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.
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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.
Also read: If a doctor can be called a glorified drug-dealer…
Once upon a time, when doctors were like angels
So very true. The profession has become a racket for fleecing money from people. I think it is very important for people to go for second and third opinions before they decide what to do.
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“Establishing a precise diagnosis instead of giving immediate relief from pain with common sense has become the need of the hour.”
Very good conclusion. The modern day 10 year (6+1+3) doctor who is neither fully good with English medicine (in Britain Indian doctors can only practice some disciplines – racist approach even after IELTS and all crap exams ) nor with “HIththala Gida” tries to put burden on the patients by making them spit money on unnecessary diagnosis with heavy machines – ofcourse he/she has to make up the 10 years of gruelling studies and atleast be classy as compared to his engineering counterparts.
I have seen this desperation by estranged doctors who never will agree that Indian food can be a good medicine. There are also attacks on vegetarianism being weak choice. We have developed another unsatisfied class under globalization.
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Very sad state of affairs. What’s even more sad is – the current practice of prescribing unnecessary multiple medications, tests..etc has made the life of an ethical doctor very difficult. My brother in law who is specialist says, if the diagnosis suggests simple changes ( rest, diet control/change…etc) for recuperation, the patient perceives that the doctor is not “smart” – for he is “not” prescribing medications or injections or tests.
The current unethical practices have made it difficult for the honest ones to do their job. And that’s disturbing.
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As always a very nice piece of writing by Dr Javeed.
Looking at the current breed of doctors who even before staring their real careers start as ‘striking junior doctors’ or doctors who accept foreign trips fully paid for by pharma companies to push their drugs “God only can help patients”.
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to hell with all the egalitarian forces here. Medicine is another business just like engineering is or sports is. Why should somebody who wants to study medicine study for the sake of providing free treatment? Cut down the population and you will see that there are enough resources for everyone. Out of 1.2 billion we have 100 wealth creators and the rest take pride in being wealth distributors. Shame on you egalitarian devils, just go away. Your life worthless anyway!
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Sanday, …you should express your thoughts to a forum that will appreciate such strong individual thinking. Rock on, rock star.
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Corrupt system breeds more corruption and the corruption is growing to gargantuan size by the day. Naturally it encircles and entwines all walks of life. It should not be a surprise if one Dr. Ketan Desai ex chief MCI was found (all of a sudden by our Govt.) to be corrupt to the core.
Nor it surprises us when we hear that a doctor of a corporate hospital tells the relatives that the patient is still recovering in ICU, even though the patient expired hours back, just to inflate bill with unjust charges of ICU.
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While the good doctor has written a thoroughly readable article, it is unfair to say that things have got worse on an average. For an average person, healthcare has become better overall. Simple indicators like life expectancy and containment of deadly diseases shows that.
People will always hanker for the good old day…
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Sanday has a valid point but wrong approach. No one grudges doctors making money and no one should. The doctor should get money for giving the right advice not for giving the referral. The diagnostic chain should charge fees based on valid cases it receives. The problem is in making the patient pay unnecessarily and go through unnecessary tests -which is also emotinally harmful.
If people dont expect to make money legally by becoming doctors and they cant live with it, such people should not become doctors.
Patients also should learn to pay for “service”, else they will pay for tests, etc. One cannot have a free lunch – there is no such thing as that.
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Excellent article. Dr.Javeed certainly seems to be a level headed guy and a good doctor too.
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Looks like western style “health care” industry is thriving in India too. The “care” part of it is forgotten completely! It’s all about doctors making money by referring them to specialists and they all get a cut. Sure there are cases for special testing etc but in most cases, it’s a money making affair. They start of always with fancy unnecessary scans right from the get go to milk the poor patient. How could the patient feel better after having to throw away so much money!!!
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Once doctors and teachers are regarded as holy professional, ironically now no more…
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