Reformers of India
      * The Great Warriors of Human Rights Movement in India
      For books Visit http://centurypubli cations.co. in





      Explore and discover exciting holidays and getaways with Yahoo! India Travel Click here!
    • jyoti das
       hello   To some extent i agree to Dr Ganesh except the fact that money nd fame govern which branch students take as money is almost similar in post
      Message 2 of 7 , Jun 1, 2009
      • 0 Attachment
         hello
         
        To some extent i agree to Dr Ganesh except the fact that money nd fame govern which branch students take as money is almost similar in post graduation.
        what matters is what r ur priorities??....what do u want to do??....sit in an A/C room nd see patients or move out in field in sun look for problems in community....thats the perspective UGs have.they want a branch in which deres is EASY EARNING...dats y dere is more shift in people taking branches such as derma , radio among toppers rather than medicine & surgery.....
        moreover they dnt see any output being come out of roaming in sun nd dey feel like it like a waste exercise..
         
        solution not only comes from higher level but from us also...people working at ground level...i think dis is high time that UG curriculum should be revised atleast in PSM nd community medicine should be demonstrated in field so that students feel that some work is being done by us nd is giving gud results....UG themselves can be involved in giving talks nd health education nd let them analyse what differnce it has made on community...
         
        i think the best change starts from us....if we can apply what r we talkn about...it will automatically generate interst amng students.
         
        with regards
         
        Dr Jyoti
        PG
        PGIMS Rohtak

        --- On Mon, 1/6/09, ganesh kumar <gane_spm@...> wrote:

        From: ganesh kumar <gane_spm@...>
        Subject: Re: [iapsm_youthmembers] Solutions to combat " Downfall in the interest of psm/community medicine"
        To: iapsm_youthmembers@yahoogroups.com
        Date: Monday, 1 June, 2009, 12:42 PM

        Dear members
         
         
        Reason for glamourous look of other field , what i thnk is,
         
        MONEY and FAME
         
        the same what we lack in our field due to some disorders in the grey matter
        of the professionals at the higher level and some ignorance of the public
        at the end level.
         
        one of the example of higher level disorder - GDP spent over the health sector.
         
        one of the example of end level disorder  - lack of community level work by us.
         
        If there is more salary and more money making options in our field , then automatically
        there will be boon of interest over our field.
        But tht way wil be incorrect, because we lost our conscience.
         
        The higher level policy makers are just making justifications for the poor performance
        of healthcare.( Just look for examples like healthcare field in France, UK , Canada)
        Health is entirely state's responsibility.
         
        Improvement in private healthcare sector is the worst indicator of universal health of the people.
         
        Ok...after all this what can be a solution...
         
        Why cant we start from higher level...
         
        Why cant we represent in addressing this issue to the MOHFW or even PM...
        Why cant we frame some perfect remedies in this issue in addressing.. .
         
        We can Stop talking and start doing things..
         
        If EXPERTS guide for a good solution i am ready to accompany to address directly to MOHFW.
         
        THANKS & REGARDS
        GANESHKUMAR
        DEPT OF COMMUNITY MEDICINE
        UNIVERSITY COLLEGE OF MEDICAL SCIENCES
        DELHI
        EMAIL:gane_spm@ yahoo.co. in
        MOB:+91 9899948487



        From: Anuja Pandey <anuja_2kn@yahoo. com>
        To: iapsm_youthmembers@ yahoogroups. com
        Sent: Sunday, 31 May, 2009 11:41:28 PM
        Subject: [iapsm_youthmembers ] Solutions to combat " Downfall in the interest of psm/community medicine"

        Dear all...
         The topic regarding downfall in interest in our specialization been an issue of hot discussion in this forum for the past few weeks. We've come up with better understanding on the topic with some excellent inputs from our members.
         
        Presently public health in India is in it's golden era, with well designed public health programmes, initiatives like IPHS standards,relevant public health policies and centres of excellence like IIPH/PHFI coming up. Perhaps the nation needs competent public health professionals now, more than ever. This downfall in  interest from undergrads, will lead to compulsive entries, in this field , rather than 'by choice' entries from passionate and competant students. And such students, who come by chance, are likely to work with less involvement, leading to an adverse and depressing picture of our speciality to the medical grads....  That means the cycle of downfall shall continue, until we do something to combat it.
         
        Let's come up with possible solutions to combat this problem. I completely hold with Dr. Subodh Sir, regarding demonstration of effects of pubic health initiatives to orient undergrads on the actual role of the subject. From my personal experience i can say, that it was just one round of pulse polio immunization which i  had worked for, as an undergrad, when i felt,that it is this branch which has the potential to affect lives of the entire population, instead on a group of patients. Public health department has the potential  to eradicate disease from the world.. what more to ask for ???  and that's how i chose my specialization.
        I request other members too to share experiences ,and solutions to combat this disinterest in community medicine among undergrads.. . Our country desperately needs a competant public health force & let's all strive to make that happen.
         
        Regards,
         
        Anuja Pandey
        Junior Resident. GMC, Nagpur.

        --- On Sun, 5/31/09, neeti goswami <drneeti2003@ yahoo.com> wrote:

        From: neeti goswami <drneeti2003@ yahoo.com>
        Subject: Re: [iapsm_youthmembers ] Downfall in the interest of psm/community medicine?
        To: iapsm_youthmembers@ yahoogroups. com
        Date: Sunday, May 31, 2009, 6:58 PM

        Hi all,
         
        Thanks sir ( Dr. Sai) for sharing the crux of problem and making it evident in tangible manner.It was an opportunity to be your student  and the interactions and discussions we had were really encouraging and motivating.
         
        Presently while doing my senior residency i am really searching for ways to connect to my interns on academic platform. Almost every day  as a group we get around thirty min after completing regular OPD's in field practice area. I have tried discussing topics of current interest but most of the time  they enquire that how this knowledge can help them in solving MCQ's, leaving a very narrow base for discussion.
         
        What maximum i have been able to achieve is that giving them random case and making them work on whole clinico social profile and the responses again are variable ( full interest to total lack of it, making the whole exercise kind of a nagging task )
         
        I wish if community members can pool in their experiences and initiatives to help me out.
         
        Regards
        Dr. Neeti Rustagi
        Senior Resident
        Deptt. of Community Medicine
        Maulana Azad Medical College
        Delhi


        --- On Sat, 5/30/09, psai kumar <psaikumar2000@ yahoo..com> wrote:

        From: psai kumar <psaikumar2000@ yahoo.com>
        Subject: Re: [iapsm_youthmembers ] Downfall in the interest of psm/community medicine?
        To: iapsm_youthmembers@ yahoogroups. com
        Date: Saturday, May 30, 2009, 2:12 AM

        Thank you Sir.
         
        Regards,
         
        Sai

        --- On Fri, 5/29/09, Jugal Kishore <drjugalkishore@ gmail.com> wrote:

        From: Jugal Kishore <drjugalkishore@ gmail.com>
        Subject: Re: [iapsm_youthmembers ] Downfall in the interest of psm/community medicine?
        To: iapsm_youthmembers@ yahoogroups. com
        Date: Friday, May 29, 2009, 10:03 PM

        Dear Sai Kumar
         
        Very good statement. All the best. 


         
        On Thu, May 28, 2009 at 5:31 PM, psai kumar <psaikumar2000@ yahoo.com> wrote:


        Dear All,
         
        I have been following this debate on interest in PSM/Coomunity Medicine. As someone who has always been the passionate about the stream and interested in the welfare of students, I for the first time wished to join the discussion board.
         
        To be fair not many students have an interest for Community Medicine during initial years in Medical School. Unfortunately, the PSM departments in medical colleges contribute in a big way to this lack of interest, or rather rejection. The rejection is not for the subject, but for what the departments in medical schools project. The faculty who shape the minds of young doctors do not sufficiently enthuse the students.
         
        To be able to enthuse the young minds, the departments need good teachers, there needs to be a change in attitude - do not try to teach and control the students, grow with them and learn with them; and lead by example. The Public Health stream needs more role models: we have them. Create opportunities for self and young doctors to interact with such role models - not for teaching on a subject but to share their experiences. .
         
        Change the teachning style - which I see some changes of late. It is difficult to teach and create interest about insects or toilets. But they can also be made exciting and interesting. New curriculum have course works/projects - get them to do something that interests the group and not what you want - from nano technology to computers to environment - make them think.. But do work with them at all stages to make them understand the epidemiological approach, the public health importance and what is reasearch - validity of findings. I always believed the entire world of public health lies within the definition of Epidemiology (by Last) 
         
        Second in line are the post graduate/registrars /residents. Do you set an example - are you confident? I was lucky to work with my seniors and colleagues/juniors  who were confident of their future, reassuring, and had positive attitude to life. Smile and positive attitude are infectious. Try and spread it.
         
        Mentor the students. Mentoring is a purposeful effort where you need to show interest in the growth, professional and personal, of your colleagues, friends and juniors. Are you interested in their growth - or just focussed on your growth. Public health is about being selfless.
         
        We are here to make a difference, and together we can. So let us make it.
         
        Regards,
         
        Sai Kumar
        PS: Some of you might know me as a resident in LHMC, New Delhi and a faculty in IAMS/DAMS for a brief period.
         
        I would like some young, dynamic and active members like Dr Chandrakant, and Dr Sonali, to share their views. It is about shaping the minds of people in the professions who can make a difference - those in medical colleges.
         
         

        --- On Tue, 5/26/09, sandeep.panigrahy <sandeep1983_ vssmc@yahoo. . co.in> wrote:

        From: sandeep.panigrahy <sandeep1983_ vssmc@yahoo. co.in>
        Subject: [iapsm_youthmembers ] MUST READ(Re: downfall in the interest of psm/community medicine?)
        To: iapsm_youthmembers@ yahoogroups. com
        Date: Tuesday, May 26, 2009, 8:17 PM

        Hi everyone
        I may be the youngest one here in this forum to comment but i totally agree with the supporters of the forum
        Its not by hard luck that i opted for this seat, I was in waiting list in the PGI and was doing well in AIIMS PG entrance, but I was looking for this seat in community medicine.. may be I dint get the premier institute finaly yet i joined in fresh....

        we need more young mind in the team of community medicine
        and like we do IEC activities we must develop curiosity in Under Graduates while we teach them... which i do always...

        Together we can join hands and do it..
        REMEMBER IF WE WIN THERE WILL BE MORE ENEMIES AGAINST US... COZ NONE OF THE DOCTORS WOULD BE HAPPY TO SEE LESS PATIENTS IN THEIR CLINIC...

        Morever you will be surprised to know that in preparation institute like SPEED and IAMS it is being told as the most growing branch now and the best subject to choose if any one has little interest for it.....

        Well hope to meet you all who are in this forum

        With regards

        Dr. Sandeep Kumar Panigrahi
        MBBS, MIPHA
        PG in Community Medicine
        SCB Medical College,
        Cuttack (Orissa)
        --- In iapsm_youthmembers@ yahoogroups. com, dinesh kumar <drdineshkl@ ...> wrote:
        >
        > hi all,
        >
        > What else do you expect on a subject which is taught based only on a single book? we need to make the subject feel more relevant to young minds and that can be done only by incorporating more and more community based experiences for the UGs may be in form of projects, case studies, problem analysis or any thing else. Imagine we teaching students teaching about ANC in field and a daily labourer who just can not move out of her work asks about her options of getting free ANC at her work place and we suggesting her some thing.The kind of impression students get out of this will be far more lasting than then our recting entire ANC protocol to them in a class room. Community is our lab ,as long as practical teaching in lab is being neglected we do not blame students for sleeping in class.
        >
        > dinesh.
        >
        >
        >
        >
        > ____________ _________ _________ __
        > From: Dr Parag Chavda <chavda_parag@ ...>
        > To: iapsm_youthmembers@ yahoogroups. com
        > Sent: Monday, 25 May, 2009 2:14:46 PM
        > Subject: Re: [iapsm_youthmembers ] downfall in the interest of psm/community medicine?
        >
        >
        >
        >
        >
        > Hi ,
        > The topic of the discussion is very relevant. It is good that there are many persons here who are spreading the positive vibes. I am proud to have taken community medicine by choice in my PG .There is no question of regretting. At the same time we also need to acknowledge the fact that community medicine is not very popular among UG students. At present very few would like to take up community medicine for PG thats a sad reality... Many do not know the scope and function of community medicine people outside medical college. Only we will have to be THE CHANGE and popularize the subject. I know it is a daunting task but we will have to start from somewhere. Lets inspire others....
        >
        > Thanks & regards,
        >
        >
        > Dr PARAG CHAVDA
        > M.B.B.S.
        > Tutor,
        > Community Medicine Dept,
        > Medical College,
        > Vadodara.
        > Gujarat, India
        > Cell: +91 9429111940
        >
        >
        >
        >
        > ____________ _________ _________ __
        > From: drneeraj_g04 <drneeraj_g04@ yahoo.com>
        > To: iapsm_youthmembers@ yahoogroups. com
        > Sent: Sunday, 24 May, 2009 11:55:23 AM
        > Subject: [iapsm_youthmembers ] downfall in the interest of psm/community medicine?
        >
        >
        > hi to everyone,
        > here can we start a discussion so as to unearth the reasons behind the downfall in the interest of PSM/Community Medicine among the aspirants of prepg.
        >
        > thnkx,
        > Dr.Neeraj Singh Gour
        > resident IIIrd yr
        > Dept. of Community Medicine
        > GRMC, GWALIOR
        >
        >
        > ____________ _________ _________ __
        > Explore and discover exciting holidays and getaways with Yahoo! India Travel Click here!
        >
        >
        >
        > Cricket on your mind? Visit the ultimate cricket website. Enter http://beta. cricket.yahoo. com
        >





        --
        Dr. J Kishore
        MBBS, MD, PGCHFWM, PGDEE, MSc., MNAMS, FIPHA
        Professor Community Medicine, Maulana Azad Medical College, New Delhi 110002,
        INDIA,
        (Mobile) 09868010950; 09968604249

        Please visit for more details: http://drjugalkisho re.blogspot. com

        President (Hony)
        Kishore Foundations; Sabasva Foundation,

        Director (Hony): Center for Inquiry Delhi Branch

        Author of
        * National Health Programs of India,
        * A Dictionary of Public Health
        * A Textbook of Health for Health Care Worker,
        * Biomedical Waste Management in India,
        * Vanishing Girl Child (on Female Feticide), Bhrun Hatiya: Apradhi Kaun?
        * The Pioneering Social  Reformers of India
        * The Great Warriors of Human Rights Movement in India
        For books Visit http://centurypubli cations.co. in





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      • gunjan taneja
        hello everybody...............   continuing with the discussion i think the whole thing finally boils down to visibility............it s a fact that most
        Message 3 of 7 , Jun 1, 2009
        • 0 Attachment
          hello everybody...............
           
          continuing with the discussion i think the whole thing finally boils down to visibility............it's a fact that most medical colleges in the country don't have a well established field practice area............the clinical departments in colleges work in a restricted area and the activities are visible to the students............the work area of PSM/Community Medicine is unrestricted and unlimited.........the changes occuring over a long period of time............i feel that the course design of MBBS in itself can't cover the entire spectrum.....though the subject is to be taught for the first three and half years, students seldom come for classes and field posting before their pre-final year (when they have to appear for their exams)............and this is too short a period for developing a liking or inclination for the subject............i feel that Public Health needs to be diversified from the Pre-MBBS period itself..........can't it be a specialized course of four years duration in specialized institutes.............i personally feel that it will uplift the whole scenario.........and produce qualified and intrested professionals.......

          as pointed out by the members we still are restricted to classroom teaching..........well the field has evolved with new specialities coming up but seldom are these brought before the UGs...........revamping of the entire curriculum is needed...........more emphasis on applied aspects as Epidemiology, Stats, Health Management and like.........we have to frame it as per today's needs...............as pointed by Abhinav Sir the PSBH initiative......similarly developing a curriculum for PGs is also a must...............

          lastly we definitely have to contribute at our individual levels............the change has to start  from us..........it's for us to contribute in whatever small way we can............the field is growing........clearly evident by the number of clinicians and non-medical professionals trying out their luck........epidemiology is taught nowadays at courses by Clinicians...........why are we lagging behind..........isn't it a thing to ponder upon...........

          with regards to one and all............

          Dr.Gunjan Taneja
          PG Student
          Dept of Community Medcine
          MGMMC Indore


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        • shantanu dubey
          Hi friends. I have been keenly following the present debate and like most people here, have been arrested and captivated by it. Allow me to make my point too.
          Message 4 of 7 , Jun 1, 2009
          • 0 Attachment

            Hi friends. I have been keenly following the present debate and like most people here, have been arrested and captivated by it. Allow me to make my point too. The topic began with the question – is there a decrease in med grads opting for PSM, and if yes, what is the reason. I would rephrase and paraphrase the question a bit and introduce some more. 

            • Is there a decrease of interest in PSM community medicine?
            • Was there ever too great an interest?
            • Was PSM ever a very popular branch?
            • What could be the reason for the low status of PSM in medical world?
            • Is it a reality that we have always suffered from low self esteem?
            • What does the future hold – good or bad tidings? 

            For a moment, I invite you to let down your cudgels and passion for the field, borne no doubt of your long association and love for the subject, and examine these questions objectively. Let us also be forewarned, however, that since it is we who are discussing this subject, we will never be able to arrive at the RIGHT conclusions, for the simple reason that we are not the study group! The subject of our study is the multitude of MBBS grads who DO NOT pick PSM. And we HAVE. So let’s be reasonable, that however we may rant and rave, our efforts to peep into why they did not pick PSM, and hence our conclusions, will at best, be erroneous. Having said that however - as they say - let the games begin!

             So is it true that other disciplines are more sought after than preventive medicine? Look around you and the answer is – yes. But why? One word has been used over and over again here – Glamour. My argument is that PSM and glamour are inherently contrarian, or oxymoronic. But before we examine this hypothesis, we need to define glamour.

            Let me propose that glamour is more than just big money and more press coverage. It’s also about fulfillment, a sense of achievement. Probe a little deeper and you realize that achievement is less of a personal facet and more of a matter of perception in the eyes of those around you. You know you’ve arrived when they know you’ve arrived. Appreciation from peers, the profuse thanks of your patients, your family’s sense of pride and most importantly but least explicitly – “neighbors envy” are what give you that sense of fulfillment and achievement. So glamour, the thing that pulls young talent, is money and achievement together. So is there less glamour in PSM? If yes, why?

            Let’s take the first prong of glamour – money. Some of us say that PSM fails to attract young talent because it begets less money. That is like stating the obvious. It isn’t rocket science to guess that the best talent will go where the money is. Suffice it to say that barring those few who have a genuine love for the subject, most people would be in a less paying branch merely because they couldn’t make it to the top rungs. Some may say that the amount of money in public health is phenomenal. True. But consider this, the % GDP of any country spent on preventive health is far less vis-à-vis that spent on curative health. Clearly, there’s less money in our field. But does that answer our original question? No. It merely gives rise to – why is there less money in PSM? Keep this in mind and we’ll come back to it again.

            Now for the argument, that PSM gets less attention from policy makers, course makers and the likes. So if it were, would it increase the Glamour in the field? Let’s assume that one fine day PSM becomes the blue eyed baby of our policy makers. For the sake of argument, so much so that they decide to spend every penny they had on preventive medicine. So would that make our field lucrative? Sadly, no. Compare the Indian State’s 15 to 20% spending on health with the public’s 85% out of pocket spending! Keeping a lot of money aside in that 85% for preventive medicine, (paid immunizations and the like) the clinicians would still be raking in more than 4 times more money than us. And that’s when we’re assuming that we get all of the State’s money. This seems very, very unlikely.

            Of course, the above is a simplistic argument, but it brings us to a profound truth – that in our times, and probably for a lot more time to come, the public does and will pay more than the government, or policy makers or the WHO and the multinational trusts and foundations.

            Some say that there’s so much technology and development in modern medicine and very little in preventive medicine. Yes, but where does technology and development come from? Consider just one of the pillars of development - research. There is far more research in clinical fields than preventive. Why? Simply because research can’t thrive on a hungry stomach. It needs funding. And  funding comes from deep pockets! And history is testimony to the fact that these deep pockets are more frequently of profit making concerns like the big business houses than from taxpayers money. Now taxpayers money would be expected to benefit the taxpayer, and the businessman’s money would benefit…? There is more research in clinical fields simply because that research has the promise of making even more money! Even those deep pockets are looking to get even deeper by laying a claim to the consumers’ money.

            The biggest payer, in finality, is the end consumer.Clinical medicine is an industry, thriving on its own without donor money, public health on the other hand, is primarily philanthropic. It may be the smart choice, but lets be fair, we’ve been unable to convince the end consumer of this smartness.

            So why doesn’t the consumer pay us? Answer: because your stake to his money is through his wisdom, his good sense; and the clinicians’ claim to his money is through fear. Fear of death, of disability, of personal loss. It’s the single most powerful emotion that can make a man part with his money. When he’s healthy, (our turn to earn from him) he has more important things to do. Save for his retirement, pay for his son’s education, pay for his daughter’s marriage. When he’s sick, (clinician’s turn to earn) he’s afraid. And he readily shells out his hard earned (and saved) money.

            And then, the other element of Glamour is achievement. But as we saw, achievement has to do with other people noticing you. What gets noticed? Consider a straight line. It goes on, endlessly. Perfect. But is it noticeable? Hardly! Contrast this with the financial chart of a rapidly emerging company. Even if you don’t know much about this company, you sit up and take notice. More twists, more changes, more drama! So, the second prong of glamour is perceptible drama! For the layman, and even subconsciously for the medicine grad, the clinician’s heroic rescue of a severely incapacitated patient, who couldn’t get up from his bed before, is dramatic. In contrast, there’s nothing dramatic or heroic about an already healthy person (or community) not falling sick! In fact, it’s not even noticeable! (Except to the statisticians!)

            So the money, (which comes from the end consumer who pays up only when he is afraid) and the heroism (the transition, the change, the shift from sickness to health) will always belong to the clinicians. And money + drama = glamour. Now you know why glamour and preventive health are innately oxymoronic. Your very aim, by definition, is to maintain status quo and prevent people from being sick, from being afraid. How the hell do you expect to be paid for that?

            The fortunes of our field will not change with innovative classroom teaching, or more allocation in the national budget, or more trips to field practice areas. Till the time we displace the clinical departments’ promise of money, name, fame and glamour, we’ll never even attract the lion’s share of spending for R&D, leave alone the brightest minds in the medical fraternity.

            If PSM is to attract more talent, it must be made more glamorous. Due to the present definition of preventive medicine, this seems to be impossible. So either of these definitions needs to change. The definition of glamour, the definition of heroism, the definition of fear, or the definition of preventive medicine. What and how, i don't know. But till that happens, we’ll need to be prepared to play second fiddle to clinicians. 

            warm regards,

            --
            Dr Shantanu Dubey
            Senior Resident
            Deptt of Hospital Administration
            AIIMS, New Delhi
            Ph - 09868371724
          • dr_astic_23
            Dear Dr Dubey, What an absolutely precise documentation of the problem, I must say. Whatever you ve said is the truth, bitter it may have been at times. But
            Message 5 of 7 , Jun 11, 2009
            • 0 Attachment
              Dear Dr Dubey,
              What an absolutely precise documentation of the problem, I must say. Whatever you've said is the truth, bitter it may have been at times. But then who has ever stopped us from remaining clinically oriented at least to the degree that is expected from a medical graduate. What about the treatment guidelines of the various national health programs? I've seen clinicians approaching us on these issues many times.
              While it is true that the "glamor-quotient" of PSM will never be equal to (at least some of) the clinical streams, yet we have our strong areas which with some more efforts will go a long way in helping us all. And I would like to stress here that it is our same "everything-under-the-sky" syllabus that is perhaps our greatest strength as well as the greatest weakness at the same time. We need to learn (and to teach) to choose from this immense bouquet.
              Best regards,
              Himanshu Chauhan
              National Health Officer
              Save the Children, India

              --- In iapsm_youthmembers@yahoogroups.com, shantanu dubey <drsdubey@...> wrote:
              >
              > Hi friends. I have been keenly following the present debate and like most
              > people here, have been arrested and captivated by it. Allow me to make my
              > point too. The topic began with the question – is there a decrease in med
              > grads opting for PSM, and if yes, what is the reason. I would rephrase and
              > paraphrase the question a bit and introduce some more.
              >
              > - Is there a decrease of interest in PSM community medicine?
              > - Was there ever too great an interest?
              > - Was PSM ever a very popular branch?
              > - What could be the reason for the low status of PSM in medical world?
              > - Is it a reality that we have always suffered from low self esteem?
              > - What does the future hold – good or bad tidings?
              >
              > For a moment, I invite you to let down your cudgels and passion for the
              > field, borne no doubt of your long association and love for the subject, and
              > examine these questions objectively. *Let us also be forewarned, however,
              > that since it is we who are discussing this subject, we will never be able
              > to arrive at the RIGHT conclusions*, for the simple reason that we are not
              > the study group! The subject of our study is the multitude of MBBS grads who
              > DO NOT pick PSM. And we HAVE. So let's be reasonable, that however we may
              > rant and rave, our efforts to peep into why they did not pick PSM, and hence
              > our conclusions, will at best, be erroneous. Having said that however - as
              > they say - let the games begin!
              >
              > So is it true that other disciplines are more sought after than preventive
              > medicine? Look around you and the answer is – yes. But why? One word has
              > been used over and over again here – Glamour. My argument is that PSM and
              > glamour are inherently contrarian, or oxymoronic. But before we examine this
              > hypothesis, we need to define glamour.
              >
              > Let me propose that glamour is more than just big money and more press
              > coverage. It's also about fulfillment, a sense of achievement. Probe a
              > little deeper and you realize that achievement is less of a personal facet
              > and more of a matter of perception in the eyes of those around you. You know
              > you've arrived when *they know you've arrived. *Appreciation from peers, the
              > profuse thanks of your patients, your family's sense of pride and most
              > importantly but least explicitly – "neighbors envy" are what give you that
              > sense of fulfillment and achievement. So glamour, the thing that pulls young
              > talent, is money and achievement together. So is there less glamour in PSM?
              > If yes, why?
              >
              > Let's take the first prong of glamour – money. Some of us say that PSM fails
              > to attract young talent because it begets less money. That is like stating
              > the obvious. It isn't rocket science to guess that the best talent will go
              > where the money is. Suffice it to say that barring those few who have a
              > genuine love for the subject, most people would be in a less paying branch
              > merely because they couldn't make it to the top rungs. Some may say that the
              > amount of money in public health is phenomenal. True. But consider this, the
              > % GDP of any country spent on preventive health is far less vis-à-vis that
              > spent on curative health. Clearly, there's less money in our field. But does
              > that answer our original question? No. It merely gives rise to – why is
              > there less money in PSM? Keep this in mind and we'll come back to it again.
              >
              > Now for the argument, that PSM gets less attention from policy makers,
              > course makers and the likes. So if it were, would it increase the Glamour in
              > the field? Let's assume that one fine day PSM becomes the blue eyed baby of
              > our policy makers. For the sake of argument, so much so that they decide to
              > spend every penny they had on preventive medicine. So would that make our
              > field lucrative? Sadly, no. Compare the Indian State's 15 to 20% spending on
              > health with the public's 85% out of pocket spending! Keeping a lot of money
              > aside in that 85% for preventive medicine, (paid immunizations and the like)
              > the clinicians would still be raking in more than 4 times more money than
              > us. And that's when we're assuming that we get all of the State's money.
              > This seems very, very unlikely.
              >
              > Of course, the above is a simplistic argument, but it brings us to a
              > profound truth – that in our times, and probably for a lot more time to
              > come, the public does and will pay more than the government, or policy
              > makers or the WHO and the multinational trusts and foundations.
              >
              > Some say that there's so much technology and development in modern medicine
              > and very little in preventive medicine. Yes, but where does technology and
              > development come from? Consider just one of the pillars of development -
              > research. There is far more research in clinical fields than preventive.
              > Why? Simply because research can't thrive on a hungry stomach. It needs
              > funding. And funding comes from deep pockets! And history is testimony to
              > the fact that these deep pockets are more frequently of profit making
              > concerns like the big business houses than from taxpayers money. Now
              > taxpayers money would be expected to benefit the taxpayer, and the
              > businessman's money would benefit…? There is more research in clinical
              > fields simply because that research has the promise of making even more
              > money! Even those deep pockets are looking to get even deeper by laying a
              > claim to the consumers' money.
              >
              > The biggest payer, in finality, is the end consumer.Clinical medicine is an
              > industry, thriving on its own without donor money, public health on the
              > other hand, is primarily philanthropic. It may be the smart choice, but lets
              > be fair, we've been unable to convince the end consumer of this smartness.
              >
              > So why doesn't the consumer pay us? Answer: because your stake to his money
              > is through his wisdom, his good sense; and the clinicians' claim to his
              > money is through fear. Fear of death, of disability, of personal loss. It's
              > the single most powerful emotion that can make a man part with his money.
              > When he's healthy, (our turn to earn from him) he has more important things
              > to do. Save for his retirement, pay for his son's education, pay for his
              > daughter's marriage. When he's sick, (clinician's turn to earn) he's afraid.
              > And he readily shells out his hard earned (and saved) money.
              >
              > And then, the other element of Glamour is achievement. But as we saw,
              > achievement has to do with other people noticing you. What gets noticed?
              > Consider a straight line. It goes on, endlessly. Perfect. But is it
              > noticeable? Hardly! Contrast this with the financial chart of a rapidly
              > emerging company. Even if you don't know much about this company, you sit up
              > and take notice. More twists, more changes, more drama! So, the second prong
              > of glamour is perceptible drama! For the layman, and even subconsciously for
              > the medicine grad, the clinician's heroic rescue of a severely incapacitated
              > patient, who couldn't get up from his bed before, is dramatic. In contrast,
              > there's nothing dramatic or heroic about an already healthy person (or
              > community) not falling sick! In fact, it's not even noticeable! (Except to
              > the statisticians!)
              >
              > So the money, (which comes from the end consumer who pays up only when he is
              > afraid) and the heroism (the transition, the change, the shift from sickness
              > to health) will always belong to the clinicians. And money + drama =
              > glamour. Now you know why glamour and preventive health are innately
              > oxymoronic. Your very aim, by definition, is to maintain status quo and
              > prevent people from being sick, from being afraid. How the hell do you
              > expect to be paid for that?
              >
              > The fortunes of our field will not change with innovative classroom
              > teaching, or more allocation in the national budget, or more trips to field
              > practice areas. Till the time we displace the clinical departments' promise
              > of money, name, fame and glamour, we'll never even attract the lion's share
              > of spending for R&D, leave alone the brightest minds in the medical
              > fraternity.
              >
              > If PSM is to attract more talent, it must be made more glamorous. Due to the
              > present definition of preventive medicine, this seems to be impossible. So
              > either of these definitions needs to change. The definition of glamour, the
              > definition of heroism, the definition of fear, or the definition of
              > preventive medicine. What and how, i don't know. But till that happens,
              > we'll need to be prepared to play second fiddle to clinicians.
              > warm regards,
              >
              > --
              > Dr Shantanu Dubey
              > Senior Resident
              > Deptt of Hospital Administration
              > AIIMS, New Delhi
              > Ph - 09868371724
              >
            • Anil Mishra
              Dear Friends,   This is really an interesting topic to discuss. I discussed this with one of my friends, who is a clinician.The reply was if public health
              Message 6 of 7 , Jun 12, 2009
              • 0 Attachment
                Dear Friends,
                 
                This is really an interesting topic to discuss.
                I discussed this with one of my friends, who is a clinician.The reply was " if public health and community medicine is not effectively working then the burden of disease comes to the clinicians, and it is our moral and ethical duty to manage this,  as a result we get paid... so simple!'
                 
                Lets channelize this discussion towards  strengthening public health in India.Remember, India is the biggest ground to learn public health.
                 
                It is a fact that there are some weaknesses in our Community Medicine functioning/ teaching.I will share some more thoughts on this.....after few days......just to keep this discussion alive.
                 
                This certainly, gives us the opportunity for introspection.......
                 
                best regards,
                Anil
                 
                 
                 
                    

                --- On Thu, 6/11/09, dr_astic_23 <dr_astic_23@...> wrote:

                From: dr_astic_23 <dr_astic_23@...>
                Subject: [iapsm_youthmembers] Re: Solutions to combat " Downfall in the interest of psm/community medicine"
                To: iapsm_youthmembers@yahoogroups.com
                Date: Thursday, June 11, 2009, 12:35 PM

                Dear Dr Dubey,
                What an absolutely precise documentation of the problem, I must say. Whatever you've said is the truth, bitter it may have been at times. But then who has ever stopped us from remaining clinically oriented at least to the degree that is expected from a medical graduate. What about the treatment guidelines of the various national health programs? I've seen clinicians approaching us on these issues many times.
                While it is true that the "glamor-quotient" of PSM will never be equal to (at least some of) the clinical streams, yet we have our strong areas which with some more efforts will go a long way in helping us all. And I would like to stress here that it is our same "everything- under-the- sky" syllabus that is perhaps our greatest strength as well as the greatest weakness at the same time. We need to learn (and to teach) to choose from this immense bouquet.
                Best regards,
                Himanshu Chauhan
                National Health Officer
                Save the Children, India

                --- In iapsm_youthmembers@ yahoogroups. com, shantanu dubey <drsdubey@.. .> wrote:
                >
                > Hi friends. I have been keenly following the present debate and like most
                > people here, have been arrested and captivated by it. Allow me to make my
                > point too. The topic began with the question – is there a decrease in med
                > grads opting for PSM, and if yes, what is the reason. I would rephrase and
                > paraphrase the question a bit and introduce some more.
                >
                > - Is there a decrease of interest in PSM community medicine?
                > - Was there ever too great an interest?
                > - Was PSM ever a very popular branch?
                > - What could be the reason for the low status of PSM in medical world?
                > - Is it a reality that we have always suffered from low self esteem?
                > - What does the future hold – good or bad tidings?
                >
                > For a moment, I invite you to let down your cudgels and passion for the
                > field, borne no doubt of your long association and love for the subject, and
                > examine these questions objectively. *Let us also be forewarned, however,
                > that since it is we who are discussing this subject, we will never be able
                > to arrive at the RIGHT conclusions* , for the simple reason that we are not
                > the study group! The subject of our study is the multitude of MBBS grads who
                > DO NOT pick PSM. And we HAVE. So let's be reasonable, that however we may
                > rant and rave, our efforts to peep into why they did not pick PSM, and hence
                > our conclusions, will at best, be erroneous. Having said that however - as
                > they say - let the games begin!
                >
                > So is it true that other disciplines are more sought after than preventive
                > medicine? Look around you and the answer is – yes. But why? One word has
                > been used over and over again here – Glamour. My argument is that PSM and
                > glamour are inherently contrarian, or oxymoronic. But before we examine this
                > hypothesis, we need to define glamour.
                >
                > Let me propose that glamour is more than just big money and more press
                > coverage. It's also about fulfillment, a sense of achievement. Probe a
                > little deeper and you realize that achievement is less of a personal facet
                > and more of a matter of perception in the eyes of those around you. You know
                > you've arrived when *they know you've arrived. *Appreciation from peers, the
                > profuse thanks of your patients, your family's sense of pride and most
                > importantly but least explicitly – "neighbors envy" are what give you that
                > sense of fulfillment and achievement. So glamour, the thing that pulls young
                > talent, is money and achievement together. So is there less glamour in PSM?
                > If yes, why?
                >
                > Let's take the first prong of glamour – money. Some of us say that PSM fails
                > to attract young talent because it begets less money. That is like stating
                > the obvious. It isn't rocket science to guess that the best talent will go
                > where the money is. Suffice it to say that barring those few who have a
                > genuine love for the subject, most people would be in a less paying branch
                > merely because they couldn't make it to the top rungs. Some may say that the
                > amount of money in public health is phenomenal. True. But consider this, the
                > % GDP of any country spent on preventive health is far less vis-à-vis that
                > spent on curative health. Clearly, there's less money in our field. But does
                > that answer our original question? No. It merely gives rise to – why is
                > there less money in PSM? Keep this in mind and we'll come back to it again.
                >
                > Now for the argument, that PSM gets less attention from policy makers,
                > course makers and the likes. So if it were, would it increase the Glamour in
                > the field? Let's assume that one fine day PSM becomes the blue eyed baby of
                > our policy makers. For the sake of argument, so much so that they decide to
                > spend every penny they had on preventive medicine. So would that make our
                > field lucrative? Sadly, no. Compare the Indian State's 15 to 20% spending on
                > health with the public's 85% out of pocket spending! Keeping a lot of money
                > aside in that 85% for preventive medicine, (paid immunizations and the like)
                > the clinicians would still be raking in more than 4 times more money than
                > us. And that's when we're assuming that we get all of the State's money.
                > This seems very, very unlikely.
                >
                > Of course, the above is a simplistic argument, but it brings us to a
                > profound truth – that in our times, and probably for a lot more time to
                > come, the public does and will pay more than the government, or policy
                > makers or the WHO and the multinational trusts and foundations.
                >
                > Some say that there's so much technology and development in modern medicine
                > and very little in preventive medicine. Yes, but where does technology and
                > development come from? Consider just one of the pillars of development -
                > research. There is far more research in clinical fields than preventive.
                > Why? Simply because research can't thrive on a hungry stomach. It needs
                > funding. And funding comes from deep pockets! And history is testimony to
                > the fact that these deep pockets are more frequently of profit making
                > concerns like the big business houses than from taxpayers money. Now
                > taxpayers money would be expected to benefit the taxpayer, and the
                > businessman' s money would benefit…? There is more research in clinical
                > fields simply because that research has the promise of making even more
                > money! Even those deep pockets are looking to get even deeper by laying a
                > claim to the consumers' money.
                >
                > The biggest payer, in finality, is the end consumer.Clinical medicine is an
                > industry, thriving on its own without donor money, public health on the
                > other hand, is primarily philanthropic. It may be the smart choice, but lets
                > be fair, we've been unable to convince the end consumer of this smartness.
                >
                > So why doesn't the consumer pay us? Answer: because your stake to his money
                > is through his wisdom, his good sense; and the clinicians' claim to his
                > money is through fear. Fear of death, of disability, of personal loss. It's
                > the single most powerful emotion that can make a man part with his money.
                > When he's healthy, (our turn to earn from him) he has more important things
                > to do. Save for his retirement, pay for his son's education, pay for his
                > daughter's marriage. When he's sick, (clinician's turn to earn) he's afraid.
                > And he readily shells out his hard earned (and saved) money.
                >
                > And then, the other element of Glamour is achievement. But as we saw,
                > achievement has to do with other people noticing you. What gets noticed?
                > Consider a straight line. It goes on, endlessly. Perfect. But is it
                > noticeable? Hardly! Contrast this with the financial chart of a rapidly
                > emerging company. Even if you don't know much about this company, you sit up
                > and take notice. More twists, more changes, more drama! So, the second prong
                > of glamour is perceptible drama! For the layman, and even subconsciously for
                > the medicine grad, the clinician's heroic rescue of a severely incapacitated
                > patient, who couldn't get up from his bed before, is dramatic. In contrast,
                > there's nothing dramatic or heroic about an already healthy person (or
                > community) not falling sick! In fact, it's not even noticeable! (Except to
                > the statisticians! )
                >
                > So the money, (which comes from the end consumer who pays up only when he is
                > afraid) and the heroism (the transition, the change, the shift from sickness
                > to health) will always belong to the clinicians. And money + drama =
                > glamour. Now you know why glamour and preventive health are innately
                > oxymoronic. Your very aim, by definition, is to maintain status quo and
                > prevent people from being sick, from being afraid. How the hell do you
                > expect to be paid for that?
                >
                > The fortunes of our field will not change with innovative classroom
                > teaching, or more allocation in the national budget, or more trips to field
                > practice areas. Till the time we displace the clinical departments' promise
                > of money, name, fame and glamour, we'll never even attract the lion's share
                > of spending for R&D, leave alone the brightest minds in the medical
                > fraternity.
                >
                > If PSM is to attract more talent, it must be made more glamorous. Due to the
                > present definition of preventive medicine, this seems to be impossible. So
                > either of these definitions needs to change. The definition of glamour, the
                > definition of heroism, the definition of fear, or the definition of
                > preventive medicine. What and how, i don't know. But till that happens,
                > we'll need to be prepared to play second fiddle to clinicians.
                > warm regards,
                >
                > --
                > Dr Shantanu Dubey
                > Senior Resident
                > Deptt of Hospital Administration
                > AIIMS, New Delhi
                > Ph - 09868371724
                >


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