Physician, heal thyself
Doctors are not the demi-gods that they were once considered to be, when they were able to meld together science and humane values. `Why is the public disillusioned with their performance?' asks Dr. KAVERY NAMBISAN, on the occasion of World Health Day today.
``Doctor, do you think I need an MRI?''
THIS from a patient whose hernia I was to operate on in a couple of days' time. He was a business executive in Madras (as it was then called) where I was a consultant surgeon, some five years ago. He explained that someone had advised him to have an MRI scan before the surgery. Why? I asked. Oh, to be doubly sure of the diagnosis. I told him to go ahead and have the scan if it made him feel any better. It would only cost Rs. 5,000.
I should have added that if it was a doctor who had advised him, it would certainly make him feel better since he would get a 30 per cent commission on the fee.
That patient was sensible enough to forget about the needless scan but it made me think: What role do doctors actually play in keeping us healthy? Specialisation and fragmentation of health care have compounded the terror of falling sick: patients visit technology-savvy hospitals and stagger out with their wallets stripped and minds still baffled about the illness. Meanwhile, doctors whiz from one hospital to the next, combining skill and speed with their money-making ability. Time is money.
A friend was relating to me his recent unhappy experience at a hospital in Bangalore. Half in jest, he added: "Doctors are as despicable as politicians." Everyone adores money, why not the doctors, I asked, in a feeble attempt to defend my colleagues and take the easy way out of a pointless argument. Pointless because I knew that there was some truth in what he said.
While introspection and an honest look at our shortcomings is the key, it will help us to look back at how Medicine has evolved. Doctors until recently earned trust and respect. This because they were able to meld the Science of Medicine and the Art of Healing with that other ingredient: Compassion.
In ancient Greece, the sick went to temples with the hope of a cure by a ritual called incubation or "temple sleep". They were said to be visited in their dreams by Aesculapius, God of Healing, who revealed to them the cure. These temples were the oldest hospitals and the inscriptions on the walls, ancient case records. Even with such supernatural modes of therapy, common sense prevailed. Aesculapius gave his patients sound advice on diet, baths and exercise.
Four hundred years before Christ, Hippocrates practised the power of careful observation. He watched the way a patient moved, spoke and sat; he listened and predicted the course of disease. He stressed the importance of diet in the cure of illness. "Our natures are the physicians of our diseases," he said.
Medical care in ancient Egypt was advanced: mummies have been found which have artificial teeth and well-set fractures. Trepanning drilling a hole in the skull to let out the evil spirit causing disease was widely used. Neurosurgeons still use this principle of decreasing the pressure within the skull by practising more sophisticated techniques.
In India, Susruta and Caraka practised around 500 B.C.. Susruta advised patients to eat the right food, to keep clean, to brush their teeth with twigs, and to wash their eyes. He advocated enemas, emetics, purgatives and sneezing powders. He kept his surgical instruments in a clean box wrapped in flannel. Two millennia ago, Harappa and Mohenjodaro had clean roads, water supply and a good system of sewage disposal.
Now, in the 21st Century, we have more knowledge, sophistication and expertise. Life expectancy has risen, even in India. With internet facilities, doctors have access to the latest information with regard to any disease. Medics armed with the finest skills spill out of medical colleges like newly-hatched chicks to deliver health care. But the public is disillusioned with our performance.
Something has gone very wrong. Specialisation is vital to medical advancement but not when the motive behind it is aggressive consumerism. Specialists should be available in recognised specialist centres to which patients can be referred. But today's system does not offer this type of service. It cleverly ensures that a patient goes to several doctors before being told what's wrong. Even then he is extremely fortunate if he gets to know the facts about his illness. Hospitals with state-of-the-art facilities (a phrase that makes my stomach turn) are springing up all over the place and they are feted by fellow doctors and politicians: Cardiac Centres and Kidney Hospitals; fertility centres; laparoscopy and lithotripsy clinics; with a hospital administrator, marketing manager, public relations officer, advertising panel and the hospital newsletter to assist in caring for patients.
A few days ago, my friend (who compared doctors to politicians) returned from Bangalore where he had to consult a cardiologist for his two-year-old son. The child has a mild heart condition from birth and needs a simple review to ensure that everything is normal. At the hospital where he had met the cardiologist six months ago, he learnt that she had shifted to another private centre 20 kilometres away. After driving there he had to spend five hours standing at doorways and jostling irate patients. In the end he saw the doctor for 10 minutes and had tests which took a quarter of an hour.
The brutal truth is that while we doctors pander to our egos and greed, diseases like Tuberculosis, Leprosy, Anaemia, worm infestation, Typhoid and Malaria which can be prevented with simple measures like hygiene, clean water and good nourishment kill millions every year. The medical speciality of Community and Preventive Medicine which tackles these issues is, ironically, the least attractive of specialities. First, because it is not lucrative; and second, in medical colleges, the subject is taught with a drabness that would send the most idealistic medic running in the opposite direction.
If the plight of the common man when he falls sick is not the doctor's responsibility, then what is? To fool patients into believing that if they swallow pills, subject themselves to tests, injections, operations or whatever, they will swing back to good health?
I wonder if young medics busy imbibing knowledge and collecting degrees will see some simple truths: There is a need for more doctors in Community Medicine; and we badly want good General Practitioners. When I was a girl, there was only one doctor to whom we went, whatever the ailment. The smell of antiseptic and the fear of injections prejudiced me against him then, but he was the most important person in our village. He was trusted, and in return he did his best for every patient. He was never hurried, harried or curt, even with the girl who pretended stomach ache to avoid going to school (having proclaimed that nothing was the matter, he offered five empty penicillin vials to assuage hurt sentiments). His earnings were modest. He saw us through the worst illnesses and, when it was beyond him, advised expert opinion. This wonderful doctor of my childhood was not even an MBBS but an LMP: A Licensed Medical Practitioner.
People talk about the ignorance of the uneducated but the ignorance of the moneyed class is amazing. They actually believe that five-star hospitals where doctors oblige them with myriad tests are doing them a service. The mysteries of the human body are not beyond our comprehension. Before submitting to multiple tests, drugs or surgery, one should ask the doctor about the reasons for doing them. Illness is as much the patient's responsibility as the doctor's and it is always better to understand what is happening within one's body. If you have an illness and the doctor asks for half a dozen tests, find out why. Especially when it's something as expensive as an MRI scan. And talking of MRIs, every person with a backache seems to want one, so well have the doctors "educated" them. Ninety per cent of back ache sufferers need nothing more than careful guidelines about their daily activities and regular exercises to strengthen the muscles which support the back. An MRI is needed in rare cases where a serious problem is suspected. It is not a routine test. Who will tell them this?
We cant about the nobility of our calling, but Trust has become an archaic word. It is still possible to pull ourselves back to where we once enjoyed trust and goodwill, where science and humane values coexist. The doctor of the future is the Community Doctor who is interested in preventing an illness, and the General Practitioner who is confident to treat your diabetes, or ulcer, a broken bone or tonsils; who is caring, astute and wise enough to know when to refer to a specialist and when not to.
Till then, we'll have to make do with state-of-the-art servicing of our body parts.
Kavery Nambisan is a surgeon and novelist, whose book On Wings of Butterflies will be released shortly. E-mail the writer at firstname.lastname@example.org
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