Covid doctors. Why pressing final year MBBS students into Covid service is a bad idea

The Tamil Nadu government’s plan to rope in 300 final year MBBS students for Covid duty, has disturbing legal and ethical implications.

A final MBBS student has seen the inside of a hospital only when he/she goes to attend clinics, where they are asked to examine a case and teachers tell them what all to note in the patient and arrive at a diagnosis. The general principles of treatment are discussed, not the specifics.

The students do not know to start an IV line, or give an injection, or take blood for investigation, put a patient on oxygen or even write up forms. The powers that be feel that they can be trained in a few days. If that were true, then why do we have a compulsory rotating internship programme that lasts one year after MBBS? And are we going to allow them to train on Covid patients?

The decision when to start an IV, or give injections needs to be as fast and smooth as possible so that you do not spend a lot of time with the patient and infect yourself.

An untrained person is a huge liability not only for himself but the entire team. Final MBBS students are that weak, untrained link.

There is always the risk of some of these students contracting Covid while treating patients. What if some student dies, who will be responsible for that?

The government has said students will be used for teleconsultation and data entry and may be tasked for hospital duty. Legal issues of consulting and prescribing aside when they do not yet have a degree, or a registration with any medical council of India, the Covid disease itself has been an evolving learning process for doctors.

How will the students understand the importance of a recurring fever and assess whether it requires steroids or antibiotics? Given the huge case loads they are not going to have a senior guiding them always. Then what happens to the hapless patient?

Challenging times call for bold measures. Apart from recruiting final MBBS year studentswhat are the options available?

Other alternatives

* There is a huge task force of doctors in the private sector who are not on active Covid duty like surgeons, ophthalmologists, ENT surgeons, who are now having spare time as elective surgeries are cancelled, many other specialist physicians like neurologists, gastro-enterologists who have cancelled their OPDs because patients do not want to risk coming to the hospital now.

* There are also a vast number of MBBS doctors in private practice who have closed shop due to the lockdown and who are in need of a job to survive.

* As many as 1,50,000 young doctors freshly out of MBBS are waiting to write the NEET PG exam. If the exam was conducted, at least one third of them would have joined as first year postgraduates. The ones who do not get into a PG programme would be willing to work for six months before sitting for the exam again.

These are all the doctors who should have been recruited, made to work in shifts and paid well for their services. Young doctors who have just completed MBBS would have been most ideal to handle the huge workload of the pandemic with least risk to themselves. That would have effectively relieved the load off the exhausted frontline doctors, rendered the same quality of care and not raised any legal or ethical issues.

‘Roping’ in Final year MBBS students, exposing them to grave personal risk and adding confusion in an already chaotic situation is madness.

Final year students pushed into service may end up bearing psychological scars and guilt if patients deteriorate and die under their ‘tele-care’.

The writer is Project Director -The Smile Train, Consultant Plastic and Reconstructive Surgeon, Anandaloke Multispeciality Hospital, Siliguri

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