DOCTOR"S PROFFESSION

DOCTOR’S PROFESSION AT THE CROSSROAD
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There was a time when the sick were being treated by senior members of the family with old tested house old remedies.

During those days most of the patients improved or recovered due to family bondage and good nursing care. If that failed, the village kabiraj or hakim was called and the later used to bring with him the herbal medicines in his kit or make fresh medicament after a through history taking from the patient or his or her relatives.

Those doctors were usually from learned families and they could read Sanskrit and other languages. Their opinion was taken as gospel truth. A kabiraj or a hakim used to cover more then five to six villages and he was a very important member of the community and his opinion was highly valued .But he was selective about his patients. The importance of life style, proper nutrition and fundamentals of good health care was what they preached and practiced, and that system continued for long.

In the 1940’s LMP doctors who were scientifically trained but equipped with limited medicines and gadgets managed the show. They were held in high social esteem along with the school teachers. They integrated themselves completely with the society and family lives of the community and earned the trust of the people. Social recognition and just enough money for sustenance was what they expected from society.

In the1950’s came the short course in medical training and pharmaceutical schools. Liquid medicines with paper marks on the bottles were dispensed by doctors or their assistants. Very few ventured to go and read in far off places. Number of lady doctor in a town could be counted with fingers.

After the discovery of penicillin, other antibiotics and the concept of vaccination made the beginning of a new era in medical field. But unfortunately during subsequent years quackery flourished as literacy level was very low amongst the villagers and going out to town was a real problem due to poor road conditions and lack of transport facilities.

Till 1960’s "Doctors can do no wrong" was believed by most of the patients and their relatives. If a patient died it was thought of as bad luck or destiny. Doctors and patient’s relationship was pure and symbolic. Later part of 60’s came the era of specialists and the focus was shifted from graduate medical practitioners and LMP doctors in villages to specialist doctors in towns. Due to too much of rush at the specialist chamber the patients instead of a human being became a number in the waiting list out side the doctors room. The IMA (Indian medical Council) in the editorial of its prestigious journal in 1958 first cautioned at the disturbing trend of separation of human touch in treating a diseased person. The doctors on their part were attracted for more money and the comforts of urban life by being a specialist.

From 1980 onwards there has been an explosive growth of medical profession, both scientifically as well as technologically. Suddenly the approach to a medical problem took a dramatic turn. Invasive cardiology, tissue grafting, organ transplantation ultrasonography , nuclear imaging and computer tomography took the medical profession by storm.

The patient on their part became more demanding and wanted different tests to be done. It was a situation where both doctor and the patient together conspired for commercialism to take care of the situation. The patient’s soma or body which fetches money became important and his psyche or mind and feelings were of no concern for the medical men.

The IMA(Indian Medical Council) was deeply concerned and to restore the human touch through general practitioners, established it’s own college of GPs (general physicians).In the early eighties doctor’s and patient’s relationship took an ‘U’ turn. Doctors like any other profession became money-minded. Society became corrupt and so also it’s people. How one can separate a doctor from the system? There was in-fighting amongst doctors for more money and materials, the profession earned a bad name, partly to be blamed for professional jealousy. Ultimately the last nail was fixed by the supreme court of India; the medical profession came under the purview of the consumer protection act (CPA). Doctor became a sales man and the patient became a customer.

Government of India in order to earn quick money forgot about drug control and till today we do not have a drug policy in line with the various drugs ill effects in India, where as countries like Bangladesh and Sri Lanka have one. Lots of spurious drugs are flooded in the market; medicines without prescriptions are freely available over the counters. Doctors have no say on this, whether his patients are taking his prescribed drug or a substandard substitute or a spurious drug is not in his jurisdiction.

The investigation equipments have become very costly, difficult to maintain, as a result most of these sophisticated gadgets are defunct in Government organisations that governs the drugs. Patients have no other options but to go to private nursing homes where these doctors have a share. Private nursing homes have mushroomed in India in last twenty years. Now a days patients are investigated for commissions and patients too have become investigation minded. He has money with him so if you do not ask for more investigations he goes to another doctor.
We spend only 2% of our annual budget on health (might have changed by now), the minimum by any country, where as we spend millions of rupees for VIPs protections. Thousands die due to gastroenteritis, malaria, road traffic accidents but who cares. Prevention is better than cure is only to be found in text books.

Then subsequent years brought about a change in the concept of modern treatment in India. Large sophisticated hospitals were opened up in metropolies which siphoned out the most talented ones from Government hospitals. Few dedicated ones remained with the Government hospitals.
The concept of medical care definitely improved due to these hospitals but unfortunately it was beyond the reach of the common man. The rich, the famous, politicians and celebrities all preferred to go out of country for treatment with exchequer’s money to be treated there by Indian doctors, even though expertise is available at door step that gave a wrong signals to the public and demoralized the Indian doctors, where as patients from Middle East, Far East and European countries come to India for treatment, now termed as medical tourism.
Only a handful of doctors follow the old practice of through history taking and a good clinical examination, as years go by the number of such doctors will be a rarity.
Doctors have fallen prey to multinational pharmaceutical companies and prescribe or operate whether required or not by his patients.
At the moment the doctor and patient relationship is not what it was some years back, the doctor apprehend that his next patient may be a potential litigant. He becomes defensive and investigates to save his skin. When the tolerance and sincerity level of people have gone down in the society how can one point a finger to a doctor who is a product of the society? Corruption has become a global phenomenon and more rampant in India. Doctors are no more treated as a doctor but as a business man. If the patient recovers, it’s God’s grace but if he or she dies the doctor becomes a villain.

Few years from now, doctors will be accompanied by a security personal and may be one advocate .Before the doctor examines a patient the agreement papers have to be signed by both the parties. The security person will be required to protect the doctors from aggressive relatives and ruffians in case of a death. Stethoscope will be an obsolete gadget to be replaced by a mobile phone size electronic instrument which will be in every doctor’s pocket. Patients will be treated like robots not as a fellow human beings.

Conclusion: Doctor’s profession is at the cross roads where and what it will be in future is difficult to guess. Many of the patients in developed countries are opting for alternate medicine due to drug side effects and prohibitive costs. Many of the nursing homes and corporate hospitals are threatened with closer in USA; the same scenario in India is bound to happen as we ape the west. I am optimistic the cycle will take a full turn and may be after a few decades we shall see the family doctors taking their rightful place. I hope the golden era of medical profession will start after fifty years from now, when due to natural calamities, war, terrorist activities, accidents and high way virus , most of the human being would be dead and the new sun will rise in the horizon to bring back the past glory of this noble profession. All said and done medical profession is still the best and rightly called the noble profession.

This article was written four years back on doctor’s day. What you have read is the changes which have occurred in India.
Dr.Sanjoy Kumar Satpathy MBBS (UU), MD (BHU), DIP: YOGA, FCCP
Ex. Joint director of Steel Authority of India