DOCTORSPEAK: Of Rural Gratitude Model And Elite Entitlement complex
Dr Reema Goswami
The contrast I have lived through over the past 17 years in Sagar—moving from the bustling metropolis of Delhi to the heart of Bundelkhand—is more than just a career progression; it is a profound sociological study of the human condition. In the corridors of a government medical college, a doctor stands at the intersection of two worlds: the Rural Gratitude Model and the Elite Entitlement complex.
In the rural landscape of Bundelkhand, medical care is not perceived as a mere routine duty, but a moral event. For a farmer who travels miles to reach Sagar, a surgeon who removes a foreign body or repairs a cut throat or does a routlne surgery is seen as a “saviour”—a term that carries religious and familial weight.
When these patients touch my feet or bring gifts like vegetable fruits or ghee ,they are attempting to balance an “unpayable debt.” To them, your skill is a divine gift, and your service grants you a permanent seat in their family hierarchy. This word-of-mouth publicity by them in their community is the ultimate form of rural trust; it is a social contract where the doctor is integrated into the village’s collective consciousness. However, because the trust is so personal, any failure is seen as a personal betrayal and at times it is tough to deal with it.
Conversely, the treatment of bureaucrats and ministers operates under the shadow of VIP Syndrome. In these encounters, a medical college is often treated as a service wing of the state. When an “order” comes from the head of the institution, the patient-doctor relationship is immediately compromised by power dynamics. This I realised when a bureaucrat came to the OPD one day with a history of accidentally swallowing a chicken bone, and he was feeling miserable.
The bureaucrat who received an emergency CT scan and surgery on a Sunday viewed the medical team through the lens of administrative entitlement. For the elite, the expertise of a doctor was a right provided by his status, not a service to be grateful for. The “silence” following his recovery—the lack of a simple thank-you message—is a psychological defense mechanism.
For a high-ranking official, being a “patient” is a position of vulnerability and weakness. Once they are healed, they often seek to dissociate and wipe out the chapter to reclaim their image of invulnerability.
The COVID-19 and Black Fungus crises served as the ultimate litmus test for these two groups. While VIPs utilised every resource and influence to survive, many subsequently chose to forget the “saviours” who risked their lives in PPE kits, viewing the ordeal as a dark period better left ignored.
In contrast, the uneducated and the poor remain the custodians of memory. They do not have the luxury of arrogance; they remember the breath that was returned to them.
My journey suggests that while the VIP patient may offer a boost to the institution’s standing, it is the rural patient who sustains the doctor’s spirit.
Dr Reema Goswami is Professor and HOD, ENT at Bundelkhand Medical College, Sagar (MP)
