DOCTOR'S DAY

                                          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