No profession in India—not even journalism, perhaps—has plunged into the abyss of disrepute with the speed and determination of medicine. Across the country, doctors, once seen as saviours next only to God, have attained the notoriety reserved for crooks and charlatans.
Hospitals and nursing homes have become big businesses, slot machines in the constantly whirring healthcare “industry”, brazenly throwing every norm to the winds with scarcely any accountability, and rare is an Indian today who hasn’t had a first-hand experience of being ripped off.
The former president of India, A.P.J. Abdul Kalam, has said doctors must possess six virtues—Generosity, Ethics, Tolerance, Perseverance, Concentration and Intelligence. How many virtues does your doctor possess? There are exceptions, of course, but they are few and far between.
And they are mostly in the past tense.
By K. JAVEED NAYEEM
Two weeks ago, while on a holiday at a rather remote place, I happened to meet a person who, on discovering that I was a doctor, said that he had been referred by his doctor after a battery of tests to a higher medical centre for establishing a diagnosis.
After listening to the account of his symptoms, I felt that the diagnosis of the problem was very evident and straight forward. Even a para-medical worker who happened to be there with us immediately came to the correct conclusion of what the problem might be.
But since I did not want to interfere with a case that was being treated by another doctor, I asked the patient to go ahead and get himself investigated fully.
While pondering over this matter later, I could not help wondering how much family medicine has changed over the brief span of time between my childhood and adulthood. I also could not help remembering our own family medicine-man who saw us all through our not so infrequent health problems.
He was Mysore Venkatsubbaiah Subba Rao whose name was conveniently abridged to ‘Subrao Dakatru‘ by almost all his patients. He actually came to me as a family legacy from our remote village of Aldur perched rather precariously on one of the crests of the many hills of Western Ghats in Chikmagalur.
It may seem like a rather improbable coincidence that a doctor who started his medical career and looked after my grandmother there, long before I was born, should end it with retirement here in Mysore, looking after me and my siblings till I myself became a doctor.
My grandmother, who admired him as a personification of selfless service, used to tell us how he used to walk barefoot for miles together in the leech-infested slush of the Malnad rainy season with his leather chappals in one hand and an umbrella in the other, closely and faithfully followed by his equally dedicated compounder Rama who used to lug a heavy medical kit and a light tiffen-carrier that used to meet the frugal needs of both servant and master.
It seems the duo used to subsist on a working diet of chappatis and pickle or dry avalakki, the steamed and beaten rice which they used to soften by soaking in water for a few minutes before consumption. The late evenings meant for a little rest before the next day’s grind began would be spent in painstakingly picking away the leeches from their legs and feet and then applying ash and alum to stop the bleeding.
It appears, Dr Subba Rao used to cycle the full 20 kilometres from Aldur, his place of posting, to Chikmagalur, the district headquarters for the weekly malaria review meeting with his boss, the district surgeon.
Although there was a bus facility between the two places, he would not avail it as the infrequent buses then would not permit him to return in time for the evening out-patient session at which his patients would be waiting.
To catch errant field workers, it seems he would tell them that he had a meeting to attend at Chikmagalur and then quietly arrive at their designated places of work to check if they were present there!
After completing nearly half his service in the nooks and crannies of Ghats, he was transferred from Agumbe, the place with the highest rainfall to Chitradurga, the place with the least rain in the then Mysore State. He continued to work there till he was transferred as medical officer to the Mysore Jail from where he retired. That was the time when my father set up a house in Mysore for our education.
As soon as we moved into it, he went looking for his good old family doctor to entrust our health into his safe hands as he would himself be away at the estate in Aldur most of the time.
The frail and elderly Dr.Subba Rao was such a sincere friend to my father that he would never fail to visit our home on his equally elderly Raleigh bicycle at least once a week to enquire about our health and well-being. He never charged us a rupee at any time for his services and would dispel our slight sense of discomfort by telling us that our grandmother had already paid for his services to us in advance with her hospitality in Aldur!
His visits were something we all used to look forward to as he used to tell us fascinating accounts of how life was during the “good old days” of his youth. After I became a medical student, he would love to exchange notes with me about what was being taught in medical colleges now vis-a-vis what had been taught in his time as a medical student and he would surprise me with the amount of clinical knowledge he possessed despite being only an LMP or Licenciate Practitioner.
His medicines were only a few but his practical knowledge was immense and that was his strongest weapon. He was so meticulous that even in the tiny private clinic that he had set up in his house at Saraswathipuram after retirement he would maintain detailed notes about the symptoms of all his patients and the medicines he had prescribed at their last visit.
Investigations were never the forte of medical practice then and all his patients used to seek his services in good faith and absolute trust and would accept his judgment with its limitations.
With old age taking its toll, he faded away from the scene quietly unsung but not without goodwill and gratitude. I still miss him.
Now a doctor is not only likely to be considered outdated if he does not show his knowledge of the latest diagnostic tests available but he will also be hauled up before a consumer court for not using them.
Establishing a precise diagnosis instead of giving immediate relief from pain with common sense has become the need of the hour. This has ushered in the era of “referral medical practice” by virtue of which a patient is shunted from one specialist to another till they all collectively decide that there is nothing seriously wrong!
Doctors have indeed become helpless and so I can only say “God help the poor patient.”
K. Javeed Nayeem is a practising physician who writes a weekly column for Star of Mysore, where this piece originally appeared.