India got its freedom from slavery some fifty- eight years ago. There were enormous health problems among Indians during that period. Even the wife of first Indian Prime Minister died of the killer disease, pulmonary tuberculosis. The leaders of medical fraternity realized that the problem of tuberculosis in this country was very high. They felt the need to start a course of diploma in tuberculosis after the degree of under graduation (MBBS) to tackle the problem of tuberculosis. Later on, this diploma course was upgraded to the degree of MD (Tuberculosis and Chest Diseases) to tackle the high incidence of pulmonary tuberculosis. As the time went on, tuberculosis kept on flourishing since the training personnel for the purpose slipped away from their basic work.
Medical postgraduates in specialities like cardiology, neurology, nephrology, gastroenterology, endocrinology etc. have to go through the rigorous training in internal medicine for three years. Subsequently, they get admitted to super-speciality of their choice for another three years. In other words, nobody can be upgraded as super specialist without the knowledge of internal medicine. The practice of super specialty without the knowledge of internal medicine remains incomplete123. Unfortunately, the medical personnel with MD in tuberculosis and respiratory diseases lack training in internal medicine. The importance of knowledge of internal medicine before that of the super-speciality must not be under-estimated.
At present, there is only one center in India which has commissioned super speciality course (DM) in pulmonary medicine parallel to the other super specialities. One can enter for this course after obtaining the degree in internal medicine. This is not enough. If this country wants to advance to speciality of respiratory diseases equal to that in world, many such centers have to be initiated. People with such training shall lead the speciality from front. They must lead the research, treatment and training programs in pulmonary medicine. In this way, this speciality will progress further in the overall interest of respiratory care.
Similarly, the thoracic surgery has not developed in this country. Thoracic surgery lies within the scope of cardio-thoracic course. Unfortunately, cardiothoracic surgeons are interested in only heart surgery for obvious reasons. This arrangement has added to the suffering of patients of respiratory diseases who need thoracic surgery.
This is high time that both the government and the Medical Council of India rethink seriously over the issue and promote different centers for super specialization in respiratory medicine (after the degree in internal medicine) as is the practice adopted all over the world.
1. Jindal SK. Pulmonary training facilities in medical colleges in India Indian J Chest Dis & Allied Sci. 1989;31:295–98
2. Jindal SK. Pulmonary and critical care medicine -Objectives of training -Part I Lung India. 1997;XV:112–4
3. Jindal SK. Pulmonary and critical care medicine-Curriculum and evaluation - Part II Lung India. 1997;XV:164–7