A lot has been written about how vulnerable they are and what a difficult reality they face in the process of becoming doctors. WhatsApp forwards are filled with long poems on how much doctors do for the society and how often they are the first ones to be blamed when a patient succumbs to his condition or disease.

It appears that the Kolkata incident was not only a wakeup call on doctor’s safety in their work spaces but also seems to have become an opportunity for doctors to pour out their frustrations on social media for doing, what they seem to convey, a largely thankless job to an ungrateful and sometimes even a dangerously vicious public.

So what is the relationship between the public and doctors? Does the public, in this day and age, actually think of doctors as gods? Well, there might be some, perhaps, who do but a large section of the public don’t hold such notions about them - especially not of doctors working in hospitals. In fact, it would seem as if the public, in their obsession with their rights, feel that it is the duty of doctors to save lives - somehow or anyhow - and, if a life is lost, the doctors are somehow to be blamed for it.

My house help is Anu. One day she was very late coming to work and when she did appear, she launched into this sorry tale about running from one diagnostic centre to another to get tests done on her husband, who had basically all the ailments that are known as “lifestyle-related diseases” - an euphemism for having smoked and indulged in drinking and not having done an honest-day’s work in his worthless life.

She told me that he had, “sugar problem, heart problem and kidney problem”. And one doctor told her that he had liver problem too. Well. I asked if she had been to the government hospital and her response was telling: “Ayyo, who will go there… the queues are so long that he would have died waiting…” She also whispered under her breath, “Maybe that would be a good thing…”!!

So, she had gone to a private practitioner who asked for various tests to be done on a man who was large, could not move about easily, who was trembling and in a foul and frightened mood. And this diminutive but gutsy woman went through the nightmare of carting him to various labs to get the tests done for the reports that the doctor wanted.

I relate this incident to highlight one point that has become a reality that we are not questioning. Doctors rely on reports. They are increasingly wary of diagnosing any patient without the diagnostic reports. Older doctors relied on reports to corroborate their diagnosis, but younger doctors tend to rely on reports to the extent that the patient becomes a file of reports. What transpires is that such doctors prescribe treatment to set the reports right first, hopefully believing that the patient will become better too. This may sound like an extreme and jaundiced look at the ‘saviours in our society’ but it is a view that needs to be addressed and debated.

Increasingly, doctors do not ‘take care’ of the patient - neither in nursing homes nor in corporate hospitals. What they do is do a minimum check on the patient, prescribe tests, check the reports, prescribe treatment and further tests and check the reports again to see if the treatment has worked - the patient is just a medium for all those tests to happen. To be fair, some doctors do have better ‘bedside manners’ than others, but for the most they are harassed and not at peace with themselves and do not give any sense of assurance to patients. What is their capacity to heal others then?

Yet another phenomenon that is occurring in up-scale hospitals is the increasing scrutiny of treatment meted out by doctors by the patient’s care givers. Patients or their relatives from middle-class backgrounds with their access to social media are fairly informed (or misinformed as the doctors vehemently say) about diseases and treatments, or so they think, and so they question doctors. Initially doctors respond by talking to them as if they are children who need to be told just so much and not more, but persistent questioning naturally irritates them and they either clam up or bombard them with all sorts of serious-sounding Latinized ailments and treatments that scare the patient or the relatives into silence.

A friend related the story of his brother-in-law, an urologist, who was practicing in the United States for many years. He recently decided to come back to India and got a plush job at a corporate hospital. After about six months or so he was made to understand that he could not turn patients away at the rate he was doing telling them they would be okay if they took some home-made remedies or made some life-style changes. Doctors had a certain target to meet. And he was not meeting that target by enrolling patients into the hospital. He had to mend his ways, he was told. He did. He quit and now has a flourishing private practice.

It reminds me of an official at a check-post who showed me his mobile that displayed the target amount he had to collect as fines and penalty for the month. So everyone has a target. Doctors in corporate hospitals have a target set for angiograms and performing angioplasty, placing stents and performing bypass surgeries. None of these corporate honchos will ever - even by mistake - suggest that there are alternative ways to treat atherosclerosis and that those methods are safe and tested, but not allopathic.

None of them will tell you the side-effects of all the medicines they pump into you or prescribe so that you are ‘fit as a fiddle soon’, but will reap the effects some years down the line. How many renal failures have we not heard of, of people who had been on long-term BP medicines? What more can I say when a cardiologist told my husband that he was a fit candidate for a bypass? Fit meaning what, I wonder?

Similar is the case with the so-called C-sections by gynecologists. There are ill-informed women who want to go in for a C-section in the hope of avoiding labour pains and these women and their families even set the time for the operation such that the baby’s birth occurs at an auspicious time. And then there are those who will reject a C-section even in emergency cases where there is a threat to the life of the baby or the mother, stating tradition or custom or something else. In all these cases, what is the role of the doctors? What are they doing for the cause of such healthcare issues?

There is a case made that doctors study very hard and long and all of that. The moot question to ask all those students who sit for NEET is this: Why do they want to become doctors? If, like Miss Universe contestants, they give responses like, “World peace”, “to serve the world” etc. they must be made to reconsider. The urge to become a doctor is something rare - it is an inner calling - which is why there are only a few excellent doctors, who understand the human body holistically, who realize that they are but bridges guiding their patients to heal themselves. The rest are all medical technicians, relying on reports to diagnose and using dubious pharmaceutical drugs to “treat” their hapless patients. When will doctors call out the racket that they are a part of?

The unasked questions to address are these:

-        Do we need more and more doctors? Why? Are we envisaging that more and more people are going to be ill? But why is that? Should we not consider how to reduce illness instead of focusing on churning out more and more doctors?

-        And the phenomenon of “management-quota” doctors is appalling and frightening. If merit is not the criteria and if the attitude is not one of caring and compassion and the intention is not to help the patient heal him/herself, should such people be called doctors?

-        Can we not learn from the experiences of other nations? The IOM report in the US has shown that doctors and hospitals are the third most important cause of death and Adverse Drug Reactions (ADRs) are the fourth! Is it not surprising to know that doctors’ strikes actually saw a decrease in hospital deaths?

-        Should we not have a policy that helps people lead a lifestyle that reduces their trips to the hospitals? Can we not divert all these “doctors” into becoming “healthcare awareness specialists” who teach the public how to lead healthy and wholesome lives by role-modelling it?

-        Why do parents push their children to become doctors if they have no inclination towards serving others? Because they consider it a steady, lucrative profession? The call of the lucre cannot be denied, but that is just the reason not to become a doctor. “But they pay so much money to get into the course, they study hard and long and now you grudge them their money?” This is the most common accusation thrown at anyone who calls out the medical profession for its hypocrisy.

-        I don’t grudge them their money. But I do hold them responsible for not being focused on healing the patient with the best and least intrusive and expensive treatment there is to offer in this world. That would include a whole lot of medicines that the allopaths have no clue about or if they do, they hold such treatments and medicines as suspect.

-        Why are alternative forms of healing not considered viable by allopathic doctors while all alternative practitioners use all available diagnostic methods to buttress their diagnosis and also acknowledge that allopathic emergency treatments are very advanced and beneficial?

-        Why are allopathic doctors arrogant and disdainful of indigenous alternative medicines? Why cannot allopathic doctors concede that alternative medicines and healing actually help patients better than their treatment methods for chronic ailments, even life-threatening ones?

Such questions will expose me to trolling of the worst order, I know. What do I know about doctors, what they do, how much they struggle, the long hours they work?! But long hours of work and struggle are part of many occupations.

Here’s a thought. If a student is struggling to study medicine then perhaps s/he has an intuitive idea of healing and the system is destroying it, or s/he is just not fit to be a doctor. Let me tell you about a boy in the village, ten years ago, who was passionate about using leaves and such to heal wounds. He cleared his 10+2 with great difficulty from a rural school. But he did not give up his quest of finding medicinal herbs and learning indigenous medicines known to vaidyas and is now a vaidya himself with a small but thriving clinic in a mofussil town.

His remedy for treating thyroid problems is acclaimed and he has patients in India and abroad who have been healed. Is he a quack because he does not have an MBBS degree? Similarly there is a vaidya in Bengaluru who dispenses an Ayurvedic medicine to dissolve plaques. Yes, you heard right. He is also famous and he never went through any NEET or niceties of that sort.

Like I said, there are healers from time immemorial who have served mankind without going through the struggle of NEET or bullying seniors or who baulked at memorising ailments and treatments. They made their own medicines and, more often than not, used it on themselves before giving them to patients. They were disciplined and inspired awe. Perhaps they were really closer to the divine. Perhaps we need to learn from them. Perhaps it is time for a complete overhaul of a system that has reached the limits of its usefulness.

*

 Do we need more Doctors?

Sujata Srinath

10 July 2019

They say every dog has his day, and hers too. A couple of weeks back it seemed to be the season for doctors. They were in the limelight for their stand-off with the Chief Minister of West Bengal, Mamata Banerjee, on the issue of their safety and security following a murderous attack on on-duty junior doctors in the NRS hospital in Kolkata.

A lot has been written about how vulnerable they are and what a difficult reality they face in the process of becoming doctors. WhatsApp forwards are filled with long poems on how much doctors do for the society and how often they are the first ones to be blamed when a patient succumbs to his condition or disease.

It appears that the Kolkata incident was not only a wakeup call on doctor’s safety in their work spaces but also seems to have become an opportunity for doctors to pour out their frustrations on social media for doing, what they seem to convey, a largely thankless job to an ungrateful and sometimes even a dangerously vicious public.

So what is the relationship between the public and doctors? Does the public, in this day and age, actually think of doctors as gods? Well, there might be some, perhaps, who do but a large section of the public don’t hold such notions about them - especially not of doctors working in hospitals. In fact, it would seem as if the public, in their obsession with their rights, feel that it is the duty of doctors to save lives - somehow or anyhow - and, if a life is lost, the doctors are somehow to be blamed for it.

My house help is Anu. One day she was very late coming to work and when she did appear, she launched into this sorry tale about running from one diagnostic centre to another to get tests done on her husband, who had basically all the ailments that are known as “lifestyle-related diseases” - an euphemism for having smoked and indulged in drinking and not having done an honest-day’s work in his worthless life.

She told me that he had, “sugar problem, heart problem and kidney problem”. And one doctor told her that he had liver problem too. Well. I asked if she had been to the government hospital and her response was telling: “Ayyo, who will go there… the queues are so long that he would have died waiting…” She also whispered under her breath, “Maybe that would be a good thing…”!!

So, she had gone to a private practitioner who asked for various tests to be done on a man who was large, could not move about easily, who was trembling and in a foul and frightened mood. And this diminutive but gutsy woman went through the nightmare of carting him to various labs to get the tests done for the reports that the doctor wanted.

I relate this incident to highlight one point that has become a reality that we are not questioning. Doctors rely on reports. They are increasingly wary of diagnosing any patient without the diagnostic reports. Older doctors relied on reports to corroborate their diagnosis, but younger doctors tend to rely on reports to the extent that the patient becomes a file of reports. What transpires is that such doctors prescribe treatment to set the reports right first, hopefully believing that the patient will become better too. This may sound like an extreme and jaundiced look at the ‘saviours in our society’ but it is a view that needs to be addressed and debated.

Increasingly, doctors do not ‘take care’ of the patient - neither in nursing homes nor in corporate hospitals. What they do is do a minimum check on the patient, prescribe tests, check the reports, prescribe treatment and further tests and check the reports again to see if the treatment has worked - the patient is just a medium for all those tests to happen. To be fair, some doctors do have better ‘bedside manners’ than others, but for the most they are harassed and not at peace with themselves and do not give any sense of assurance to patients. What is their capacity to heal others then?

Yet another phenomenon that is occurring in up-scale hospitals is the increasing scrutiny of treatment meted out by doctors by the patient’s care givers. Patients or their relatives from middle-class backgrounds with their access to social media are fairly informed (or misinformed as the doctors vehemently say) about diseases and treatments, or so they think, and so they question doctors. Initially doctors respond by talking to them as if they are children who need to be told just so much and not more, but persistent questioning naturally irritates them and they either clam up or bombard them with all sorts of serious-sounding Latinized ailments and treatments that scare the patient or the relatives into silence.

A friend related the story of his brother-in-law, an urologist, who was practicing in the United States for many years. He recently decided to come back to India and got a plush job at a corporate hospital. After about six months or so he was made to understand that he could not turn patients away at the rate he was doing telling them they would be okay if they took some home-made remedies or made some life-style changes. Doctors had a certain target to meet. And he was not meeting that target by enrolling patients into the hospital. He had to mend his ways, he was told. He did. He quit and now has a flourishing private practice.

It reminds me of an official at a check-post who showed me his mobile that displayed the target amount he had to collect as fines and penalty for the month. So everyone has a target. Doctors in corporate hospitals have a target set for angiograms and performing angioplasty, placing stents and performing bypass surgeries. None of these corporate honchos will ever - even by mistake - suggest that there are alternative ways to treat atherosclerosis and that those methods are safe and tested, but not allopathic.

None of them will tell you the side-effects of all the medicines they pump into you or prescribe so that you are ‘fit as a fiddle soon’, but will reap the effects some years down the line. How many renal failures have we not heard of, of people who had been on long-term BP medicines? What more can I say when a cardiologist told my husband that he was a fit candidate for a bypass? Fit meaning what, I wonder?

Similar is the case with the so-called C-sections by gynecologists. There are ill-informed women who want to go in for a C-section in the hope of avoiding labour pains and these women and their families even set the time for the operation such that the baby’s birth occurs at an auspicious time. And then there are those who will reject a C-section even in emergency cases where there is a threat to the life of the baby or the mother, stating tradition or custom or something else. In all these cases, what is the role of the doctors? What are they doing for the cause of such healthcare issues?

There is a case made that doctors study very hard and long and all of that. The moot question to ask all those students who sit for NEET is this: Why do they want to become doctors? If, like Miss Universe contestants, they give responses like, “World peace”, “to serve the world” etc. they must be made to reconsider. The urge to become a doctor is something rare - it is an inner calling - which is why there are only a few excellent doctors, who understand the human body holistically, who realize that they are but bridges guiding their patients to heal themselves. The rest are all medical technicians, relying on reports to diagnose and using dubious pharmaceutical drugs to “treat” their hapless patients. When will doctors call out the racket that they are a part of?

The unasked questions to address are these:

-        Do we need more and more doctors? Why? Are we envisaging that more and more people are going to be ill? But why is that? Should we not consider how to reduce illness instead of focusing on churning out more and more doctors?

-        And the phenomenon of “management-quota” doctors is appalling and frightening. If merit is not the criteria and if the attitude is not one of caring and compassion and the intention is not to help the patient heal him/herself, should such people be called doctors?

-        Can we not learn from the experiences of other nations? The IOM report in the US has shown that doctors and hospitals are the third most important cause of death and Adverse Drug Reactions (ADRs) are the fourth! Is it not surprising to know that doctors’ strikes actually saw a decrease in hospital deaths?

-        Should we not have a policy that helps people lead a lifestyle that reduces their trips to the hospitals? Can we not divert all these “doctors” into becoming “healthcare awareness specialists” who teach the public how to lead healthy and wholesome lives by role-modelling it?

-        Why do parents push their children to become doctors if they have no inclination towards serving others? Because they consider it a steady, lucrative profession? The call of the lucre cannot be denied, but that is just the reason not to become a doctor. “But they pay so much money to get into the course, they study hard and long and now you grudge them their money?” This is the most common accusation thrown at anyone who calls out the medical profession for its hypocrisy.

-        I don’t grudge them their money. But I do hold them responsible for not being focused on healing the patient with the best and least intrusive and expensive treatment there is to offer in this world. That would include a whole lot of medicines that the allopaths have no clue about or if they do, they hold such treatments and medicines as suspect.

-        Why are alternative forms of healing not considered viable by allopathic doctors while all alternative practitioners use all available diagnostic methods to buttress their diagnosis and also acknowledge that allopathic emergency treatments are very advanced and beneficial?

-        Why are allopathic doctors arrogant and disdainful of indigenous alternative medicines? Why cannot allopathic doctors concede that alternative medicines and healing actually help patients better than their treatment methods for chronic ailments, even life-threatening ones?

Such questions will expose me to trolling of the worst order, I know. What do I know about doctors, what they do, how much they struggle, the long hours they work?! But long hours of work and struggle are part of many occupations.

Here’s a thought. If a student is struggling to study medicine then perhaps s/he has an intuitive idea of healing and the system is destroying it, or s/he is just not fit to be a doctor. Let me tell you about a boy in the village, ten years ago, who was passionate about using leaves and such to heal wounds. He cleared his 10+2 with great difficulty from a rural school. But he did not give up his quest of finding medicinal herbs and learning indigenous medicines known to vaidyas and is now a vaidya himself with a small but thriving clinic in a mofussil town.

His remedy for treating thyroid problems is acclaimed and he has patients in India and abroad who have been healed. Is he a quack because he does not have an MBBS degree? Similarly there is a vaidya in Bengaluru who dispenses an Ayurvedic medicine to dissolve plaques. Yes, you heard right. He is also famous and he never went through any NEET or niceties of that sort.

Like I said, there are healers from time immemorial who have served mankind without going through the struggle of NEET or bullying seniors or who baulked at memorising ailments and treatments. They made their own medicines and, more often than not, used it on themselves before giving them to patients. They were disciplined and inspired awe. Perhaps they were really closer to the divine. Perhaps we need to learn from them. Perhaps it is time for a complete overhaul of a system that has reached the limits of its usefulness.