Expertise, trust, and empathy are three pillars of an effective doctor-patient relationship. At the heart of this relationship lies communication. A common language helps bridge the information asymmetry between doctor and patient, facilitating the treatment process. It makes doctors more ‘accessible’ instead of ‘elite’ in patients’ eyes, especially those from rural areas. From this perspective, the recent decision of the Madhya Pradesh (MP) government to conduct the MBBS course in Hindi seems pertinent. However, good intentions do not always result in good outcomes.
Through the policy lens, the decision appears unsound for three reasons. First, there is a lack of clarity regarding why this change is necessary. The claim that reliance on English negatively affects the accessibility and quality of medical education needs evidence. Open discussion and debate on the issue are called for. Second, it tends to neglect the complexity of medical education. A half-baked policy may impose high costs on the entire system while delivering unintended negative consequences. The contemplated benefits from policy change must be scrupulously weighed against the costs. Third, the ‘native’ language in the Indian context does not just mean Hindi. The government seems oblivious to the ‘domino effect’ the implementation of this policy may have on medical education across the Indian States. Thus, hasty announcements and implementation of such an impactful decision might do more harm than good.
Russia, China, Japan, and many other countries have MBBS courses in their native languages. But unlike these nations, India does not have linguistic homogeneity of the natal tongue. Indian states are formed on a linguistic basis. Medical Education is placed in List III (Concurrent List) in the Seventh Schedule of the Indian Constitution. If MP provides MBBS education in Hindi, we may soon see various state governments developing MBBS courses in their official languages. Such fragmentation of medical education and profession based on language might restrict choices for medical aspirants and graduates to study and work, respectively.
Backward and forward linkages
Firstly, let us look at the backward linkage. The policy would suit students who completed their school education in Hindi medium. The MP government announced that there would be bilingual classes–Hindi and English in medical colleges. At later stages, students would be given a choice regarding the medium of instruction. Considering that more than 40% of students in MP pass out of English-medium private schools (U-DISE 2021), nearly half of medical students are likely to prefer English as the medium of instruction. Medical colleges, thus, would require simultaneous facilities for instruction in both languages. Would the colleges conduct examinations in bilingual mode? Would the external examiners for viva always be comfortable in Hindi? Would it affect the availability of quality examiners? The policy must address these issues.
Through the National Eligibility cum Entrance Test (NEET), aspirants seek admission to medical courses across different medical institutes in the country. What happens when each state government conducts an MBBS course in the state’s official language? The proposed bilingual classes may not be attractive to students outside the state. This may become a political tool for state governments to promote the ‘sons of the soil’ policy discouraging students from other states. Such a scenario would be inimical to national interest and may hurt the students’ interests.
English as a medium of instruction allows for uniformity in curriculum and academic standards across the country. The existing large pool of doctors, practitioners, and academicians provide expert faculty ensuring the quality of instruction in medical colleges. English is not just a language. It is a skill and tool for upward mobility in an increasingly competitive world. Classrooms, hospitals, and teachers provide exposure, but doctors are made in libraries, where these students burn the midnight oil exploring numerous sources on multiple topics. Access to quality medical literature and exchange of knowledge with mentors and peers allows students to expand their horizons and get better career opportunities within and outside the country.
Let us now consider the forward link. Will we conduct various postgraduate courses in the vernacular medium in the future? Would non-English medium MBBS candidates have a disadvantage while applying to prestigious postgraduate and super-speciality institutes in India and abroad? Ill-conceived ideas implemented without adequate planning may adversely affect the career growth of students. India is emerging as a top medical tourism destination and an exporter of medical services and professionals. Indian doctors make up a sizable proportion of medical professionals in countries like the US, UK, Canada, and Australia.
Modern medicine is an ever-evolving and dynamic field. Despite the enormous body of knowledge available, COVID-19 has shown that there are many ‘unknowns’ yet. The growth of medical research and development is contingent upon sharing knowledge, learnings, and insights within the medical fraternity. In a linguistically diverse landscape, English acts as a bridge. In this context, creating a language barrier may be the last thing we need.
Public healthcare in India is faced with acute challenges. According to the Rural Health Statistics 2020-21 by the MoHFW, there is a shortfall of 4% of allopathic doctors and 80% of specialists in rural India. The government spends only 1.28% of GDP on healthcare, and out-of-pocket expenditure is 53.2% of current health expenditure (2018-19). The urban-to-rural doctor density ratio is 3.8:1, representing a highly skewed distribution. Currently, 57.3% of allopathic medicine practitioners do not have a medical qualification. The language issue appears peripheral to the overall strengthening of the country’s healthcare system when weighed against these stats.
The language pill
Certain steps can be taken to ensure the best outcome without compromising the long-term interests of students, teachers, and colleges.
First, the medium of instruction for the MBBS course must be English. Any change in the status quo would be justified when clarity about forward and backward linkages is obtained. The issues of access to medical education and facilitating doctor-patient communication are crucial. But the cure must not be worse than the disease. Changing the medium of instruction in medical colleges is not the solution to the mentioned issues. We must refrain from using students as pawns in the ‘language wars’ manufactured for political interests.
Second, medical colleges can encourage and facilitate communication in the local languages. Candidates having difficulty understanding the local language can be offered supplementary courses to improve the same. Workable knowledge of such languages would simplify various medical terms and aid the process of doctor-patient communication. Apps can be developed to easily translate complex medical jargon into local languages to avoid overburdening medical students.
Third, reputed central institutions like AIIMS, can conduct pilot projects to test the viability of MBBS courses in native languages. The data from these small-scale studies must be shared and used to devise policies to be implemented at a large scale. State governments must go slow, discussing and debating the data obtained from pilot studies. Simultaneous efforts can be made to translate medical curricula into native languages without diluting the quality.
Fourth, while addressing domestic demand, India must aim to develop into a global healthcare hub. India has an advantage because of highly professional doctors, cutting-edge technology, and state-of-the-art medical infrastructure. Increasing the number of medical colleges and promoting English language skills can help build a pool of human resources that would be an asset to the nation. India can become a medical education and tourism hub, catering to the developed and developing world. This will also contribute to improving the domestic healthcare industry.
Lastly, we need a comprehensive language policy for the entire education sector–including higher education. This is in the spirit of the National Education Policy 2020, seeking to break silos and vows to keep the learners’ interests at the core. However, we mustn’t miss the forest for the trees. The core objective of medical education is to produce competent and compassionate doctors and promote the health and well-being of patients. Let the Hippocratic injunction of Primum non nocere (‘first, do no harm’) be the cornerstone of any policy change in medical education.
Read More: MSP seen through the lens of the Austrian School of Economics
Post Disclaimer
The opinions expressed in this essay are those of the authors. They do not purport to reflect the opinions or views of CCS.
