DOCTOR’S PROFESSION AT THE CROSSROAD
The
Doctor's Day is celebrated on July 1 all across India to honor the legendary
physician and the second Chief Minister of West Bengal, Dr Bidhan Chandra Roy.
He was born on July 1, 1882 and died on the same date in 1962, aged 80 years.
Dr Roy was honored with the country's highest civilian award, Bharat Ratna on
February 4, 1961.
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There was a time in
India, when the sick were being treated by senior members of the family with
old tested house hold remedies.
During that time most of
the sick of any age improved or recovered due to family bondage and good
nursing care. If that failed, the kabiraj or hakim was called to treat the sick
and the diseased. He with him would bring home made herbal preparations or used
to give the recipe which needed certain leaves, roots, seeds or fruits to be
brought from the back yard garden or near by forest and he would make the fresh
medicaments. There will be clear instructions regarding the time and duration
of the medicine doses. Diet was his main stay of treatment.
Those doctors were
usually from learned family and they knew how to read Sanskrit and other languages.
What they told was accepted as gospel truth. They used to cover five or six
villages by foot or by bicycle .They were a very important member of the
community and their opinion was highly valued but he was very selective about
his patients. The importance of life style, diet, weight control, and other
advice on prevention were preached and practiced which continued for many
years.
In the 40’s LMP doctors
who were scientifically trained but equipped with limited medicines managed the
show. They were held in high social esteem along with schoolteachers. They
integrated themselves completely with the social 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 for their service.
In 50’s came the short
course medical training and pharmaceutical schools. Medicines in bottles with
paper marks were dispensed by doctor’s assistant. Very few students ventured to
go and read medicine in far off places.
After the discovery of penicillin,
other newer medicines and vaccine the medical profession entered a new era.
Quackery flourished, for any illness penicillin and other newer drugs were
used. At the beginning they were all imported and were very costly.
Till 60’s doctors can do
no wrong was believed by most of their patients and their relatives. If the
patient died it was presumed by their near and dear ones as unfortunate, bad
luck or destiny. Doctors and patients relationship was pure and symbolic. Later
part of 60’s came the era of the specialists and the focus was shifted from
village doctors to town specialists. Due to rush at the specialist a patient
instead of a human being became another name in the waiting list out side the
doctor’s chamber. The Indian Medical Council (IMC) in the editorial of its
journal in 1958 first cautioned the medical professionals at the disturbing
trend of separation of human touch in treating the disease. The doctors on
their part were attracted for more money and the comforts of urban life by
being a specialist.
From 1980 onwards there
have been an exponential growth of medical profession, both scientifically as
well as technologically; the profession took a dramatic turn. Invasive cardiology,
ultrasound, endoscopes, tumor markers, computer tomography and MRI took over
the profession by storm.
The patients on there
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 control of the situation that was how corporatization and
commercialism took over the medical care system. The patients soma i.e. body
which fetches money became important and his psyche i.e. mind and feelings were
of no concern to the new generation of doctors.
The IMA (Indian Medical
Association) was deeply concerned and to restore the human touch through the
general practisoner (GP), established its own college of GP doctors in the
early eighties. During this period probably doctor’s and patient’s relationship
took a U turn. Doctors like any other profession became money minded. Society
became corrupt, so also its people. A doctor is also a product of the society,
hence how he can be a saint? Majority of the fresh graduates from medical
colleges both private and government organization became money minded.
Immediately after passing out majority started collecting the invested money
with interest from their patients without concern for his or her financial
status. Doctors started legal and mudslinging acts against own colleagues for more
money and promotions.
The profession earned a
bad name due to this professional jealousy ultimately the last nail was put by
the supreme court of India. Medical profession came under the purview of CPA (consumer
protection act), doctor became a sales man and the patient became a customer.
Government in order to
earn more revenue forgot about drug control policy in India (Exists only in
paper) and still today we have no proper drug policy, where as country like Sri
Lanka, Bangladesh have one. Lots of spurious drugs and banned drugs are
available over the counter. No one can be sure whether the patients are taking
the original or spurious medicines.
The medical equipments
became costly, difficult to maintain, as a result of which most of the gadgets
are defunct in Government run hospitals. Patients have to go to private clinics
or hospitals for investigations. Every other day a nursing home is being opened
in our country. Now patients get investigated for commissions and patients too
have become health conscious and investigation minded. Doctor shopping is very
common now a days, if one does not ask for a battery of investigations then he
is not a good doctor, a good doctor is one who investigates and prescribe a
dozen of medicines, whether required or not, ethical practice is a thing of the
past.
We spend only 2% of our
annual budget on health, the minimum by any developing country, where as we
spend crores for our VIP security, thousands die due to diarrhea, malaria, TB
and other infectious diseases but who cares, they are disease of the poor .
Then the five star
hospitals made its appearance in India. Employees of Government, semi
government, PSUemployees, VIPs wanted to be referred to these hospitals. Rich
and famous went abroad for minor aliments to be treated there by same Indian doctors;
where as patients from different countries come to India for better treatment
at an affordable cost. Our medical
experts are at par with the best in the world but our politicians, rich film
stars and cricketers prefer to go to a foreign land for simple aliments.
Number of doctors who
follow the age old practice of good history taking and clinical examination
have become a rarity, the number will still go down if this trend of teaching
continues in our medical colleges. Doctors have fallen prey to the
pharmaceutical companies and prescribe or operate or investigate whether it’s
required for that patient or not.
Now the doctor and
patient relationship is not what it was some time back, the doctor thinks his
next patient may be a potential litigant, he becomes careful, defensive and
investigate to save his skin. Corruption has become a global phenomenon, when
the tolerance and sincerity level of the people in the society have gone down,
how one can point a finger to a doctor who is a product of the society? Doctors
are no more treated as a doctor but another businessman. If the patient
recovers its God’s grace and if dies its doctor’s negligence. Negligent doctors
are there but not all doctors are negligent.
May be after few decades
doctors will be accompanied by security personals and an advocate. First paper
work, agreement then doctor will examine the patient. Security persons will be
required to save doctors from violent attendants. Stethoscope will be obsolete
(already), a mobile phone size gadget will replace it. Patients will be treated
like a machine not as human being.
Medical profession is at
a cross road in India, where and how it will proceed from now on is difficult
to predict. Due to cost factor or non affordability many patients may opt for
alternate medicine. One will be surprised to know that many people in developed
country are opting for alternative medicine, like Unani, acupuncture, yoga and
Ayurveda. Many hospitals in USA are closing down due to man power and financial
problems. The same scenario is bound to happen as we ape the West very fast.
One should be optimistic that the old –“patient doctor’s relationships” will
return back and the family doctor system reappears again for better medical care
at an affordable cost.
Let’s
hope the golden era of medical profession will return after four or five
decades from now on, when natural calamities, war, terrorist activities, accidents,
high way virus and bacteria would have wipe off major chunk of people from earth.
The new sun will rise in the horizon to bring back the lost glory of this noble
profession. All said and done-medical profession is still the best and rightly
called the noble profession.
DR.SANJOY KUMAR SATPATHY
Ex. Joint Director &
Senior Medicine Consultant, S.A.I.L
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