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The Beleaguered profession
The Statesman
Dr. ARUNABHA SENGUPTA
 

From the advent of medicine, political and religious leaders have always been at odds with the medical profession because they never liked the independence of the physicians. Besides, in the beginning science was not rigorous in its approach, and much of magic was passed off as medicine and many charlatans passed themselves off as healers.

The authority of the profession grew in the eighteenth century when new scientific theories enabled the physicians to act with a background of proper knowledge.
The intellectual and cultural openings fostered by the Renaissance served the medical profession well as doctors became more trusted healer-humanists within the new social fabric. Paradoxically, by dressing the physician solely in the garb of nobility and failing to appreciate the built-in conflicts and diverse ethical issues inherent within a medical practice, society also misunderstood him at times.

        In the modern health care scenario, those misunderstandings have often congealed into mistrust. Consumerism and privatization of health services, contraction of old institution and values, and state power that has gradually changed from its role as a service provider to only that of a regulatory authority has all put that old orthodox physician on that back foot.

But no amount of laws or edicts can replace the old covenant of mutual trust and compassion between the doctor and his patients and no system of medicine can survive, without some primacy of the physician.

Though about punishing the men who want to play God have always excited the populace and activated the political and religious institutions which seek to rule medicine. The ruling powers, universally, never liked the independence of the physicians. In the heyday of Ayurveda, the scholars often faced the wrath of the king and the priest and, according to some, were forced to incorporate Slokas singing the glory of the king and the gods within their medical discourses. In ancient India, political and religious power secluded the medical profession for the ‘Ambasthas’, a cast inferior to the Brahmins. The proud Romans had no physicians; every roman was a doctor himself. The first physicians in Rome came from Greek slaves and it was Julius Caesar who first accorded full Roman citizenship to the physician.

Despite the Greek notion of the practice of medicine being the noblest of all arts forms, societies did not always view the medical profession as noble as to be above all reproach. Hippocrates himself decreed that cities should devise law to punish there errant physicians.

For a greater part of history, magic passed as medicine and outside the schools of medical studies charlatans abounded. Some physicians flourished because of there higher intellect and shrewd business sense and not for their integrity or nobility. Many English physicians took as active a part as any of their compatriots in raiding the Spanish ship in the South Seas. Thomas Dover, whose anti-fever “Dover’s powder” used to be stocked in every hospital pharmacy till recently, rescued Alexander Selkirk during one such voyage. Back home, the poor village Kaviraj used to run a grocery shop or a tutorial and also served as the village astrologer. Things began to change for the eighteen century when science became stronger everyday and with that came the liberalization of minds. Men engaged in serious studies of medicine were the first amongst the humanists became they already knew how to see a man as a whole.

The physician, a bit mythical, (as seen in old  movies dressed up in a three-piece suit amongst sparsely  clad village folks and his shoes shining as brilliantly  through the muddy village roads as his medical feats) mixed his compassion with the characteristics of traditional healers. Specialists were seen as maestros, keepers of pure faith and knowledge.

The catholic physician learnt his value there and took his profession as noblesse oblige. What made him tick thereafter was an atmosphere ruled by mutual trust and compassion. This phenomenon was universal including in India where traditional Indian medicine shared much of the teaching of the Greek medicine. Tradition here caused no great conflict with the adaptation of a new system. People trusted the system and its deliverers, who they believed had been tutored in an ethics that affirm, “Primum non cerum – above all do no herm”.

Paradoxically this unmitigated trust blinded the people from seeing the inherent conflicts within a medical practice. Dr Raman, the fictional physician in RK Narayan’s Algoid, never beloved in saying agreeable words and never lied to his patients. But when one night his friend Gopal, almost dying, wanted to know how long he would live so that he could sign his will in time, Dr. Raman lied to him. The good doctor himself though was convinced that Goal would not survive the night and was aware of the consequences of his life long belief and failed to do what was ethically correct for him.

That young doctor in Mikhail Bulgakov’s The steel windpipe coerced the mother and the grandmother of a young child to gain permission to do an emergency tracheotomy to save the child’s life when he was himself unsure  of  being able to perform the operation. The child could have died from his inexperience and the meager resources he had at his command but still he dared and the child survived.

Those are fictional accounts but in real life much more complex situations occur every day. Every nigh, through out the world, young surgeons dare in unkind conditions, without waiting for the world to have woken up, only because their training tells them to so act. Undoubtedly, there is a wide gap between what is a doctor can deliver in a community practice and the best-known approach for a particular disease. In an atmosphere of mutual trust and compassion, society accepted that simply as a fact of life.

Consumerism has brought about some qualitative improvements in medical treatment but it has also caused havoc within the medical society itself. It is now possible for a novice, adept at one particular technical procedure, to earn many times more that an experienced teacher. The natural system of progression and hierarchy is lost. Organizations lack the solid dept of old institution where values were cultivated and humanism takes a back seat. Driven by market forces, the orthodox physician finds himself at odds with a society that demands value for money, and with a system that has changed its identity from “health services” to “health care industry”.

To describe the mental state of the average common practitioner, the authors of an article in the Annals of medicine chose the word “beleaguered”. Today, the physician is under threat from every quarter, from the corporate houses, from the multinationals transferring technology, from competition that flourishes through propaganda and services through slander, and from the king and the priest who rule his hospitals.